Methicillin-resistant staphylococcus aureus nasal colonization prevalence among Emergency Medical Services personnel.
TL;DR: There is evidence that EMS personnel have a higher prevalence of MRSA colonization than the general population, which can be a risk to patients and can be recognized as an occupational hazard.
Abstract: IntroductionThe prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization among Emergency Medical Services (EMS) personnel is not well studied. Methicillin-resistant Staphylococcus aureus colonization can be a health hazard for both EMS personnel and patients. The aim of this study was to quantify the prevalence of MRSA colonization among EMS personnel. This study will help the scientific community understand the extent of this condition so that further protocols and policies can be developed to support the health and wellbeing of EMS personnel.Hypothesis/ ProblemThe hypothesis of this study was that the prevalence of MRSA colonization among EMS personnel is significantly higher than among the general population.MethodsThis was a cross-sectional study. A total of 110 subjects were selected from two major US Mid-Atlantic fire departments. Methicillin-resistant Staphylococcus aureus colonization was detected by nasal swabbing. Nasal swabs were inoculated onto a special agar medium (C-MRSAgar) with polymerase chain reaction testing performed. One-sided binomial distribution at the StudySize 2.0 Web calculator was used. Using the Web calculator, p (H0 proportion) = 1.5%; a difference (H1-H0) ‘Δ’ = 4.53% can be detected at α = 5% and power = 80% with N = 110.ResultsSamples were collected from 110 volunteers. Seven samples were positive for MRSA, resulting in a prevalence of 7/110 or 6.4% (95% CI, 1.8%-11%; P < .0003) compared with a 1.5% prevalence of MRSA colonization among the general population.ConclusionThere is evidence that EMS personnel have a higher prevalence of MRSA colonization than the general population. This can be a risk to patients and can be recognized as an occupational hazard.Al AmiryA, BissellRA, MaguireBJ, AlvesDW. Methicillin-Resistant Staphylococcus Aureus Nasal Colonization Prevalence among Emergency Medical Services Personnel. Prehosp Disaster Med. 2013;28(4):1-5.
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TL;DR: Evidence is provided that ambulances represent a source of prehospital multidrug-resistant infections and the extent of bacterial contamination in ambulance vehicles and the degree of antimicrobial resistance among isolated pathogens is analyzed.
Abstract: Background Ambulances may represent a potential source of infection to patients, patients' relatives, and paramedical staffs. In this study, we analyzed the extent of bacterial contamination in ambulance vehicles and measured the degree of antimicrobial resistance among isolated pathogens. Materials and methods Twenty-five vehicles were included and 16 sampling points were swabbed in each vehicle. Then the swabs were immediately transferred to the laboratory to identify bacterial contaminants utilizing standard microbiological procedures and API® systems. Antibiotic susceptibility testing and screening for methicillin-resistant staphylococci and extended spectrum β-lactamases (ESBLs)-producing Gram-negative rods were carried out. Results A total of 400 samples were collected, 589 bacteria were isolated and 286 (48.6%) of the isolates were potentially pathogenic. The highest contamination rate with pathogenic bacteria was detected in suction devices (75.8%) and stethoscopes (67.7%). Staphylococci were the most frequently detected microorganisms (n=184) followed by Klebsiella spp. (49), Escherichia coli (40), Citrobacter spp. (7), and Proteus spp. (6). Staphylococci were mostly sensitive to vancomycin, whereas Gram-negative bacteria were sensitive to imipenem. Overall, 46.1% of Staphylococcus aureus were methicillin resistant, whereas 20.4% of the coagulase-negative staphylococci were methicillin resistant. Moreover, 36.7% of Klebsiella spp. and 27.5% of E. coli were ESBL producers. Conclusion Our study provides evidence that ambulances represent a source of prehospital multidrug-resistant infections.
31 citations
Cites background from "Methicillin-resistant staphylococcu..."
...Of great concern is the fact that previous studies have reported that MRSA colonization was detected among emergency services personnel.(6) Microorganisms were detected not only in the interior of ambulances but also on the emergency services equipment....
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TL;DR: In order to develop and implement measures to increase safety, EMS personnel must be involved with the research and implementation process and to develop, test, and implement interventions in such a way that they can be reliably evaluated and the results published in peer-reviewed journals.
Abstract: IntroductionEach year, Emergency Medical Services (EMS) personnel respond to over 30 million calls for assistance in the United States alone. These EMS personnel have a rate of occupational fatality comparable to firefighters and police, and a rate of non-fatal injuries that is higher than the rates for police and firefighters and much higher than the national average for all workers. In Australia, no occupational group has a higher injury or fatality rate than EMS personnel. Emergency Medical Services personnel in the US have a rate of occupational violence injuries that is about 22-times higher than the average for all workers. On average, more than one EMS provider in the US is killed every year in an act of violence.Hypothesis/ObjectiveThe objective of this epidemiological study was to identify the risks and factors associated with work-related physical violence against EMS personnel internationally.MethodsAn online survey, based on a tool developed by the World Health Organization (WHO; Geneva, Switzerland), collected responses from April through November 2016.ResultsThere were 1,778 EMS personnel respondents from 13 countries; 69% were male and 54% were married. Around 55% described their primary EMS work location as “urban.” Approximately 68% described their employer as a “public provider.” The majority of respondents were from the US.When asked “Have you ever been physically attacked while on-duty?” 761 (65%) of the 1,172 who answered the question answered “Yes.” In almost 10% (67) of those incidents, the perpetrator used a weapon. Approximately 90% of the perpetrators were patients and around five percent were patient family members. The influence of alcohol and drugs was prevalent. Overall, men experienced more assaults than women, and younger workers experienced more assaults than older workers.Conclusions:In order to develop and implement measures to increase safety, EMS personnel must be involved with the research and implementation process. Furthermore, EMS agencies must work with university researchers to quantify agency-level risks and to develop, test, and implement interventions in such a way that they can be reliably evaluated and the results published in peer-reviewed journals.MaguireBJ, BrowneM, O’NeillBJ, DealyMT, ClareD, O’MearaP. International Survey of Violence Against EMS Personnel: Physical Violence Report. Prehosp Disaster Med. 2018;33(5):526–531.
30 citations
TL;DR: This study demonstrates that EMS providers are potential vectors of microorganisms if proper hand hygiene is not performed properly, and proper application of accepted standards for hand hygiene can help reduce the presence of microbes on provider hands and subsequent transmission to patients and the environment.
28 citations
TL;DR: The worldwide prevalence of MRSA on fomites within the contexts of hospital and community settings is highlighted and highlighted in this review.
Abstract: Staphylococcus genus is a Gram-positive coccus normally associated with skin and mucous membranes of warm-blooded animals. It is part of the commensal human microflora, or found in animals, or cont...
23 citations
TL;DR: Exposure to infectious diseases is decreasing, yet it remains significant, the decrease is attributed to prevention strategies; however, paramedic knowledge and attitudes as well as the uncontrolled environment paramedics work in can be a barrier.
Abstract: Background Paramedics respond to emergency scenes in often uncontrolled settings without being aware of potential risks. This makes paramedicine one of the most dangerous occupations. One of these dangers is the risk of contracting infectious diseases. Research in this area is predominantly focused on compliance in the use of protective equipment, attitudes and perceptions of paramedics, infectious disease policy, and exposure rates to blood and body fluids. The purpose of this scoping review was to determine what is known about the impact of infectious disease on the health of paramedics. Methods Using the Arskey and O'Malley methodological framework, a scoping review was undertaken, which allows for a broad search of the available evidence. Results The literature search identified eight articles for review that reported on paramedic exposure trends; the lack of reported blood-borne infections contracted, such as hepatitis B, hepatitis C, and human immunodeficiency virus (HIV); instances of severe acute respiratory syndrome (SARS) infections; and the higher prevalence of methicillin-resistant staphylococcus aureus (MRSA) nasal infections amongst paramedics. Conclusions Exposure to infectious diseases is decreasing, yet it remains significant. The decrease is attributed to prevention strategies; however, paramedic knowledge and attitudes as well as the uncontrolled environment paramedics work in can be a barrier. Contraction of infectious diseases is generally low; exceptions to this are MRSA colonization, influenza, and SARS. Paramedics are at greater risk of acquiring these infectious diseases compared to the general public. The effect on the health of paramedics is not well reported. Thomas B , O'Meara P , Spelten E . Everyday dangers - the impact infectious disease has on the health of paramedics: a scoping review. Prehosp Disaster Med. 2017;32(2):217-223.
20 citations
Cites background from "Methicillin-resistant staphylococcu..."
...5% of the general population.(32) Hubble et al(28) found paramedics are at-risk of contracting and spreading influenza among co-workers, patients, and relatives with 59....
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...The final disease identified was methicillin-resistant staphylococcus aureus (MRSA) that is spread via direct contact.(32) Reed et al(14) and Sayed et al(27) report on the exposure rates to infectious diseases generally....
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References
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TL;DR: The collective expertise of multiple disciplines must be harnessed to support the best approaches to the major global health challenges and the disciplines of epidemiology health policy economics law environmental science and certainly bioethics can make essential contributions to a comprehensive global health strategy.
Abstract: More than ever before the US Department of Health and Human Services (DHHS) needs to be a global health agency working to protect the health economic and security interests of US citizens through global collaboration and commitment to the public good. Public health preparedness extends beyond public health surveillance preparation for bioterrorism and political policy. Preparedness involves understanding the 21st-century world--its changing disease burden its changing demographics and its changing political and environmental substrata. It is the moral responsibility of the US government particularly through its lead health entity to address the high-disease burden global health challenges. DHHS agencies must work within multinational and bilateral structures to build consensus respond to global health threats and cultivate science to build a strong global public health infrastructure. Global health is both an economic priority and a security priority of the United States. Therefore the collective expertise of multiple disciplines must be harnessed to support the best approaches to the major global health challenges. The disciplines of epidemiology health policy economics law environmental science and certainly bioethics can make essential contributions to a comprehensive global health strategy. (excerpt)
1,368 citations
TL;DR: Nal colonization with MRSA has increased in the United States, despite an overall decrease in nasal colonization with S. aureus, and PFGE types associated with community transmission only partially account for the increase.
Abstract: Background. Staphylococcus aureus is a common cause of infection, particularly in persons colonized by this organism. Virulent strains of methicillin-resistant S. aureus (MRSA) have emerged in the general community. Methods. A nationally representative survey of nasal colonization with S. aureus was conducted from 2001 through 2004 as part of the National Health and Nutrition Examination Survey. MRSA isolates were identified by the oxacillin disk-diffusion method. The pulsed-field gel electrophoresis (PFGE) type was determined for all MRSA isolates. A t statistic was used to compare the prevalence of colonization across biennia and across population subgroups. Cofactors independently associated with colonization were determined with backward stepwise logistic modeling. Results. The prevalence of colonization with S. aureus decreased from 32.4% in 2001-2002 to 28.6% in 2003-2004 (P <.01), whereas the prevalence of colonization with MRSA increased from 0.8% to 1.5% (P <.05). Colonization with MRSA was independently associated with healthcare exposure in males and with having been born in the United States, age ≥60 years, diabetes, and poverty in females. In 2003-2004, a total of 19.7% (95% confidence interval, 12.4%-28.8%) of MRSA-colonized persons carried a PFGE type associated with community transmission. Conclusions. Nasal colonization with MRSA has increased in the United States, despite an overall decrease in nasal colonization with S. aureus. PFGE types associated with community transmission only partially account for the increase in MRSA colonization.
948 citations
TL;DR: MRSA should be a national priority for disease control, according to the World Health Organization.
Abstract: Hospital-acquired infections with Staphylococcus aureus, especially methicillin-resistant S. aureus (MRSA) infections, are a major cause of illness and death and impose serious economic costs on patients and hospitals. However, the recent magnitude and trend of these infections have not been reported. We used national hospitalization and resistance data to estimate the annual number of hospitalizations and deaths associated with S. aureus and MRSA from 1999 through 2005. During this period, the estimated number of S. aureus-related hospitalizations increased 62%, from 294,570 to 477,927, and the estimated number of MRSA-related hospitalizations more than doubled, from 127,036 to 278,203. Our findings suggest that S. aureus and MRSA should be considered a national priority for disease control.
925 citations
"Methicillin-resistant staphylococcu..." refers background in this paper
...MRSA control is considered a national priority, and its rapid spread supports the need for collaborative infection control efforts by both hospitals and communities.(39) Since EMS is a vital sector of community services, this national priority can be viewed as a motivation for governmental grants to upgrade EMS departments’ infection control policies and improve their quality of care....
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TL;DR: These evidence-based guidelines have been produced after a literature review of the laboratory diagnosis and susceptibility testing of methicillin-resistant Staphylococcus aureus and suggest what tests should be used but not when the tests are applicable.
Abstract: These evidence-based guidelines have been produced after a literature review of the laboratory diagnosis and susceptibility testing of methicillin-resistant Staphylococcus aureus (MRSA). We have considered the detection of MRSA in screening samples and the detection of reduced susceptibility to glycopeptides in S. aureus. Recommendations are given for the identification of S. aureus and for suitable methods of susceptibility testing and screening for MRSA and for S. aureus with reduced susceptibility to glycopeptides. These guidelines indicate what tests should be used but not when the tests are applicable, as aspects of this are dealt with in guidelines on control of MRSA. There are currently several developments in screening media and molecular methods. It is likely that some of our recommendations will require modification as the new methods become available.
429 citations
"Methicillin-resistant staphylococcu..." refers background in this paper
...PCR is proven effective in molecularly indentifying MRSA and excluding false positive growth from convenient cultures.(14)...
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...aureus and MRSA in laboratories.(14) The culture was incubated for 24 hours at 378C under aeration....
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TL;DR: The utility of administrative databases, a computerized clinical data repository, and an electronic rule to enhance surveillance for CA-MRSA at Stroger (Cook County) Hospital, a 464-bed public safety net hospital in Chicago, and its associated clinics are assessed.
Abstract: To the Editor: Community-associated (CA) methicillin-resistant Staphylococcus aureus (CA-MRSA) is a global emerging threat (1–7). Accurate measures of the extent of CA-MRSA are critical to allocate resources, guide control measures, and inform prescribing practices (8). We assessed the utility of administrative databases, a computerized clinical data repository, and an electronic rule to enhance surveillance for CA-MRSA at Stroger (Cook County) Hospital, a 464-bed public safety net hospital in Chicago, and its associated clinics—all part of the Cook County Bureau of Health Services (CCBHS).
Using data collected within the Chicago Antimicrobial Resistance Project computerized clinical data repository (9) from September 1, 2001, to August 31, 2004, we developed an electronic rule to define persons with CA infection with S. aureus. This rule used the electronic records of all persons from whom MRSA or methicillin-susceptible S. aureus (MSSA) had been identified in cultures of soft tissue, pus, bone, or joints. Infections from patients who met the following electronic case definition were designated CA: 1) culture obtained as an outpatient or within the first 3 days of hospitalization, 2) no clinical culture with MRSA in the last 6 months, 3) no hospitalization or surgeries within 1 year, and 4) no hemodialysis. All other infections were defined as healthcare associated. Data for microbiology results, demographics, and recent surgery or hospitalization were linked by a unique patient identification number. Dialysis use was detected by the use of biochemical tests obtained around the time of dialysis or of hemodialyis-related ICD-9 procedure codes (39.27, 90945, 39.95, 90935, 54.98, 39.43, 39.42, or 38.95). Because the electronic data sources were complete for the period specified, absence of data for a patient was considered to be due to the absence of exposure, not missing data.
Using the electronic case definition and data repository, we randomly selected 100 patients with putative CA- and 100 with putative healthcare-associated S. aureus infections. The paper charts for these 200 patients were reviewed to validate the designations of CA- or healthcare-associated infection, by using the same criteria as for the electronic rule. To ensure blinding for manual chart reviews, all references to results of the electronic rule were removed from data collection instruments. Using information obtained from chart review as the standard, we determined sensitivity and specificity of the electronic rule and calculated agreement (κ statistic) between manual and electronic reviews. To ascertain data sources of most value in detecting healthcare exposures, we examined data tables required for each type of exposure and for coincident exposures to develop more parsimonious data requirements.
During the study period, 714 (386 MSSA and 328 MRSA) healthcare-associated and 1,222 (518 MRSA and 704 MSSA) CA infections occurred; all electronic data elements were available for all patient encounters that occurred within CCBHS. Sampling yielded 47 CA- and 52 healthcare-associated MRSA infections and 53 CA- and 48 healthcare-associated MSSA infections.
The electronic case definition performed well when compared with chart review. All 100 healthcare-associated infections identified electronically were confirmed by manual chart review as classified correctly. Among the 100 community-associated infections identified electronically, 3 (3%) were determined by chart review to have been misclassified: 2 patients had been hospitalized, and a third had surgery within the previous year, all outside CCBHS. The sensitivity of the electronic case definition for community association was 100%; specificity was 97%. The κ statistic was 0.97 (confidence interval [CI] 0.83–1.00), which indicated superior agreement between chart review and electronic rule. For misclassified cases, 1 infection was due to MRSA, and 2 were due to MSSA. The performance characteristics of the rule for CA-MRSA were sensitivity 100%, specificity 98.1%, and κ = 0.98 (CI 0.78–1.00).
The Table describes data elements required to detect healthcare exposures. The most data-intensive exposure to detect was hemodialysis, which required a search of laboratory and discharge diagnosis databases. Isolates of MRSA were designated healthcare-associated most commonly because of prior hospitalization (523 [73%] of 714) and date of culture (i.e., >3 days after hospital admission) (259 [36%] of 714). With the use of only admission/discharge and microbiology data, 28 patients (90%) who had undergone dialysis and 23 (85%) who had undergone surgery were identified. The use of only admission/discharge and microbiology data would have detected 707 patients, 99% of those who would have been detected by the full algorithm.
Table
Data sources for healthcare exposures
Our study had limitations. Chart review may have undercounted healthcare-associated factors and is dependent on clinician histories and documentation. However, retrospective review of paper charts is the principal method that infection control practitioners use to gather information. Also, this study was conducted at a single center that served a population that may have had difficulty seeking care elsewhere. For single hospitals or systems with a less captive population, electronic measures may not function as well until disparate systems can be integrated, i.e., at the level of health departments or through data sharing among regional health information organizations.
In conclusion, using easily accessible data from a computerized clinical data repository, we readily classified S. aureus and MRSA infections as CA or healthcare associated. Comparison of the electronic method with manual paper chart review demonstrated high agreement for MRSA (κ = 0.98). Additional review suggested that use of only 1 or 2 data sources efficiently detected prior healthcare exposures. A major dividend of increased use of information technology in healthcare is application of electronically stored data to improve public health surveillance.
394 citations
"Methicillin-resistant staphylococcu..." refers background in this paper
...Further efforts can be focused on the development of guidelines for proper management of MRSA outbreaks in communities.(38) Amiry, Bissell, Maguire, et al 351...
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