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Healthcare workers – Source, vector or victim of MRSA?

Abstract number: 1733_807

Albrich W.C., Harbarth S.

Objectives: There is ongoing controversy about the role of healthcare workers (HCWs) in transmission of methicillin-resistant Staphylococcus aureus (MRSA). We performed a systematic literature search of electronic databases from 1980 through March 2006 to determine the likelihood of MRSA colonisation in HCWs, their role in MRSA transmission and their own subsequent risk of infection.

Methods: We scanned the English, French and German literature and excluded articles that did not present quantitative data. Two reviewers independently assessed the relevance of the included studies.

Results: In 121 studies, the prevalence of MRSA carriage among 33,318 screened HCWs was 4.6% (range: 0–65%). Average MRSA carriage in HCWs working in settings with endemic MRSA was 8.1%, compared to 3.9% in outbreak settings. Risk factors of MRSA carriage included chronic skin diseases, poor hygienic practices, close contact with infected or colonised patients and having worked abroad. Transient or intermittent colonisation predominated, but persistently colonised HCWs were found to be responsible for several nosocomial MRSA clusters. Almost 80 reports supported a causal role of HCWs in transmission of MRSA to patients. Success rates of eradication therapy were high (461/521 HCWs; 88.5%), and independent from duration of therapy. Subclinical infections and colonisation of extranasal sites were associated with persistent carriage after eradication therapy. Eradication of the MRSA carrier status and/or removal of personnel from patient care were successful in terminating MRSA transmission in most cases. About 4.9% of colonised HCWs developed infections, primarily of the skin and soft tissues. In settings with a high prevalence of community-associated MRSA, HCWs carriage of MRSA was 3.2% (92/2,832) with a high proportion of clinical infections (4/63; 6.3%).

Conclusion: A non-negligible number of HCWs become colonised with MRSA and 5% of those develop clinical disease. HCWs most frequently act as vectors and not as main sources of MRSA transmission. HCWs as persistent reservoir of MRSA are rare but nonetheless important. Aggressive screening and eradication policies seem justified in outbreak investigations or when MRSA has not reached highly endemic levels yet.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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