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Nasal and Hand Carriage of Staphylococcus aureus in Staff at a Department for Thoracic and Cardiovascular Surgery: Endogenous or Exogenous Source?

Published online by Cambridge University Press:  02 January 2015

Ann Tammelin*
Affiliation:
Department of Infection Control and Hospital Hygiene, University Hospital of Huddinge, Stockholm, Sweden
Fia Klötz
Affiliation:
Department of Infection Control and Hospital Hygiene, University Hospital of Uppsala, Uppsala, Sweden
Anna Hambræus
Affiliation:
Department of Infection Control and Hospital Hygiene, University Hospital of Uppsala, Uppsala, Sweden
Elisabeth Ståhle
Affiliation:
Department of Thoracic and Cardiovascular Surgery, University Hospital of Uppsala, Uppsala, Sweden
Ulrika Ransjö
Affiliation:
Department of Infection Control and Hospital Hygiene, University Hospital of Uppsala, Uppsala, Sweden
*
Department of Infection Control and Hospital Hygiene, Laboratory of Clinical Bacteriology, University Hospital of Huddinge, S-141 86 Stockholm, Sweden

Abstract

Objective:

To investigate the rates of Staphylococcus aureus carriage on the hands and in the noses of healthcare workers (HCWs) and the relatedness of S. aureus isolates found in the two sites.

Design:

Point-prevalence study.

Setting:

Department for Thoracic and Cardiovascular Surgery at the University Hospital of Uppsala, Uppsala, Sweden.

Subjects and Methods:

Samples were obtained from 133 individuals, 18 men and 115 women, using imprints of each hand on blood agar and a swab from the nose. S. aureus isolates were identified by standard methods and typed by pulsed-field gel electrophoresis.

Results:

S. aureus was found on the hands of 16.7% of the men and 9.6% of the women, and in the noses of 33.3% of the men and 17.4% of the women. The risk ratio for S. aureus carriage on the hands with nasal carriage was 7.4 (95% confidence interval, 2.7 to 20.2; P < .001). Among the 14 HCWs carrying S. aureus on their hands, strain likeness to the nasal isolate was documented for 7 (50%).

Conclusions:

Half of the HCWs acquired S. aureus on the hands from patients or the environment and half did so by apparent self-inoculation from the nose. Regardless of the source of contamination, good compliance with hand hygiene is needed from all HCWs to protect patients from nosocomial infections. The moderate rate of S. aureus carriage on hands in this setting could be the result of the routine use of alcoholic hand antisepsis.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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References

1.Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR, the Healthcare Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999;20:247280.Google Scholar
2.Tammelin, A, Hambraus, A, Stähle, E. Routes and sources of Staphylococcus aureus transmitted to the surgical wound during cardiothoracic surgery: possibility of preventing wound contamination by use of special scrub suits. Infect Control Hosp Epidemiol 2001;22:338346.Google Scholar
3.Pittet, D. Improving adherence to hand hygiene practice: a multidisci-plinary approach. Emerg Infect Dis 2001;7:234240.CrossRefGoogle Scholar
4.The Swedish Reference Group for Antibiotics. Available at www.srga.orgGoogle Scholar
5.Miranda, AG, Singh, KV, Murray, BE. DNA fingerprinting of Enterococcus faecium by pulsed-field gel electrophoresis may be a useful epidemiologic tool. J Clin Microbiol 1991;29:27522757.Google Scholar
6.Tenover, FC, Arbeit, RD, Goering, RV, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for strain typing. J Clin Microbiol 1995;33:22332239.Google Scholar
7.Williams, REO. Healthy carriage of Staphylococcus aureus: its prevalence and importance. Bacteriological Reviews 1963;27:5671.CrossRefGoogle ScholarPubMed
8.Henning, C, Hillborgh, U, Lindvall, K, et al.Comparison of Staphylococcus aureus carriage and skin infection rates in hospital and office employees. Journal of Hygiene Cambridge 1979;83:437444.CrossRefGoogle ScholarPubMed
9.Horn, WA, Larson, EL, McGinley, KJ, Leyden, JJ. Microbial flora on the hands of health care personnel: differences in composition and antibacterial resistance. Infect Control Hosp Epidemiol 1988;5:189193.Google Scholar
10.Bauer, TM, Ofner, E, Just, HM, Just, H, Daschner, FD. An epidemiological study assessing the relative importance of airborne and direct transmission of microorganisms in a medical intensive care unit. J Hosp Infect 1990;15:301309.Google Scholar
11.Doebbeling, BN. Nasal and hand carriage of Staphylococcus aureus in healthcare workers. J Chemother 1994;6(suppl. 2):1117.Google Scholar
12.Ojajärvi, J. Effectiveness of hand washing and disinfection methods in removing transient bacteria after patient nursing. Journal of Hygiene (London) 1980;85:193203.CrossRefGoogle ScholarPubMed
13.Goroncy-Bermes, P, Schouten, MAVoss, A. In vitro activity of a non-medicated handwash product, Chlorhexidine, and an alcohol-based hand disinfectant against multiply resistant gram-positive microorganisms. Infect Control Hosp Epidemiol 2001;22:194196.CrossRefGoogle Scholar
14.Solberg, CO. A Study of Carriers of Staphylococcus aureus [dissertation]. Bergen, Norway: University of Bergen; 1964.Google Scholar
15.Goldblum, SE, Ulrich, JAGoldman, RS, Reed, WP. Nasal and cutaneous flora among hemodialysis patients and personnel: quantitative and qualitative characterization and patterns of staphylococcal carriage. Am J Kidney Dis 1982;2:281286.Google Scholar
16.Jakob, HG, Borneff-Lipp, M, Bach, A, et al.The endogenous pathway is a major route for deep sternal wound infection. Eur J Cardiothorac Surg 2000;17:154160.Google Scholar
17.Noble, WC, Somerville, DAMicrobiology of Human Skin. London: W. B. Saunders; 1974.Google Scholar
18.Weber, S, Herwaldt, LA, McNutt, L-A, et al.An outbreak of Staphylococcus aureus in a pediatric cardiothoracic surgery unit. Infect Control Hosp Epidemiol 2002;23:7781.Google Scholar
19.Casewell, MW, Hill, RLR. Elimination of nasal carriage of Staphylococcus aureus with mupirocin (‘pseudomonic acid’): a controlled trial. J Antimicrob Chemother 1986;17:365372.Google Scholar
20.Doebbeling, BN, Breneman, DL, Neu, HC, et al.Elimination of Staphylococcus aureus nasal carriage in health care workers: analysis of six clinical trials with calcium mupirocin ointment. Clin Infect Dis 1993;17:466474.Google Scholar