882 infection control & hospital epidemiology july 2018, vol. 39, no. 7


adherence to communicable disease control measures. Despite these challenged, the implemented control measures (ie, vaccination, enhanced environmental cleaning, closure of the unit to new admissions, and closure of common day areas) during the surveillance period prevented additional cases from occurring, and the hospital unit was re-opened for admissions. Maintaining a clean and safe environment for this patient


population is challenging. The spread of HAV in this hospital was likely due to both close contact with the index patient and contaminated living quarters and hospital unit restroom of the index case. Although similar outbreaks have been identified among adults with developmental disabilities5 and disabled patients in congregate living situations,6 outbreaks in mental health facilities are rare.7 Screening patients in mental hospi- tals who lack the ability to adhere to hygienic practices and vaccinating susceptible persons on admission may reduce the risk for outbreaks of acute HAV infection in these facilities.


acknowledgments


Financial support: No financial support was provided relevant to this article. Potential conflicts of interest: All authors report no conflicts of interest relevant to this article.


Curtis Croker, MPH;1


Susan Hathaway, RN, MPH;1 Amy Marutani, MPH;1


Margilane Hernandez, RN, MSN/ED, PHN;2


Crystal Cadavid, RN, MSN, PHN, CMSRN, CIC;1 Shobita Rajagopalan, MD, MPH;2 Bessie Hwang, MD, MPH;1 Moon Kim, MD, MPH1


Affiliations: 1. Acute Communicable Disease Control Program, Los Angeles


County Department of Public Health, Los Angeles, California; 2. Community Health Services, Los Angeles County Department of Public Health, Whittier, California Address correspondence to Curtis Croker, MPH, Acute Communicable


Disease Control Program, Los Angeles County Department of Public Health, 313NFigueroa St,Room222, LosAngeles,CA90012 (ccroker@ph.lacounty.gov).


Received December 15, 2017; accepted February 26, 2018; electronically published April 17, 2018 Infect Control Hosp Epidemiol 2018;39:881–882 © 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2018/3907-0020. DOI: 10.1017/ice.2018.77


references


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2. Viral Hepatitis Surveillance United States, 2015. Centers for Disease Control and Prevention website. https://www.cdc.gov/ hepatitis/statistics/2015surveillance/pdfs/2015HepSurveillanceRpt. pdf. Published 2015. Accessed March 14, 2018.


3. Update: Prevention of hepatitis A after exposure to hepatitis A virus and in international travelers. Updated recommendations


Staphylococcus aureus remains a leading cause of hospital- acquired infections (HAIs) in neonates.1 Some neonatal intensive care units (NICUs) use active surveillance cultures (ASCs) and decolonization to prevent methicillin-resistant S. aureus (MRSA) transmission and infections.2 However, methicillin-susceptible S. aureus (MSSA) infections occur more frequently and have similar mortality in neonates.3 In The Johns Hopkins NICU, prior to April 2013, neonates


were screened for MRSA colonization and carriers were decolo- nized.4 In April 2013, the program expanded to include MSSA screening and decolonization. Previously, we showed that after implementation of MSSA ASCs andtargeteddecolonization, S. aureus clinical cultures and infections decreased.4 Our objective was to assess whether the reduction was sustained over 3 years.


methods


Using The Johns Hopkins Pathology information system, we retrospectively identified neonates admitted to the NICU between April 1, 2011, and June 30, 2016. Clinical cultures positive for Staphylococcus aureus were defined as non- surveillance cultures growing S. aureus. Cultures from the same patient were considered unique events if they were col- lected from the same body site at least 30 days apart or from different body sites at least 14 days apart. NICU-attributable was defined as clinical cultures obtained >2 days after unit


Association of an Active Surveillance and Decolonization Program on Incidence of Clinical Cultures Growing Staphylococcus aureus in the Neonatal Intensive Care Unit


of the Advisory Committee on Immunization Practices (ACIP). Morbid Mortal Weekly Rept 2007;56:1080–1084.


4. Morbidity and Mortality Weekly Report. Summary of notifiable diseases. Centers for Disease Control and Prevention website. https://www.cdc.gov/mmwr/mmwr_nd/index.html. Updated November 2, 2017. Accessed March 14, 2018.


5. Bohm SR,MS, BergerKW,Hackert PB, et al. Hepatitis A outbreak among adults with developmental disabilities in group homes— Michigan, 2013. Morbid Mortal Weekly Rept 2015;64:148–152.


6. Lim HS, Choi K, Lee S. Epidemiological investigation of an outbreak of hepatitisA at a residential facility for the disabled, 2011. J PrevMed Public Health 2013;46:62–73.


7. Fukuta YY. Muder. Infections in psychiatric facilities, with an emphasis on outbreaks. Infect ControlHosp Epidemiol 2013;34:80–88.


8. Update #5: Hepatitis A virus outbreak in San Diego County. State of California Health and Human Services website. http://www. sandiegocounty.gov/content/sdc/hhsa/programs/phs/community_ epidemiology/dc/Hepatitis_A.html. Published August 16, 2017. Accessed March 14, 2018.


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