MRSA, Mersa, Staph, Staff Infection, Treatment & Symptoms

Branson Advocates Testing Hospital Workers for Superbugs

Branson Advocates Testing Hospital Workers for Superbugs.

In an interview with the BBC, Richard Branson, billionaire chairman of the Virgin Group and vice-president of health charity Patients Association, suggested major reforms for National Health Service hospitals in the fight against “superbugs” such as MRSA. Branson believes that hospitals should test hospital workers for MRSA, saying that possibly as many as 30 percent of workers carry MRSA.

Highly resistant bacteria common in ER workers

Highly resistant bacteria common in ER workers - Yahoo! News.

Lovell and colleagues collected nasal swabs from a sample of 105 emergency department staff at their institution. Sixteen subjects (15 percent) tested positive for MRSA, including 12 nurses, 2 physicians, and 2 technicians. The MRSA positivity rates in our emergency department health care workers is "much higher than that found in the general US population, but is similar to rates seen in other studies of non-ED medical personnel," Dr. Lovell said.

CA MRSA Outbreak at New York Maternity Ward Hits Staff

FOXNews.com - MRSA Outbreak at New York Maternity Ward - Infectious Disease.

Officials at St. John’s Riverside Hospital in Yonkers, N.Y., became aware of the problem after the newborns developed skin rashes consistent with the drug-resistant staph infection, wcbs880.com reported. "We are assuming that all seven cases are connected," Jim Foy, St. John's Riverside Hospital President and CEO, told the news radio station. "The strain seems to be community acquired. It is a localized skin infection but again, any infection that comes from a hospital is something you're concerned with. You're supposed to get better when you come to a hospital, not have anything come and make it worse."

MRSA in Healthcare Workers - 4% to 15%

Link: MRSA in Healthcare Workers - Journal Watch Infectious Diseases.

Suffoletto and colleagues conducted a prospective convenience-sample survey from October through December 2006 among emergency department healthcare workers in five Pittsburgh teaching hospitals. Among the 255 participants, 81 (31.8%) had nasal colonization with S. aureus, including 11 (4.3%) with MRSA. All MRSA-colonized workers were nurses, nursing assistants, or patient-care technicians. Bisaga and colleagues conducted a similar study from May through September 2006 at a tertiary care community teaching hospital near Chicago, using a PCR assay for MRSA. Nasal MRSA colonization was found in 16 of 105 participants (15.2%), with no statistically significant difference in prevalence among nurses, physicians, and technicians.

Italians seek to keep hospital staff MRSA free

Link: HighWire Press -- Medline Abstract.

The present study was performed to investigate the in vitro activity of oxacillin and other antimicrobial agents against S. aureus strains obtained from nursing personnel. The study included 56 hospital personnel of Universitary Policlinic of Messina. S. aureus strain was isolated in 14 samples (25%); resistent patterns have been studied and results have demonstrated: none methicillin resistant, while 14% oxacillin and tetraciclin resistant. The incidence of methicillin sensitive was 100%, while 86% proved to be sensitive to oxacillin and tetraciclin. In conclusion, the usually hygienic methods (disposable gowns, hygienic hand disinfection after each patients contact, masks use when is a risk of aerosolization of MRSA) are indicate for significantly reducing of these strains. Continuing education programmes can help to increase awareness among hospital staff.

Colonised Staff Pass on MRSA despite Hand Hygiene & Masks

Link: Review Urges Aggressive MRSA Screening for Health Workers - washingtonpost.com.

"Poor infection control practices were implicated in both acquisition and transmission of MRSA by personnel, but even good adherence to infection control -- including masks and hand hygiene -- did not entirely prevent transmission of MRSA from heavily colonized staff to patients," they wrote.  "Screening of infected health-care workers only will likely miss a large number of asymptomatic personnel capable of transmitting MRSA to patients, since staphylococcal carriage is mainly dependent on whether the person is a nasal carrier (of MRSA)... Our search revealed 18 studies with proven, and 26 studies with likely, transmission to patients from (health-care workers) who were not clinically infected with MRSA," the authors wrote.

1 in 400 hospital workers have active MRSA infection

Link: Am I Passing MRSA to My Patients? - Journal Watch Emergency Medicine.

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.

Medical staff 3 times more likely to be MRSA carriers

Link: Nurses, staff should receive MRSA screenings, researchers say - McKnight's Long Term Care News.

Leaders of healthcare facilities should seriously consider having staff members screened for MRSA, the drug-resistant infection that can wreak havoc on senior populations, Swiss and South African researchers say. Worker screenings for Methicillin-resistant Staphylococcus aureus (MRSA) should be conducted "irrespective of the presence of risk factors or pus-producing infections as part of pre-employment examination, or [especially during large MRSA outbreaks] even periodically and unannounced before a work shift," study authors wrote. They found 4.6% of workers carried MRSA. Of those, 5.1% had clinical MRSA infections. Researchers reviewed information from 169 studies in 37 countries, encompassing more than 33,300 individuals, to reach their conclusions. "Poor infection control practices were implicated in both acquisition and transmission of MRSA by personnel, but even good adherence to infection control -- including masks and hand hygiene -- did not entirely prevent transmission of MRSA from heavily colonized staff to patients," they wrote.

MRSA-infected medics allowed to keep working

Link: MRSA-infected medics allowed to keep working - Health News, Health & Wellbeing - The Independent.

Hospital trusts are allowing doctors and nurses to continue treating patients even after testing positive for potentially lethal superbugs including MRSA. Hundreds of trusts do not take their staff off wards automatically if they are found to be carrying one of the most virulent hospital bugs, methicillin-resistant Staphylococcus aureus (MRSA), which can be spread by human contact. A survey of trusts carried out by The Independent on Sunday revealed that few routinely screen staff for the infection, or even keep records of the number of employees infected with MRSA. They claimed such a policy was fully in line with government guidelines. The approach is backed by many unions – including one that warned that a hardline policy could damage its members' financial well-being and career prospects.

1 in 6 Hospital staff are MRSA carriers

Link: HighWire Press -- Medline Abstract.

To compare the sensitivity of various protocols for methicillin-resistant Staphylococcus aureus (MRSA) surveillance, active surveillance for detecting MRSA nasal colonization was performed on 97 members of the medical staff and 218 patients in the Intensive Care Unit (ICU) of a university hospital. Duplicate nasal swabs were collected from each participant. One was plated directly on a blood agar plate (D-BAP) and observed at 24 and 48 hr. Another was incubated overnight in tryptic soy broth (TSB) with 6.5% NaCl, and subcultured on both BAP (B-BAP) and mannitol salt agar with 4 mg/L of oxacillin (B-MSAOXA). The MRSA colonization rate was similar in the medical staff and patient samples (16.5% vs 11.9%, p = 0.285). Among the medical staff members, the sensitivity of MRSA detection was the same (93.8%) in D-BAP and B-BAP. In the ICU patients, which are a high-risk group, the sensitivity of MRSA detection was improved by adding a pre-enrichment step (73.1% on D-BAP vs 96.2% on B-BAP). The simple direct plating protocol was sufficiently sensitive for the medical staff members, but pre-enrichment was an essential step to increase detection of MRSA in the ICU patients.

1 in 6 ICU staff MRSA carriers?

Link: Comparison of Protocols for Surveillance of Methicillin-resistant Staphylococcus aureus (MRSA): Medical Staff vs ICU Patients -- Lee et al. 37 (3): 248 -- Annals of Clinical and Laboratory Science.

The MRSA colonization rate was similar in the medical staff and patient samples (16.5% vs 11.9%, p = 0.285). Among the medical staff members, the sensitivity of MRSA detection was the same (93.8%) in D-BAP and B-BAP. In the ICU patients, which are a high-risk group, the sensitivity of MRSA detection was improved by adding a pre-enrichment step (73.1% on D-BAP vs 96.2% on B-BAP). The simple direct plating protocol was sufficiently sensitive for the medical staff members, but pre-enrichment was an essential step to increase detection of MRSA in the ICU patients.

15% of staff carriers of infection?

Link: Long Persistence of Methicillin-Susceptible Strains of Staphylococcus aureus Causing Sepsis in a Neonatal Intensive Care Unit -- Gomez-Gonzalez et al. 45 (7): 2301 -- Journal of Clinical Microbiology.

Molecular epidemiology of Staphylococcus aureus strains causing bacteremia in neonates during 2002 to 2005 revealed seven clones, with four MSSA clones responsible for 80% of the cases. Some clones persisted or reappeared throughout the study. Three bacteremic clones were found colonizing health care workers (HCWs), particularly clone C, which was harbored by at least 15% of HCWs.

Hospital Staff MRSA Super Carriers?

Link: Press Release

Another topic that was not openly addressed at the conference is why APIC does not recommend universal screening of healthcare personnel. One issue is the potential legal liability if a patient learns that a physician may have been the source of a serious infection. Furthermore, some Sates have reporting requirements that would necessitate the physician taking work leave until the MRSA were cleared. These self-protective attitudes seem foolhardy when one considers the medical risk an MRSA carrying physician poses to him or herself and to other staff, family and community members. Moreover, it is unreasonable to extend a hospital's reluctance for self-testing to nurses, nursing aids, ward personnel and janitorial support staff. Complacency on this issue may also reflect the usual assumption that only sick patients are really at risk for serious MRSA infections. Unlike earlier strains, today's MRSA generally produce a powerful toxin, termed PVL. Upon inadvertant entry of MRSA into even healthy tissues, this toxin can readily overcome the body's defenses leading to an invasive and occasionally flesh-eating disease. Whether out of ignorance or for other reasons, the emphasis is still being placed on the antibiotic resistance of MRSA, rather than on the more recently acquired capacity for toxin production. Carriage of toxic MRSA is also likely to be a determining factor in the severity of the pneumonia that can complicate influenza, including the anticipated bird flu epidemic.

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3% of staff permenant MRSA carriers?

Link: HighWire Press -- Medline Abstract.

Between October 2001 and February 2002, 324 healthcare workers were screened for methicillin-resistant Staphylococcus aureus (MRSA) by nose and throat swabs. A positive finding led to activation of a standardised control programme for the affected person who was immediately excluded from work. Family members of those who were MRSA-positive were offered screening free of charge. An eradication programme was carried out in the permanent carriers. MRSA was found in 17 (5.3%) healthcare workers, 11 of whom proved to be permanent carriers, and six temporarily colonised. Three children of a positive healthcare worker showed nasopharyngeal MRSA, the acquisition of which occurred within the hospital. The standardised eradication programme for carriers was successful in most cases but failed in two individuals, whereupon systemic antibiotics were used successfully. The decolonised carriers, observed for more than one year, remained MRSA negative. Isolation precautions in hospitals do not always prevent hospital staff and their families from acquiring MRSA. The identification of affected employees is difficult because in most cases only asymptomatic colonisation occurs. Screening and eradication can be complicated and costly, and for the affected employees the occupational consequences can be far-reaching as they have no guaranteed legal protection.

10% of staff MRSA carriers?

Link: Best Syndication.

    The community is being continually seeded by MRSA positive patients who are discharged from hospitals. Moreover, up to 10% of United States healthcare providers are now carriers of MRSA; bringing the bacteria home to their families as well as spreading it among patients and other contacts. The risk they pose to the community has yet to dawn on many healthcare providers. Unlike in the Netherlands, MRSA testing of healthcare providers is not compulsory in the United States. Yet, to protect themselves, as well as family members, one might expect healthcare providers to insist upon being tested. Most hospitals are also hesitant to test admitted patients for MRSA. Should severe infection subsequently occurs, not knowing the MRSA status of the patient on admission, can make it harder to prove the infection originated in the hospital.

Indian study highlights staff as carriers of MRSA

Link: HighWire Press -- Medline Abstract.

    It was shown that the major reservoir of methicillin resistant staphylococci in hospitals are colonized/infected inpatients and colonized hospital workers, with carriers at risk for developing endogenous infection or transmitting infection to health care workers and patients. The results were confirmed by molecular typing using PFGE by SmaI-digestion. It was shown that the resistant markers G and T got transferred from clinical S. aureus (JS-105) to carrier S. aureus (JN-49) and the ciprofloxacin (Cf) and erythromycin (E) resistance seemed to be chromosomal mediated. In one of the experiments, plasmid pJMR1O from Staphylococcus aureus coding for ampicillin (A), gentamicin (G) and amikacin (Ak) resistance was transformed into Escherichia coli. The minimal inhibitory concentrations (MICs) for A and G were lower in E. coli than in S. aureus. However, the MIC for Ak was higher in E. coli transformants than in S. aureus. CONCLUSIONS: There is a progressive increase in MRSA prevalence and multi-drug resistance in staphylococci. Vancomycin is still the drug of choice for MRSA infections. The major reservoir of methicillin resistant staphylococci in hospitals is colonized/infected inpatients and colonized hospital workers. Resistance transfer from staphylococci to E. coli as well as from clinical to carrier staphylococci due to antibiotic stress seemed to be an alarming threat to antimicrobial chemotherapy.

Healthcare staff at risk for MRSA-CA

Link: United Press International

    Two healthcare workers of a Baltimore clinic were found to have community-acquired methicillin-resistant Staphylococcus aureus, or MRSA-CA. Researchers at the Johns Hopkins University Hospital say that MRSA-CA has greater potential risk to staff and patient safety than previously thought. No patients were found to be infected as a result of the outbreak, but afflicted staffers required treatment, the researchers said. "Community-acquired MRSA is an increasing problem in inpatient and outpatient settings, as exposure can occur in the workplace," says senior hospital epidemiologist Dr. Trish Perl. "Our experience shows that healthcare workers need to be aware of the risk, alert infection control staff immediately after an infection is suspected, and understand that tighter infection control procedures can guard against subsequent exposure."

Elimination of a Community-Acquired Methicillin-Resistant Staphylococcus aureus Infection in a Nurse

Link:

A 21-year-old female nurse who worked in an inpatient cardiology department presented with a 6-month history of continuously recurring skin abscesses and soft tissue infections. Her medical history revealed atopic diathesis with rhinoconjunctivitis and chronic eczema. The atopic eczema and the recurrent abscesses had not been medically treated. A differential blood cell count and immunoelectrophoresis did not show any hematologic or immunologic deficiencies. Reportedly, her former boyfriend also had suffered from recurring abscesses some months earlier. He has not received any special medical treatment either, to our knowledge.

Clinical examination revealed multiple pustules and abscesses mainly disseminated on the patient’s back and limbs. The largest lesion, which was approximately 3 cm in diameter, was seen in the thoracolumbar region of the back. Microbiologic culture showed abundant Staphylococcus aureus organisms in evacuated pus and colonization of the anterior nares.

Aussies to screeen staff

Link: Hospitals told to clean up their act - National - smh.com.au.

Reducing the number of hospital infections will soon be part of the performance appraisals of senior health executives, while hand washing - the best front-line defence against drug-resistant bacteria - will be strictly enforced in all hospitals. Under a new plan endorsed yesterday by infection control specialists, extra resources will be provided to increase surveillance in the state's hospitals. Those most susceptible to infection with methicillin-resistant Staphylococcus aureus (MRSA) - critically ill patients and people undergoing orthopedic or cardiovascular surgery - will be screened, as will the staff who treat them. NSW Health will also enforce improved compliance among all health facilities in reporting MRSA blood stream infections and Staphylococcus aureus infections.

Decolonising staff an MRSA key

Link: HighWire Press -- Medline Abstract.

OBJECTIVES: To describe an outbreak of hospital-acquired MRSA in a NICU and to identify the risk factors for, outcomes of, and interventions that eliminated it. SETTING: An 18-bed, level III-IV NICU in a community hospital. METHODS: Interventions to control MRSA included active surveillance, aggressive contact isolation, and cohorting and de-colonization of infants and HCWs with MRSA. A case-control study was performed to compare infants with and without MRSA. RESULTS: A cluster of 6 cases of MRSA infection between September and October 2001 represented an increased attack rate of 21.2% compared with 5.3% in the previous months. Active surveillance identified unsuspected MRSA colonization in 6 (21.4%) of 28 patients and 6 (5.5%) of 110 HCWs screened. They were all successfully decolonized. There was an increased risk of MRSA colonization and infection among infants with low birth weight or younger gestational age. Multiple gestation was associated with an increased risk of colonization (OR, 37.5; CI95, 3.9-363.1) and infection (OR, 5.36; CI95, 1.37-20.96). Gavage feeding (OR, 10.33; CI95, 1.28-83.37) and intubation (OR, 5.97; CI95, 1.22-29.31) were associated with increased risk of infection. Infants with MRSA infection had a significantly longer hospital stay than infants without MRSA (51.83 vs 21.46 days; P = .003). Rep-PCR with mec typing and PVL analysis confirmed the presence of a single common strain of hospital-acquired MRSA. CONCLUSION: Active surveillance, aggressive implementation of contact isolation, cohorting, and decolonization effectively eradicated MRSA from the NICU for 2 1/2 years following the outbreak.