Interventions
Decolonization
➤ Intranasal mupirocin twice daily for 5–7 days is an acceptable
method for S. aureus decolonization of infants. However, the
optimal decolonization method for infants has not been determined.
➤ Units:
• Units should not use systemic antimicrobials as a decolonization strateg y.
This approach has not been studied in this population and it may select for
antibiotic-resistant organisms and lead to adverse drug events.
• Choose to perform targeted S. aureus decolonization in specific situations
to reduce the risk of infection in colonized infants — for example: (1) when
an outbreak has been identified and (2) when a colonized patient may be at
higher risk for infection (e.g., low birth weight, indwelling devices, or prior to
high-risk surgeries).
➤ The effectiveness of universal decolonization (treating all infants
regardless of S. aureus colonization status) as a strategy to prevent
S. aureus infections in NICUs is not definitively known.
Contact Precautions
➤ Maintain contact precautions for the duration of hospitalization for
infants:
• In high-risk groups likely to remain MRSA-colonized – for example, infants
with invasive (endotracheal tube) or noninvasive (nasal prongs) ventilation, a
tracheostomy, or a draining/open wound.
• Who are MRSA-colonized, due to high rates of persistent and/or recurrent
colonization.
➤ Units should:
• Define criteria for removal of contact precautions.
• Develop processes to document infants who have cleared MRSA through
surveillance testing.
• Perform serial surveillance testing to document continued clearance of
MRSA colonization after contact precautions are removed.
• Consider applying preemptive contact precautions for complex patients
in outbreak settings or NICUs with ongoing MRSA transmission – for
example, with central venous catheters, nonintact skin, or ventilator tubes,
while admission S. aureus surveillance results are pending. Preemptive contact
precautions may not be needed in non-outbreak settings and NICUs without
ongoing MRSA transmission.
