MRSA carriage among healthcare workers in a Vietnamese intensive care unit: a prospective cohort study

Authors

  • Thuy B. Duong Hospital for Tropical Diseases - Vietnam and School of Population Health - University of New South Wales - Australia image/svg+xml https://orcid.org/0000-0001-8593-589X
  • Minh C. Duong School of population health, University of New South Wales: Sydney - Australia https://orcid.org/0000-0002-9300-0047
  • James I. Campbell Oxford University Clinical Research Unit – Vietnam (OUCRU-VN), Ho Chi Minh City - Vietnam
  • Hoang V.M. Nguyen 3Oxford University Clinical Research Unit – Vietnam (OUCRU-VN), Ho Chi Minh City - Vietnam
  • Hien H. Nguyen Hospital for Tropical Diseases, Ho Chi Minh City - Vietnam https://orcid.org/0000-0002-3665-1572
  • Hanh T.B. Bui Hospital for Tropical Diseases, Ho Chi Minh City - Vietnam
  • Chau V.V. Nguyen Hospital for Tropical Diseases, Ho Chi Minh City - Vietnam https://orcid.org/0000-0003-4668-1019
  • Anita Heywood School of Population Health, University of New South Wales, Sydney, New South Wales - Australia

DOI:

https://doi.org/10.33393/dti.2022.2504

Keywords:

Healthcare workers, Intensive care unit, Methicillin-resistant Staphylococcus aureus carriage, Vietnam

Abstract

Background: Little is known about the magnitude and patterns of methicillin-resistant Staphylococcus aureus (MRSA) carriage among intensive care unit (ICU) healthcare workers (HCWs), especially in lower-middle-income countries like Vietnam.

Materials and methods: A prospective cohort study was conducted on HCWs working in the adult ICU of the Hospital for Tropical Diseases in Vietnam between October 28 and December 20, 2019. These HCWs included physicians, nurses, and nursing assistants who were responsible for all essential medical activities and basic patient care. A questionnaire was used to collect participants’ information, including age, sex, profession, ICU working time, and underlying diseases. Hand and nasal swabs were collected weekly for 8 consecutive weeks for MRSA screening. Staphylococcal isolates were checked for catalase and coagulase and, for methicillin resistance using cefoxitin disk diffusion, then rechecked on the matrix-assisted laser desorption/ionization time-of-flight mass spectrometry.

Results: Among 55 HCWs, 16 (29.1%) carried MRSA in their noses or hands. MRSA intermittent hand carriage was documented in 2 (3.6%) HCWs. Among 53 HCWs undertaking nasal swabs, 13 (24.5%) were MRSA persistent and 3 (5.6%) were intermittent carriers. The MRSA carriage rate was highest among nursing assistants (50%, 4/8). More HCWs with underlying diseases were found to be MRSA carriers (31.8%, 7/22) compared with those without comorbidities (27.3%, 9/33).

Conclusion: MRSA carriage among HCWs is not rare. The findings highlight an urgent need to review and update the local infection prevention and control measures to prevent MRSA transmission from HCWs to patients.

References

  1. Jarvis WR. The epidemiology of colonization. Infect Control Hosp Epidemiol. 1996;17(1):47-52. https://doi.org/10.2307/30142366 PMID:8789688 DOI: https://doi.org/10.1086/647189
  2. Honda H, Krauss MJ, Coopersmith CM, et al. Staphylococcus aureus nasal colonization and subsequent infection in intensive care unit patients: does methicillin resistance matter? Infect Control Hosp Epidemiol. 2010;31(6):584-591. https://doi.org/10.1086/652530 PMID:20426656 DOI: https://doi.org/10.1086/652530
  3. Albrich WC, Harbarth S, Bern H. Health-care workers: source, vector, or victim of MRSA? Lancet Infect Dis. 2008;8(5):289-301. https://doi.org/10.1016/S1473-3099(08)70097-5PMID:18471774 DOI: https://doi.org/10.1016/S1473-3099(08)70097-5
  4. Joachim A, Moyo SJ, Nkinda L, et al. Nasal carriage of methicillin-resistant Staphylococcus aureus among health care workers in tertiary and regional hospitals in Dar es Salam, Tanzania. Int J Microbiol. 2018;2018:5058390. https://doi.org/10.1155/2018/5058390 PMID: 30275835 DOI: https://doi.org/10.1155/2018/5058390
  5. Hawkins G, Stewart S, Blatchford O, Reilly J. Should healthcare workers be screened routinely for methicillin-resistant Staphylococcus aureus? A review of the evidence. J Hosp Infect. 2011;77(4):285-289. https://doi.org/10.1016/j.jhin.2010.09.038 PMID:21292349 DOI: https://doi.org/10.1016/j.jhin.2010.09.038
  6. Thuy DB, Campbell J, Hoang NVM, et al. A one-year prospective study of colonization with antimicrobial-resistant organisms on admission to a Vietnamese intensive care unit. PLoS One. 2017;12(9):e0184847. https://doi.org/10.1371/journal.pone.0184847 PMID:28910379 DOI: https://doi.org/10.1371/journal.pone.0184847
  7. Huang YC, Su LH, Wu TL, Lin TY. Methicillin-resistant Staphylococcus aureus nasal carriage in international medical conference attendees. J Microbiol Immunol Infect. 2019;52(2):242-247. https://doi.org/10.1016/j.jmii.2018.08.004 PMID:30181097 DOI: https://doi.org/10.1016/j.jmii.2018.08.004
  8. Van Nguyen K, Zhang T, Thi Vu BN, et al. Staphylococcus aureus nasopharyngeal carriage in rural and urban northern Vietnam. Trans R Soc Trop Med Hyg. 2014;108(12):783-790. http://trstmh.oxfordjournals.org/cgi/doi/10.1093/trstmh/tru132https://doi.org/10.1093/trstmh/tru132 PMID:25187670 DOI: https://doi.org/10.1093/trstmh/tru132
  9. Tang CT, Nguyen DT, Ngo TH, et al. An outbreak of severe infections with community-acquired MRSA carrying the Panton-Valentine leukocidin following vaccination. PLoS One. 2007;2(9):e822. https://doi.org/10.1371/journal.pone.0000822 PMID:17786194 DOI: https://doi.org/10.1371/journal.pone.0000822
  10. Thuy DB, Campbell J, Nhat LTH, et al. Hospital-acquired colonization and infections in a Vietnamese intensive care unit. PLoS One. 2018;13(9):e0203600. https://doi.org/10.1371/journal.pone.0203600 PMID:30192894 DOI: https://doi.org/10.1371/journal.pone.0203600
  11. Faibis F, Laporte C, Fiacre A, et al. An outbreak of methicillin-resistant Staphylococcus aureus surgical-site infections initiated by a healthcare worker with chronic sinusitis. Infect Control Hosp Epidemiol. 2005;26(2):213-215. https://doi.org/10.1086/502529 PMID:15756895 DOI: https://doi.org/10.1086/502529
  12. World Health Organization. Guidelines on hand hygiene in health care. 2009. https://www.who.int/publications/i/item/9789241597906. Accessed October 2022.
  13. Thuy DB, Campbell J, Thuy CT, et al. Colonization with Staphylococcus aureus and Klebsiella pneumoniae causes infections in a Vietnamese intensive care unit. Microb Genom. 2021;7(2):1-14. https://doi.org/10.1099/mgen.0.000514 PMID:33502303 DOI: https://doi.org/10.1099/mgen.0.000514
  14. Fernandes CJ, Fernandes LA, Collignon P; Australian Group on Antimicrobial Resistance. Cefoxitin resistance as a surrogate marker for the detection of methicillin-resistant Staphylococcus aureus. J Antimicrob Chemother. 2005;55(4):506-510. https://doi.org/10.1093/jac/dki052PMID:15743899 DOI: https://doi.org/10.1093/jac/dki052
  15. Clark AE, Kaleta EJ, Arora A, Wolk DM. Matrix-assisted laser desorption ionization-time of flight mass spectrometry: a fundamental shift in the routine practice of clinical microbiology. Clin Microbiol Rev. 2013;26(3):547-603. https://doi.org/10.1128/CMR.00072-12 PMID:23824373 DOI: https://doi.org/10.1128/CMR.00072-12
  16. Singhal N, Kumar M, Kanaujia PK, Virdi JS. MALDI-TOF mass spectrometry: an emerging technology for microbial identification and diagnosis. Front Microbiol. 2015;6(791):791. https://doi.org/10.3389/fmicb.2015.00791 PMID:26300860 DOI: https://doi.org/10.3389/fmicb.2015.00791
  17. Dulon M, Peters C, Schablon A, Nienhaus A. MRSA carriage among healthcare workers in non-outbreak settings in Europe and the United States: a systematic review. BMC Infect Dis. 2014;14(1):363. https://doi.org/10.1186/1471-2334-14-363 PMID:24996225 DOI: https://doi.org/10.1186/1471-2334-14-363
  18. Sassmannshausen R, Deurenberg RH, Köck R, et al. MRSA prevalence and associated risk factors among health-care workers in non-outbreak situations in the Dutch-German EUREGIO. Front Microbiol. 2016;7:1273. https://doi.org/10.3389/fmicb.2016.01273 PMID:27597843 DOI: https://doi.org/10.3389/fmicb.2016.01273
  19. Bhatta DR, Koirala S, Baral A, et al. Methicillin-resistant Staphylococcus aureus contamination of frequently touched objects in intensive care units: potential threat of nosocomial infections. Can J Infect Dis Med Microbiol. 2022:1023241. https://doi.org/10.1155/2022/1023241 PMID 35637744 DOI: https://doi.org/10.1155/2022/1023241
  20. Salmon S, McLaws ML. Qualitative findings from focus group discussions on hand hygiene compliance among health care workers in Vietnam. Am J Infect Control. 2015;43(10):1086-1091. https://doi.org/10.1016/j.ajic.2015.05.039 PMID:26164768 DOI: https://doi.org/10.1016/j.ajic.2015.05.039
  21. Duong MC, McLaws ML. Dangerous practices in a hemodialysis unit in Vietnam identify from mixed methods. BMC Infect Dis. 2017;17(1):181. https://doi.org/10.1186/s12879-017-2290-3 PMID:28249573 DOI: https://doi.org/10.1186/s12879-017-2290-3
  22. Lien TQ, Chuc NTK, Hoa NQ, et al. Knowledge and self-reported practices of infection control among various occupational groups in a rural and an urban hospital in Vietnam. Sci Rep. 2018;8(1):5119. https://doi.org/10.1038/s41598-018-23462-8 PMID:29572463 DOI: https://doi.org/10.1038/s41598-018-23462-8
  23. Zimmerman PA, Yeatman H, Jones M, Murdoch H. Success in the South Pacific: a case study of successful diffusion of an infection prevention and control program. Healthc Infect. 2015;20(2):54-61. https://doi.org/10.1071/HI14036 PMID:32288840 DOI: https://doi.org/10.1071/HI14036
  24. Boyce JM, Opal SM, Potter-Bynoe G, Medeiros AA. Spread of methicillin-resistant Staphylococcus aureus in a hospital after exposure to a health care worker with chronic sinusitis. Clin Infect Dis. 1993;17(3):496-504. https://doi.org/10.1093/clinids/17.3.496 PMID:8218696 DOI: https://doi.org/10.1093/clinids/17.3.496
  25. Bonten MJM, Weinstein RA. Making sense of universal screening for MRSA. Lancet Infect Dis. 2016;16(3):272-273. https://doi.org/10.1016/S1473-3099(15)00435-1 PMID:26616207 DOI: https://doi.org/10.1016/S1473-3099(15)00435-1
  26. Nouwen JL, Ott A, Kluytmans-vandenbergh MFQ, Van Belkum A, Verbrugh HA. Predicting the Staphylococcus aureus nasal carrier state: derivation and validation of a “culture rule”. CID; 2004:39. DOI: https://doi.org/10.1086/423376
  27. Montoya A, Schildhouse R, Goyal A, et al. How often are health care personnel hands colonized with multidrug-resistant organisms? A systematic review and meta-analysis. Am J Infect Control. 2019;47(6):693-703. https://doi.org/10.1016/j.ajic.2018.10.017 PMID:30527283 DOI: https://doi.org/10.1016/j.ajic.2018.10.017
  28. Nouwen J, Boelens H, van Belkum A, Verbrugh H. Human factor in Staphylococcus aureus nasal carriage. Infect Immun. 2004;72(11):6685-6688. https://doi.org/10.1128/IAI.72.11.6685-6688.2004 PMID:15501803 DOI: https://doi.org/10.1128/IAI.72.11.6685-6688.2004
  29. El Aila NA, Al Laham NA, Ayesh BM. Nasal carriage of methicillin resistant Staphylococcus aureus among health care workers at Al Shifa hospital in Gaza Strip. BMC Infect Dis. 2017;17(1):28. https://doi.org/10.1186/s12879-016-2139-1 PMID:28056831 DOI: https://doi.org/10.1186/s12879-016-2139-1
  30. Legese H, Kahsay AG, Kahsay A, et al. Nasal carriage, risk factors and antimicrobial susceptibility pattern of methicillin resistant Staphylococcus aureus among healthcare workers in Adigrat and Wukro hospitals, Tigray, Northern Ethiopia. BMC Res Notes. 2018;11(1):250. https://doi.org/10.1186/s13104-018-3353-2 PMID:29685170 DOI: https://doi.org/10.1186/s13104-018-3353-2
  31. Malini J, Harle SA, Padmavathy M, et al. Methicillin-resistant Staphylococcus aureus carriage among the health care workers in a tertiary care hospital. J Clin Diagn Res. 2012;6(5):791-793.
  32. Gurieva TV, Bootsma MCJ, Bonten MJM. Decolonization of patients and health care workers to control nosocomial spread of methicillin-resistant Staphylococcus aureus: a simulation study. BMC Infect Dis. 2012;12(302):302. https://doi.org/10.1186/1471-2334-12-302 PMID:23151152 DOI: https://doi.org/10.1186/1471-2334-12-302
  33. Robotham JV, Graves N, Cookson BD, et al. Screening, isolation, and decolonisation strategies in the control of methicillin resistant Staphylococcus aureus in intensive care units: cost effectiveness evaluation. BMJ. 2011;343(7827):d5694. https://doi.org/10.1136/bmj.d5694PMID:21980062 DOI: https://doi.org/10.1136/bmj.d5694
  34. Wassenberg MWM, de Wit GA, Bonten MJM. Cost-effectiveness of preoperative screening and eradication of Staphylococcus aureus carriage. PLoS One. 2011;6(5):e14815. https://doi.org/10.1371/journal.pone.0014815 PMID:21637333 DOI: https://doi.org/10.1371/journal.pone.0014815
  35. Nguyen KV, Thi Do NT, Chandna A, et al. Antibiotic use and resistance in emerging economies: a situation analysis for Viet Nam. BMC Public Health. 2013;13(1):1158. http://www.biomedcentral.com/1471-2458/13/1158 https://doi.org/10.1186/1471-2458-13-1158PMID:24325208 DOI: https://doi.org/10.1186/1471-2458-13-1158
  36. Nga TT, Chuc NTK, Hoa NP, et al. Antibiotic sales in rural and urban pharmacies in northern Vietnam: an observational study. BMC Pharmacol Toxicol. 2014;15(1):6. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3946644&tool=pmcentrez&rendertype=abstract https://doi.org/10.1186/2050-6511-15-6PMID:24555709 DOI: https://doi.org/10.1186/2050-6511-15-6
  37. Angen Ø, Feld L, Larsen J, et al. Transmission of methicillin-resistant Staphylococcus aureus to human volunteers visiting a swine farm. Appl Environ Microbiol. 2017;83(23):1-10. https://doi.org/10.1128/AEM.01489-17 PMID:28970219 DOI: https://doi.org/10.1128/AEM.01489-17