MRSA (Mersa) Questions

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.

Hundreds of Hospital Staff Carry MRSA Bug

Link: RedNova News.

HUNDREDS of NHS staff are carrying deadly hospital superbugs, according to the first official figures on the controversial issue. The Mail on Sunday used Freedom of Information laws to ask England's 170 hospital trusts how many of their doctors and nurses are carrying MRSA, which kills at least 1,000 people a year in this country. Astonishingly, our enquiries revealed that many hospitals do not test staff at all for MRSA and some that do simply refused to reveal their figures. But the data made available by a handful of hospital trusts shows that an average of ten staff from each has the bug, with figures as high as 42 in one trust. If the infection rates are similar across England, it suggests 1,700 medical staff are carrying the bug. Last night campaigners warned that doctors and nurses are largely responsible for the spread of hospitalacquired infections such as MRSA. Tony Field, of the group MRSA Support, said: 'Staff should be tested. What we need is infection prevention rather than infection control.' In total there are at least 300,000 hospital infections of all kinds and 5,000 deaths a year, costing the NHS Pounds 1billion in extra care.

CF Suffers are MRSA Prone

Link: HighWire Press -- Medline Abstract.

Methicillin-resistant Staphylocosis aureus (MRSA) is an emerging infection in patients with cystic fibrosis (CF). MRSA may be a management dilemma for healthcare workers (HCWs) with CF. Eradication of MRSA with long-term rifampicin and fusidic acid can be achieved in patients with CF. We describe a case of recurrent MRSA infection in a HCW with CF. Molecular typing of the MRSA isolates supported re-infection rather than re-emergence of an earlier MRSA infection. Infection control advice for HCWs with CF who acquire MRSA remains controversial.

Infected nurses sent home for a month

Link: english.eastday.com.

The eight infected babies have been isolated and treated with antibiotics, said Mark Jones, adding the disease is fatal to infant but usually has not so much hazard to the adult. It was not surprising the bug was found in the unit but the strain was unique and there would be international interest in how it evolved, said Mark Jone. The staphylococcus is carried by about a third of all New Zealand without showing signs of infection. Fifteen nurses of the hospital have contracted the infection and six were asked to stay at home temporarily. The hospital said the nurses and their would not be in risk. There are currently no risk of community spreading as well for the "superbug" being only tested in the unit, said the hospital. Mark Jones admitted that the hospital's neonatal unit is now facing staff shortage, and had cut admission to avoid further infection. He said it would take about a month to clear the nurses of the infection. "That month is made up of a week of treatment of the nurses carrying it and three weeks to assess weather they have got rid of it," said Mark Jones.