日本未熟児新生児学会雑誌　第18巻　第2号　42～48頁（2006年）

日本未熟児新生児学会雑誌　18(2)：232-238；2006　

受付日：平成17．05．18

受理日：平成17．08．23

新生児集中治療室（NICU）におけるMRSA感染撲滅対策

Eradication of methicillin-resistant Staphylococcus aureus（MRSA）infections in NICU and preventive measures for reducing MRSA carrier state

大阪府立母子保健総合医療センター　新生児科

Osaka Medical Center and Research Institute for Maternal and Child Health

北島博之・隅　清彰・田中真也・白石　淳・佐野博之・藤村正哲

Hiroyuki KITAJIMA，Kiyoaki SUMI，Shinya TANAKA，Jun SHIRAISHI，Hiroyuki SANO，Masanori FUJIMURA

Key Words：NICU，MRSA，nosocomial infection，infection control

　NICU病棟において基本的な接触感染に対する標準予防策の厳密な実施の下に，保菌者の除菌を追加することにより，1998年11月から5年間の年月を要して病棟開設以来23年でMRSAを初めて撲滅できた。まず対策開始初期の6回の保菌者除菌の結果を基礎にして，有効な除菌方法を見出した。保菌患児にはムピロシン軟膏による鼻腔・外耳道消毒・皮膚の強酸性水による消毒・気管内挿管児は挿管チューブの周囲へのムピロシン軟膏の塗布を同時に行うことにより児の50～80％以上が除菌できた。そして保菌職員には同軟膏を1日2回7日間鼻腔への塗布でほぼ除菌できた（重症アトピー性皮膚炎1例だけ例外）。さらに除菌対策を行っていく上で，初めて勤務交代の保菌職員によるMRSA導入が容易に起こることが判明した。このことはNICUにおけるMRSA感染症予防対策は，単にNICU内部の問題ではなく，病院全体ひいては地域，そして大きくは国全体における成人のMRSA保菌を減少に向かわせる以外に根本的な予防策はないことを意味する。

　For the first time since our hospital was established 21 years ago, we have been successful in eradicating methicillin-resistant Staphylococcus aureus（MRSA）among patients and staff in the NICU who were MRSA carriers. The incidence of MRSA infections was greatly reduced by strict adherence to standard precautionary measures and the use of mupirocin ointment. Effective measures were established on the basis of 6 initial trials which started 5 years ago （Nov, 1998）to reduce MRSA colonization by stringent eradication measures.
　Mupirocin ointment was applied to the nasal passages（3 times/day for 3-7 days）and ear canals（once/day for 7 days）of MRSA carrier patients and their bodies were rinsed with acid water（once/day for 7 days）. For intubated infants, the endo-tracheal tubes were exchanged with tubes that had small amounts of mupirocin ointment applied to the external surfaces. Eradication rates of over 50-80％ were obtained. Staff members who were MRSA carriers applied the ointment to their nasal cavities（twice/day for 7 days）. The eradication rates were almost 100％ except for one case with severe atopic skin.
　It was also observed that new staff members carrying MRSA easily brought the bacteria into the NICU. We, therefore, began routine MRSA cultures of every new staff member before they started work in the NICU.
　For wards specializing in neonatal care, the treatments of MRSA carriers as well as stringent preventive measures to inhibit the spread of the bacteria are of utmost importance. However, to eradicate MRSA colonization completely, fundamental measures to prevent its spread at all levels, not only in hospitals but also throughout the community, will be necessary. Eradication needs to be a countrywide effort to be successful.