Staphylococcus aureus is a medically important pathogen that is often acquired from hospital settings (nosocomial) as well as from the community (community acquired). Bacteria that reside in anterior nares of hosts serve as reservoirs for both the spread of the pathogen and predispose the host to subsequent infections. Here, we will review the extent and variability of nasal carriage, and the possible causative factors--both from the host and the bacterium. We also discuss the existing molecular typing techniques used for studying variations among strains of S. aureus. Finally, we discuss the possible areas of studies that are open in this field. Given the pathogen's importance in healthcare setting, such areas of study vary vastly, from fundamental research to applied medical care and use of alternative medical regimes for control of S. aureus nasal carriage. Unsurprisingly, our conclusions also underscore the importance of making policy decisions based on local ethnic and socioeconomic population structure.

Staphylococcus aureus nasal carriage and its contributing factors

Should healthcare workers be screened routinely for meticillin-resistant Staphylococcus aureus? A review of the evidence.

Objective – To familiarize the reader with the epidemiology, diagnosis, and infectious and zoonotic potential of methicillin-resistant staphylococci.



Data sources – Original research publications, scientific reviews and abstracts, case reports, and conference proceedings.



Human Data Synthesis – Staphylococcus aureus is a common human commensal organism; acquisition of genes encoding an altered penicillin-binding protein confers resistance to β-lactam antimicrobial drugs. Methicillin-resistant S. aureus (MRSA) are often resistant to non–β-lactam antimicrobial drugs as well. Originally described as an important cause of nosocomial infection, MRSA colonization and infection are now often identified in humans outside healthcare settings. Like other S. aureus, MRSA may be present without clinical illness. However, when they do cause infection the consequences can be extremely serious.



Veterinary Data Synthesis – The major domestic animal species, including pets and livestock, may become contaminated, colonized, or infected with methicillin-resistant staphylococci, including MRSA. Dogs and cats are more likely to be colonized/infected with Staphylococcus pseudintermedius than S. aureus, but this pathogen can acquire genes encoding methicillin resistance (ie, MRSP). Diagnosis of MRSA or MRSP has implications not only for treatment of infected animals, but for potential zoonotic transmission.



Conclusions – MRSA infection is an important cause of morbidity and mortality in humans. Animals may be contaminated, colonized, or infected with MRSA, with implications for the animal's health and as a potential reservoir for human infection. Staphylococci other than S. aureus may also acquire genes for methicillin resistance, and these species can also result in animal and occasionally human morbidity or mortality.

A veterinary perspective on methicillin-resistant staphylococci.

Assessment of noise pollution in and around a sensitive zone in North India and its non-auditory impacts.

Patients and staff in hospitals are exposed to a complex sound environment with rather high noise levels. In intensive care units, the main noise sources are hospital staff on duty and medical equipment, which generates both operating noise and acoustic alarms. Although noise in most cases is produced during activities for the purpose of saving life, noise can induce significant changes in the depth and quality of sleep and negatively affect health in general. Results of a survey of hospital staff are presented, as well as measurements in two German hospital wards: a standard two-bed room and a special intermediate care unit (IMC-Unit), each in a different intensive care unit (ICU). Sound pressure data were collected over a 48 hour period and converted into different levels (L(AFeq), L(AFmax) L(AFmin), L(AF 5%)), as well as a rating level L(Ar), which is used to take tonality and impulsiveness into account. An analysis of the survey and the measured data, together with a comparison of thresholds of national and international regulations and standards describe the acoustic situation and its likely noise effects on staff and patients.

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Noise in an intensive care unit

Methicillin-resistant Staphylococcus aureus (MRSA) is a problem within healthcare organizations and in the community. The aims of this study were to identify the prevalence of S. aureus in the anterior nares of surgical unit staff, to analyse their antibiogram with special reference to methicillin resistance, and to compare the isolates among surgical unit staff and in relation to the wards where they worked. Sterile swabs were used to collect the samples from the anterior nares of 100 healthcare workers working in 5 surgical wards who satisfied rigid inclusion and exclusion criteria. Standard procedures were followed for isolation, identification, and antibiotic sensitivity testing. S. aureus carrier status was observed in 13 individuals, of whom 2 (15.4%) were resistant to methicillin. All the isolates of S. aureus were multidrug-resistant but sensitive to vancomycin and bacitracin. One of the 13 was resistant to linezolid. Sixty-three of the staff were carriers of coagulase-negative Staphylococcus. The presence of methicillin resistance may cause problems in hospital infection control programs and may indicate emerging issues. This study suggests the need for periodic screening of hospital personnel in order to monitor trends and take steps to treat carriers.

Nasal carriage of methicillin-resistant Staphylococcus aureus among surgical unit staff.

High levels of noise in hospitals may interfere with patient care services, the doctor-patient relationship and medical education activities. The aim of this study was to assess the noise level at different places in a tertiary care hospital and suggest measures to reduce the noise. Sound levels of fourteen places inside the hospital were recorded using a Digital Sound Level Meter . A total of 20 readings were taken at three minute intervals between successive recordings during the morning (9 to 10 a.m.) and evening hours (6 to 7 p.m.) and analyzed using simple descriptive statistics. The mean equivalent sound pressure levels (Leq) during the morning and evening hours were 70.38 and 64.46 dB(A) respectively. During the morning hours, the maximum Leq was observed in the mortuary (76.70 dBA) whereas the minimum Leq was in the intensive care unit (I.C.U) (58.34 dBA). The maximum and minimum Leq during evening hours were recorded at O.G (Obstetrics and Gynecology) ward (71.86 dBA) and mortuary (57.08 dBA) respectively. The morning hours showed higher levels of noise in most of the places probably due to overcrowding and higher vehicular movement. This study highlights the need for noise monitoring and control measures inside hospital areas.

Noise levels in a tertiary care hospital.

Sir,

The incidence of liver disease associated with the hepatitis B virus (HBV) is a world-wide public health problem. The disease is transmitted by perinatal, parenteral, sexual routes.(1) Healthcare workers, particularly surgeons, pathologists, dentists and physicians working in hemodialysis and oncology units, are at a higher risk of contracting HBV infection via minor skin cuts and accidental needle punctures.(2) Since proper vaccination can prevent HBV infection, complete hepatitis B vaccination is necessary for medical and paramedical students.

The present study was carried out to observe the attitude and practice of medical students towards hepatitis B vaccination and find out if they completed all three doses and, if not, elicit the reasons for incomplete vaccination.

The study group consisted of medical students admitted in the year 2000 and 2001. After giving a brief introduction on the study, pre-tested, self-administered, anonymous questionnaires were distributed with reference to hepatitis B immunization history and reasons for non-compliance among those who had not completed three doses. The questionnaires were distributed in a single day in June 2005 in order to avoid sharing of information. The data were analysed statistically using Chi-square test.

Out of the 250 questionnaires circulated, 217 (M = 130, F = 87) were returned, and the response rate was 86.8%. Among them, only 29 (22.3%) boys and 21 (24.1%) girls maintained their vaccination record. Nineteen (8.7%) (9 boys, 10 girls) students had already completed three doses and received booster dose on admission. Unfortunately, without vaccination against HBV, 12 (9.2%) boys and 3 (3.4%) girls produced certificates from qualified and registered medical practitioners. Among the rest (183), the numbers that received the first, second and third dose of hepatitis B vaccination were 109 (100%), 62 (56.9%) and 33 (30.3%) boys, respectively, and 74 (100%), 41 (55.4%) and 31 (41.9%) girls, respectively. Complete coverage was significantly (P < 0.05) more among girls. The reasons for non-compliance were many and are mentioned in Table 1. Some dominant reasons were forgetfulness (38.8%), no reminder (35.8%), lack of knowledge on hepatitis B infection (23.1%), lack of compulsion (20.1%), etc.



Table 1

Reasons for non-compliance of hepatitis B vaccination



Medical students are susceptible to HBV infection during their exposure to clinical cases and different procedures. Hence, medical students were advised to have vaccination against HBV before coming to clinical side, as they acquire good immune response with immune memory.(3) Three doses of vaccination are provided free of charge to all the students (both day scholars and hostelites) during the time of admission. They were provided with a vaccination card indicating the schedule for subsequent doses.

For want of follow-up, reminding, monitoring and supervising systems, 119 did not complete vaccination. Hence, it is suggested that the students and their parents/family members who come on the day of admission should be educated on HBV infection and motivated for successful and effective vaccination. The process of vaccination may be completed with the help of student council. The study also highlights the need for a national policy in countries where hepatitis B vaccination to health care personnel is not made mandatory. Limitations of this study include non-availability of vaccination record in many and recall bias in addition to non-screening of their blood for hepatitis B surface antigen and antibodies too.

Hepatitis B vaccination among medical students

Background: Lay press creates awareness on issues related to health and illnesses, and thus influences the attitude of public. Objective: The present study was undertaken to find out the pattern of information provided in print media on Chikungunya fever and to elicit the readers' views. Materials and Methods: Information displayed on Chikungunya fever in one of the oldest English daily newspapers 'The Hindu' and its supplements published from Madurai and Chennai, India from April 1, 2006 to October 31, 2006 were read, analyzed, and classified into different categories. A readership questionnaire survey was carried out among policy makers (n = 25), health professionals (n = 170), medical students (n = 200), and the public (n = 150) to find out their preferences and usefulness on the category of information provided. The data were analyzed by simple descriptive statistics. Results: During the study period of 214 days, 74 items related to chikungunya fever, one in April, three in May, five in June, six in July, 15 in August, 18 in September, and 25 in October appeared. Most of the articles centered around the government policy matters (n = 37) and others in the order of preventive aspects (n = 32), statistics (n = 31), geographical distribution (n = 21), symptomatology (n = 16), transmission of illness (n=16), etc., Overall areas of interest of policy makers and health professionals were different significantly ( P Conclusion: Media have provided information, improved knowledge, altered the attitude, and influenced decision making. It is suggested that students and researchers of health sciences should be motivated to read standard newspapers as it provides information on health and illnesses much earlier than they appear in their professional journals.

A Vinodhkumaradithyaa

Papers

Nasal carriage of methicillin-resistant Staphylococcus aureus among surgical unit staff.

Noise levels in a tertiary care hospital.

Hepatitis B vaccination among medical students

Chikungunya epidemic: Analysis of reports of a lay press