AMERICAN JOURNAL OF INFECTION CONTROL, Volume 23, Number 3: Pages 200-208,
June 1995.

Use of 0.3% triclosan (Bacti-Stat) to eradicate an outbreak of methicillin-resistant Staphylococcus aureus in a neonatal nursery.

A. B. Zafar, MBBS, MPHa
R. C. Butler, PhD, ABMLIb
D. J. Reese, MDc
L. A. Gaydos, MDd
P. A. Mennonna, RNe

Department of Infection Control,
Arlington Hospital, VA 22205, USA.

BACKGROUND: Once established in an institution, methicillin-resistant Staphylococcus aureus (MRSA) outbreaks have proved difficult to eradicate, despite intensive infection control measures. This report describes the nosocomial infection with MRSA of 22 male infants in a neonatal nursery during a 7-month period and the infection control procedures that effectively brought this outbreak under control and eliminated recurrence for more than 3 1/2 years.

METHODS: After a single index case of bullous impetigo caused by MRSA in a neonate discharged from the nursery 2 weeks previously, an additional 18 cases of MRSA skin infections were clustered in a 7-week period. Aggressive infection control measures were instituted, including changes in umbilical cord care, circumcision procedures, diapers, handwashing, gloves, gowns, linens, disinfection, placement in cohorts of neonates and staff, surveillance, and monitoring.

RESULTS: These measures were not effective in slowing the outbreak. The single additional measure of changing handwashing and bathing soap to a preparation containing 0.3% triclosan (Bacti-Stat) was associated with the immediate termination of the acute phase of the MRSA outbreak.

CONCLUSION: The nursery has remained free of MRSA for more than 3 1/2 years, attesting to the success of our program.

Text Extract One:

From 1961 to 1987 there were 25 reported nursery outbreaks of S. aureus infection in the United States.10 The suspected mode of transmission was hand carriage by health care workers, and two of these 12 outbreaks were caused by methicillin-resistant S. aureus (MRSA).10 Several studies have reported that as many as 30% to 50% of physicians and nurses have colonization of their anterior nares with S. aureus, and 2% are colonized with MRSA.11-14 Whether this carriage plays a role in nursery outbreaks, however, is unknown.

Text Extract Two:

Of particular interest was the fact that all 22 infected neonates were male and all but two were circumcised. Previous studies have reported that male neonates are more likely to become colonized78 and infected77,79 with S. aureus than are female neonates. In one study, the male-female infection rate was 3:179, in another it was 6:1.77 High male-female ratios have also been reported in outbreaks of neonatal scalded skin syndrome.80-82 Authors of these reports speculated that the circumcision site may be particularly susceptible to bacterial growth. In our study, however, none of the MRSA infections were at the circumcision site, although many were in the genital region. No conclusions could be drawn to explain the fact that only male infants were infected with MRSA in this outbreak.


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From the Departments of Infection Control,a Pathology,b Pediatrics/Neonatalogy,c Administratiion,d and Quality Assessment,e Arlington Hospital.

*Baci-Stat is a trademark of Huntington Labs, Inc., Huntington, Indiana.

Reprint requests: Abdul J. Zafar, MBBS, MPH, The Arlington Hospital, 1701 N. George Mason Drive, Alexandrian, VA 22205.

Copyright © 1995 by the Association for Professionals in Infection Control and Epidemiology, Inc.

(File revised 18 November 2005)