Guidance Balances Staph Infection Prevention in Critically Ill Infants with Family Contact

SHEA White Paper Outlines Targeted Screening and Decolonization Recommended for NICU
September 15, 2020

Neonatal intensive care units (NICU) should balance prevention of Staphylococcus aureus infections in critically ill infants with the need for skin-to-skin contact with parents and siblings, according to a Society for Healthcare Epidemiology of America (SHEA) white paper published in the journal Infection Control & Hospital Epidemiology. The paper serves as a practical clinical companion to the newly released recommendations from the Centers for Disease Control and Prevention’s (CDC) Healthcare Infection Control Practices Advisory Committee to help clinicians in NICUs make decisions about infection prevention, detection, and control practices.

“Infants remain at risk for Staph infections, yet there are effective strategies to decrease transmission that can easily be applied within the NICU without sacrificing the vital benefits these very young, tiny infants receive from care and bonding with parents, caregivers or other close relatives,” said Ibukun Akinboyo, MD, an author of the paper and medical director of pediatric infection prevention at Duke University Hospital. “Limited literature exists on prevention of Staph in the NICU, so this document looks to address common challenges faced by healthcare personnel in this environment.”

The paper, SHEA neonatal intensive care unit (NICU) white paper series: Practical approaches to Staphylococcus aureus disease prevention, provides expert opinion and evidence-based responses to frequently asked questions clinicians may have in implementing the updated CDC guidance for preventing, detecting, and controlling the spread of Staph infections, including methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA). Staph infections can become serious in NICU patients and are often associated with medical devices, like catheters used for feeding and medication, as well as direct and indirect exposure to bacteria on healthcare personnel, parents, caregivers, family members, other critically ill infants, and the healthcare environment.

The document discusses how to safely handle Staph bacteria colonization and infection in parents or visitors and in NICU patients, including hospitalized multiples (e.g., twins or triplets) with different colonization or infection statuses. The document can also help guide decisions about when and how to decolonize infants who have asymptomatic S. aureus or MRSA, while taking into account safety considerations for this patient population.

The authors note that recommendations may need to be adjusted during outbreaks of S. aureus or MRSA to address specific issues.


Ibukunoluwa Akinboyo, Kenneth Zangwill, Wendy Berg, Joseph Cantey, Beth Huizinga, Aaron Milstone. “SHEA neonatal intensive care unit (NICU) white paper series: Practical approaches to Staphylococcus aureus disease prevention” Web (September 14, 2020)

About ICHE
Published through a partnership between the Society for Healthcare Epidemiology of America and Cambridge University Press, Infection Control & Hospital Epidemiology provides original, peer reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. ICHE is ranked 19th out of 83 Infectious Disease Journals in the latest Web of Knowledge Journal Citation Reports from Thomson Reuters.

The Society for Healthcare Epidemiology of America (SHEA) is a professional society representing more than 2,000 physicians and other healthcare professionals around the world who possess expertise and passion for healthcare epidemiology, infection prevention, and antimicrobial stewardship. The society’s work improves public health by establishing infection-prevention measures and supporting antibiotic stewardship among healthcare providers, hospitals, and health systems. This is accomplished by leading research studies, translating research into clinical practice, developing evidence-based policies, optimizing antibiotic stewardship, and advancing the field of healthcare epidemiology. SHEA and its members strive to improve patient outcomes and create a safer, healthier future for all. Visit SHEA online at and

About Cambridge University Press
Cambridge University Press is part of the University of Cambridge. It furthers the University’s mission by disseminating knowledge in the pursuit of education, learning and research at the highest international levels of excellence. Its extensive peer-reviewed publishing lists comprise 45,000 titles covering academic research, professional development, over 400 research journals, school-level education, English language teaching and bible publishing. Playing a leading role in today’s international marketplace, Cambridge University Press has over 50 offices around the globe, and it distributes its products to nearly every country in the world. For further information about Cambridge University Press, visit

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