Letter to the Editor: Methicillin-Resistant Staphylococcus aureus Is Carried by Healthcare Providers Engaged in Dressing Orthopedic Patients: A Simple Answer to a Complex Problem

To the Editor:

S taphylococcus aureus (Staph aureus or “Staph”) is a gram-positive coccus bacterium carried on the skin or nasal lining of up to 30% of healthy individuals. In this setting, the bacteria usually cause no symptoms. However, when the skin is damaged, Staphylococcus aureus can cause a wide range of problems such as impetigo, cellulitis, superficial abscesses, breast abscesses, etc. Initially, most Staphylococcus aureus infections were sensitive to penicillin. In the 1950s, many infections became resistant to penicillin and methicillin (a related drug developed to treat these germs). Thus, the term methicillin-resistant Staphylococcus aureus (MRSA) was derived. Staphylococcus aureus is the most common infective organism seen in orthopedic patients. It is gram-positive cocci in clusters.

Control of MRSA transmission has been unsuccessful in many hospitals. For a long time, MRSA has been considered the prototype of multiresistant nosocomial pathogens, causing infections in high-risk patients. Changes in the healthcare system, coupled with the evolution of this versatile micro-organism, have transformed MRSA into a cause of community-onset infections in both patients who have contact with the healthcare system and patients without such a risk factor. New lineages of MRSA, defined as community-acquired (CA)-MRSA, have emerged that have a propensity to cause infections in young individuals without risk factors. It has been observed that dressers assigned for dressing wounds transmit the infection to non-infected patients.

There are many studies about the screening of patients for MRSA. However, a few are related to the screening of healthcare professionals and the transmission of infection to patients from hospital encounters. It is mentioned in the studies that healthcare workers can also transmit the infection to patients visiting rehabilitation centers. A study conducted in Germany in 2008 showed that the transmission of MRSA from healthcare personnel to patients was likely in 63 (93%) of 68 studies that undertook genotyping. In 449 (88%) of 510 healthcare workers, MRSA eradication was achieved. Subclinical infections and colonization of extra-nasal sites were associated with persistent carriage. Samples from nares, axillae, and hands were inoculated onto appropriate media to perform colony counts of methicillin-susceptible Staphylococcus aureus (MSSA) and MRSA.

Here we recommend a proper solution: the education and regular screening of the healthcare personnel assigned for the regular dressing of open wounds in orthopedic wards such as nasal swabs for polymerase chain reaction (PCR) every week. Apart from that, we can also use topical antibiotic agents.

Proper education and awareness of the healthcare professionals and their target screening could help to decrease the burden of antibiotic agents for nosocomial MRSA infections. Target screening of dressers and other healthcare personnel would be possible in every hospital to lessen the load of microbes. Unfortunately, in third-world countries, no proper measures are being taken to reduce the transfer of microbes from service providers to patients.

To conclude, MRSA has become a major burden for healthcare centers. Studies suggest that it can be transmitted from dressers to admitted patients. If correctly set up and a team is available in every tertiary care hospital for screening of healthcare personnel, there would surely be a decrease in wound complications and further usage of broad-spectrum antibiotic agents, increasing the financial burden on the healthcare system. Second, MRSA-sensitive antibiotic agents have many adverse effects, such as their role in organ failure after overusage, monitoring, and lengthy hospital stay.