Background: Beginning October 2007, the MRSA Screening and Reporting Act (210 ILCS 83/) mandated active surveillance for all ICU patients in Illinois, with isolation of MRSA-colonized patients. We assessed MRSA colonization prevalence among neonatal (NICU) and pediatric ICU (PICU) patients using a series of point prevalence surveys (PPSs).
Methods: Chicago hospitals with NICU or PICU patients were recruited for 6 single-day PPSs approximately 6 months apart between June 2008 and July 2011. All ICU patients were cultured for MRSA (nose and umbilicus for neonates; nose and groin for pediatrics) using a single swab for each body site. Hospital-reported admission screen results (i.e. 210 ILCS 83/-mandated) were also obtained. PPS swabs were processed centrally and screened for MRSA using broth enrichment, chromogenic agar, and standard confirmatory methods. MRSA trends were analyzed using generalized estimating equations to account for ICU and hospital-level correlation across time.
Results: All eligible hospitals (N=10) participated (10 NICUs and 6 PICUs) with 99.6% of NICU and 93% of PICU eligible patients cultured across PPSs. Hospital-reported adherence to admission screens mandated by 210 ILCS 83/ was 96% for NICU and 94% for PICU. Overall MRSA prevalence by PPSs in NICUs was 4.1% (65/1577); PICU, 5.2% (25/485). MRSA colonization prevalence declined significantly in NICUs (estimated yearly odds ratio [OR], 0.65, 95% confidence interval [CI] 0.51 to 0.84, P<0.001) but not in PICUs (OR 1.43, 95% CI 0.90 to 2.26, P=0.13) (figure).
Admission MRSA prevalence reported by hospitals (210 ILCS 83/-mandated) was lower for NICU vs PICU (1.3 vs 6.2 %, P<0.001), median length of stay was longer for NICU vs PICU (18 vs 8 days, P<0.001), and 6 of 10 NICUs performed weekly screening, versus 0 of 6 PICUs (P=0.03). The proportion of PPS-identified MRSA+ patients who were in contact precautions was lower in the NICU than PICU (46% [30/65] vs 72% [18/25], P=0.03).
Conclusion: Since implementation of a law mandating active surveillance with isolation, MRSA colonization prevalence declined among NICU but not PICU patients. Although the decline among NICU patients may be due to direct effects of the legislative mandate, there may be other temporally-related contributory factors.
R. D. Lyles-Banks,
K. Lolans, None
M. Hayden, None
H. Li, None
A. Kallen, None
S. G. Weber, Joint Commission Resources: Consultant, Salary
R. Weinstein, None
W. Trick, None