Is isolation of outborn infants required at admission to the neonatal intensive care unit?

Background To measure the rate of colonization of outborn infants with methicillin-resistant Staphylococcus aureus (MRSA) to evaluate the need for Contact Precautions (including isolation) at the time of admission to the neonatal intensive care unit (NICU). Methods All 239 consecutive infants referred from the neonatal units of other hospitals to a tertiary NICU in Al Ain, United Arab Emirates, between January 2000 and December 2007 were screened for MRSA colonization. Swabs from the ear, nose, rectum, axillae, and groin were obtained from each patient, and the rates of colonization were calculated retrospectively. Results Some 72% of newborns were admitted to our NICU in the first week. Only 1 patient, admitted from Oman, grew MRSA from the ear swab (rate, 0.4%; 95% confidence interval = 0.01%∼2.3%). Conclusion This study from a tertiary NICU in a developing country shows that outborn infants are unlikely to harbor MRSA, and thus their routine admission in a single-bed isolation room is not justified. MRSA screening on admission has a very low yield and does not appear to be cost-effective. Contact Precautions should be reserved for those newborns transferred from general pediatric wards and those admitted from home.