Academic journal article ABNF Journal

Prevention of Methicillin-Resistant Staphylococcus Aureus in Neonatal Intensive Care Units: A Systematic Review

Academic journal article ABNF Journal

Prevention of Methicillin-Resistant Staphylococcus Aureus in Neonatal Intensive Care Units: A Systematic Review

Article excerpt

BACKGROUND AND SIGNIFICANCE Healthcare-Acquired Infections (HAI)

ealthcare-acquired infections (HAI) are one of the most significant causes of death and illness among infants and premature neonates. Among those HAI, MRSA infection is significant among NICU patients (Navarro, Pekelharing-Berghuis, de Waal, & Thijsen, 2011). The Centers for Disease Control and Prevention (CDC) estimate that approximately 1.7 million HAI occur in United States (US) hospitals every year, including more than 33,000 cases in the NICU (Klevens, Edwards, Richards, Horan, Gaynes, Pollock, & Cardo, 2007). The incidences of late-onset MRSA infections in NICU increased more than 300% from 1995 to 2004 (Milstone, Song, Coffin, & Elward, 2010). Methicillin-resistant Staphylococcus aureus in the NICU may be acquired from colonized parents, healthcare workers (HCW), and other neonates often resulting in poor outcomes and long-term sequelae (Carey, DellaLatta, Huard, Wu, Graham, Carp, & Saiman, 2010; Maree, Miller, Daum, Boyle-Vavra, & Matayoshi, 2007; McAdams, Rajnik, Ellis, & Trevino, 2008). Neonates who are exposed to MRSA shortly after birth can become colonized quickly after contact with adult skin or the environment (Nelson, & Gallagher, 2012). Methicillinresistant Staphylococcus aureus colonization or infection in neonates is associated with significant morbidity, and the cost of medical treatment for these infants carry a high financial burden (Huang, Chou, Su, Lien, & Lin, 2006). Interventions have been implemented to minimize the transmission of MRSA in the healthcare setting including screening high-risk patients upon admission and using proper hand hygiene by healthcare workers (Buick, Joffe, Taylor, & Conly, 2015; Chiu, Michelow, Cronin, Ringer, Ferris, & Puopolo, 2011; Huang, Septimus, Kleinman, Moody, Hickok, Avery,... & Hayden, 2013; Papia, Louie, Tralla, Johnson, Collins, & Simor, 1999). Despite these measures and precautions being rigorously enforced, ongoing MRSA transmission and infection have been recorded for many years (Calfee, Salgado, Milstone, Harris, Kuhar, Moody,... & Yokoe, 2014; Dantes, Mu, Belflower, Aragon, Dumyati, Harrison, & Ray, 2013).

Precautions for Spread of MRSA in NICU

Precautions currently set in place in NICU facilities seek to reduce the rate of infection among patients by implementing preventative practices that quarantine those who have tested positive, while maintaining strict hygiene practices for both patients and healthcare workers. Preventive measures include healthcare workers hand hygiene, environmental cleaning, and occasionally, the decolonization of colonized neonates (Pierce, Lessler, & Milstone, 2015; Septimus, & Schweizer, 2016).

The lack of complete adherence to preventive practices allows MRSA to continue to be a significant cause of morbidity in NICU. Understanding that many healthcare workers can be carriers for MRSA serve to increase the methods set in place to prevent transmission from them to neonate. Preventive measures serve to reduce the transmission from HCW who may carry the infection from one neonate to another, while addressing those other adults who come into contact with neonates who may be carriers themselves.

Impact of Surveillance

Diligent surveillance of individuals both prior to recognition of MRSA and after, are important in effectively preventing and managing the disease. In terms of surveillance, data have shown that the vast majority of neonates do not test positive for MRSA on NICU admission screenings. This evidence serves to further address the importance of prophylactic measures throughout the course of patient care, and also serves to further the notion that screening of parents of infants requiring NICU care may be a useful adjunct to increase surveillance measures currently set in place (Sullivan & Goodier, 2015).

Impact of Infection Control Practices

Infection control practices in the NICU setting include policies and procedures that pertain to all persons present throughout the course of patient care. …

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