MRSA Prevention

TITLE: METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) PREVENTION: STRATEGIC TRAINING AND MULTIDISCIPLINARY APPROACH

DESCRIPTION OF OUR ORGANIZATION Local Health Trust of Piacenza includes four hospitals located across the territory (Figure 1). The hospital offers acute care, internal medicine, specialized services, included and the Women’s, Childhood, and Adolescent Health Department, which includes both hospital and community-based structures to ensure continuous care for the health needs of women and children through various stages of growth and development. The inpatient wards of the neonatal and paediatric areas are centralized in the Piacenza HUB. The Healthcare Facilities Hygiene Unit is responsible for Infection Prevention and Control conducting active surveillance for epidemiologically significant alert microorganisms, including in the pediatric area.

INTRODUCTION Methicillin-Resistant Staphylococcus aureus (MRSA) represents a major etiologic agent of healthcareassociated infections (HAI) in early childhood because of the vulnerability and still-developing immune system of such patients. Neonatal infections confer an increased risk of short-term morbidity and mortality, as well as adverse long-term outcomes, especially in very immature preterm infants. The spread of MRSA represents a much feared event in the Obstetrics and Neonatology wards. The spread of MRSA is facilitated by the hospital environment, where close contact with patients, the use of invasive medical devices and the failure to apply precautions contribute to a high risk of transmission. Besides, hospitalized neonates are in close contact with healthcare workers, whose MRSA carriage rate seems to be 2–3 times higher than in the general population. To prevent epidemics and minimize the risk of spread, it is essential to adopt an integrated approach that includes evidence-based prevention measures.

AIM/OBJECTIVE The prevention and management strategies for the risk of MRSA spread in healthcare settings focus on a combination of active surveillance at the time of ward admission, hand hygiene practices, proper use of barrier precautions, appropriate management of medical devices, and through environmental cleaning. Other measures that can contribute to the prevention of MRSA colonisations or infections include education of healthcare staff, cohorting and isolation of MRSA-positive patients, avoiding ward crowding, and, in some units, surveillance of healthcare workers and visitors. Continuous education of healthcare personnel and the promotion of infection control bundles are key elements of infectious risk management programs for reducing the risk of MRSA transmission in pediatric units, particularly in neonatal care, where newborns are even more vulnerable. This work aims to highlight the central role of specific protocols based on scientific evidence, which should be disseminated through comprehensive training to reach all involved healthcare workers.

METHODS Since 2010, the hospital has implemented an automatic alert system to report microorganisms detected by Microbiology laboratory, enabling continuous monitoring of the epidemiological trends of pathogens across various wards. This structured system includes a surveillance program that involves screening for MRSA at the time of admission to the neonatal pathology unit, using nasal, auricular and pharyngeal swabs. Through this system, an increase in MRSA cases was identified during 2012, 2013 and 2014, affecting the newborn, neonatal pathology and pediatric wards to varying extents. This detection prompted the immediate implementation of containment measures to prevent the spread of MRSA, including environmental disinfection and the development of an organizational protocol, followed by targeted staff training that has been maintained over time. As part of the HAI training initiated in 2024 under the PNRR (National Recovery and Resilience Plan), the infection control bundle was updated and retraining was conducted.

RESULTS The analysis of data from the alert microorganism reporting system shows a spread of MRSA cases from 2012 to 2014 in inpatient wards of the neonatal and pediatric areas (Figure 2). Although there have been no critical issues for a decade, as a preventive measure and in conjunction with the training required by the PNRR, the specific care bundle for MRSA prevention (Figure 3) has been update and widely disseminated to all staff in the Women’s, Childhood, and Adolescent Health Department. The training program includes a general introduction on infectious risk via distance learning (FAD), a 4-hour interactive in-person training session and training on the job. The training on-the-job first included a “Training of trainers” coordinated by the Healthcare Facilities Hygiene Unit staff and the production of paper infographics delivered to the departments in September 2024. Starting from October 2024, these tutors trained their colleagues in the departments with a structured one-hour training on-the-job with a defined ratio of 1 tutor for 5 students. A total of 157 staff members will be trained (80% of the total department staff), involving not only healthcare workers in the newborn unit but also, for example, midwives from the maternity ward (Figure 3).

CONCLUSION For prevention and control of MRSA colonisation or infection, the approach adopted by Local Health Trust of Piacenza has been integrated and multidisciplinary. In our experience, widespread training, structured in an interactive and personalized manner, has significantly improved adherence to specific prevention protocols. The involvement of all healthcare workers has helped reinforce the culture of risk prevention, which has made it possible to drastically limit the spread of MRSA and prevent further transmission. The experience of managing a MRSA outbreak generated positive clinical care behaviours that continued over time and were favored by a multi-professional approach. The management method adopted can be summarized as follows: communication and sharing of critical events, continuous monitoring of the progress of MRSA, creation of a network that shares method and data, establishment of a multidisciplinary group (infectious disease specialist, neonatologist, gynecologist, surgeon, midwife, pediatric nurse and case manager), identification of the appropriate diagnostic-therapeutic operating protocol, hygienic care protocol and correct care behaviour. Given the magnitude of the infectious risk and the local epidemiological trend of MRSA, training should be considered one of the key drivers for controlling HAI, not only in response to specific outbreaks but also as a long-term prevention strategy.