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Eliminating MRSA transmission in a tertiary neonatal unit–A quality improvement initiative

      Highlights

      • Simple infection control measures can help to eliminate MRSA transmission in NICU.
      • Improving hand hygiene and environmental hygiene compliance are pivotal.
      • Active surveillance to detect positive cases and contact precaution are crucial.
      • Cohorting outborn babies prior to surveillance swab result is key to prevention.
      • Sustainability of results need reinforcement of infection control practices.

      Background

      Health care facility-onset methicillin-resistant Staphylococcus aureus (HO-MRSA) colonization or infection is a major cause of health care–associated infection (HAI) worldwide. HAIs are preventable and considered a health care quality outcome indicator. A quality improvement project to eliminate HO-MRSA transmission was conducted in a tertiary care neonatal unit over a 9-month period, and sustainability data were monitored. The primary aim of this project was to achieve zero transmission of MRSA among all neonatal unit admissions, and secondary aims were to improve hand hygiene (HH) and environmental hygiene compliance to 100%.

      Methods

      Existing inpatient admission processes, staff HH, and environmental hygiene practices were critically analyzed. Sequential interventions were implemented, including reinforcing staff awareness on infection control practices through regular education and updates, providing “just in time” feedback, ensuring easy availability of cleaning equipment, individualizing items for all patients, keeping personal belongings away from clinical areas, and revising admission work flow for ex-utero transferred babies from other hospitals.

      Results

      The neonatal unit achieved zero MRSA transmission to previously noninfected and noncolonized patients over the 9-month period, and HH and environmental hygiene compliance improved from a preintervention median of 87.1% and 82.2%, respectively, to 100%, which has been sustained to date.

      Conclusions

      Intensive reinforcement of infection control practices, strict cohorting of ex-utero transfers, universal surveillance on admission, and improvement in HH and environmental hygiene compliance were key to infection prevention and control measures, resulting in elimination of MRSA transmission in our neonatal unit.

      Key Words

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