We read with interest Laing’s article on controlling an outbreak of MRSA in a neonatal unit. We have also learnt from outbreaks on our neonatal unit. Laing et al talk about cohort nursing for those babies found to be colonised. In our experience it is important to isolate/cohort not just those babies that are MRSA colonised, but also to cohort those babies whom are known contacts, with MRSA swabs repeated weekly. It is important that both staff and parents realise that a single negative MRSA screen does not outrule low level colonisation in the baby. For this reason, we continue to isolate or cohort nurse both MRSA positive babies and their contacts until discharge from the neonatal unit. We ask that all staff; including pharmacists and radiographers visit these rooms last when visiting the neonatal unit. We ensure people maintain scrupulous hand hygiene practices.

We acknowledge that the treatment of staff is contentious. Laing et al mention anonymised staff screening. We have used a screen and treat approach i.e, all staff are screened and immediately started on a decolonisation protocol. The advantage of this approach is that positive individuals do not usually have to be subsequently removed from duty.

Good communication is vital during such an outbreak. Regular meetings briefing neonatal staff and also key individuals in affiliated departments (e.g. obstetrics and midwifery), supported by circulated minutes ensure that everyone is receiving the same information. We keep daily cot position maps detailing where each baby is, so as to see how spread might have occurred. If the neonatal unit closes, it is important to notify all other hospitals within the perinatal network to ensure that they know that they may be receiving a higher workload and will not be able to repatriate babies back to the affected unit.

Dr Geraldine Ng, Consultant Neonatologist, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London

Dr Marianne Nolan, Consultant Microbiologist, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London

References

1. Laing IA, Gibb AP, McCallum A. Controlling an outbreak of MRSA in the neonatal unit: a steep learning curve. Arch Dis Child 2009;94:F307-310

2. Deurenberg RH, Stobberingh EE. The molecular evolution of hospital - and community-associated methicillin-resistant Staphylococcus aureus. Curr Mol Med. 2009;9(2):100-15