Abstract :
ISSUE: Possible transmission of MRSA from mother to 25-week gestation twin neonates weighing <1000 grams. Our goal was to prevent similar cases of transmission by developing a policy directing healthcare workers (HCWs) in the management of parents with MRSA who have babies in the NICU.
PROJECT: A mother gave birth via C-section to 25-week gestation twins. Within 72 hours post op, the mother developed MRSA bacteremia with no clearly identified source. The mother and babies were immediately placed in contact isolation. Staff wore gowns and gloves when handling each baby. Due to their low birthweight, the parents were not allowed to hold the babies, but were allowed to touch the babies without wearing gloves. The babies were fed breastmilk via feeding tube. At 12 days after birth, Baby A grew MRSA from a blood culture. At 14 days after birth, Baby B grew MRSA from a sputum and blood culture. Typing of the isolates by pulsed-field gel electrophoresis (PFGE) proved they were the same as the motherʹs. A review of literature is mixed regarding breastfeeding. A recent article suggested transmission of MRSA may occur through breastmilk. The breastmilk was cultured with no MRSA detected. It is also unknown as to whether or not transmission occurred at birth. A policy was developed to guide HCWs in the future management of this occurrence. The policy states that gown and gloves should be worn for each HCW and parental contact with the babies. Frequent hand hygiene is an essential component of the policy. Skin-to-skin contact and breastfeeding is left to the discretion of the physician based on the clinical picture of the infant. An educational sheet is given to parents to assist in their understanding of the risk and the precautions that must be taken to prevent transmission of MRSA from parent to baby.
RESULTS: There have not been any similar situations in our facility previous to or since this initial occurrence. However, staff is now educated and informed and will be able to assist MRSA-positive parents in making an informed decision regarding their newborn.
LESSONS LEARNED: Any family member having MRSA or a history of MRSA who has a baby in the NICU must use contact precautions when touching the baby. It is our responsibility as HCWs to educate and inform the parents of the possible risks and necessary measures for prevention of transmission.
