By Will Boggs, MD

NEW YORK (Reuters Health) - Health care workers in emergency departments are often carriers of the methicillin-resistant Staphylococcus aureus, or (MRSA), potentially putting patients at risk, according to two reports in the Annals of Emergency Medicine.

Testing positive for MRSA is sometimes transient among health care workers, but unfortunately the results of this study, along with the findings of the second report, reinforce concerns that MRSA carriers are an important part of the transmission of MRSA among patients, Dr. Elise O. Lovell from Advocate Christ Medical Center, Oak Lawn, Illinois, told Reuters Health.

Lovell and colleagues collected nasal swabs from a sample of 105 emergency department staff at their institution. Sixteen subjects (15 percent) tested positive for MRSA, including 12 nurses, 2 physicians, and 2 technicians.

The MRSA positivity rates in our emergency department health care workers is "much higher than that found in the general US population, but is similar to rates seen in other studies of non-ED medical personnel," Dr. Lovell said.

In the second report, Dr. Brian P. Suffoletto and colleagues from the University of Pittsburgh Department of Emergency Medicine measured the prevalence of Staphylococcus aureus and MRSA in 255 emergency department health care workers.

Just under one third of nasal cultures (31.8 percent) were positive for S. aureus, the researchers report, and the overall prevalence of MRSA 0was 4.3 percent.

None of the demographic and exposure characteristics examined were significantly associated with MRSA colonization, the investigators say, but MRSA colonization was restricted to nurses, nursing assistants, and radiology and respiratory technicians.

"The varying prevalence among the different health care workers was unexpected," Suffoletto told Reuters Health.

The relationship between MRSA-positive ED personnel and patient transmission is "still largely unexplored," Suffoletto continued. First we will need to establish if MRSA in ED personnel is transient or persistent. "Then we wish to determine the rate of unprotected contacts between ED personnel and patients."

Both Lovell and Suffoletto stressed the importance of using universal infection control practices in the emergency department.

"It's been demonstrated repeatedly that these hygiene techniques are poorly followed in the ED, yet they represent the best (and simplest) way to minimize the spread of MRSA between our patients and to keep our patients and ourselves safe," Lovell said.

"The findings in these reports may have important implications for infection control practice," agrees Dr. John A. Jernigan from the U.S. Centers for Disease Control and Prevention, Atlanta, writing in a related editorial.

"Better implementation of current recommendations for preventing transmission of MRSA and other multidrug-resistant organisms will likely yield important benefits for both patients and health care personnel."

SOURCE: Annals of Emergency Medicine, November 2008.

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