772 - Outcomes of Implementation of Surveillance and Decolonization for Methicillin-Resistant Staphylococcus aureus in a Midwest Neonatal

Publication Number: 1748.772

Mohamed W. Mohamed, Sanford Children's Hospital - Fargo, Fargo, ND, United States; Amy Johnson, Sanford Children's Hospital - Fargo, Fargo, ND, United States; Aileen Aldrich, University of North Dakota School of Medicine and Health Sciences, West Fargo, ND, United States

Background: Methicillin-resistant Staphylococcus aureus (MRSA) infection remains a significant cause of morbidity and mortality in neonatal intensive care units (NICUs), with colonized infants particularly vulnerable to invasive disease. In 2024, our NICU experienced an increase in MRSA infection rates, prompting the launch of a coordinated quality improvement (QI) initiative to address the issue.

Objective: To reduce MRSA colonization and eliminate MRSA infections in the NICU through multidisciplinary collaboration, standardized surveillance, and targeted decolonization protocols.

Design/Methods: In September 2024, a dedicated MRSA Task Force was established, composed of the NICU medical director, nurse educator, nurse manager, respiratory therapy manager, infection control representative, pediatric infectious diseases specialist, and the children's hospital chief medical officer. Weekly meetings were held to review surveillance data and monitor progress. Interventions implemented beginning October 2024 included nasal MRSA screening for all infants on admission and weekly, decolonization with topical mupirocin with or without chlorhexidine for colonized infants, and mandatory glove use for any patient contact. Staff education was reinforced through town halls, daily huddles, and emails to promote awareness and compliance. Enhanced environmental hygiene practices were introduced in collaboration with environmental services, and the use of hospital-provided scrubs for unit staff was reinforced to minimize cross-contamination. Continuous feedback loops and real-time data monitoring guided ongoing improvements.

Results: MRSA colonization rates decreased steadily following implementation, with rates dropping to zero by spring 2025 and no invasive MRSA infections for ten consecutive months (Figure 1). A modest rebound of colonizations occurred in summer 2025, corresponding to the first new infection after the interventions. Among colonized infants undergoing decolonization between October 2024 and September 2025, 36% were successfully cleared, 43% experienced recurrence, 7% persisted, and 14% had unknown outcomes (Figure 2).

Conclusion(s): Implementation of a structured MRSA surveillance and decolonization program resulted in near elimination of invasive infections and a marked decline in colonization rates. Continued focus on adherence, education, and multidisciplinary collaboration remains essential to sustain these improvements and prevent recurrence.

Figure 1
MRSA Colonizations vs. Reservoir. MRSA positives decreased in parallel with a decline in reservoir cases, reaching near-zero by early 2025, with a modest rebound in summer 2025.

Figure 2.
Outcomes of MRSA Decolonization in the NICU (Oct 2024 - Sept 2025). Among colonized infants undergoing MRSA decolonization, 36% were successfully cleared, 43% experienced recurrence at some point, 7% persisted despite therapy, and 14% had unknown outcomes (discharged prior to further testing). These findings highlight both the effectiveness of the decolonization protocol and the need for continued surveillance to reduce recurrence.