Developing a Checklist to Identify and Manage MRSA Outbreaks in the Neonatal ICU using a Multi-Disciplinary Approach

BACKGROUND: From 2001 to 2015, the New York State Department of Health (NYSDOH) received 241 hospital-associated infection reports from neonatal ICUs (NICUs); 72 (29%) were caused by methicillin-resistant Staphylococcus aureus (MRSA) and involved 390 babies at initial report. Given this MRSA burden and variability in outbreak response, a checklist was developed to help NICUs identify and manage MRSA outbreaks. NYSDOH and academic partners conducted a workshop to teach NICU multidisciplinary teams these skills. METHODS: The checklist committee were members of the NYSDOH and academic subspecialists in infectious disease, infection control and neonatology from three medical centers in NYC; all of whom had reported MRSA outbreaks within the past year. The committee met twice monthly for 6 months and developed the checklist as a practical tool for a multidisciplinary care team to implement existing guidelines. A checklist draft was distributed during the NYSDOH’s one-day workshop to Control and Prevent MRSA Outbreaks, attended by 73 individuals from 25 NICUs in the NYC metropolitan region. Attendees provided feedback to modify the checklist. RESULTS: The checklist has 10 sections including guidance about developing a case definition and line list; reporting to the NYS DOH; managing census; communicating with local microbiology laboratories, interdisciplinary teams, families, and employee health service; using transmission-based precautions, obtaining surveillance cultures, cohorting infants and staff, and improving environmental cleaning. Implementation strategies are emphasized, e.g., evaluate effectiveness of environmental cleaning and disinfection practices and empower staff to observe and enforce hand hygiene compliance. Practical tips are provided, e.g., assess equipment shared with other units, review clinical cultures for patterns suggestive of acquisition route, take a non-punitive approach with MRSA-positive staff, perform environmental cultures if other strategies fail to stop transmission. CONCLUSION: Checklists facilitate healthcare delivery. This is the first comprehensive checklist designed to reduce MRSA burden in NICUs. Future work will assess the impact of the checklist on reporting and outbreak size and duration. DISCLOSURES: All authors: No reported disclosures.