Successful Control of MRSA in Endemic Neonatal Intensive Care Units

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Abstract
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is among the most important nosocomial pathogens in the
intensive care unit (ICU) worldwide, including Taiwan. Since 1997, our neonatal ICUs (NICUs) had become endemic for
MRSA.
Methodology/Principal Findings: To control MRSA spread in our NICUs, we implemented a series of infection control
measures stepwise, including reinforcement of hand hygiene since January 2000, augmentation of aseptic care over the
insertion site of central venous catheter since July 2001, introduction of alcohol-based handrubs since April 2003,
surveillance culture for MRSA and cohort care for the colonized patients between March 2003 and February 2004, and
surveillance culture with subsequent decolonization of MRSA between August 2005 and July 2006. After implementation of
these measures, MRSA healthcare-associated infection (HAI) density reduced by 92%, from 5.47 episodes per 1000 patientdays
in 1999 to 0.45 episodes per 1000 patient-days in 2006; MRSA bloodstream infection reduced from 40 cases in 1999 to
only one case in 2006. Compared to those obtained during the period of surveillance culture without decolonization, both
rates of MRSA colonization (8.6% vs. 41%, p,0.001) and infection (1.1% vs. 12%, p,0.001) decreased significantly during the
period of surveillance and decolonization. Molecular analysis of the clinical isolates during the study period showed that the
endemic clone, which dominated between 1998 and 2005, almost disappeared in 2006, while the community clones
increased significantly in 2006–2007.
Conclusion/Significance: Through infection control measures, MRSA HAIs can be successfully controlled, even in areas with
high levels of endemic MRSA infections such as our NICUs.

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