Abstract
Abstract
Objective:
To evaluate the effect that discontinuing contact precautions for children with methicillin-resistant
Staphylococcus aureus
(MRSA) had on MRSA healthcare-associated infections (HAIs).
Design:
Retrospective, nonrandomized, observational, quasi-experimental study.
Setting:
A large pediatric healthcare system including two tertiary children’s hospitals with level 4 neonatal intensive care units (NICUs).
Patients:
Hospitalized children.
Methods:
Contact precautions for children infected or colonized with MRSA was discontinued in October 2018. Prospective surveillance for MRSA HAIs was performed using standard definitions. Control charts monitored changes in annual MRSA HAI rates from 2014 to 2025. In March 2024, active surveillance cultures for MRSA were initiated in NICU A primarily for antibiotic stewardship purposes. MRSA nasal cultures were obtained upon admission and repeated every two weeks unless a patient was positive for MRSA. Healthcare-associated (HA) conversion was defined as a positive MRSA culture after one or more negative surveillance cultures.
Results:
Annual MRSA HAI rates/1000 patient days decreased for the System, Hospital A and Hospital B. Rates remained stable for NICU A and NICU B. Between March 2024 and December 2025, there were 1904 MRSA surveillance cultures from 682 patients in NICU A. Thirty-seven patients (5.4%) had a positive MRSA surveillance culture. HA conversion occurred in 21 patients (3.1%).
Conclusion:
After seven years, discontinuing contact precautions for MRSA did not result in increased MRSA HAI rates in a large pediatric healthcare system. NICU MRSA HAI rates remained stable, and HA conversion of MRSA was low.