MRSA Best Practices?

[Mags4711, RN]

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!

[NicuGal, MSN, RN]

We have rooms/pods with up to six kids each. We routinely screen on admission and no other routine screens after that. We do send weekly trach aspirates for all our vent kids. Once a kid comes up positive then the room is isolated and all the kids swabbed. If all the other kids come back negative then only the first one remains isolated.We put a cart with signage and gowns/gloves right in front of the bed space. If we have more than 2 come up positive then the whole unit is swabbed and all positives are co-roomed together. After being treated with Bactroban for 2 weeks we reswab. We don't use chloroprep but Bactistat soap on kids over 1500 grams...they get bathed once a week. We also bath our post ops in it since most of our surgical kids were coming up positive (eeeekkkk). Per our hospital policy once you are positive you are flagged for one year in your chart. And you are isolated until discharge. Parents have to gown and glove. We encourage mom to pump before she gowns up and if they Kangaroo they can't go else where in the unit (ie lactation room). If there are multiples the see the clean ones first, isolated last. We haven't figured out the kangarooing if both are positive.

[katierobin23]

1. We swab nares on admission and then every two weeks. We used to do umbilicus as well, but just had a policy change. Once positive, we don't retest. I've seen parents request a repeat, and we'll do it, but even if repeat is negative, baby does not come off isolation.

Tracheal aspirates are sent every week. Same protocol if positive.

2. Once positive, baby is on isolation until discharge. Known maternal MRSA means the baby gets admitted on precautions and tested per protocol until (if) they themselves test positive.

3. We don't use CHG on skin. We only treat babies who test positive. We use Bactroban to nares for five days. Vancomycin for positive tracheal aspirates.

4. Assignments are not influenced by isolation status. Might not have an isolation kid, might have four... Depends on where the kids are located and how the assignments work out. (They do try to not overload a single nurse with a bunch of babies on precautions though.)

5. We have a combo of private rooms and semi-private pods. Two babies ideally are in a pod, but we can "bunk up" and put up to four in one if needed due to high census, we would not bunk a non-positive baby with a positive one.

6. Parents are mostly not treated any differently than others, although Mom is asked to pump at the bedside rather than in the lactation room. All other visitors must gown and glove.

Kangaroo'ing is encouraged just as much as with any other baby. If one twin is positive and the other isn't, non-positive one is held/breast fed/kangaroo'd with first. Ideally, mom holds positive baby right before she goes home and showers.

[smilingbig]

1. We screen all babies in our neonatal ICU every Tuesday (We do nasal, oropharyngeal, periumbilical and perirectal cultures. If they are currently on abx we do not culture them.)

2. Yes, we retest all babies every week (unless on abx-or going home). We require 3 consecutive negative follow-up cultures obtained one week apart to have isolation precautions discontinued.

3. I don't think CHG bath wipes are to be used on neonates. It was my understanding that according to the literature and the manufacturer instructions, CHG wipes have not been tested nor approved for this use. Our doctors generally do not decolonize any of our patients (unless there is a specific situation in which it would be most beneficial to the patients care to do so).

4. Our NICU can cohort if possible, but it is not something that we require. We do not use 1:1 if we were to have only one baby on isolation; the literature shows that adherence to contact isolation precautions and proper hand hygiene are sufficient to prevent the spread of MRSA (or any organism for that matter).

5. Our visitors do not need to gown and glove.

I don't know if you are a member of any infection prevention/control professional organizations, but there are some forums out there that have specifically addressed many of these types of practices so there may be more specific Infection Prevention/Infection Control information there.

Good luck to you!!

[Bortaz, MSN, RN]

Are y'all talking about babies not born in your hospital, or do you test for MRSA in kids born at your facility?

[NicuGal, MSN, RN]

Every kid that enters our unit gets swabbed.

[Bortaz, MSN, RN]

Every kid that enters our unit gets swabbed.

hmm. We only do kids from ER or transport.

Sent from my iPhone using allnurses.com

[katierobin23]

All babies. We only get babies in by transport if they started in our unit and had to go out for surgery. They get swabbed on readmission and then back into the every 2 week routine.

[NicuGal, MSN, RN]

We started it because of something with reimbursement for nosocomial infections. If the kid is positive at admission it most likely came from mom. When it shows up later it is considered hospital acquired.

[Bortaz, MSN, RN]

That makes sense, I reckon.

[Mags4711, RN]

...3. I don't think CHG bath wipes are to be used on neonates. It was my understanding that according to the literature and the manufacturer instructions, CHG wipes have not been tested nor approved for this use. Our doctors generally do not decolonize any of our patients (unless there is a specific situation in which it would be most beneficial to the patients care to do so)...

We have been using CHG wipes on our neonates for a little over a year. We only decolonize if they turn positive, though (CHG wipe baths for seven days, and Bactroban Nasal Ointment 2% to nares and umbilicus for five days).

...I don't know if you are a member of any infection prevention/control professional organizations, but there are some forums out there that have specifically addressed many of these types of practices so there may be more specific Infection Prevention/Infection Control information there.

Good luck to you!!

Thanks for the well wishes! I have looked through lots of forums, and rifled through just about everything I can here on allnurses, but most everything you read is not neonatal specific. I was hoping to capture exactly the kind of wonderful info given by yourself and others in this forum that is geared towards our population.

[Mags4711, RN]

Are y'all talking about babies not born in your hospital, or do you test for MRSA in kids born at your facility?

Same here, every baby that enters our unit gets swabbed on admission, every Monday (unless positive, then they are no longer screened), and on transfer or discharge.