Methicillin resistant Staphylococcus aureus Carriage among the Health Care Workers in a Tertiary Care Hospital
Dr. Malini J. MBBD, MD
Assistant Professor, Dept of Microbiology
Methicillin-resistant Staphylococcus aureus (MRSA) nosocomial infection outbreaks and prevalence among various populations have been well reported in the literature, particularly with respect to the developed and the developing countries. The hospital personnel tend to have higher colonization of MRSA than the general population. The personnel with MRSA colonization are the sources of dissemination of the organisms, both in the hospital and the community.
The present study was conducted to assess the carriage rate of MRSA among health care workers (HCWs).
A hospital based prospective study.
Place and Duration:
Department of Microbiology, ESIC-MC-PGIMSR, Rajajinagar, Bangalore, from October 2010 to April 2011.
Materials and Methods:
A total of 150 HCWs who were involved in the management of critically ill patients [in the intensive care unit (adult), all surgical specialties, post-operative surgical wards, major OT and minor OT] were screened for MRSA by collecting their nasal swabs, throat swabs and swabs from the webs of their fingers. Staphylococcus aureus was identified by the standard methods. Antibiotic susceptibility was performed according to the Kirby-Bauer disc diffusion method. MRSA was identified by using a cefoxitin 30 mcg disc and it was interpreted according to the Clinical Laboratory Standards Institute guidelines. All the carriers which were identified were decolonized with Mupirocin (Supirocin ointment 2% Glen mark), local application twice a day for ten days, and subsequently, they were checked for the decolonized state.
The findings were statistically analyzed by using the Chi-square test.
Of the 150 HCWs who were screened, 15 (10%) had MRSA either in the nose or on the hand. The nasal carriage of MRSA was higher (8%) than the hand carriage (2%) and none had throat carriage as compared to the Methicillin sensitive Staphylococcus aureus carriage rate in the nose and on the hand 3.4% and 0.6% respectively, which was statistically significant (p< 0.05). Doctors, nurses and nursing orderlies were the predominant carriers (4%, 2%, and 2%, respectively). The antibiogram of the MRSA isolates revealed the highest resistance to penicillin and amoxyclav (93% each). The sensitivity to erythromycin, gentamicin, amikacin, ciprofloxacin and cotrimoxazole was variable (53%-73%). All the MRSA isolates were sensitive to vancomycin. Thirteen (86.6 %) carriers were successfully decolonized with the local application of Mupirocin. However, two of the carriers did not take part in the further studies.
The MRSA carriage rate among the HCWs in our hospital was high, particularly among the doctors and nurses. Screening and decolonization may be effective in decreasing the MRSA carriage rate among the HCWs. Standard infection control precautions should be employed in the professional practice to minimize either the carriage or the transmission rate.