• Kathleen Gibbs, Samuel DeMaria, Scarlett McKinsey, Andrea Fede, Anne Harrington, Deborah Hutchison, Carol Torchen, Adam Levine, and Andrew Goldberg.
• Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: gibbska@email.chop.edu.
• J. Pediatr. 2018 Mar 1; 194: 22-27.e5.

ObjectiveTo describe the successful implementation of an in situ simulation program to diagnose and correct latent safety threats in a level 4 neonatal intensive care unit (NICU) to mitigate a methicillin-resistant Staphylococcus aureus (MRSA) outbreak.Study DesignAn investigational report describes a simulation intervention that occurred during a 4-month MRSA outbreak in a single-center, 46-bed, newly renovated level 4 NICU. The simulation program was developed for all NICU providers in which they were exposed to a 30-minute in situ human simulation intervention that included education, evaluation, and debriefing to resolve perceived or observed latent safety threats. The primary study outcome was improved hand hygiene compliance and an enhanced estimate of the culture of safety during a 6-month period.ResultsA total of 99 healthcare providers including physicians, nurses, respiratory therapists, and environmental service workers completed the course. Before the simulation intervention, there were 18 patients colonized or infected with a single MRSA clone; after the intervention, there were no new episodes of colonization or infection.ConclusionsAn in situ, simulation-based intervention can counter threats to patient safety related to workflow and lapses in infection control practices and improve patient outcomes.Copyright © 2017 Elsevier Inc. All rights reserved.

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