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Role of Healthcare Workers in Outbreaks of Methicillin-Resistant Staphylococcus aureus: A 10-Year Evaluation From a Dutch University Hospital

Published online by Cambridge University Press:  02 January 2015

Hetty E. M. Blok
Affiliation:
University Medical Center Utrecht, Eijkman-Winkler Centre for Microbiology, Infectious Diseases and Inflammation, Department of Hospital Hygiene & Infection Prevention, Utrecht, the Netherlands
Annet Troelstra
Affiliation:
University Medical Center Utrecht, Eijkman-Winkler Centre for Microbiology, Infectious Diseases and Inflammation, Department of Hospital Hygiene & Infection Prevention, Utrecht, the Netherlands
Titia E. M. Kamp-Hopmans
Affiliation:
University Medical Center Utrecht, Eijkman-Winkler Centre for Microbiology, Infectious Diseases and Inflammation, Department of Hospital Hygiene & Infection Prevention, Utrecht, the Netherlands
Ada C. M. Gigengack-Baars
Affiliation:
University Medical Center Utrecht, Eijkman-Winkler Centre for Microbiology, Infectious Diseases and Inflammation, Department of Hospital Hygiene & Infection Prevention, Utrecht, the Netherlands
Christina M. J. E. Vandenbroucke-Grauls
Affiliation:
Free University Medical Center, Department of Medical Microbiology and Infection Control, Amsterdam, the Netherlands
Annemarie J. L. Weersink
Affiliation:
University Medical Center Utrecht, Eijkman-Winkler Centre for Microbiology, Infectious Diseases and Inflammation, Department of Hospital Hygiene & Infection Prevention, Utrecht, the Netherlands
Jan Verhoef
Affiliation:
University Medical Center Utrecht, Eijkman-Winkler Centre for Microbiology, Infectious Diseases and Inflammation, Department of Hospital Hygiene & Infection Prevention, Utrecht, the Netherlands
Ellen M. Mascini*
Affiliation:
University Medical Center Utrecht, Eijkman-Winkler Centre for Microbiology, Infectious Diseases and Inflammation, Department of Hospital Hygiene & Infection Prevention, Utrecht, the Netherlands
*
University Medical Center Utrecht, Department of Hospital Hygiene & Infection Prevention, HP G 04.614, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands

Abstract

Background and Objective:

The benefit of screening healthcare workers (HCWs) at risk for methicillin-resistant Staphylococcus aureus (MRSA) carriage and furloughing MRSA-positive HCWs to prevent spread to patients is controversial. We evaluated our MRSA program for HCWs between 1992 and 2002.

Setting:

A university medical center in the Netherlands, where methicillin resistance has been kept below 0.5% of all nosocomial S. aureus infections using active surveillance cultures and isolation of colonized patients.

Design:

HCWs caring for MRSA-positive patients or patients in foreign hospitals were screened for MRSA. MRSA-positive HCWs had additional cultures, temporary exclusion from patient-related work, assessment of risk factors for persisting carriage, decolonization therapy with mupirocin intranasally and chlorhexidine baths for skin and hair, and follow-up cultures.

Results:

Fifty-nine HCWs were colonized with MRSA. Seven of 840 screened employees contracted MRSA in foreign hospitals; 36 acquired MRSA after contact with MRSA-positive patients despite isolation precautions (attack rate per outbreak varied from less than 1% to 15%). Our hospital experienced 17 MRSA outbreaks, including 13 episodes in which HCWs were involved. HCWs were index cases of at least 4 outbreaks. In 8 outbreaks, HCWs acquired MRSA after caring for MRSA-positive patients despite isolation precautions.

Conclusion:

Postexposure screening of HCWs allowed early detection of MRSA carriage and prevention of subsequent transmission to patients. Where the MRSA prevalence is higher, the role of HCWs may be greater. In such settings, an adapted version of our program could help prevent dissemination.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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