Screening for methicillin-resistant Staphylococcus aureus among health care workers in the African Oncology Institute, Sabrata—Libya

Abstract

To the Editor: Carriage of methicillin-resistant Staphylococcus aureus (MRSA) among health care workers (HCWs) is a well-recognized phenomenon. The aim of the present study was to determine the current prevalence of MRSA among HCWs working in intensive care unit (ICU) and operating theaters (OTs) in African Oncology Institute in Sabrata, Libya, using real-time polymerase chain reaction. The present study was conducted during March 2009, and a total of 43 samples (Table 1) was obtained from HCWs (15 doctors and 28 nurses). All HCWs were informed of the purpose of the study, and their consent was obtained before specimen collection. Information on guidelines/policy toward hand hygiene, use of alcohol-based hand rub, and compliance of hand hygiene was also obtained. No MRSA outbreak has been reported during the last 12 months prior to start of the study. Two samples were collected from each person, an anterior nasal swab was collected with sterile cotton swab moistened with sterile 0.9% saline solution, and fingertip cultures were also collected by placing fingertip impressions on mannitol salt agar. Plates were directly incubated for 24 to 48 hours at 37°C. Staphylococcus aureus was fully identified by conventional methods and then subjected to DNA extraction to detect mecA gene. The 2 nasal swab samples were also processed directly using Smart-cycler protocol for detection of mecA gene (Cepheid Smart Cycler software, Cepheid, Sunnyvale, CA), using the BD GeneOhm MRSA assay following the manufacturer's instructions (BD Diagnostics, Sparks, MD).Table 1Distribution of MRSA among HCWsCarriage of MRSANasalFingertipsNasal and fingertipsTotal carriageHCWs screenedNo.(%)No.(%)No.(%)No.(%)Doctors151(6.6)1(6.6)1(6.6)3(20)Nurses28-2(7.14)-2(7.14)Total431(6.6)3(7.0)1(6.6)5(11.6) Open table in a new tab It was observed that the rate of carriage was 5 of 43 (11.6%) individuals: 2 of these carriers had MRSA simultaneously isolated from both nasal swab and from the fingertips; the other 2 HCWs had MRSA isolated only from the fingertips; and 1 individual had MRSA detected from nasal swab only. Among doctors, the prevalence of MRSA was 3 of 15 (20%), whereas carriage of MRSA among nurses was 2 of 28 (7.14%) and was detected only from the fingertips; these results showed that doctors had higher carriage rate compared with nurses. The lower carriage of MRSA among nurses was remarkable because of the fact that none of these nurses were detected as nasal carriers of MRSA (Table 1). There were no guidelines/policy towards hand hygiene. Alcohol-based hand rub was not routinely used, and the compliance with hand hygiene among HCWs was low. An investigation of 127 reviewed literature has shown that carriage rates of MRSA were 6.4% for hands and the prevalence of MRSA among ICU personnel was 4.7% and that the prevalence of MRSA within Middle East region was 6.1%.1Albrich W.C. Harbarth S. Health care workers: source, vector, or victim of MRSA?.Lancet Infect Dis. 2008; 8: 289-301Abstract Full Text Full Text PDF PubMed Scopus (372) Google Scholar In a recent study conducted in Libya, 643 swabs were obtained from HCWs working in 6 different hospitals, and 36.8% of HCWs were found to be MRSA positive.2Zorgani A. Elahmer O. Franka E. Grera A. Abudher A. Ghengheah K.S. Detection of meticillin-resistant Staphylococcus aureus among healthcare workers in Libyan hospitals.J Hosp Infect. 2009; 73: 91-92Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar Therefore, these results indicate that the presence of MRSA among doctors working in critical areas (ICU and OTs) is high and might increase the risk of transmission to immunocompromised patients receiving cancer chemotherapy. None of these patients were screened for MRSA prior to admission. Detection of colonization of MRSA among HCWs can be affected by frequency of sampling, and it is not possible by a single random sampling to determine whether the carrier state is transient, short-term, or persistent among MRSA positive HCWs.3Cookson B. Peters B. Webster M. Phillips I. Rahman M. Noble W. Staff carriage of epidemic methicillin-resistant Staphylococcus aureus.J Clin Microbiol. 1989; 27: 1471-1476PubMed Google Scholar Many studies recommend screening of health care personnel irrespective of the presence of risk factors associated with nasal carriage of MRSA.4Vonberg R.P. Stamm-Balderjahn S. Hansen S. Zuschneid I. Ruden H. Behnke M. Gastmeier P. How often do asymptomatic healthcare workers cause methicillin-resistant Staphylococcus aureus outbreaks? A systematic evaluation.Infect Control Hosp Epidemiol. 2006; 27: 1123-1127Crossref PubMed Scopus (63) Google Scholar Because the compliance of hand hygiene is low and these personnel are more closely associated with these immunocompromised patients who receive extra care, it is recommended that they follow strict and effective infection protocols.