Consideration to culture health care workers related to increased methicillin-resistant Staphylococcus aureus activity in a neonatal intensive care unit

Background: For 2 consecutive years, a care level III neonatal intensive care unit (NICU) in a 700-bed health care facility experienced an increase in health care-associated methicillin-resistant Staphylococcus aureus (MRSA). To decrease transmission, standard infection prevention techniques. active surveillance cultures, and deoxyribonucleic acid typing were done. After control was achieved, members of the organization outside of infection prevention and control requested health care worker (HCW) screening for MRSA, believing that it would decrease chances of future transmission. Methods: To develop effective tools to communicate with organization members: (1) questions that must be resolved before HCW screening can be done accurately, (2) operational requirements for HCW screening, and (3) a "trigger point" for HCW screening should MRSA activity increase in the future. Results: Developed tools to determine when MRSA screening of HCWs is warranted and for the preparation process when MRSA screening is necessary Without performing HCW screening in the NICU, there were no health care-associated infections with MRSA for 20 months or colonization for 5 months. Conclusion: Proactive consideration of HCW screening can be achieved by designing and implementing tools to illustrate the complexity of the HCW screening process and by defining a "trigger point" for HCW culturing if needed for MRSA control. Decreasing MRSA transmission in this NICU was accomplished without culturing health care workers. (Am J infect Control 2008;36:638-43.)