556. Routine  Methicillin-Resistant Staphylococcus aureus (MRSA) surveillance & cohorting: Does it impact MRSA Disease (MRSD) in the NICU?
Session: Poster Abstract Session: MRSA Surveillance and Infection Prevention
Friday, October 21, 2011
Room: Poster Hall B1
Background: 

Strategies to prevent healthcare associated MRSD including active surveillance with isolation/cohorting of colonized patients have been implemented in several NICUs across the country. Therefore, studies delineating impact on MRSD are needed.

Methods: 

An IRB approved retrospective observational study that included all admissions to our NICU during a defined period. MRSA surveillance policy was introduced in April 2008 where all neonates are tested for MRSA nasal carriage at admission and every 2 weeks thereafter. MRSA colonized (MCO) neonates at admission (MCOadmit) and during hospitalization (MCOhosp) are placed in a cohort room throughout hospitalization.  Pre surveillance period P1 (April 2006 to March 2008) was compared with post surveillance period P2 (April 2008 –April 2010). MRSD was strictly defined as clinical disease with isolation from sterile sites.

Results: 

During P1 and P2, there were 1576 and 1512 neonates; of these 6 (3.8/1000) and 8 (5.3/1000) developed MRSD respectively(p= 0.73). During P2 there were 54 MCO: 31 MCOadmit and 23 MCOhosp.  Interestingly during P2, 0 (0%) MRSD occurred in non cohorted patients compared to 8 MRSD in cohorted patients(p<0.005) resulting in 0 versus 15 % MRSD in nonMCO and MCO  respectively. Sensitivity of surveillance for detecting subsequent MRSD was 100 %. Of the 8 MRSD, 1 occurred in MCOadmit versus 7 in MCOhosp resulting in 1: 30 MCOadmit compared to 1:3 MCOhosp(p<0.05). Impact of MRSD on mortality was comparable (0 MRSD deaths during P1,1 during P2).

Direct screening cost was 208$ per patient. Since 28 neonates had to be screened to detect one colonization, $5824 estimated per detection. Additional extensive indirect costs make this a gross underestimation.

Conclusion: 

Surveillance cultures and cohorting may produce a double edged effect by protecting nonMCO and increasing MRSD in MCOhosp patients. Tailored infection control measures in MCO population may further decrease risk of MRSD in NICU cohorts. Usefulness of healthcare expenditure on MRSA surveillance is questionable and further studies are needed to delineate cost benefit analysis of MRSA surveillance.


Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Ashlesha Kaushik, MD1, Helen Kest, MD2, Vincent A DeBari, Ph.D1 and Michael Lamacchia, MD1, (1)Pediatrics, St. Joseph's Children's Hospital, Paterson, NJ, (2)Division of Pediatric Infectious Disease, Department of Pediatrics, St. Joseph's Children's Hospital, Paterson, NJ

Disclosures:

A. Kaushik, None

H. Kest, None

V. A. DeBari, None

M. Lamacchia, None

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