Abstract
Surveillance of perinatal care systems by midwives in 2003 revealed that only 8.6% of hospitals with over 501 beds have isolated obstetric wards, whereas the majority of large hospitals in Japan have mixed wards for obstetrics/gynecology/internal/surgical adult or pediatric patients. Such mixed wards include patients with terminal illnesses and carriers of MRSA, provoking great concern for maternal and especially neonatal health. The relationship between MRSA infections and perinatal care systems for newborns of up to 28 days old was studied based on data collected from a nationwide hospital surveillance by the Japanese Nosocomial Infection Surveillance (JANIS) program from 2004 to 2005. Analysis of the data for the 27 participating hospitals revealed the following. All 37 cases of neonates with MRSA skin infections including 4 with septicemia and 1 with pneumonia came from 8 hospitals with mixed wards. However, no case of MRSA infection occurred in the 3 hospitals with isolated obstetric wards. The 5 hospitals with 2 or more cases within 2004-5 had mostly over 500 deliveries a year and the ratio of deliveries to numbers of midwives and obstetrics nurses was over 20. MRSA infections tended to be concentrated in hospitals where mothers and newborns were separated, suggesting nosocomial infections. No MRSA infections occurred in the 3 hospitals with isolated obstetric wards, 2 of which separated mothers and newborns. Annual deliveries for each of these 3 hospitals were 814 (complete rooming-in), 650 (3 days separation), and 250 (complete separation).
These findings suggest strengthening surveillance systems as well as developing preventive measures against nosocomial infections in neonates.
