|Year : 2016 | Volume
| Issue : 3 | Page : 169-171
Prevalence of methicillin-resistant Staphylococcus aureus among hospital healthcare workers in a tertiary care hospital: A cross-sectional study
Kannan Sridharan1, Anshika Mallik2, Molly Madan2
1 Department of Health Sciences, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
2 Department of Microbiology, Subharti Medical College and Hospital, Meerut, Uttar Pradesh, India
|Date of Web Publication||5-Aug-2016|
Dr. Kannan Sridharan
Department of Health Sciences, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva
Source of Support: None, Conflict of Interest: None
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most common hospital-acquired infections associated with a significant morbidity and mortality. Healthcare workers (HCWs) act as carriers for MRSA and transmit the organism across individuals. Hence, we undertook this study to assess the prevalence of MRSA among HCWs in a tertiary care hospital and their hand washing hygienic practices. Materials and Methods: A cross-sectional study between March and November 2014 was conducted. Dry swabs were taken from the nasal mucosal membrane, both the palms, web space between the fingers from each of the participants and were subsequently cultured on mannitol salt agar and antibiotic susceptibility to methicillin was assessed using Kirby-Bauer disc diffusion method using cefoxitin. In addition, information on demographics, occupation, and use of antiseptics were collected from the study participants. Results: A total of 17/150 (11.3%) were found to be MRSA positive of which 10 were staff nurses, three each were laboratory technicians and class IV employees and one was a doctor. Of the 17, 11 (64.7%) had shown growth from nasal swabs, 5 (29.4%) from digital and 1 (5.9%) in both the regions. Of them, 8/15 (53.3%) reported the use of only soap for hand washing whereas 7/15 (46.7%) were using soap and hand sanitizers and the remaining two not responded to this question. Only 9/15 (60%) frequently washed their hands, and the rest rarely did. Conclusion: More awareness and training sessions on the importance of MRSA and hand hygienic measures to contain the carrier status of MRSA among hospital care workers is warranted.
Keywords: Antimicrobial resistance, carriers, hospital-acquired infections
|How to cite this article:|
Sridharan K, Mallik A, Madan M. Prevalence of methicillin-resistant Staphylococcus aureus among hospital healthcare workers in a tertiary care hospital: A cross-sectional study. Int J Health Allied Sci 2016;5:169-71
|How to cite this URL:|
Sridharan K, Mallik A, Madan M. Prevalence of methicillin-resistant Staphylococcus aureus among hospital healthcare workers in a tertiary care hospital: A cross-sectional study. Int J Health Allied Sci [serial online] 2016 [cited 2021 Apr 14];5:169-71. Available from: https://www.ijhas.in/text.asp?2016/5/3/169/187829
| Introduction|| |
Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most important cause of hospital acquired infections.  Increased morbidity, mortality, the length of hospital stay and economic burden on hospitals has been noted significantly with these infections.  Among the various mode of spread of the micro-organism, healthcare workers (HCWs) provide the main mode.  Studies carried out worldwide to assess the prevalence of MRSA carrier state among the HCW found an estimate of around 10-40%. , Dulon et al.  conducted a meta-analysis of 31 studies that had assessed the prevalence of MRSA colonization among HCW and found out that the pooled MRSA colonization rate was 1.8% (95% confidence interval, 1.34-2.50%) and the rate was higher in nursing staff (6.9%). Frequent hand washing technique has been found out to reduce MRSA infection effectively.  However, considering the lacunae of extensive studies in Indian scenario, the present study has been envisaged to assess the prevalence of MRSA carrier state amongst the HCW in our hospital and their practice of hand washing.
| Materials and Methods|| |
This study was a cross-sectional study carried out between March and November 2014 after obtaining Institutional Ethics Committee approval and informed consent from the study participants. Dry swabs were taken from the nasal mucosal membrane, both the palms, web space between the fingers from each of the participants and were subsequently cultured on mannitol salt agar within 1 h of collection and incubated at 37°C for 24-48 h. Antibiotic susceptibility to methicillin was assessed using Kirby-Bauer disc diffusion method using cefoxitin as recommended by Clinical Laboratory Standards Institute.  In addition, information on demographics, occupation and use of antiseptics were collected from the study participants. Considering the prevalence of 10% from previous studies, with 5% precision, a sample size of 150 was achieved. Descriptive statistics was used to represent the prevalence of MRSA.
| Results|| |
A total of 150 HCW were recruited during the study of which 49 were staff nurses, 14 doctors, 19 laboratory technicians and 68 other HCW (pharmacists, nursing students, and class IV employees). Their age ranged between 19 and 67 with a median of 30 years. Of them, 67 (44.7%) were females and the rest were males. A total of 17/150 (11.3%) were found to be MRSA positive of which 10 were staff nurses, three each were laboratory technicians and class IV employees and one was a doctor [Table 1]. Six out of 17 (35.3%) belonged to microbiology, 4/17 (23.5%) were from general medicine, 2 (11.8%) each from respiratory medicine and pathology and 1 (5.9%) each from dermatology, pediatrics and central laboratory. Median (range) of current working experience of the participants who grew MRSA was 2 (1-12) years. Of the 17, 11 (64.7%) had shown growth from nasal swabs, 5 (29.4%) from digital and 1 (5.9%) in both the regions. Of them, 8/15 (53.3%) reported the use of only soap for hand washing whereas 7/15 (46.7%) were using soap and hand sanitizers and the remaining two not responded to this question. Only 9/15 (60%) frequently washed their hands and the rest rarely did. Of the 12 who had shown MRSA positivity in their nasal swabs, only 4 (33%) had reported frequent hand washing. None of the data distributions were found to be statistically significant.
| Discussion and Conclusion|| |
In this study, MRSA prevalence of 11.3% was observed among the HCW similar to previous studies from a similar population.  The importance of MRSA stems from the fact that they are increasingly becoming resistant to many classes of antimicrobial agents like macrolides, lincosamides, aminoglycosides, and beta-lactam antibiotics.  Reports indicate that nearly 40-50% of the isolated S. aureus turn out to be resistant to methicillin worldwide  including India. , MRSA colonization precedes infection and so decolonization procedures are necessary of which hand hygiene practices form a cornerstone. HCW have been reported to act as silent carriers of MRSA. Ben-David et al.  assessed the prevalence of MRSA in HCW in a burns unit and found out six out of the total 133 (4.5%) HCW were carriers of MRSA and transmitted the micro-organism between the burns patients. Further, the authors have also found out that decolonization of this personnel significantly reduced the incidence of MRSA infections among the patients. Similarly, a study conducted in Spain during MRSA outbreak suggested that institution of a control program prevented 76% of expected MRSA cases and reduction in a fatality to an extent of around 86% due to MRSA in the Intensive Care Unit (ICU).  Hence, screening of HCW for possible colonization of MRSA is essential to contain the same in hospital settings during the outbreak. In addition to the decolonization of HCW, it is also important to control the microorganism spread through equipment, and so frequent thorough cleaning with an efficient disinfectant and strict hand hygiene are mandatory. Murthy et al.  did a cost-effectiveness analysis of MRSA screening in all patients undergoing surgery by polymerase chain reaction (PCR) in a Swiss Hospital and found out that PCR for universal screening not cost-effective. A similar conclusion was also attained by a decision tree analysis using models using single and multiplex sensitivity analysis by Tübbicke et al.  Contrarily, Robotham et al.  did a cost-effective analysis of both screening and decolonization procedures for MRSA in ICUs in the United Kingdom and found out that PCR coupled with mupirocin decolonization of MRSA positive individuals to be cost effective. However, considering the lacunae of cost-effectiveness studies worldwide, regular screening of all the HCW for MRSA colonization is debatable, and generation of region specific evidence is a must to come to a conclusion. We also found that nearly 40% of the HCW in this study did not attempt in washing their hands frequently. The single most important way to control MRSA infection is hand hygiene.  Many practice guidelines exist  for carrying out hand washing in an appropriate manner. In addition, hospital infection control committee shall be established to monitor the practice of hand washing techniques and assessing the outcomes at frequent intervals to reduce the MRSA prevalence amongst HCW.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Boucher H, Miller LG, Razonable RR. Serious infections caused by methicillin-resistant Staphylococcus aureus
. Clin Infect Dis 2010;51 Suppl 2:S183-97.
McNicoll L, Marsella M. The growing problem of methicillin-resistant Staphylococcus aureus
: Will hospitals prevail? Med Health 2010;93:267-70.
Dantes R, Mu Y, Belflower R, Aragon D, Dumyati G, Harrison LH, et al.
National burden of invasive methicillin-resistant Staphylococcus aureus
infections, United States, 2011. JAMA Intern Med 2013;173:1970-8.
Albrich WC, Harbarth S. Health-care workers: Source, vector, or victim of MRSA? Lancet Infect Dis 2008;8:289-301.
Azeez-Akanda O. Global trend of methicillin-resistant Staphylococcus aureus
and emerging challenges for control. Afr J Clin Exp Microbiol 2010;11:150-8.
Dulon M, Peters C, Schablon A, Nienhaus A. MRSA carriage among healthcare workers in non-outbreak settings in Europe and the United States: A systematic review. BMC Infect Dis 2014;14:363.
CLSI. Performance Standards for Antimicrobial Susceptibility Testing. CLSI Approved Standard M100-S23. Wayne, PA: Clinical and Laboratory Standards Institute; 2013.
Chandrasekhar DK, Chandrakanth C, Sunilkumar B, Gangane R, Basavaraj P, Amaresh, et al
. Prevalence of methicillin Staphylococcus aureus
in a tertiary care hospital in Gulbarga, Karnataka. J Pharm Biomed Sci 2012;19:1-3.
Boucher HW, Corey GR. Epidemiology of methicillin-resistant Staphylococcus aureus
. Clin Infect Dis 2008;46 Suppl 5:S344-9.
Radhakrishna M, D′Souza M, Kotigadde S, Saralaya VK, Kotian SM. Prevalence of methicillin resistant Staphylococcus aureus
carriage amongst healthcare workers of critical care units in Kasturba medical college hospital, Mangalore, India. J Clin Diagn Res 2013;7:2697-700.
Joshi S, Ray P, Manchanda V, Bajaj J, Chitnis DS, Gautam V, et al
. Methicillin resistant Staphylococcus aureus
in India: Prevalence and susceptibility pattern. Indian J Med Res 2013;137:363-9.
Ben-David D, Mermel LA, Parenteau S. Methicillin-resistant Staphylococcus aureus
transmission: The possible importance of unrecognized health care worker carriage. Am J Infect Control 2008;36:93-7.
Valls V, Gómez-Herruz P, González-Palacios R, Cuadros JA, Romanyk JP, Ena J. Long-term efficacy of a program to control methicillin-resistant Staphylococcus aureus
. Eur J Clin Microbiol Infect Dis 1994;13:90-5.
Murthy A, De Angelis G, Pittet D, Schrenzel J, Uckay I, Harbarth S. Cost-effectiveness of universal MRSA screening on admission to surgery. Clin Microbiol Infect 2010;16:1747-53.
Tübbicke A, Hübner C, Hübner NO, Wegner C, Kramer A, Fleba S. Cost comparison of MRSA screening and management - A decision tree analysis. BMC Health Serv Res 2012;12:438.
Robotham JV, Graves N, Cookson BD, Barnett AG, Wilson JA, Edgeworth JD, et al.
Screening, isolation, and decolonisation strategies in the control of meticillin resistant Staphylococcus aureus
in intensive care units: Cost effectiveness evaluation. BMJ 2011;343:d5694.
Mathur P. Hand hygiene: Back to the basics of infection control. Indian J Med Res 2011;134:611-20.