Prevalence of nasal methicillin-resistant Staphylococcus aureus colonization in healthcare workers in a Western Australian acute care hospital

  • P. E. B. Verwer
  • J. O. Robinson
  • G. W. Coombs
  • T. Wijesuriya
  • R. J. Murray
  • H. A. Verbrugh
  • T. Riley
  • J. L. Nouwen
  • K. J. Christiansen
Article
First Online:
Received:
Accepted:

Abstract

Due to a longstanding comprehensive “search and destroy policy”, methicillin-resistant Staphylococcus aureus (MRSA) is not endemic in Western Australian (WA) acute care hospitals. As the prevalence of MRSA in the community has increased, healthcare workers (HCW) are at risk of importing MRSA into hospitals. We aimed to determine the prevalence of and risk factors for nasal MRSA colonization in our HCW population. A period prevalence study was conducted at an 850-bed tertiary hospital. Basic demographics and a nasal swab were obtained. A total of 1,542 HCWs employed in our centre were screened for MRSA, of whom 3.4% (n = 52) were colonized. MRSA colonization was more common in patient care assistants (6.8%) and nurses (5.2%) than in allied health professionals (1.7%) and doctors (0.7%) (p < 0.01). Working in “high-risk” wards that cared for MRSA colonized/infected patients was the strongest risk factor for HCW MRSA colonization (p < 0.001). ST1-IV and ST78-IV (the most common community clones in the region) were the most frequently identified clones. In conclusion, MRSA colonization of HCWs occurs primarily in HCWs caring for patients colonized or infected with MRSA. Surveillance screening of HCWs should be regularly performed on wards with patients with high MRSA colonization prevalence to prevent further spread in the hospital.

Keywords

Mupirocin Nasal Swab Western Australia Royal Perth Hospital Australian Acute Care 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Notes

Acknowledgements

The authors want to thank all the healthcare workers of Royal Perth Hospital who participated in this study.

This study was supported by the Department of Microbiology and Infectious Diseases, Royal Perth Hospital.

Conflict of interest

All authors report no conflict of interest.

References

  1. 1.
    Pearman JW, Christiansen KJ, Annear DI, Goodwin CS, Metcalf C, Donovan FP, Macey KL, Bassette LD, Powell IM, Green JM et al (1985) Control of methicillin-resistant Staphylococcus aureus (MRSA) in an Australian metropolitan teaching hospital complex. Med J Aust 142(2):103–108PubMedGoogle Scholar
  2. 2.
    Boyce JM, Cookson B, Christiansen K, Hori S, Vuopio-Varkila J, Kocagoz S, Oztop AY, Vandenbroucke-Grauls CM, Harbarth S, Pittet D (2005) Methicillin-resistant Staphylococcus aureus. Lancet Infect Dis 5(10):653–663PubMedCrossRefGoogle Scholar
  3. 3.
    Nimmo GR, Coombs GW, Pearson JC, O'Brien FG, Christiansen KJ, Turnidge JD, Gosbell IB, Collignon P, McLaws ML (2006) Methicillin-resistant Staphylococcus aureus in the Australian community: an evolving epidemic. Med J Aust 184(8):384–388PubMedGoogle Scholar
  4. 4.
    Dailey L, Coombs GW, O'Brien FG, Pearman JW, Christiansen K, Grubb WB, Riley TV (2005) Methicillin-resistant Staphylococcus aureus, Western Australia. Emerg Infect Dis 11(10):1584–1590PubMedCrossRefGoogle Scholar
  5. 5.
    Udo EE, Pearman JW, Grubb WB (1993) Genetic analysis of community isolates of methicillin-resistant Staphylococcus aureus in Western Australia. J Hosp Infect 25(2):97–108PubMedCrossRefGoogle Scholar
  6. 6.
    Coombs GW, Pearson JC, Christiansen K (2009) Western Australian antibiotic-resistant gram-positive bacteria epidemiology and typing report (MRSA and VRE), Perth. http://www.public.health.wa.gov.au/cproot/2491/2/HD%20REPORT%20December%202008.pdf. Cited 24 May 2010
  7. 7.
    Coombs GW, Pearson JC, O'Brien FG, Murray RJ, Grubb WB, Christiansen KJ (2006) Methicillin-resistant Staphylococcus aureus clones, Western Australia. Emerg Infect Dis 12(2):241–247PubMedCrossRefGoogle Scholar
  8. 8.
    Coombs GW, Pearson J, Peterson A, Christiansen K (2010) Long term care facility patients and healthcare workers are a reservoir of EMRSA-15 in Western Australia. Interscience Conference on Antimicrobial Agents and Chemotherapy, Boston, Massachusetts, USAGoogle Scholar
  9. 9.
    Vos MC, Behrendt MD, Melles DC, Mollema FP, de Groot W, Parlevliet G, Ott A, Horst-Kreft D, van Belkum A, Verbrugh HA (2009) 5 years of experience implementing a methicillin-resistant Staphylococcus aureus search and destroy policy at the largest university medical center in the Netherlands. Infect Control Hosp Epidemiol 30(10):977–984PubMedCrossRefGoogle Scholar
  10. 10.
    Amorim ML, Vasconcelos C, Oliveira DC, Azevedo A, Calado E, Faria NA, Pereira M, Castro AP, Moreira A, Aires E, Cabeda JM, Ramos MH, Amorim JM, de Lencastre H (2009) Epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization among patients and healthcare workers in a Portuguese hospital: a pre-intervention study toward the control of MRSA. Microb Drug Resist 15(1):19–26Google Scholar
  11. 11.
    Elie-Turenne MC, Fernandes H, Mediavilla JR, Rosenthal M, Mathema B, Singh A, Cohen TR, Pawar KA, Shahidi H, Kreiswirth BN, Deitch EA (2010) Prevalence and characteristics of Staphylococcus aureus colonization among healthcare professionals in an urban teaching hospital. Infect Control Hosp Epidemiol 31(6):574–580PubMedCrossRefGoogle Scholar
  12. 12.
    Saxena S, Goyal R, Das S, Mathur M, Talwar V (2002) Prevalence of methicillin-resistant Staphylococcus aureus colonization among healthcare workers and healthy community residents. J Health Popul Nutr 20(3):279–280PubMedGoogle Scholar
  13. 13.
    Coombs GW, Van Gessel H, Pearson JC, Godsell MR, O'Brien FG, Christiansen KJ (2007) Controlling a multicenter outbreak involving the New York/Japan methicillin-resistant Staphylococcus aureus clone. Infect Control Hosp Epidemiol 28(7):845–852PubMedCrossRefGoogle Scholar
  14. 14.
    Vonberg RP, Stamm-Balderjahn S, Hansen S, Zuschneid I, Ruden H, Behnke M, Gastmeier P (2006) How often do asymptomatic healthcare workers cause methicillin-resistant Staphylococcus aureus outbreaks? A systematic evaluation. Infect Control Hosp Epidemiol 27(10):1123–1127PubMedCrossRefGoogle Scholar
  15. 15.
    Robinson JO, Pearson JC, Christiansen KJ, Coombs GW, Murray RJ (2008) Community-associated versus healthcare-associated methicillin-resistant Staphylococcus aureus bacteraemia: a 10-year retrospective review. Eur J Clin Microbiol Infect Dis 28(4):353–361Google Scholar
  16. 16.
    Costa AM, Kay I, Palladino S (2005) Rapid detection of mecA and nuc genes in staphylococci by real-time multiplex polymerase chain reaction. Diagn Microbiol Infect Dis 51(1):13–17PubMedCrossRefGoogle Scholar
  17. 17.
    Coombs GW, Monecke S, Ehricht R, Slickers P, Pearson JC, Tan HL, Christiansen KJ, O'Brien FG (2010) Differentiation of clonal complex 59 community-associated methicillin-resistant Staphylococcus aureus in Western Australia. Antimicrob Agents Chemother 54(5):1914–1921PubMedCrossRefGoogle Scholar
  18. 18.
    O'Brien FG, Udo EE, Grubb WB (2006) Contour-clamped homogeneous electric field electrophoresis of Staphylococcus aureus. Nat Protoc 1(6):3028–3033PubMedCrossRefGoogle Scholar
  19. 19.
    Tenover FC, Arbeit RD, Goering RV, Mickelsen PA, Murray BE, Persing DH, Swaminathan B (1995) Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 33(9):2233–2239PubMedGoogle Scholar
  20. 20.
    Enright MC, Day NP, Davies CE, Peacock SJ, Spratt BG (2000) Multilocus sequence typing for characterization of methicillin-resistant and methicillin-susceptible clones of Staphylococcus aureus. J Clin Microbiol 38(3):1008–1015PubMedGoogle Scholar
  21. 21.
    Albrich WC, Harbarth S (2008) Health-care workers: source, vector, or victim of MRSA? Lancet Infect Dis 8(5):289–301PubMedCrossRefGoogle Scholar
  22. 22.
    Eveillard M, Martin Y, Hidri N, Boussougant Y, Joly-Guillou ML (2004) Carriage of methicillin-resistant Staphylococcus aureus among hospital employees: prevalence, duration, and transmission to households. Infect Control Hosp Epidemiol 25(2):114–120PubMedCrossRefGoogle Scholar
  23. 23.
    Nimmo GR, Pearson JC, Collignon PJ, Christiansen KJ, Coombs GW, Bell JM, McLaws ML (2007) Prevalence of MRSA among Staphylococcus aureus isolated from hospital inpatients, 2005: report from the Australian Group for Antimicrobial Resistance. Commun Dis Intell 31(3):288–296PubMedGoogle Scholar
  24. 24.
    Duggan JM, Hensley S, Khuder S, Papadimos TJ, Jacobs L (2008) Inverse correlation between level of professional education and rate of handwashing compliance in a teaching hospital. Infect Control Hosp Epidemiol 29(6):534–538PubMedCrossRefGoogle Scholar
  25. 25.
    Rioux C, Armand-Lefevre L, Guerinot W, Andremont A, Lucet JC (2007) Acquisition of methicillin-resistant Staphylococcus aureus in the acute care setting: incidence and risk factors. Infect Control Hosp Epidemiol 28(6):733–736PubMedCrossRefGoogle Scholar
  26. 26.
    Cookson B, Peters B, Webster M, Phillips I, Rahman M, Noble W (1989) Staff carriage of epidemic methicillin-resistant Staphylococcus aureus. J Clin Microbiol 27(7):1471–1476PubMedGoogle Scholar
  27. 27.
    Baker SE, Brecher SM, Robillard E, Strymish J, Lawler E, Gupta K (2010) Extranasal methicillin-resistant Staphylococcus aureus colonization at admission to an acute care Veterans Affairs hospital. Infect Control Hosp Epidemiol 31(1):42–46PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • P. E. B. Verwer
    • 1
    • 2
  • J. O. Robinson
    • 2
    • 3
  • G. W. Coombs
    • 2
    • 3
  • T. Wijesuriya
    • 2
  • R. J. Murray
    • 4
    • 5
  • H. A. Verbrugh
    • 1
  • T. Riley
    • 4
    • 5
    • 6
  • J. L. Nouwen
    • 1
  • K. J. Christiansen
    • 2
    • 3
  1. 1.Department of Medical Microbiology & Infectious DiseasesErasmus Medical CentreRotterdamThe Netherlands
  2. 2.Departments of Microbiology and Infectious Diseases and PathWest Laboratory Medicine WARoyal Perth HospitalPerthAustralia
  3. 3.Australian Collaborating Centre for Enterococcus and Staphylococcus Species Typing and Research, PathWest Laboratory Medicine WA and Curtin University of TechnologyBentleyAustralia
  4. 4.Department of Infectious DiseasesSir Charles Gairdner HospitalPerthAustralia
  5. 5.Department of Microbiology, PathWest Laboratory Medicine – WA, Queen Elizabeth II Medical CentrePerthAustralia
  6. 6.Departments of Microbiology and ImmunologyUniversity of Western AustraliaPerthAustralia

Personalised recommendations