Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-17T21:33:01.872Z Has data issue: false hasContentIssue false
  • English
  • Français

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 ,
Annet Troelstra ,
Titia E. M. Kamp-Hopmans ,
Ada C. M. Gigengack-Baars ,
Christina M. J. E. Vandenbroucke-Grauls ,
Annemarie J. L. Weersink ,
Jan Verhoef  and
Ellen M. Mascini
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
Get access Rights & Permissions [Opens in a new window]

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
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 9 , September 2003 , pp. 679 - 685
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Voss, A, Doebbeling, BN. The worldwide prevalence of methicillin-resistant Staphylococcus aureus. Int J Antimicrob Agents 1995;5:101–106.CrossRefGoogle ScholarPubMed
2.Reagan, DR, Doebbeling, BN, Pfaller, MA, et al.Elimination of coincident Staphylococcus aureus nasal and hand carriage with intranasal application of mupirocin calcium ointment. Ann Intern Med 1991;114:101–106.CrossRefGoogle ScholarPubMed
3.John, JF, Barg, NL. Staphylococcus aureus. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control, 1st ed. Baltimore: Williams & Wilkins; 1996:271–290.Google Scholar
4.Ballemans, CAJM, Weersink, AJL, Blok, HEM, Vandenbroucke-Grauls, CMJE, Verhoef, J. Screening for methicillin-resistant Staphylococcus aureus (MRSA): one hour versus twenty-four hours sampling interval. J Hosp Infect 1999;316–317.Google Scholar
5.Vandenbroucke-Grauls, CMJE. Methicillin-resistant Staphylococcus aureus control in hospitals: the Dutch experience. Infect Control Hosp Epidemiol 1996;17:512–513.CrossRefGoogle ScholarPubMed
6.Verhoef, J, Beaujean, D, Blok, H, et al.A Dutch approach to methicillin-resistant Staphylococcus aureus. Eur J Clin Microbiol Infect Dis 1999;18:461–466.CrossRefGoogle ScholarPubMed
7.Dutch Working Party for Infection Prevention. Management Policy for Methicillin Resistant Staphylococcus aureus. Leiden, the Netherlands: Dutch Working Party for Infection Prevention; 1995:35a. Available at www.WIP.nl.Google Scholar
8.Garner, JS, Hospital Infection Control Practices Advisory Committee. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol 1996;17:53–80.CrossRefGoogle ScholarPubMed
9.Vandenbroucke-Grauls, CMJE, Frénay, HME, van Klingeren, B, Savelkoul, TF, Verhoef, J. Control of epidemic methicillin-resistant Staphylococcus aureus in a Dutch university hospital. Eur J Clin Microbiol Infect Dis 1991;10:6–11.CrossRefGoogle Scholar
10.Bowler, I. Strategies for the management of healthcare staff colonized with epidemic methicillin-resistant Staphylococcus aureus, J Hosp Infect 1997;36:321–322.Google Scholar
11.Cox, RAConquest, C. Strategies for the management of healthcare staff colonized with epidemic methicillin-resistant Staphylococcus aureus. J Hosp Infect 1997;35:117–127.CrossRefGoogle ScholarPubMed
12.Wertheim, H, Verbrugh, HA, van Pelt, C, de Man, P, van Belkum, AVos, MC. Improved detection of methicillin-resistant Staphylococcus aureus using phenyl mannitol broth containing aztreonam and ceftizoxime. J Clin Microbiol 2001;39:2660–2662.Google Scholar
13.Fluit, AC, Wielders, CLC, Verhoef, J, Schmitz F-J. Epidemiology and susceptibility of 3,051 Staphylococcus aureus isolates from 25 university hospitals participating in the European SENTRY study. J Clin Microbiol 2001;39:3727–3732.Google Scholar
14.Voss, AMilatovic, D, Wallrauch-Schwarz, C, Rosdahl, VT, Braveny, I. Methicillin-resistant Staphylococcus aureus in Europe. Eur J Clin Microbiol Infect Dis 1994;13:50–55.CrossRefGoogle ScholarPubMed
15.Weersink, AJL. Een nieuwe medewerker vol verrassingen. Infectieziekten Bulletin 1998;9:39.Google Scholar
16.Vriens, MR, Fluir, AC, Troelstra, A, Verhoef, J, van der Werken, C. Is methicillin-resistant Staphylococcus aureus more contagious than methicillin-susceptible S. aureus in a surgical intensive care unit? Infect Control Hosp Epidemiol 2002;23:491–494.Google Scholar
17.Cookson, BD. Methicillin-resistant Staphylococcus aureus in the community: new battlefronts, or are the battles lost? Infect Control Hosp Epidemiol 2000;21:398–403.CrossRefGoogle ScholarPubMed
18.Ploy, M-C, Francois, B, Mounier, M, Vignon, Ph, Denis, F. Nasal carriage of vancomycin-intermediate Staphylococcus aureus among intensive care unit staff. Clin Infect Dis 2001:33:1951.CrossRefGoogle ScholarPubMed
19.Hancox, R, Cummins, AKelsey, MC. An outbreak of EMRSA 2 associated with long-term colonization of medical staff. J Hosp Infect 1992;22:170–172.Google Scholar
20.Allen, KD, Anson, JJ, Parsons, LA, Frost, NG. Staff carriage of methicillin-resistant Staphylococcus aureus (EMRSA 15) and the home environment: a case report. J Hosp Infect 1997;35:307–311.Google Scholar
21.Vriens, MR, Troelstra, A, Yzerman, EPF, Poth, AM, Verhoef, J, Van der Werken, C. Meticilline resistente Staphylococcus aureus bij medisch en paramedisch personeel terug van werkbezoek aan een buitenlands ziekenhuis. Nederlands Tijdschrift voor Geneeskunde 2000;144:887–889.Google Scholar
22.Lessing, MPAJordens, JZ, Bowler, ICJ. When should healthcare workers be screened for methicillin-resistant Staphylococcus aureus? J Hosp Infect 1996;34:205–210.Google Scholar
23.Cookson, B, Peters, B, Webster, M, Phillips, I, Rahman, M, Noble, W. Staff carriage of epidemic methicillin-resistant Staphylococcus aureus. J Clin Microbiol 1989;27:1471–1476.CrossRefGoogle ScholarPubMed
24.Pittet, D. Improving adherence to hand hygiene practice: a multidisci-plinary approach. Emerg Infect Dis 2001;7:234–240.Google Scholar
25.Boyce, JM. MRSA patients: proven methods to treat colonization and infection. J Hosp Infect 2001;48(suppl):S9–S14.Google Scholar
26.Vriens, MR, Blok, HEM, Fluit, AC, Troelstra, Avan der Werken, C, Verhoef, J. Ten years of strict MRSA policy in a Dutch University Hospital Medical Center: a 10-year survey. Eur J Clin Microbiol Infect Dis 2002;21:782–786.CrossRefGoogle Scholar
27.Mascini, EM, Blok, HEM, Kamp-Hopmans, TEM, et al.Screening op MRSA-dragerschap na patiëntencontact in het buitenland. Infectieziekten Bulletin 2002;13:13–17.Google Scholar
28.Chaix, C, Durand-Zaleski, I, Alberti, C, Brun-Buisson, C. Control of endemic methicillin-resistant Staphylococcus aureus: a cost-benefit analysis in an intensive care unit. JAMA 1999;282:1745–1751.CrossRefGoogle Scholar
29.Arnold, MS, Dempsey, JM, Fishman, M, McAuley, PJ, Tibert, C, Vallande, NC. The best hospital practices for controlling methicillin-resistant Staphylococcus aureus: on the cutting edge. Infect Control Hosp Epidemiol 2002;23:69–76.Google Scholar
30.Farr, BM, Jarvis, WR. Would active surveillance cultures help control healthcare-related methicillin-resistant Staphylococcus aureus infections? Infect Control Hosp Epidemiol 2002;23:65–68.Google Scholar
31.Wenzel, RP, Reagan, DR, Bertino, JS, Baron, EJ, Arias, K. Methicillin-resistant Staphylococcus aureus outbreak: a consensus panel's definition and management guidelines. Am J Infect Control 1998;26:102–110.Google Scholar