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Am I Passing MRSA to My Patients?

A literature review finds that healthcare workers play a role in MRSA transmission, and the authors make screening recommendations.

Methicillin-resistant Staphylococcus aureus (MRSA) has become ubiquitous in emergency departments, but the role of healthcare workers in its transmission is unclear. To assess likelihood of MRSA colonization, infection, and transmission among healthcare workers, researchers performed a comprehensive literature search and identified 127 investigations involving 33,318 screened healthcare workers.

Only 18 studies failed to detect MRSA in healthcare workers. Inadequate hand-washing, chronic skin diseases, and having worked in countries with endemic MRSA were identified as risk factors for MRSA carriage. The overall MRSA carriage rate was 4.6%, and most colonization was on the hands or in the nasopharynx of affected healthcare workers. Of these carriers, 5.1% had clinical infections. Healthcare-worker transmission of MRSA to patients was deemed likely in 63 of 68 studies (93%) that performed genotyping. Transmission occurred from both transiently and persistently colonized workers. Eight studies documented transmission to workers’ family members. According to data from one systematic review, nasal mupirocin led to MRSA eradication in 91% of 143 treated workers within 48 to 96 hours.

Although acknowledging that the cost might be prohibitive, the authors recommend healthcare-worker screening, especially for all staff during outbreak investigations, for all new employees, and for all staff on high-risk units (e.g., intensive care units, burn units, and surgical wards). In cases of eradication failure or frequent relapses, the authors recommend testing household contacts (including pets) and home environments.

Comment: Not only can we become colonized or infected with MRSA from our patients, but also we can infect them and even become the source of community MRSA clusters. Healthcare personnel have an essential responsibility for meticulous attention to hand hygiene before and after every patient contact and proper adherence to contact precautions. Both are critical to stopping the rampant spread of MRSA.

— Kristi L. Koenig, MD, FACEP

Published in Journal Watch Emergency Medicine April 18, 2008

Citation(s):

Albrich WC and Harbarth S. Health-care workers: Source, vector, or victim of MRSA? Lancet Infect Dis 2008 May; 8:289.

• Medline abstract (Free)