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More aggressive superbug screening of healthcare workers needed

Screen all healthcare workers, and more often, urge researchers

OnMedica Staff

Tuesday, 15 April 2008

Healthcare workers should be more aggressively screened in a bid to curb infection rates in facilities with endemic MRSA, concludes an analysis of published research in the May issue ofThe Lancet Infectious Diseases.

Even good infection control practice does not prevent transmission, say the authors, who reanalysed data from 169 studies involving more than 30,000 screened healthcare staff from 37 mostly high-income countries.

They found that 4.6% of these workers carried MRSA, and of these, 5.1% had clinical MRSA infections.

“MRSA carriage or infection in a healthcare worker should be considered an occupational hazard,” they say.

“Poor infection control practices were implicated in both acquisition and transmission of MRSA by personnel, but even good adherence to infection control—including masks and hand hygiene—did not entirely prevent transmission of MRSA from heavily colonised staff to patients,” they add.

Healthcare staff who carry MRSA in their noses or thorats can become “cloud” workers, because they release substantial clouds of MRSA into the air when they catch a cold or other upper respiratory tract infections.

Burns patients, or those with large open wounds, are particularly vulberable to airborne MRSA infection.

Carriers also pose a transmission risk for their partners and other family members, a factor which can also help to spread the infection further.

It has been proposed that screening should be focused on those healthcare workers with symptomatic infection, but the authors contend that such a policy would miss a potentially large reservoir of transmissible infection

The authors suggest that all healthcare workers should be screened as part of pre-employment checks and periodically, especially during large outbreaks, before a shift.

And to increase detection rates, both nose and throat swabs should be taken with separate swabs since eradication therapy differs, depending on the location of the MRSA, they say.

They acknowledge that screening is not universally feasible because of its cost, but they point out that in regions of low MRSA prevalence such as Scandinavia, the Netherlands and Western Australia this is routine.

And ultimately, it would save money and be better for patients, they say.

Meanwhile Unison, the public sector union, is calling for at least two cleaners for every 30 patients per shift as a standard for hospital cleaning, in a drive to step up the control of MRSA and C difficile.

The union also wants every hospital to have a clean hospital committee, made up of cleaners, their supervisors, nurses, and managers, in order to give cleaners a much needed voice.

Karen Jennings, Unison’s head of health, said that the government’s much publicised “deep clean” was just a starting point.

“It should be a requirement that all NHS organizations have safe minimum staffing levels for their cleaning services that are based on quality, not costs, and with staff receiving proper up-to-date training and equipment,” she said.

(Picture: Wellcome Images)

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