Epidemiology and genomics of a slow outbreak of methicillin-resistant Staphyloccus aureus (MRSA) in a neonatal intensive care unit: Successful chronic decolonization of MRSA-positive healthcare personnel
Abstract Objective: To describe the genomic analysis and epidemiologic response related to a slow and prolonged methicillin-resistant Staphylococcus aureus (MRSA) outbreak. Design: Prospective observational study. Setting: Neonatal intensive care unit (NICU). Methods: We conducted an e...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Andre forfattere: | |
| Format: | Article |
| Sprog: | English |
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Cambridge University Press (CUP)
2023
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| Online adgang: | https://hdl.handle.net/1721.1/148377 |
| _version_ | 1826189655160127488 |
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| author | Quan, Kathleen A Sater, Mohamad RA Uy, Cherry Clifton-Koeppel, Robin Dickey, Linda L Wilson, William Patton, Pat Chang, Wayne Samuelson, Pamela Lagoudas, Georgia K Allen, Teri Merchant, Lenny Gannotta, Rick Bittencourt, Cassiana E Soto, JC Evans, Kaye D Blainey, Paul C Murray, John Shelton, Dawn Lee, Helen S Zahn, Matthew Wolfe, Julia Madey, Keith Yim, Jennifer Gohil, Shruti K Grad, Yonatan H Huang, Susan S |
| author2 | Massachusetts Institute of Technology. Department of Biological Engineering |
| author_facet | Massachusetts Institute of Technology. Department of Biological Engineering Quan, Kathleen A Sater, Mohamad RA Uy, Cherry Clifton-Koeppel, Robin Dickey, Linda L Wilson, William Patton, Pat Chang, Wayne Samuelson, Pamela Lagoudas, Georgia K Allen, Teri Merchant, Lenny Gannotta, Rick Bittencourt, Cassiana E Soto, JC Evans, Kaye D Blainey, Paul C Murray, John Shelton, Dawn Lee, Helen S Zahn, Matthew Wolfe, Julia Madey, Keith Yim, Jennifer Gohil, Shruti K Grad, Yonatan H Huang, Susan S |
| author_sort | Quan, Kathleen A |
| collection | MIT |
| description | Abstract
Objective:
To describe the genomic analysis and epidemiologic response related to a slow and prolonged methicillin-resistant Staphylococcus aureus (MRSA) outbreak.
Design:
Prospective observational study.
Setting:
Neonatal intensive care unit (NICU).
Methods:
We conducted an epidemiologic investigation of a NICU MRSA outbreak involving serial baby and staff screening to identify opportunities for decolonization. Whole-genome sequencing was performed on MRSA isolates.
Results:
A NICU with excellent hand hygiene compliance and longstanding minimal healthcare-associated infections experienced an MRSA outbreak involving 15 babies and 6 healthcare personnel (HCP). In total, 12 cases occurred slowly over a 1-year period (mean, 30.7 days apart) followed by 3 additional cases 7 months later. Multiple progressive infection prevention interventions were implemented, including contact precautions and cohorting of MRSA-positive babies, hand hygiene observers, enhanced environmental cleaning, screening of babies and staff, and decolonization of carriers. Only decolonization of HCP found to be persistent carriers of MRSA was successful in stopping transmission and ending the outbreak. Genomic analyses identified bidirectional transmission between babies and HCP during the outbreak.
Conclusions:
In comparison to fast outbreaks, outbreaks that are “slow and sustained” may be more common to units with strong existing infection prevention practices such that a series of breaches have to align to result in a case. We identified a slow outbreak that persisted among staff and babies and was only stopped by identifying and decolonizing persistent MRSA carriage among staff. A repeated decolonization regimen was successful in allowing previously persistent carriers to safely continue work duties. |
| first_indexed | 2024-09-23T08:19:04Z |
| format | Article |
| id | mit-1721.1/148377 |
| institution | Massachusetts Institute of Technology |
| language | English |
| last_indexed | 2024-09-23T08:19:04Z |
| publishDate | 2023 |
| publisher | Cambridge University Press (CUP) |
| record_format | dspace |
| spelling | mit-1721.1/1483772023-03-07T04:38:14Z Epidemiology and genomics of a slow outbreak of methicillin-resistant Staphyloccus aureus (MRSA) in a neonatal intensive care unit: Successful chronic decolonization of MRSA-positive healthcare personnel Quan, Kathleen A Sater, Mohamad RA Uy, Cherry Clifton-Koeppel, Robin Dickey, Linda L Wilson, William Patton, Pat Chang, Wayne Samuelson, Pamela Lagoudas, Georgia K Allen, Teri Merchant, Lenny Gannotta, Rick Bittencourt, Cassiana E Soto, JC Evans, Kaye D Blainey, Paul C Murray, John Shelton, Dawn Lee, Helen S Zahn, Matthew Wolfe, Julia Madey, Keith Yim, Jennifer Gohil, Shruti K Grad, Yonatan H Huang, Susan S Massachusetts Institute of Technology. Department of Biological Engineering Abstract Objective: To describe the genomic analysis and epidemiologic response related to a slow and prolonged methicillin-resistant Staphylococcus aureus (MRSA) outbreak. Design: Prospective observational study. Setting: Neonatal intensive care unit (NICU). Methods: We conducted an epidemiologic investigation of a NICU MRSA outbreak involving serial baby and staff screening to identify opportunities for decolonization. Whole-genome sequencing was performed on MRSA isolates. Results: A NICU with excellent hand hygiene compliance and longstanding minimal healthcare-associated infections experienced an MRSA outbreak involving 15 babies and 6 healthcare personnel (HCP). In total, 12 cases occurred slowly over a 1-year period (mean, 30.7 days apart) followed by 3 additional cases 7 months later. Multiple progressive infection prevention interventions were implemented, including contact precautions and cohorting of MRSA-positive babies, hand hygiene observers, enhanced environmental cleaning, screening of babies and staff, and decolonization of carriers. Only decolonization of HCP found to be persistent carriers of MRSA was successful in stopping transmission and ending the outbreak. Genomic analyses identified bidirectional transmission between babies and HCP during the outbreak. Conclusions: In comparison to fast outbreaks, outbreaks that are “slow and sustained” may be more common to units with strong existing infection prevention practices such that a series of breaches have to align to result in a case. We identified a slow outbreak that persisted among staff and babies and was only stopped by identifying and decolonizing persistent MRSA carriage among staff. A repeated decolonization regimen was successful in allowing previously persistent carriers to safely continue work duties. 2023-03-06T19:57:37Z 2023-03-06T19:57:37Z 2022 2023-03-06T19:13:32Z Article http://purl.org/eprint/type/JournalArticle https://hdl.handle.net/1721.1/148377 Quan, Kathleen A, Sater, Mohamad RA, Uy, Cherry, Clifton-Koeppel, Robin, Dickey, Linda L et al. 2022. "Epidemiology and genomics of a slow outbreak of methicillin-resistant Staphyloccus aureus (MRSA) in a neonatal intensive care unit: Successful chronic decolonization of MRSA-positive healthcare personnel." Infection Control and Hospital Epidemiology. en 10.1017/ICE.2022.133 Infection Control and Hospital Epidemiology Creative Commons Attribution-Noncommercial-Share Alike http://creativecommons.org/licenses/by-nc-sa/4.0/ application/pdf application/pdf image/jpeg application/pdf application/pdf application/pdf application/pdf application/pdf Cambridge University Press (CUP) Prof. Blainey |
| spellingShingle | Quan, Kathleen A Sater, Mohamad RA Uy, Cherry Clifton-Koeppel, Robin Dickey, Linda L Wilson, William Patton, Pat Chang, Wayne Samuelson, Pamela Lagoudas, Georgia K Allen, Teri Merchant, Lenny Gannotta, Rick Bittencourt, Cassiana E Soto, JC Evans, Kaye D Blainey, Paul C Murray, John Shelton, Dawn Lee, Helen S Zahn, Matthew Wolfe, Julia Madey, Keith Yim, Jennifer Gohil, Shruti K Grad, Yonatan H Huang, Susan S Epidemiology and genomics of a slow outbreak of methicillin-resistant Staphyloccus aureus (MRSA) in a neonatal intensive care unit: Successful chronic decolonization of MRSA-positive healthcare personnel |
| title | Epidemiology and genomics of a slow outbreak of methicillin-resistant Staphyloccus aureus (MRSA) in a neonatal intensive care unit: Successful chronic decolonization of MRSA-positive healthcare personnel |
| title_full | Epidemiology and genomics of a slow outbreak of methicillin-resistant Staphyloccus aureus (MRSA) in a neonatal intensive care unit: Successful chronic decolonization of MRSA-positive healthcare personnel |
| title_fullStr | Epidemiology and genomics of a slow outbreak of methicillin-resistant Staphyloccus aureus (MRSA) in a neonatal intensive care unit: Successful chronic decolonization of MRSA-positive healthcare personnel |
| title_full_unstemmed | Epidemiology and genomics of a slow outbreak of methicillin-resistant Staphyloccus aureus (MRSA) in a neonatal intensive care unit: Successful chronic decolonization of MRSA-positive healthcare personnel |
| title_short | Epidemiology and genomics of a slow outbreak of methicillin-resistant Staphyloccus aureus (MRSA) in a neonatal intensive care unit: Successful chronic decolonization of MRSA-positive healthcare personnel |
| title_sort | epidemiology and genomics of a slow outbreak of methicillin resistant staphyloccus aureus mrsa in a neonatal intensive care unit successful chronic decolonization of mrsa positive healthcare personnel |
| url | https://hdl.handle.net/1721.1/148377 |
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