Involvement of occupational physicians in the management of MRSA-colonised healthcare workers in Germany – a survey

Abstract

BackgroundColonisation of healthcare workers (HCWs) with methicillin-resistant Staphylococcus aureus strains (MRSA) is a challenge for any healthcare facility. Persistent carriage of MRSA among HCWs causes special problems, particularly in occupational-medical care. German occupational physicians responsible for healthcare facilities were therefore asked about their experience in managing MRSA-colonised HCWs.MethodsIn May 2012, 549 occupational physicians were asked in writing about in-house management of MRSA-colonised HCWs. The semi-standardised survey form contained questions about collaboration between the infection control team and the occupational physician, the involvement of the occupational physician in in-house management of MRSA carriers and the number of persistently colonised HCWs in 2011. The answers were intended to apply to the largest facility cared for by the occupational physician.Results207 occupational physicians took part in the survey (response rate 38%). In 2011, 73 (35%) occupational physicians were responsible for the occupational-medical management of an average of four MRSA-colonised HCWs. Eleven doctors (5.3% of 207) managed a total of 17 persistently colonised HCWs. One of these 17 employees was dismissed. In the case of MRSA carriage among HCWs, most occupational physicians cooperated with the infection control team (77%) and 39% of occupational physicians were responsible for the occupational-medical management of the affected carrier. 65% of facilities had specified policies for the management of MRSA-colonised HCWs. After the first MRSA-positive screening result, 79% of facilities attempt to decolonise the affected employee. In 6% of facilities, the colonised HCWs were excluded from work while receiving decolonisation treatment. In 54% of facilities, infection control policies demand the removal of MRSA carriers from patient care.ConclusionsNot all facilities have policies for the management of MRSA-colonised HCWs and there are major differences in occupational consequences for the affected HCWs. In order to protect both the employees and the patients, standards for the in-house management of MRSA colonisation in HCWs should be developed.

Infections in Healthcare Workers in Germany—22-Year Time Trends

“…Nurses were more often affected than physicians [12]. As colonisation of a HW with MRSA is not covered by accident insurance, occupational health physicians are reluctant to screen HWs for MRSA due to not knowing how to manage cases of MRSA-positive HWs who are not only transitorily colonised [50,51,52]. In order to prevent transmission of MRSA from HWs to patients, regulations are needed for the screening of HWs and the management of MRSA-positive HWs.…”

Methicillin-resistant Staphylococcus sp. colonizing health care workers of a cancer hospital

“…We also believe that knowledge of MRS colonization may contribute to changing HCWs attitudes in relation to prevention and control measures ( Eveillard et al , 2004 ). With regard to occupational safety, colonization or infection of HCWs with MRSA should be considered an occupational hazard and injury according to local legislation ( Albrich and Harbarth, 2008 ; Dulon et al , 2013 ), and we emphasize that colonization by MR-CoNS also represents a risk to HCWs’ health.…”

Beruflich erworbene MRSA-Besiedelung in der berufsdermatologischen Begutachtung (BK-Nr. 3101)

“…Umfragen unter Betriebsärzten in Deutschland ergaben, dass derzeit noch sehr große Unterschiede zwischen verschiedenen Pflegeeinrichtungen bezüglich des Umgangs mit MRSA-kolonisierten Mitarbeitern herrschen [11].…”