Info requested.

[nanceynurse]

Do you have a problem with Mrsa in your Nicu's. What steps has your facilites taken to decrease the incidence?

[Gompers, BSN, RN]

Do you have a problem with Mrsa in your Nicu's. What steps has your facilites taken to decrease the incidence?

As MRSA becomes more of a problem in the community, yes, we have seen more MRSA lately. Usually it's just one or two kids at a time. At the present time, we don't have a single baby with it - but a few months back, we had a handful.

We started swabbing every baby upon admission to get a baseline - positive or negative. We used to swab every baby every week, but we found that it was very very rare to have a baby that just suddenly became positive for MRSA. The vast majority of them were positive from birth, from the mother. L&D has been swabbing their patients as well, and sometimes we know even before delivery that we have a positive patient and start isolation from the start.

We no longer cohort the patients - you can care for a MRSA baby and a non-MRSA baby in the same assignment. We just gown and glove whenever we are at the MRSA bedside, even using gloves to look through the chart, etc. They stay on isolation until discharge.

We rarely have to treat the MRSA. Once we had a baby with MRSA that was actually very sick from it and we did try to treat it with various antibiotics. But usually they're just colonized with it and not sick. One time we actually used Bactroban cream in a baby's nose (BID) for two weeks. After three negative MRSA swabs, she was released from isolation. I wonder why we don't do that more often...

[Sweden]

Hi

I have worked in the same nicu for 5 years and I still havn´t seen one mrsa positive patient! :roll

Until recently we swabed all babies once a week but now we only swab them if they come from certain hospitals (that we know have had mrsa patients). We are extremly strict with hand hygiene and use alcoholfluids on hands/arms before and after touching a patient.

In sweden mrsa is still qute rare and I certainly hope it stays that way (but I have a feeling it´s not going to). I do think we as a society use less antibiotica than some other countries and that´s probobly what´s saving us.

Anna

[TiffyRN, BSN, PhD]

We still co-hort and isolate. Every infant that was in the same room with a positive infant will be co-horted and isolated until a negative culture comes back. I like this idea of culturing from the beginning but I believe (though have no proof) that some of our infants are not positive from the beginning. Almost all have had blood cultures and many have had tracheal aspirate cultures. True they haven't had nasal cultures until an MRSA infection is suspected. I do think we need to revise some of our policies.

My husband works at another local NICU and they isolate pretty much the same way but they also swab all bedside caregivers (including RT, OT/ST/PT, physicians and even social workers). If they have positive cultures they give them PTO time and start them on bactroban nasal. There is no punishment environment to it, they understand that many humans (much less healthcare workers) can have MRSA in their noses. The hospital also does DNA analysis to track if any strains of MRSA have been seen before in our hospital (useful to track frequent infections from certain nursing homes, not so much for our NICU).

My silly unit refuses to do that and claim it would be impossible to do because it would expose the employee to negative job consequences. And truthfully the way they are doing it now, it would. We are not permitted to work in NICU if we have been diagnosed with MRSA. A nurse that works with me now knew she had a leg wound (like a small boil) with probable MRSA as her daughter had the same type wound and it had cultured MRSA a week before. She was advised (by our manager & employee health) to not have it cultured because if it was positive she would have to transfer out of NICU forever. Her doctor treated her for MRSA and she came back after a week of antibiotics. Now admittedly she could have just never said anything to the manager and emp. health as it was her confidential information but that's not the point. They are being stupid about it in my opinion.

[dawngloves, BSN, RN]

Can I highjack here? Has anyone ever seen an adverse outcome from MRSA? Or even VRE? Every patient I have seen test positive for either has gone home in the end .

[Gompers, BSN, RN]

Can I highjack here? Has anyone ever seen an adverse outcome from MRSA? Or even VRE? Every patient I have seen test positive for either has gone home in the end .

We only had one MRSA+ baby pass away, but it was from NEC and he was a very sick micropreemie from day one...

Otherwise, they seem to do just fine.

[danissa, LPN, LVN]

Do you have a problem with Mrsa in your Nicu's. What steps has your facilites taken to decrease the incidence?

Hi, MRS A still visits us on a semi-regular basis, although it seems to be isolated cases and not an outbreak, this makes it easy to isolate the baby.We still swab on admission from other units, and on a weekly basis, and occasionally the weekly swabs will throw up a case.we keep swabbing until the babe is neg., although in most cases dont swab the parents etc. staff have been swabbed if we have two or more cases at one time.

To decrease the incidence, vigillant hand disenfection and washing is crucial. We had use of a lumilight case from our infection control dept. for a while, this really opens your eyes! You go through all your careful scrub etc., but stick your hands under a lumilight and you will never feel the same about your hands again! wash wash and wash once more. I know its not always practical to do this, if you have to go in quickly to a babe who is going off its the alchogel rub, isn't it! Just making sure that you wear no rings/ jewellery helps fight the spread of infection, and showing parents the proper way to hand washing and disenfection, rather than saying just give your hands a wee wash does help.

[SURFnNURSE]

We culture all of our babies for MRSA on the 15th of each month and also on admission with a transport. We find more cases of VRE from transports than MRSA. Once positive, they get put on isolation until they have 3 neg cultures.