CONTROL OF METHICILLIN-RESISTANT STAPHYLOCOCCUS-AUREUS IN A PEDIATRICBURN UNIT

Background: Control of methicillin-resistant Staphylococcus aureus (MR SA) is particularly difficult in burn units, which are often cited as sources of hospital-wide MRSA outbreaks. We developed a successful MRS A control program and document here its apparent effectiveness in cont rolling MRSA transmission in a pediatric burn unit. Methods: An MRSA c ontrol program that included surveillance culturing, clinician feedbac k, flexible, site-specific isolation, and a list of known carriers was consistently applied in a pediatric burn unit through a 7-year period . Microbiology reports of MRSA isolates from patients and environmenta l surfaces and records of all patients from whom MRSA was isolated wer e reviewed. Results: During calendar years 1985 through 1991, a total of 991 acutely burned children were admitted to the Boston unit of the Shriners Burns Institute. Forty MRSA cases (4%) were identified. One patient both had MRSA at admission and met our criteria for nosocomial MRSA. Of the remaining 39 patients, 11 had MRSA at admission and 28 h ad nosocomial MRSA. There were 17 wound infections, two cases of pneum onia, and two bloodstream infections. No deaths were attributed to MRS A sepsis. Conclusion: An MRSA control program including surveillance c ulturing, clinician feedback, flexible, site-specific isolation, and a list of known carriers is associated with a low rate of nosocomial MR SA in a pediatric burn unit.