NASAL CARRIERS OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA), INFECTION SAFETY AND HAND HYGIENE AMONG HEALTH WORKERS IN SULAIMANI CITY
Narmeen Nasradden Fathi*, Sherko A Omer * and Mohammed O Mohammed **
* Department of Microbiology, School of Medicine, Faculty of Medical sciences, University of Sulaimani.
** Department of Medicine, School of Medicine, Faculty of Medical sciences, University of Sulaimani.
Submitted: 31/5/2012; Accepted: 29/7/2012; Published 1/6/2013
DOI Link: https://doi.org/10.17656/jsmc.10026
Staphylococcus aureus, a well known constant human pathogen that also exploit human as carrier to new hosts when inhabiting area like nose and skin. Over years strains had emerged with ability to resist the effect of several antimicrobial agents. The ability to resist the methicillin caused by different genetic backgrounds was one of the problems in the fight against these organisms.
This study was aimed to isolate and identify Methicillin resistant Staphylococcus aureus (MRSA) inhabiting the nose of health workers in the main hospitals in Sulaimani city and to identify the susceptibility of these strains to several antimicrobial agents, also to inquire about daily infection safety and hand hygiene practice of the health workers.
To those who agreed to participate in the study, questionnaires were documented. Nasal swabs were obtained and isolation of Staphylococci was done on selective media, then S. aureus was confirmed and subjected to antimicrobial susceptibility using disk diffusion method.
The participants were grouped in to nine occupational groups. Gloves were always used by 30.5% of the participants, not used in 18.8% and the other 50.6% were selective in using gloves. Hand cleansing with antiseptic were practiced in 31.7% while face mask were used by 18.4%. Hand washing during work in health facility were not practiced in 58.6%, 1-10 times hand washing was reported in 20.4%, 11-20 times hand washing in 10.8% and more than twenty time washing in 10%. Forty five out of 249 nasal swabs yielded S. aureus making the carrier rate of 18% while methicillin-resistant S. aureus rate was 5.6% among the participants.
Hand hygiene practice and infection safety were suboptimal in our health facilities. Nasal carrier of S. aureus was 18% in health workers while MRSA strains were isolated in 5.6% of the health workers. Prompt measure for hand hygiene must be implemented urgently to control transmission of S. aureus and to limit development of antimicrobial resistance.
MRSA, Staphylococcus aureus, Health workers, Sulaimani.
1- Brooks GF, Carroll KC. The Staphylococci. In: Brooks GF, Carroll KC, Butel JS, Morse SA, editors. Jawetz, Melnick, & Adelberg's Medical Microbiology 2010 ed: The Mac-Grawhill Companies; 2010. p. 832
2-Rosenbach FJ. Mikro-organismen bei den Wund-Infections-Krankheiten
des Menschen. Bergmann, Weisbaden. 1884.
3- Peacock S. Staphylococcus aureus In: Gillespie SH, Hawkey PM, editors. Principles and Practice of Clinical Bacteriology
2nd Edition ed. West Sussex PO19 8SQ, England Johe Wiley & Sons, Ltd 2006.
4- Drummond MC, Tager M. Fibrinogen Clotting and Fibrino-Peptide Formation by Staphylocoagulase and the Coagulase-Reacting Factor. Journal of bacteriology. 1963;85:628-35.
5- Kluytmans JA, Manders MJ, van Bommel E, Verbrugh H. Elimination of nasal carriage of Staphylococcus aureus in hemodialysis patients. Infect Control Hosp Epidemiol. 1996;17(12):793-7.
6- Abass VT, Omer SA. Oral Findings and Microflora in Type II Diabetes Mellitus in Sulaimani City. Journal of Sulaimani Medical College. 2011;1(1):13-28.
7- Pfaller MA, Jones RN, Doern GV, Kugler K. Bacterial pathogens isolated from patients with bloodstream infection: frequencies of occurrence and antimicrobial susceptibility patterns from the SENTRY antimicrobial surveillance program (United States and Canada, 1997). Antimicrob Agents Chemother. 1998;42(7):1762-70.
8- Fluit AC, Schmitz FJ, Verhoef J. Frequency of isolation of pathogens from bloodstream, nosocomial pneumonia, skin and soft tissue, and urinary tract infections occurring in European patients. Eur J Clin Microbiol Infect Dis. 2001;20(3):188-91.
9- Nimmo GR, Bell JM, Mitchell D, Gosbell IB, Pearman JW, Turnidge JD. Antimicrobial resistance in Staphylococcus aureus in Australian teaching hospitals, 1989-1999. Microb Drug Resist. 2003;9(2):155-60.
10- Ghuysen JM. Molecular structures of penicillin-binding proteins and beta-lactamases. Trends in microbiology. 1994;2(10):372-80.
11- Gillespie MT, May JW, Skurray RA. Antibiotic resistance in Staphylococcus aureus isolated at an Australian hospital between 1946 and 1981. J Med Microbiol. 1985;19(2):137-47.
12- Eriksen KR ["Celbenin"-resistant staphylococci]. Ugeskrift for laeger. 1961;123:384-6.
13- Katayama Y, Ito T, Hiramatsu K. A new class of genetic element, staphylococcus cassette chromosome mec, encodes methicillin resistance in Staphylococcus aureus. Antimicrob Agents Chemother. 2000;44(6):1549-55.
14- Voss A, Milatovic D, Wallrauch-Schwarz C, Rosdahl VT, Braveny I. Methicillin-resistant Staphylococcus aureus in Europe. Eur J Clin Microbiol Infect Dis. 1994;13(1):50-5.
15- Chambers HF. The changing epidemiology of Staphylococcus aureus? Emerging infectious diseases. 2001;7(2):178-82.
16- Panlilio AL, Culver DH, Gaynes RP,
Banerjee S, Henderson TS, Tolson JS, et al. Methicillin-resistant Staphylococcus aureus in U.S. hospitals, 1975-1991. Infect Control Hosp Epidemiol. 1992;13(10):582-6.
17- Diekema DJ, Pfaller MA, Schmitz FJ, Smayevsky J, Bell J, Jones RN, et al. Survey of infections due to Staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe, and the Western Pacific region for the SENTRY Antimicrobial Surveillance Program, 1997-1999. Clin Infect Dis. 2001;32 Suppl 2:S114-32.
18- Atlas RM, Snyder JW. HANDBOOK OF Media for Clinical Microbiology: CRC Press; 2006. 544 p.
19- F. MJ. Media for Isolation-Cultivation-Identification-Maintenance of Medical Bacteria. Baltimore: Williams and Wilkins; 1985.
20- Colaninno PM. Identification of Gram-Positive Organisms. In: Goldman E, H. GL, editors. Practical Handbook of Microbiology. Second ed. Boca Raton CRC Press; 2009.
21- Sperber WH, Tatini SR. Interpretation of the tube coagulase test for identification of Staphylococcus aureus. Applied microbiology. 1975;29(4):502-5.
22- Bauer AW, Kirby WM, Sherris JC, Turck M. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol. 1966;45(4):493-6.
23- CLSI. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-First Informational Supplement. CLSI document M100-S21 Wayne, PA: Clinical and Laboratory Standards Institute;. 2011.
24- Toma E, Barriault D. Antimicrobial activity of fusidic acid and disk diffusion susceptibility testing criteria for gram-positive cocci. J Clin Microbiol. 1995;33(7):1712-5.
25- Ashley SS. Biostatistics Student Edition. Apple store; 2011 [cited 2012 10/4/2012]; Available from: http://itunes.apple.com/us/app/biostatistics-student-edition/id415378283?mt=8.
26- Kluytmans J, van Belkum A, Verbrugh H. Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clinical microbiology reviews. 1997;10(3):505-20.
27- P M, Y-A Q, M. G. Staphyloccocus aureus (including staphylococcal toxic shock). In: G M, J B, R D, editors. Mandell, Douglas, and Bennett’s principles and practices of infectious diseases 2005 ed. Philadelphia: Elsevier Churchill Livingstone; 2005. p. 2321–51.
28- JM B, D P. Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. CDC, 2002.
29- Shinefield HR, NaomiL.Ruff. Staphylococcal Infections: A Historical Perspective. In: Gorwitz RJ, Jernigan JA, editors. Staphylococcal Infections, An Issue of Infectious Disease Clinics. 1 ed: Saunders; 2009.
30- Pittet D. Improving compliance with hand hygiene in hospitals. Infect Control Hosp Epidemiol. 2000;21(6):381-6.
31- Larson EL, Quiros D, Lin SX. Dissemination of the CDC's Hand Hygiene Guideline and impact on infection rates. American journal of infection control. 2007;35(10):666-75.
32- Creedon SA. Healthcare workers' hand decontamination practices: compliance with recommended guidelines. Journal of advanced nursing. 2005;51(3):208-16.
33- Bukhari SZ, Hussain WM, Banjar A, Almaimani WH, Karima TM, Fatani MI. Hand hygiene compliance rate among healthcare professionals. Saudi medical journal. 2011;32(5):515-9.
34- Collins F, Hampton S. Hand-washing and methicillin-resistant Staphylococcus aureus. Br J Nurs. 2005;14(13):703-7.
35-.Allegranzi B, Pittet D. Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect. 2009;73(4):305-15.
36- Lederer JW, Jr., Best D, Hendrix V. A comprehensive hand hygiene approach to reducing MRSA health care-associated infections. Jt Comm J Qual Patient Saf. 2009;35(4):180-5.
37- Anwar MS, Jaffery G, Rehman Bhatti KU, Tayyib M, Bokhari SR. Staphylococcus aureus and MRSA nasal carriage in general population. J Coll Physicians Surg Pak. 2004;14(11):661-4.
38- Han Z, Lautenbach E, Fishman N, Nachamkin I. Evaluation of mannitol salt agar, CHROMagar Staph aureus and CHROMagar MRSA for detection of meticillin-resistant Staphylococcus aureus from nasal swab specimens. J Med Microbiol. 2007;56(Pt 1):43-6.
39- Ben Nsira S, Dupuis M, Leclercq R. Evaluation of MRSA Select, a new chromogenic medium for the detection of nasal carriage of methicillin-resistant Staphylococcus aureus. Int J Antimicrob Agents. 2006;27(6):561-4.
40-Bischof LJ, Lapsley L, Fontecchio K, Jacosalem D, Young C, Hankerd R, et al. Comparison of chromogenic media to BD GeneOhm methicillin-resistant Staphylococcus aureus (MRSA) PCR for detection of MRSA in nasal swabs. J Clin Microbiol. 2009;47(7):2281-3.
41-Kateete DP, Kimani CN, Katabazi FA, Okeng A, Okee MS, Nanteza A, et al. Identification of Staphylococcus aureus: DNase and Mannitol salt agar improve the efficiency of the tube coagulase test. Annals of clinical microbiology and antimicrobials. 2010;9:23.
42-Vandenbergh MF, Verbrugh HA. Carriage of Staphylococcus aureus: epidemiology and clinical relevance. The Journal of laboratory and clinical medicine. 1999;133(6):525-34.
43- Zanelli G, Sansoni A, Zanchi A, Cresti S, Pollini S, Rossolini GM, et al. Staphylococcus aureus nasal carriage in the community: a survey from central Italy. Epidemiology and infection. 2002;129(2):417-20.
44- Noble WC. Carriage of Staphylococcus aureus and beta haemolytic streptococci in relation to race. Acta dermato-venereologica. 1974;54(5):403-5.
45- Noble WC, Valkenburg HA, Wolters CH. Carriage of Staphylococcus aureus in random samples of a normal population. The Journal of hygiene. 1967;65(4):567-73.
46- Albrich WC, Harbarth S. Health-care workers: source, vector, or victim of MRSA? Lancet Infect Dis. 2008;8(5):289-301.
47- Amorim ML, Vasconcelos C, Oliveira DC, Azevedo A, Calado E, Faria NA, et al. 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. 2009;15(1):19-26.
48- Brady RR, McDermott C, Graham C, Harrison EM, Eunson G, Fraise AP, et al. A prevalence screen of MRSA nasal colonisation amongst UK doctors in a non-clinical environment. Eur J Clin Microbiol Infect Dis. 2009;28(8):991-5.
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