A new consensus document on methicillin-resistant Staphylococcus aureus (MRSA) recommends screening healthcare personnel (HCP) for infection or colonization if they are epidemiologically linked to a cluster of MRSA infections.
“Screening of HCP can be an important component of an outbreak investigation if HCP have been epidemiologically linked to a clonal cluster of MRSA cases or if there is evidence of ongoing transmission despite comprehensive implementation of basic MRSA control measures,” according to the compendium document, whose authors include The Joint Commission and the Society for Healthcare Epidemiology of America (SHEA).1
HCP can become transiently or persistently colonized with MRSA and can be the source of hospital outbreaks. However, routine screening is not recommended for HCP if MRSA at the facility is endemic. Decolonization measures may be necessary if there is an ongoing outbreak.
Such was the case in a hospital that experienced a prolonged MRSA outbreak in a neonatal intensive care unit (NICU) that eventually included six HCP and 15 babies.2 The unit recorded excellent hand hygiene compliance and few infections to this point, but gradually began seeing intermittent cases.
“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,” the authors of the report on the incident wrote. “We identified a slow outbreak that persisted among staff and babies and was only stopped by identifying and decolonizing persistent MRSA carriage among staff.”
In total, 12 cases occurred over a one-year period (mean, 31 days apart), followed by three additional cases seven months later. After trying several infection control enhancements, to no avail, the NICU began screening patients and healthcare workers.
“Only decolonization of HCP found to be persistent carriers of MRSA was successful in stopping transmission and ending the outbreak,” the authors concluded. “A repeated decolonization regimen was successful in allowing previously persistent carriers to safely continue work duties.”
The decolonization regimen was not available, but one used in a similar outbreak called for nasal mupirocin for colonized infants and nasal povidone iodine for colonized HCP.3
REFERENCES
1. Popovich K, Aureden K, Ham DC, et al. SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute-care hospitals: 2022 update. Infect Control Hosp Epidemiol 2023; Jun 29:1-29. doi: 10.1017/ice.2023.102. [Online ahead of print].
2. Quan KA, Sater MRA, Uy C, et al. Epidemiology and genomics of a slow outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in a neonatal intensive care unit: Successful chronic decolonization of MRSA-positive healthcare personnel. Infect Control Hosp Epidemiol 2023;44:589-596. doi: 10.1017/ice.2022.133. [Epub June 16, 2022].
3. Madera S, McNeil N, Serpa P, et al. Prolonged silent carriage, genomic virulence potential and transmission between staff and patients characterize a neonatal intensive care unit (NICU) outbreak of methicillin-resistant Staphylococcus aureus (MRSA). Infect Control Hosp Epidemiol 2023;44:40-46. doi: 10.1017/ice.2022.48. [Epub March 21, 2022].
The authors of a new consensus document recommend screening healthcare personnel for infection or colonization if they are epidemiologically linked to a cluster of such infections.
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