MRSA Best Practices?

Specialties NICU

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Hello fellow NICU folk!

I am working on MRSA best practices and am trying to get a sense (beyond what the "Consensus Statement of the Chicago-Area Neonatal MRSA Working Group" says) of what *your* NICU's are doing re: MRSA practices.

Could you please answer the following questions?

1. Do you routinely screen for MRSA? If so, who and when/how often? (for example, we screen ALL on admission, then once a week thereafter unless positive)

2. If someone is positive, do they get retested? Can they come off precautions?

3. Do you Universally Decolonize ALL patients (MRSA+ or not) with CHG bath?

4. Do you cohort nursing or patients or both (i.e. one nurse has only MRSA patients, or do they care for a MRSA+ and non-MRSA patient; do the MRSA+ patients get moved together?)? If only one patient on the unit is positive, is that patient made a 1:1?

5. How is your unit configured? (Single Patient Rooms, wards, etc.)

6. How do you handle visitors? Do they (parents included) have to gown and glove? What about multiples? Kangarooing?

Hello ID folk!

I am working on MRSA best practices for our neonatal ICU and am trying to get a sense of what your institutions in general are doing re: MRSA practices.

Could you please answer the following questions?

1. Do you routinely screen for MRSA? If so, who and when/how often? (for example, we screen ALL on admission, then once a week thereafter unless positive)

2. If someone is positive, do they get retested? Can they come off precautions?

3. Do you Universally Decolonize ALL patients (MRSA+ or not) with CHG bath?

4. Do you cohort nursing or patients or both (i.e. one nurse has only MRSA patients, or do they care for a MRSA+ and non-MRSA patient; do the MRSA+ patients get moved together?)? If only one patient on the unit is positive, is that patient made a 1:1?

5. How do you handle visitors? Do they have to gown and glove?

Thank you all in advance!

Every baby (transport or in-born) gets tested on admission, and every Monday. Nare swab only. We use to do umbilicus as well. If they test positive, we stop the continual screening, and they are put in contact isolation until discharge. They are not 1:1. Parents are required to wear gowns but not gloves (attendings want parents to be able to touch/bond with their baby). We don't treat them at all for being just colonized. Vancomycin for the active MRSA infections (which I've seen maybe 1-2 times in 5 years).

Most of the nurses in our unit find it to be very annoying, and very distressing for the parents because we have to tell them "your baby is colonized with MRSA but is not sick, and we aren't treating it.. oh and you have to deal with this icky isolation crap for the rest of his/her stay". It's very hard for parents to understand how they can "have something" and are not being treated, and are isolated for it like they're highly contagious. I understand the point is to lower MRSA being spread to others but the fact that the parents don't have to wear gloves in our unit (and aren't very good about washing AFTER visiting) makes me wonder why nurses need to gown/glove when proper hand washing between patients should suffice since it seems to be the answer for parents.

How do you all feel about the screenings?

Oh I forgot to add that we very rarely do chlorohexadine baths, I've seen it maybe 3 times in my 5 years, and it was usually a circumstance of some other contaminate happening. We've never used Bactroban Nasal Ointment 2%.

And sorry, I can't answer your PM until I have 15 posts, since I'm new here! :( So I'm not ignoring you, I'll just answer when I'm allowed to.

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