An outbreak of infection with a methicillin-resistant Staphylococcus aureus in a special care baby unit: value of topical mupirocin and of traditional methods of infection control

doi:10.1016/0195-6701(87)90137-X

Journal of Hospital Infection

Volume 10, Issue 2, September 1987, Pages 120-128

https://doi.org/10.1016/0195-6701(87)90137-X Get rights and content

Abstract

This report deals with the problems associated with a high incidence rate of methicillin-resistant Staphylococcus aureus in low birth weight infants in a regional special care baby unit. Strict isolation facilities were not used and the outbreak was promptly brought under control by the use of intensive traditional methods of infection control and the use of topical mupirocin in a paraffin base.

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Cited by (67)

Health-care workers: source, vector, or victim of MRSA?
2008, The Lancet Infectious Diseases
Citation Excerpt :
Although not recommended or specifically mentioned in British and US guidelines,6,153,154 Dutch10 and German8 guidelines emphasise removal of nasal carriers from patient care for at least 48 h after initiation of eradication therapy10 or proven eradication.8,10 Within 2–3 days of starting mupirocin, MRSA is usually eradicated from the nares;66,89,144,155 therefore, some institutions do not require health-care workers to be removed from patient contact.32,34 The timing and number of follow-up cultures required remains controversial.
There is ongoing controversy about the role of health-care workers in transmission of meticillin-resistant Staphylococcus aureus (MRSA). We did a search of the literature from January, 1980, to March, 2006, to determine the likelihood of MRSA colonisation and infection in health-care workers and to assess their role in MRSA transmission. In 127 investigations, the average MRSA carriage rate among 33 318 screened health-care workers was 4·6%; 5·1% had clinical infections. Risk factors included chronic skin diseases, poor hygiene practices, and having worked in countries with endemic MRSA. Both transiently and persistently colonised health-care workers were responsible for several MRSA clusters. Transmission from personnel to patients was likely in 63 (93%) of 68 studies that undertook genotyping. MRSA eradication was achieved in 449 (88%) of 510 health-care workers. Subclinical infections and colonisation of extranasal sites were associated with persistent carriage. We discuss advantages and disadvantages of screening and eradication policies for MRSA control and give recommendations for the management of colonised health-care workers in different settings.
The role of healthcare personnel in the maintenance and spread of methicillin-resistant Staphylococcus aureus
2008, Journal of Infection and Public Health
Citation Excerpt :
Just as there may be controversy over what constitutes a ‘positive’ healthcare worker, there is also some concern about what constitutes an appropriate set of negative cultures to define the non-colonized healthcare worker. The latter may be especially pertinent to decolonization treatment efforts [21,26,39,43,59,122,126,127]. The assessment of asymptomatic carriage, therefore, must always be tempered by an understanding of the limitations that the screening methods engender.
Healthcare workers may acquire methicillin-resistant Staphylococcus aureus (MRSA) from patients, both hospital and home environments, other healthcare workers, family and public acquaintances, and pets. There is a consensus of case reports and series which now strongly support the role for MRSA-carrying healthcare personnel to serve as a reservoir and as a vehicle of spread within healthcare settings. Carriage may occur at a number of body sites and for short, intermediate, and long terms. A number of approaches have been taken to interrupt the linkage of staff–patient spread, but most emphasis has been placed on handwashing and the treatment of staff MRSA carriers. The importance of healthcare workers in transmission has been viewed with varying degrees of interest, and several logistical problems have arisen when healthcare worker screening is brought to the forefront. There is now considerable support for the screening and treatment of healthcare workers, but it is suggested that the intensity of any such approach must consider available resources, the nature of the outbreak, and the strength of epidemiological associations. The task of assessing healthcare personnel carriage in any context should be shaped with due regard to national and international guidelines, should be honed and practiced according to local needs and experience, and must be patient-oriented.
Staphylococcal Infections
2006, Infectious Diseases of the Fetus and Newborn Infant
Staphylococcal Infections
2005, Infectious Diseases of the Fetus and the Newborn Infant
Rapid control of an outbreak of Staphylococcus aureus on a neonatal intensive care department using standard infection control practices and nasal mupirocin
2004, American Journal of Infection Control
Staphylococcus aureus is a common pathogen in neonatal intensive care departments, causing significant morbidity, mortality, and cost. Frequently, S aureus outbreaks may last for months or years. After a cluster of 4 clinically significant S aureus infections in a 7-day period in our 35-bed neonatal intensive care department, we immediately introduced standard outbreak control measures. Unique to our approach was the addition of immediate nasal mupirocin treatment of all staff members and selected patients.
Patients were screened for S aureus colonization and were cohorted with separate caregivers. S aureus isolates were submitted to a reference laboratory for pulse-field gel electrophoretic typing. Infection control practices were emphasized and education was provided for staff, physicians, and parents of patients. All caregivers and selected patients were treated immediately with nasal mupirocin. Cohorting was maintained until all patients who were colonized or infected were discharged.
A total of 5 patients were found to be infected and 4 of 19 patients tested were found to be colonized during the study period. Patients who were infected were successfully treated. Secondary colonization and infection did not occur after implementation of controls.
Rapid and comprehensive implementation of standard outbreak controls along with immediate treatment of direct care staff and patients with nasal mupirocin successfully controlled this outbreak within 4 weeks and no further cases have been noted.
Nosocomial transmission of methicillin-resistant Staphylococcus aureus from a mother to her preterm quadruplet infants
2002, American Journal of Infection Control
Citation Excerpt :
There has been a previous report by Hollis and colleagues11 demonstrating probable MRSA transmission from an infant to a mother to a subsequent preterm infant, but no additional unrelated infants were infected with this clone. Infection control strategies implemented in our NICU included traditional methods: cohorting infected/colonized infants, use of contact isolation precautions, reinforcing hand hygiene, and eradicating MRSA carriage with topical mupirocin applied to the anterior nares of the infants.3-5 However, expanded efforts to halt the outbreak included taking cultures from the parents of the quadruplets and treating their mother as well.
Background: Patient-to-patient transmission of methicillin-resistant Staphylococcus aureus (MRSA) in neonatal intensive care units (NICUs) has been well described. We report the first documented outbreak of probable transmission of MRSA from a mother to 3 of her preterm quadruplet infants postnatally. Methods: Routine surveillance of clinical microbiologic laboratory reports revealed an increased incidence of MRSA infections in our NICU, including 3 of 4 preterm quadruplets. Surveillance cultures of the anterior nares of all patients and the quadruplets' parents were performed to detect MRSA carriage. The isolates were typed by pulsed-field gel electrophoresis with the restriction endonuclease Sma I. Infection control strategies included mupirocin treatment and contact isolation precautions for infected/colonized infants. Results: Clinical cultures from infants A, C, and D and surveillance cultures of the quadruplets' mother and 2 additional unrelated infants grew the same clone of MRSA. The mother's only identified risk factors for MRSA acquisition were 2 prepartum hospitalizations related to the multiple gestation and previous treatment with antibiotics. All anterior nares cultures were negative for MRSA after mupirocin treatment. Conclusions: Use of gowns and gloves by the family members of women with multiple gestations should be recommended to prevent transmission of potential pathogens in the NICU. (Am J Infect Control 2002;30:170-3.)

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Journal of Hospital Infection

Abstract

References (14)

Methicillin-resistant Staphylococcus aureus in a London Hospital

Lancet

Nasal carriage of gentamicin and methicillin resistant Staphylococcus aureus treated with topical pseudomonic acid

Lancet

Gentamicin methicillin-resistant Staphylococcus aureus: Epidemiology and containment of an outbreak

Journal of Hospital Infection

Outbreak of gentamicin-methicillin-resistant Staphylococcus aureus infection in an intensive care unit for children

Journal of Hospital Infection

An outbreak of infection with a gentamicin and methicillin resistant Staphylococcus aureus in a neonatal unit

Journal of Hospital Infection

The role of an isolation unit in the control of hospital infection with methicillin resistant Staphylococci

Journal of Hospital Infection

Elimination of nasal carriage of Staphylococcus aureus with mupirocin (‘pseudomonic acid’) a controlled trial

Journal of Antimicrobial Chemotherapy

Cited by (67)

Health-care workers: source, vector, or victim of MRSA?

The role of healthcare personnel in the maintenance and spread of methicillin-resistant Staphylococcus aureus

Staphylococcal Infections

Staphylococcal Infections

Rapid control of an outbreak of Staphylococcus aureus on a neonatal intensive care department using standard infection control practices and nasal mupirocin

Nosocomial transmission of methicillin-resistant Staphylococcus aureus from a mother to her preterm quadruplet infants

Original articleAn outbreak of infection with a methicillin-resistant Staphylococcus aureus in a special care baby unit: value of topical mupirocin and of traditional methods of infection control

Abstract

Lancet

Lancet

Journal of Hospital Infection

Journal of Hospital Infection

Journal of Hospital Infection

Journal of Hospital Infection

Elimination of nasal carriage of Staphylococcus aureus with mupirocin (‘pseudomonic acid’) a controlled trial

Journal of Antimicrobial Chemotherapy

Original article
An outbreak of infection with a methicillin-resistant Staphylococcus aureus in a special care baby unit: value of topical mupirocin and of traditional methods of infection control