From the Guidelines
Methicillin-resistant Staphylococcus epidermidis (MRSE) infections in a Neonatal Intensive Care Unit (NICU) should be managed with contact precautions rather than standard precautions alone. When caring for neonates with confirmed MRSE infections, healthcare workers should wear gloves and gowns upon entering the patient's room or care area, and remove them before leaving. This approach is necessary because MRSE can spread through direct contact with the patient or contaminated surfaces in the patient's environment. While specific guidelines may not always explicitly name MRSE, it falls under the broader category of multidrug-resistant organisms (MDROs) for which contact precautions are recommended, as seen in the guidelines for the diagnosis, treatment, prevention and control of infections caused by carbapenem-resistant gram-negative bacilli 1. The vulnerable immune systems of neonates in the NICU make them particularly susceptible to infections, and MRSE can cause serious complications including bacteremia, meningitis, and device-associated infections. Contact precautions help reduce the risk of transmission between patients through healthcare workers' hands or clothing. Some key considerations for implementing contact precautions include:
- Single room isolation is preferred, and separate toilet should be provided for those infected/colonized with MDROs, as recommended in the guidelines 1.
- Nursing staffs designated to care for patients with MDRO infections or colonization should not participate in caring for other patients.
- Proper hand hygiene before and after patient contact remains essential, as does appropriate environmental cleaning of the patient care area to prevent the spread of this resistant organism within the NICU. Although the evidence currently available is derived from observational studies and the quality of the evidence for critical outcomes is low, expert experience derived from clinical practice shows that bundle management including isolation is generally well accepted during clinical management, and it is feasible in most medical institutions 1.
From the Research
MRSE Infection Precautions in Neonatal ICU
- There is no direct mention of MRSE in the provided studies, but MRSA (Methicillin-resistant Staphylococcus aureus) is discussed extensively.
- According to 2, contact precautions including isolation in a single room are performed in MRSA-positive patients, but if a single room cannot be provided, contact precautions can be performed in a shared room as an alternative.
- The study 3 found that discontinuing contact precautions for MRSA and applying standard precautions in an intensive care unit did not increase the incidence of acquired MRSA, given certain conditions such as single rooms with dedicated equipment, strict application of hand hygiene, and good antibiotic stewardship.
- However, it is essential to note that the provided studies do not specifically address MRSE (Methicillin-resistant Staphylococcus epidermidis), and the guidelines for MRSE may differ from those for MRSA.
- In general, the decision to use contact precautions or standard precautions for MRSE infection in a neonatal ICU should be based on the specific hospital's policies, the patient's condition, and the local epidemiology of MRSE, as suggested by 4.
Guidelines for MRSE
- There are no specific guidelines mentioned in the provided studies for MRSE.
- However, the studies suggest that hospitals should have evidence-based standard operating procedures and individual infection control recommendations for managing multidrug-resistant organisms, including MRSA, as mentioned in 2.
- The study 5 emphasizes the importance of regular screening and decolonization of MRSA carriers, reinforcing infection control measures, and enhancing cleaning and disinfection procedures within NICUs to prevent the spread of MRSA.
- Similar measures may be applicable to MRSE, but more research is needed to determine the most effective approach to controlling MRSE in neonatal ICUs, as suggested by 4.