(621) Utility and Cost of Umbilical Cord Methicillin-Resistant Staphylococcus aureus Surveillance Testing

Introduction: Our Neonatal Intensive Care Unit (NICU) performs surveillance testing for methicillin-resistant Staphylococcus aureus (MRSA) on all patients. Surveillance cultures are collected from the patient’s nares, rectum, and intact umbilical cord stump, if applicable, on admission and weekly thereafter. Patients with a positive MRSA culture are placed on contact precautions to prevent transmission. MRSA culture positivity for all three surveillance sites combined was 1.97% in the NICU from 2018-2022. Anecdotally, it was noted that few umbilical cultures were positive, prompting a review of positivity by body site. A literature review revealed that the nares and rectum are the most common sites included in surveillance testing, and that culturing multiple body sites should be considered to yield higher sensitivity. The purpose of this project was to assess the utility and cost of routine umbilical MRSA surveillance testing.

Methods: As part of our continuous quality improvement efforts, we used the hospital’s electronic surveillance database to collect MRSA surveillance testing results from the nares, rectums, and umbilical cords of NICU patients from 2018-2022. Data was transferred to an Excel™ database and reviewed to ensure no duplicate results were included in the analyses. Positive results for each site were examined, and the cost of obtaining umbilical cultures was calculated.

Results: A total of 1,648 MRSA surveillance cultures were collected from the umbilical cords of patients admitted to the NICU from 2018-2022, and 0.36% (6/1648) were positive. All 6 patients with a positive umbilical culture also had a positive culture from the rectum and/or nares on the same collection date. The total cost of the 1,642 negative and 6 positive umbilical cultures from 2018-2022 was $159,442.95.

Conclusions: Given low MRSA positivity from umbilical cords and the overlap of positivity with other body sites, umbilical MRSA surveillance testing was discontinued in our NICU. This intervention provides an estimated cost savings of $30,000 per year. MRSA surveillance from the nares and rectum is still done on admission and weekly. Resuming umbilical testing could be considered in the context of a suspected MRSA outbreak.