Implementing Best Practices Through Staff Education to Eradicate Gentamicin-Resistant Staphylococcus aureus in a Neonatal Intensive Care Unit

Hospital-associated infections are estimated to affect more than two million patients a year; which is associated with an increase in morbidity, mortality, length of stay, and costs (Lowy. N Engl J Med. 1998;339:520-532; Burke. N Engl J Med. 2003;348:651-656). The rate of hospital-associated infections increases with the degree of prematurity and low birth weight. Hospital-associated infections affect up to 30% of very-low-birth-weight premature infants with a high percentage of bloodstream infections, which are associated with an increase in morbidity, mortality, length of stay, and costs, as well as slower growth among infants with very low birth weights (Sohn et al. J Pediatr. 2001;139:821-827). Specifically, Staphylococcus aureus is a well-known hospital-associated organism affecting neonatal intensive care patients, remaining one of the most common and virulent pathogens. Recently, the medical literature highlighted the prevalence of methicillin-resistant S aureus, yet methicillin-susceptible S aureus occurs much more frequently in nurseries (Graham et al. Infect Control Hosp Epidemiol. 2002;23:677-682). The incidence of hospital-associated bacteremia varies among neonatal units and may be related to management decisions and practice style (Kilbride et al. Pediatrics 2003;111:e519-e533). This article describes practice changes, the evidence obtained to drive them, and their effect on clinical processes during an outbreak of methicillin-resistant S aureus in a neonatal intensive care unit.