Analysis of a mini-outbreak of methicillin-resistant Staphylococcus aureus in a surgical ward by using arbitrarily primed-polymerase chain reaction

The role of healthcare personnel in the maintenance and spread of methicillin-resistant Staphylococcus aureus

Healthcare workers may acquire methicillin-resistant Staphylococcus aureus (MRSA) from patients, both hospital and home environments, other healthcare workers, family and public acquaintances, and pets. There is a consensus of case reports and series which now strongly support the role for MRSA-carrying healthcare personnel to serve as a reservoir and as a vehicle of spread within healthcare settings. Carriage may occur at a number of body sites and for short, intermediate, and long terms. A number of approaches have been taken to interrupt the linkage of staff-patient spread, but most emphasis has been placed on handwashing and the treatment of staff MRSA carriers. The importance of healthcare workers in transmission has been viewed with varying degrees of interest, and several logistical problems have arisen when healthcare worker screening is brought to the forefront. There is now considerable support for the screening and treatment of healthcare workers, but it is suggested that the intensity of any such approach must consider available resources, the nature of the outbreak, and the strength of epidemiological associations. The task of assessing healthcare personnel carriage in any context should be shaped with due regard to national and international guidelines, should be honed and practiced according to local needs and experience, and must be patient-oriented.

Bed, bath and beyond: pitfalls in prompt eradication of methicillin-resistant Staphylococcus aureus carrier status in healthcare workers

Healthcare workers (HCWs) in close contact with patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) were screened for MRSA acquisition. From 1995 to 2001, MRSA was identified from the nasopharyngeal swabs of 87 HCWs, collected one to two weeks after contact with 592 known MRSA-positive patients. These HCWs were withdrawn from work and treated with topical antibiotics/antiseptics. They were advised to disinfect their bathrooms and personal hygiene articles, and to wash bed linen and pillows. They were screened for successful eradication for up to three months. Seventy-three (84%) HCWs lost their carrier status. The eradication regimen failed in 14 cases. In 11 of these MRSA was detected only in later nasopharyngeal swabs (suspected recolonization). Screening identified nasal colonization of close household contacts in eight of these 11 cases. Environmental sampling detected contamination in seven out of eight screened home environments. When eradication treatment was applied to household contacts and when household surfaces were cleaned and disinfected, the carriage cleared in most cases within a few weeks. However, when home environments are heavily contaminated, despite adequate medical treatment, eradication took upto two years. Due to withdrawal from work, the 14 carriers without prompt and lasting eradication after the first course of treatment accounted for about 70% of all lost working days. These experiences support the hypothesis that control measures should not be restricted to antibiotic or antiseptic treatment of long-term carriers (HCWs as well as patients), but must also include cleaning and disinfection of the household.

The effect of Virkon S fogging on survival of Salmonella enterica and Staphylococcus aureus on surfaces in a veterinary teaching hospital

The objective of the study was to determine the disinfection efficacy of aerosolizing (cold fogging) Virkon S on survival of Stahpylococcus aureus and Salmonella enterica on different surfaces. Two experiments were conducted in different locations. Salmonella enterica and S. aureus were grown in broth culture and then seeded into pre-marked areas in each location and allowed to dry. Virkon S (1%) was aerosolized into the rooms (approximately 1L of per 30 m(3)). Samples were collected pre- and post-fogging for quantitative cultures to evaluate the efficacy of aerial disinfection. The reduction of S. enterica or S. aureus counts ranged from 3.40 to 0.95 log(10) (Salmonella) or 4.92 to 0.02 log(10) (Staphylococcus). The greatest reduction was evident in samples collected from non-porous horizontal surfaces, which were not obstructed from the air flow. These results indicate that fogging with Virkon S could be beneficial in routine disinfection of pre-cleaned surfaces. The benefits of routine use of cold fogging with Virkon S in veterinary hospital settings would include its wide-range antimicrobial action and minimal working-men power required to disinfect large areas. Also, fogging would potentially minimize microbial contamination in the hard to reach areas.

The organization of hospital infection control in Turkey

This article describes the current organization of infection control in Turkey in regard to regulations, functions and responsibilities of infection control committees and the national NosoLINE project. Also, incidence and prevalence of hospital infections and antimicrobial resistance in Turkey are reported.