An Outbreak of Methicillin-Resistant<i>Staphylococcus aureus</i>Surgical-Site Infections Initiated by a Healthcare Worker With Chronic Sinusitis

Faibis, F.; Laporte, C.; Fiacre, A.; Delisse, Chantal; Lina, Gérard; Demachy, Marie-Claude; Botterel, Françoise

doi:10.1086/502529

Cited by 36 publications

(25 citation statements)

References 8 publications

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“…It has been proposed, however, that such resistance was capable of occurring, albeit rare under a lack of (a) Screening sites which have been used to establish culture-positive status. Nares only [21,22,[26][27]31,35,37,39,[43][44][45]50,59, Hands only [12,100], nares/hands [11,[101][102][103][104][105][106][107], nares/perineum [32,74,108] Nares/throat [39,[109][110][111][112][113][114][115], nares/hands/throat [29,116], nares/lesions [42,117] Nares/wrists/hands [118], nares/axilla/perineum [119], nares/wrists/hands/groin [120] Nares/throat/axilla/perineum [121,122], five sites [123,124], nares/subungual [125] Nares/throat/hands/perineum [60] (b) Anatom...…”

Section: Seek and Ye Shall Findmentioning

confidence: 99%

“…It has been recognized that some healthcare workers may yield positive screens only after a shift in an endemic work setting, and thus it has been proposed that health personnel screening should take place at the start of a shift [116,119,128]. The continuing staff reservoir for MRSA is mainly the long-term carrier, and such dissemination can be intermittent or continuous [34,36,41,45,77,79,83,84,131,132].…”

Section: Seek and Ye Shall Findmentioning

confidence: 99%

“…The bacterium may be found in the context of simple carriage or active infection. Staff with active infections are more likely to shed bacterium [27,32,38,45,84,114,120,[141][142][143][144][150][151][152]. Physical trauma to workers in an endemic setting may facilitate subsequent MRSA infection [138].…”

Section: Seek and Ye Shall Findmentioning

confidence: 99%

“…Some have proposed that staff carrier rates may be so low that no such screening should be conducted [185]. The latter view is very much in the minority, and staff surveillance cultures have been procured in numerous outbreaks as part of the various control methods [25][26][27]29,31,33,35,36,39,[41][42][43]45,53,59,60,63,65,70,[74][75][76][77]86,[92][93][94]96,104,106,111,113,117,120,124,127,129,131,139,159,183,[186][187][188]. Some have proposed that staff screening should be an active component of routine control methods [36,41,43,…”

Section: Seek and Ye Shall Findmentioning

confidence: 99%

“…Whereas a particular setting may yield obvious clues, it may require more formal epidemiological analyses to elaborate on the contribution of staff carriage. Such epidemiological links may take various forms [27,32,36,37,[44][45][46]66,71,103,110,152,160,170,200]. Analysis of clusters or case-control studies may be invoked when epidemiological links are obvious.…”

Section: Epidemiological Curiosmentioning

confidence: 99%

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The role of healthcare personnel in the maintenance and spread of methicillin-resistant Staphylococcus aureus

Cimolai

2008

Journal of Infection and Public Health

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Healthcare workers may acquire methicillin-resistant Staphylococcus aureus (MRSA) from patients, both hospital and home environments, other healthcare workers, family and public acquaintances, and pets. There is a consensus of case reports and series which now strongly support the role for MRSA-carrying healthcare personnel to serve as a reservoir and as a vehicle of spread within healthcare settings. Carriage may occur at a number of body sites and for short, intermediate, and long terms. A number of approaches have been taken to interrupt the linkage of staff-patient spread, but most emphasis has been placed on handwashing and the treatment of staff MRSA carriers. The importance of healthcare workers in transmission has been viewed with varying degrees of interest, and several logistical problems have arisen when healthcare worker screening is brought to the forefront. There is now considerable support for the screening and treatment of healthcare workers, but it is suggested that the intensity of any such approach must consider available resources, the nature of the outbreak, and the strength of epidemiological associations. The task of assessing healthcare personnel carriage in any context should be shaped with due regard to national and international guidelines, should be honed and practiced according to local needs and experience, and must be patient-oriented.

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Section: Seek and Ye Shall Findmentioning

confidence: 99%

Section: Seek and Ye Shall Findmentioning

confidence: 99%

Section: Seek and Ye Shall Findmentioning

confidence: 99%

Section: Seek and Ye Shall Findmentioning

confidence: 99%

Section: Epidemiological Curiosmentioning

confidence: 99%

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The role of healthcare personnel in the maintenance and spread of methicillin-resistant Staphylococcus aureus

Cimolai

2008

Journal of Infection and Public Health

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Reasons Why Physicians and Advanced Practice Clinicians Work While Sick

et al. 2015

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IMPORTANCE When clinicians work with symptoms of infection, they can put patients and colleagues at risk. Little is known about the reasons why attending physicians and advanced practice clinicians (APCs) work while sick.OBJECTIVE To identify a comprehensive understanding of the reasons why attending physicians and APCs work while sick. DESIGN, SETTING, AND PARTICIPANTS We performed a mixed-methods analysis of a cross-sectional, anonymous survey administered from January 15 through March 20, 2014, in a large children's hospital in Philadelphia, Pennsylvania. Data were analyzed from April 1 through June 1, 2014. The survey was administered to 459 attending physicians and 470 APCs, including certified registered nurse practitioners, physician assistants, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives. MAIN OUTCOMES AND MEASURES Self-reported frequency of working while experiencing symptoms of infection, perceived importance of various factors that encourage working while sick, and free-text comments written in response to open-ended questions. RESULTS Of those surveyed, we received responses from 280 attending physicians (61.0%) and 256 APCs (54.5%). Most of the respondents (504 [95.3%]) believed that working while sick put patients at risk. Despite this belief, 446 respondents (83.1%) reported working sick at least 1 time in the past year, and 50 (9.3%) reported working while sick at least 5 times. Respondents would work with significant symptoms, including diarrhea (161 [30.0%]), fever (86 [16.0%]), and acute onset of significant respiratory symptoms (299 [55.6%]). Physicians were more likely to report working with each of these symptoms than APCs (109 [38.9%] vs 51 [19.9%], 61 [21.8%] vs 25 [9.8%], and 168 [60.0%] vs 130 [50.8%], respectively [P < .05]). Reasons deemed important in deciding to work while sick included not wanting to let colleagues down (521 [98.7%]), staffing concerns (505 [94.9%]), not wanting to let patients down (494 [92.5%]), fear of ostracism by colleagues (342 [64.0%]), and concern about continuity of care (337 [63.8%]). Systematic qualitative analysis of free-text comments from 316 respondents revealed additional reasons why attending physicians and APCs work while sick, including extreme difficulty finding coverage (205 [64.9%]), a strong cultural norm to come to work unless remarkably ill (193 [61.1%]), and ambiguity about what constitutes "too sick to work" (180 [57.0%]). CONCLUSIONS AND RELEVANCE Attending physicians and APCs frequently work while sick despite recognizing that this choice puts patients at risk. The decision to work sick is shaped by systems-level and sociocultural factors. Multimodal interventions are needed to reduce the frequency of this behavior.

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Elimination ofStaphylococcus AureusCarriage: Importance and Strategies

Herwaldt

Boyce

2009

Staphylococci in Human Disease

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An Outbreak of Methicillin-ResistantStaphylococcus aureusSurgical-Site Infections Initiated by a Healthcare Worker With Chronic Sinusitis

Cited by 36 publications

References 8 publications

The role of healthcare personnel in the maintenance and spread of methicillin-resistant Staphylococcus aureus

The role of healthcare personnel in the maintenance and spread of methicillin-resistant Staphylococcus aureus

Reasons Why Physicians and Advanced Practice Clinicians Work While Sick

Elimination ofStaphylococcus AureusCarriage: Importance and Strategies

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