In the Journals

Hand hygiene, but not census impacts MRSA colonization in NICU

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July 6, 2015

Hand hygiene compliance affected MRSA colonization in single-patient and open-model rooms alike in a neonatal ICU, but average daily census only affected infants in single-patient rooms, according to research published in Infection Control & Hospital Epidemiology.

Further, single-patient rooms did not reduce rates of MRSA colonization, late-onset sepsis or death in a retrospective cohort study conducted by Samuel Julian, MD, of the department of pediatrics, Washington University School of Medicine, and colleagues in a tertiary referral center.

“In this analysis, average census positively correlated with MRSA colonization only within the single-patient room configuration,” the researchers wrote. “Increased vigilance is required during periods of high census, with particular attention paid to hand hygiene, the only variable that affected MRSA colonization.”

In a unit organized into single-patient and open-unit rooms, the team examined clinical data sets including bed location and microbiology results from 1,823 patients (55,166 patient-days) during 29 months. The investigators calculated differences in outcomes between configurations using chi-square tests and Cox regression.

Similar incidence of MRSA colonization and MRSA colonization-free survival times was observed in both room models.

Average daily census was only associated with MRSA colonization rates in single-patient rooms (HR = 1.31; 95% CI, 1.02-1.68). Hand hygiene compliance on room entry (HR = 0.834; 95% CI, 0.731-0.951) and exit (HR = 0.719; 95% CI, 0.611-0.846) was associated with lower MRSA colonization (per 1% greater compliance) regardless of configuration.

Single-patient and open-unit models demonstrated similar rates of late-onset sepsis, as well as sepsis-free survival and the combined outcome of sepsis or death.

Bed configuration did not affect MRSA colonization, late-onset sepsis, or mortality based on multivariate Cox regression and after controlling for demographic, clinical and unit variables.

“Further studies are warranted to assess how facility design might reduce the burden of sepsis and MRSA colonization in this high-risk population,” the researchers wrote. – by Allegra Tiver

Disclosure: The researchers report no relevant financial disclosures.