of the following:
1. Immaturity of humoral and cellular immune defense mechanisms
2. Breach of natural mucous membrane and skin barrier defense

6. High census, crowding, suboptimal nurse: patient ratios that
promote transmission of nosocomial organism from one infant to
another through poor handwashing

B. Universal precautions have been renamed "standard precautions,"
because these precautions are recommended for all patients to protect
health care workers from infectious body fluids. These apply to all
body fluids, secretions, and excretions, non-intact skin and mucous
membranes. The following techniques are included:

are likely to be sprayed during patient care activities
4. Non-sterile gowns during procedures
5. Patient care equipment should be handled in a manner that

contamination of clothing
6. Blood-borne pathogen exposure should be avoided
7. Mouthpieces, resuscitation bags, and other ventilation devices

C. Appropriate precautions for MRSA infections include:
1. Isolation in a separate room (private room or isolation unit)
2. Contact precautions to control transmission which includes (1)

3. Contact transmission, the most important and frequent route of
transmission in nosocomial infections, has two modes: direct and
indirect

2. Negative air-pressure ventilation (minimum: 6 changes per hour)
3. Masks at all times
4. Respirator masks for pulmonary tuberculosis

E. Droplet precautions should be used when organisms from infected
person (sneezing, coughing) are propelled a short distance and
deposited on health care worker's mucosa (eg, N. meningitidis,
diphtheria, pertussis, respiratory viruses, rubella, streptococcal
pharyngitis or scarlet fever). Specific precautions to be used are:
1. Private room (preferred)
2. Use of a mask if within 3 feet of patient

F. Strategies for controlling the outbreak would be to encourage the
following:
1. Adherence to hand washing policy and other contact precautions
2. Minimize number of persons with access to infected patients
3. Surveillance of all NICU infants for MRSA infection
4. Isolation of MRSA infected infants
5. Cohorting of admissions into "clean" areas
6. Dedicate specific health-care workers to provide one-on-one care