Use of 0.3% triclosan (Bacti-Stat) to eradicate an outbreak of methicillin-resistant Staphylococcus aureus in a neonatal nursery

American Journal of Infection Control, Volume 23, Issue 3: Pages 200-208, June 1995.

A. B. Zafar, MBBS, MPHa
R. C. Butler, PhD, ABMLIb
D. J. Reese, MDc
L. A. Gaydos, MDd
P. A. Mennonna, RNe

Department of Infection Control, Arlington Hospital, VA 22205, USA.

Abstract

BACKGROUND: Once established in an institution, methicillin-resistant Staphylococcus aureus (MRSA) outbreaks have proved difficult to eradicate, despite intensive infection control measures. This report describes the nosocomial infection with MRSA of 22 male infants in a neonatal nursery during a 7-month period and the infection control procedures that effectively brought this outbreak under control and eliminated recurrencefor more than 3 1/2 years.

METHODS: After a single index case of bullous impetigo caused by MRSA in a neonate discharged from the nursery 2 weeks previously, an additional 18 cases of MRSA skin infections were clustered in a 7-week period. Aggressive infection control measures were instituted, including changes in umbilical cord care, circumcision procedures, diapers, handwashing, gloves, gowns, linens, disinfection, placement in cohorts of neonates and staff, surveillance, and monitoring.

RESULTS: These measures were not effective in slowing the outbreak. The single additional measure of changing handwashing and bathing soap to a preparation containing 0.3% triclosan (Bacti-Stat) was associated with the immediate termination of the acute phase of the MRSA outbreak.

CONCLUSION: The nursery has remained free of MRSA for more than 3 1/2 years, attesting to the success of our program.

Text Extract One:

From 1961 to 1987 there were 25 reported nursery outbreaks of S. aureus infection in the United States.10 The suspected mode of transmission was hand carriage by health care workers, and two of these 12 outbreaks were caused by methicillin-resistant S. aureus (MRSA).10 Several studies have reported that as many as 30% to 50% of physicians and nurses have colonization of their anterior nares with S. aureus, and 2% are colonized with MRSA.11-14 Whether this carriage plays a role in nursery outbreaks, however, is unknown.

Text Extract Two:

Of particular interest was the fact that all 22 infected neonates were male and all but two were circumcised. Previous studies have reported that male neonates are more likely to become colonized78 and infected77,79 with S. aureus than are female neonates. In one study, the male-female infection rate was 3:1,79 in another it was 6:1.77 High male-female ratios have also been reported in outbreaks of neonatal scalded skin syndrome.80-82 Authors of these reports speculated that the circumcision site may be particularly susceptible to bacterial growth. In our study, however, none of the MRSA infections were at the circumcision site, although many were in the genital region. No conclusions could be drawn to explain the fact that only male infants were infected with MRSA in this outbreak.

References

  1. Remington JS, Klein JO. Infectious diseases of the fetus and newborn infant. 3rd ed. Philadelphia: WB Saunders, 1990:1001-3.
  2. Nahmias AJ, Eickhoof TC. Staphylococcus infections in hospitals: recent developments in epidemiologic and laboratory investigations. N Engl J Med 1961;26:120-8.
  3. Mulligan ME, Murray-Leisure KA, Ribner BS, et al. Methicillin-resistant Staphylococcus aureus: a consensus review of the microbiology, pathogenesis, and epidemiology with implications for prevention and management. Am J Med 1993;94:313-28. [External link Medline]
  4. Shovein J, Young SM. MRSA: Pandora's box for hospitals. Am J Nurs 1992;92(2):48-52.
  5. Haley RW, Bregman DA. The role of understaffing and overcrowding in recurrent outbreaks of staphylococcal infection in a neonatal special care unit. J Infect Dis 1982;145:875-85. [External link Medline]
  1. Nakashima AK, Allen JR, Martone WJ, et al. Epidemic bullous impetigo in a nursery due to a nasal carrier of Staphylococcus aureus colonization: role of epidemiology and control measures. Infect Control 1984;5:326-31. [External link Medline]
  2. Thompson DJ, Gezon HM, Hatch TF. Sex distribution of Staphylococcus aureus colonization and disease in newborn infants. New Engl J Med 1963;269;337-41.
  3. Gooch JJ, Brit EM. Staphylococcus aureus colonization and infection in newborn nursery patients. Am J Dis Child 1978;132:893-6. [External link Abstract]
  4. Curran JP, Al-Salihi FL. Neonatal staphylococcal scalded skin syndrome: massive outbreak due to an unusual phage type. Pediatrics 1980,66:285-90.
  5. Annunziato D, Goldblum LM. Staphylococcal scalded skin syndrome: a complication of circumcision. Am J Dis Child 1978:132:1187-8.
  6. Tanner EI, Bullin J, Bullin CH, et al. An outbreak of post operative sepsis due to a staphylococcal disperser. J Hyg [Lond] 1980;85:219-25. [External link Medline]

From the Departments of Infection Control,a Pathology,b Pediatrics/Neonatalogy,c Administratiion,d and Quality Assessment,e Arlington Hospital.

*Baci-Stat is a trademark of Huntington Labs, Inc., Huntington, Indiana.

Reprint requests: Abdul J. Zafar, MBBS, MPH, The Arlington Hospital, 1701 N. George Mason Drive, Alexandrian, VA 22205.

Copyright © 1995 by the Association for Professionals in Infection Control and Epidemiology, Inc.


Citation:

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