Healthcare-associated transmission of Panton-Valentine leucocidin positive methicillin-resistant Staphylococcus aureus: the value of screening asymptomatic healthcare workers

Abstract

BackgroundThree patients hospitalised in the coronary care unit of a general district hospital (England, UK) were tested positive for Panton-Valentine leucocidin methicillin-resistant Staphylococcus aureus colonisation during their routine weekly screening for methicillin-resistant Staphylococcus aureus (MRSA). The isolates were indistinguishable and all three patients have previously had negative screening tests. The outbreak investigation team considered exploring the possibility of PVL-MRSA transmission from members of staff to the patients and potentially between members of staff.MethodAs part of the investigations, healthcare workers on coronary care unit and intensive care unit were screened for MRSA carriage.ResultsAmong 134 screened healthcare workers, five staff members (3.7%) were MRSA colonised. Among these isolates, four were Panton-Valentine leukocidin positive. However, only two healthcare workers had an indistinguishable isolate with the isolate identified among the colonised patients. Decolonisation treatment was offered to all colonised patients and healthcare workers.ConclusionIn low MRSA prevalence settings, healthcare workers may be a reservoir of MRSA and an important potential source of transmission to patients. Screening and decolonisation of colonised healthcare workers may provide a valuable strategy in managing linked hospital acquisitions and reduce the risk of occupationally acquired complications. MRSA mass screen of healthcare workers should be considered in transmission with a strain that has a potentially increased virulence, such as Panton-Valentine leucocidin methicillin-resistant Staphylococcus aureus.

Prevalence of Panton-Valentine leukocidin in methicillin-resistant Staphylococcus aureus clinical isolates at a university hospital in Northern Cyprus: a pilot study

“…PVL-MRSA has been also linked to nosocomial infections in which hospital transmission of CA-MRSA had occurred in the US [40], highlighting the important source of CA-MRSA as a public health threat in hospitals. In low MRSA prevalence settings, healthcare workers may also serve as a reservoir of MRSA and an important potential source of transmission to patients as demonstrated by several studies [41,42]. Several EU-EEA countries are still reporting high levels of MRSA.…”

Methicillin Resistant Staphylococcus aureus Nasal Carriage among Health Care Workers at Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan

“…HCWs of three major hospitals of Peshawar district and the general population were screened for MRSA colonization in a study carried out in Pakistan. The study observed a high prevalence in nasal mucosa both in HCWs and in the general population as compared to colonization in the armpit [20].…”

Determinants for voluntary participation in staff screening during an methicillin-resistant Staphylococcus aureus (MRSA) outbreak on a neonatal ward

“…This finding is in agreement with a study that identified the 'fear of stigmatization if confidentiality and anonymity protection fails' to be a challenge in staff MRSA screening. 7 'Subjective norms' seem to play an inferior role in predicting HCW behavior; only half of HCWs felt that they had been motivated by others to participate in the screening. Still, the invitation for screening by superiors might be beneficial because other studies have shown that counselling and emotional support from the decreeing authority is a facilitator for participation.…”