HOW TO DEAL WITH A MRSA COLONISED HEALTH CARE WORKERS?

                                                                               Dr.T.V.Rao MD

 A complex question to many health care establishments what are implication of health care workers practicing critical care procedures, with MRSA positive nasal swabs, In a good organization with strict health care practices and effective housekeeping practices we listen to both positive and negative voices on concern with MRSA as we are aware Methicillin-resistant Staphylococcus aureus (MRSA) refers to types of staph that are resistant to a type of antibiotic methicillin however it is no more used in testing and the testing method replaced with Cefoxitin , MRSA is often resistant to other antibiotics, as well. While 33% of the population is colonized with staph (meaning that bacteria are present, but not causing an infection with staph), it is the true problem when we randomly screen all the Health care workers attending a procedure as in Surgical operation theater or a critical care, however approximately 1% is colonized with MRSA in Workers who are in frequent contact with MRSA and staph-infected people and animals are at risk of infection. These included those in hospitals and healthcare facilities, correctional facilities, daycare facilities, livestock settings, and veterinary clinics. The rights of the people to continue to work with MRSA as they subscribe they got infected from the work place ie the Hospitals, Although studies have demonstrated that patients colonized with MRSA are at a higher risk of subsequent MRSA infection due to their own flora, than the colonized, Major studies proving healthcare workers (HCWs) are rarely the source of MRSA transmission to patients. In fact, literature review found that only 1.6% of 191 MRSA outbreaks in a nosocomial setting were associated with asymptomatic HCWs. (Ref 1) I wish to state that I am associated with at least 5 to 6 major studies at several work places, there was never major our break with MRSA in any critical care or surgical patients, even though 0.5 to 1% isolation of MRSA, Today most of the Indian establishments are loaded with Superbugs as ESBL and Carbapenem resistant gram negative bacteria as the trends change with more use of broad spectrum antibiotics to deal with Gram negative bacteria, In comparison with the issues related with MRSA are lesser threat than many gram negative bacteria, and certainly one fells with much pressure on Gram negative both as commensals and pathogen trends are changing and many are less concerned with MRSA when we have options to decide which needs a priority, However today many peer reviewed surveys think Routine screening of asymptomatic HCWs for MRSA colonization is thus not warranted. Of note, when HCWs are implicated in MRSA transmission, this is more likely due to poor hand hygiene resulting in patient-to-patient transmission, Although MRSA is still a major patient threat, a CDC study published in the Journal of the American Medical Association Internal Medicine showed that invasive life-threatening) MRSA infections in healthcare settings are declining. Invasive MRSA infections that began in hospitals declined 54% between 2005 and 2011, with 30,800 fewer severe MRSA infections. In addition, the study showed 9,000 fewer deaths in hospital patients in 2011 versus 2005. ( Ref 2 )Routine decolonization of HCWs who are asymptomatic MRSA carriers is not recommended. However, if a HCW is identified as the source of a MRSA outbreak, as happens when multiple cases infected by the surgeon or a regular care taking nurse then decolonization is considered in combination with a full infection control management plan. In this situation, the HCW should avoid direct patient care activities until culture results are negative. In situations where decolonization is necessary, the optimal pharmacologic regimen has not been firmly established. Options include topical decolonization of the nares alone; topical nasal and whole body decolonization; and topical decolonization plus oral antimicrobial agents. Mupirocin remains the only medication approved by the US Food and Drug Administration for nasal decolonization. However, other topical products such as bacitracin are under investigation for mupirocin-resistant MRSA strains. Mupirocin is commonly used with antiseptic body washes such as chlorhexidine, with or without oral agents such as rifampin, tetracyclines, or trimethoprim-sulfamethoxazole. Two recent reviews provide a detailed discussion of the evidence for each therapy and are useful resources. Importantly, investigations to date have not addressed key areas such as the long-term effect of decolonization on infection recurrence, rates of re-colonization after a pharmacologic intervention, or the effect of decolonization on drug resistance

In summary, given that asymptomatic MRSA-colonized HCWs rarely transmit MRSA to patients, US guidelines do not recommend routine screening of or decolonization for asymptomatic HCWs. Similarly, guidelines do not recommend restricting work activities unless colonized HCWs are found to be the source of MRSA transmission and causing work place infections with MRSA Although pharmacologic decolonization is an important tool in clinical management of MRSA colonization in certain situations, it cannot replace the importance of consistent hand hygiene.

This article is created for the benefit of post graduates on basic understanding, need to track the matters in their own work place with coordination of the Clinicians and outcomes of the MRSA isolations in Laboratories with quality controls

YET THERE IS NO BETTER WAY THAN HAND WASHING

Ref 1 and adopted from -Should Healthcare Workers Colonized with MRSA Avoid Patients? Kimberly K. Scarsi, PharmD, MS Medscape

Ref 2 MRSA Tracking CDC Atlanta USA guidelines on new trends

Dr.T.V.Rao MD Freelance Clinical Microbiologist and Reporter on Infectious diseases