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14 © 2009, AWHONN http://nwh.awhonn.org

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Screening for MRSA in Neonates

DOI: 10.1111/j.1751-486X.2009.01393.x

Nursing for Women’s Health readers can con-

nect with each other and with our authors and

editors at our new online blog site nwhTalk.

awhonn.org. Here’s a sampling of one recent

online discussion at the site:

Screening for MRSA in NeonatesI thoroughly enjoyed the excellent article on

MRSA in neonates by Bakunas-Kenneley (2008).

Although the primary reservoir for colonization

of S. aureus is the anterior nares in the general

population, is that the most appropriate place

for a swab in the small newborn (VLBW or

LBW), or would an anal swab be more ap-

propriate? Is anyone aware of studies that have

compared accuracy between these approaches?

Barbara Wilson

ReferenceBakunas-Kenneley, I. (2008). Community-ac-

quired MRSA in Neonates: Prevention and Con-trol in the Clinical Setting. Nursing for Women’s Health, 12(5), 396–402.

Author’s Response:Thank you for your kind words and great

question! I have included here citations for two

articles that directly address your question. The

fi rst one is a study that was done in 2006 in

which researchers cultured neonates and com-

pared the sites cultured. Their fi ndings indicate

that the best recovery rates of MRSA was when

the nares AND the umbilicus were both cul-

tured (they compared two separate hospitals).

The citation for this article is:

Rosenthal, A., White, D., Churilla, S., Brodie, S.,

& Katz, K. C. (2006). Optimal Surveillance Cul-

ture Sites for Detection of Methicillin-Resistant

Staphylococcus aureus in Newborns. Journal of

Clinical Microbiology, 44(11), 4234–4236.

The second article was published recently by

the Society for Healthcare Epidemiology of

America (SHEA). The citation is: Calfee, D.P.,

et al. (2008). Strategies to Prevent Transmission

of Methicillin-Resistant Staphylococcus aureus

in Acute Care Hospitals. Infection Control &

Screening for MRSA in Neonates

February | March 2009 Nursing for Women’s Health 15

BLo

gpositive site, with sensitivity ranging from

73 percent to 93 percent. Because of the easy

accessibility of this site, the anterior nares are

generally considered to be the primary site for

sampling in MRSA screening programs.

(b) Collection of samples from other sites

such as wounds, foreign body (eg, gastrostomy

or tracheostomy tube) exit sites, the throat, the

perianal area, and/or the umbilicus (recom-

mended from the 2006 studyæin neonates) will

allow identifi cation of additional colonized

patients who would not be identifi ed by testing

of nasal specimens alone.

Take care, and let me know if you have any

other excellent questions/observations!

Irena B. Kenneley, PhD, APRN-BC, CIC

Hospital Epidemiology, 29, S62–S80. You can

also access this article online at http://www.

journals.uchicago.edu/doi/full/10.1086/591061.

What they essentially recommend is that along

with culturing the nares, the addition of the

umbilicus and/or perineum or rectum cultures

are to be done at the discretion of the infection

prevention and control team (whatever entity

that might be in your institution).

To summarize, here’s what researchers have

found and what SHEA is recommending for the

determination of anatomic sites to include for

screening for neonates:

(a) Anterior nares are the primary site for

sampling MRSA in screening programs. The

anterior nares appear to be the most frequently

In Gratitude…

Warm thanks to the following individuals who reviewed manuscripts in 2008