Abstract
Background: Neonatal sepsis causes 1.4 million (36%) neonatal deaths annually. Staphylococcus aureus (SA), a common skin pathogen, remains the second leading cause of late-onset sepsis in the neonatal intensive care unit (NICU). Methicillin-resistant Staphylococcus aureus (MRSA), a resistant strain of SA, has created a significant global communicable health risk, especially in the NICU.
Purpose: To examine evidence related to NICU infection control practices surrounding MRSA surveillance, identification, and isolation in response to the clinical question, "What strategies should be universally implemented in the NICU to identify and prevent the spread of MRSA?"
Methods/Search Strategy: Databases were examined for articles on the topical area of MRSA in the neonate. Key terms were used to streamline the search, resulting in 20 primary works and 3 guideline/consensus statements considered imperative in response to the clinical questions.
Findings/Results: Hand hygiene remains the cornerstone to sound infection control practice. Colonization often leads to systemic infection, with smaller neonates at greatest risk. Hospital infection control compliance has improved outcomes. MRSA surveillance has reduced horizontal spread. No universal, specific recommendations exist to guide surveillance and management of MRSA in the NICU.
Implications for Practice: Standardized guidelines with procedures for hand hygiene, patient surveillance and isolation, and patient cohorting with recommended staffing patterns should guide practice in the NICU. Both MRSA culture and polymerase chain reaction effectively identify positive patients. Decolonization practices are not yet clear.
Implications for Research: Evaluation of standard isolation practices versus outbreak response and approaches to neonatal decolonization should be evaluated for efficacy, safety, and resistance.