Should Healthcare Workers Colonized With MRSA Avoid Patients?

Question

If a healthcare worker is colonized with methicillin-resistant Staphylococcus aureus as determined by a positive culture result from the nares, what treatment should they receive? Are there any restrictions against working in an acute care facility?

Response from Kimberly K. Scarsi, PharmD, MS Assistant Professor, Research, Division of Infectious Diseases, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Clinical Pharmacist, Northwestern Memorial Hospital, Chicago, Illinois

Preventing transmission of drug-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA) is a high priority for infection control and prevention. Although studies have demonstrated that patients colonized with MRSA are at a higher risk of subsequent MRSA infection due to their own flora, colonized healthcare workers (HCWs) are rarely the source of MRSA transmission to patients. In fact, 1 literature review found that only 1.6% of 191 MRSA outbreaks in a nosocomial setting were associated with asymptomatic HCWs.^[1] Routine screening of asymptomatic HCWs for MRSA colonization is thus not warranted. Of note, when HCWs are implicated in MRSA transmission, this is more likely due to poor hand hygiene resulting in patient-to-patient transmission.^[2]

Routine decolonization of HCWs who are asymptomatic MRSA carriers is not recommended. However, if a HCW is identified as the source of a MRSA outbreak, then decolonization is considered in combination with a full infection control management plan. In this situation, the HCW should avoid direct patient care activities until culture results are negative.^[2] In situations where decolonization is necessary, the optimal pharmacologic regimen has not been firmly established. Options include topical decolonization of the nares alone; topical nasal and whole body decolonization; and topical decolonization plus oral antimicrobial agents.

Mupirocin (Bactroban^®) remains the only medication approved by the US Food and Drug Administration for nasal decolonization. However, other topical products such as bacitracin are under investigation for mupirocin-resistant MRSA strains. Mupirocin is commonly used with antiseptic body washes such as chlorhexidine, with or without oral agents such as rifampin, tetracyclines, or trimethoprim-sulfamethoxazole. Two recent reviews provide a detailed discussion of the evidence for each therapy and are useful resources.^[3,4] Importantly, investigations to date have not addressed key areas such as the long-term effect of decolonization on infection recurrence, rates of re-colonization after a pharmacologic intervention, or the effect of decolonization on drug resistance.^[2]

In summary, given that asymptomatic MRSA-colonized HCWs rarely transmit MRSA to patients, US guidelines do not recommend routine screening of or decolonization for asymptomatic HCWs. Similarly, guidelines do not recommend restricting work activities unless colonized HCWs are found to be the source of MRSA transmission. Although pharmacologic decolonization is an important tool in clinical management of MRSA colonization in certain situations, it cannot replace the importance of consistent hand hygiene.

Source : http://www.medscape.com/viewarticle/703473?src=mp&spon=34&uac=133298AG