Healthcare Worker Contact Research Articles

The procedures of hygiene to control hospital-acquired diarrhoea in paediatric wards: a multicentre audit

An audit was carried out in paediatric wards to study the compliance of healthcare workers (HCWs) to the procedures recommended for the control of hospital-acquired diarrhoea. Thirty-two paediatric wards in the southeast of France participated on a voluntary basis in this prospective observational study after completing a self-administered questionnaire recording measures of hygiene. All the observations were made by the same investigator and focused on preventive procedures: use of single room, handwashing, hand disinfection, overclothing, single-use gloves and masks. Two hundred and seventy patient–HCW contacts were observed, including mainly diapering, temperature measurement, collection of blood sample and catheter care. The isolation of patients in a single room and use of gowns by HCWs were significantly associated with diarrhoea. Whereas handwashing before care was performed by HCWs in more than 95% of all the procedures, the compliance in the use of disposable gloves by HCWs was only of 39.4% for technical procedures (including those with potential exposure to blood) and 20.3% for diapering or temperature measurement. A substantial agreement between reported and observed measures of hygiene was observed for handwashing before contact and hand disinfection with antimicrobial soap before contact. In contrast, this agreement was moderate for use of single room, handwashing after contact, overclothing and wearing disposable gloves after a diaper change. Despite the excellent compliance of HCWs to handwashing, clearer recommendations for the indication and use of disinfectants and disposable gloves are urgently needed.

When should healthcare workers be screened for methicillin-resistant Staphylococcus aureus?

The role of screening of healthcare workers (HCWs) in the control of methicillin-resistant Staphylococcus aureus (MRSA) is controversial. It is recommended in guidelines by expert groups in both North America and the United Kingdom, although the role of MRSA carriage by HCWs in outbreaks is not clearly defined. The present report describes the spread of a distinct strain of MRSA to patients by a single HCW on three separate occasions over 27 months. The isolates from this HCW and patient contacts were shown to be indistinguishable by antibiogram and repetitive extragenic palindromic polymerase chain reaction (REP/PCR); none were typeable by lytic phage-typing. Throat carriage of the MRSA probably recurred in this HCW, despite attempts to eradicate it on three occasions. Over the same period, nine other small clusters were seen in the Oxford Hospital Group, involving 66 patients and 22 HCWs colonized, or occasionally infected, with a variety of MRSA strains. In none of these instances could HCWs be implicated in the initiation of an outbreak. The advantages of a screening policy include the determination of the full extent of MRSA-colonization and work exclusion; the disadvantages include detection of transient nasal carriage, disruption of staff routine and stigmatization. Screening of HCWs can be a valuable tool in the control of MRSA outbreaks but it should be used selectively. This strategy remains an important part of a control programme.