Occupational risk of exposure to methicillin-resistant Staphylococcus aureus (MRSA) and the quality of infection hygiene in nursing homes

Highlights

• Staff members were not colonised with MRSA.

• But staff were exposed to MRSA from air, sedimented dust and surfaces.

• MRSA was found in the rooms of MRSA-colonised residents but not in common areas.

• Staff worry about MRSA and spreading it to other residents, family, and acquaintances.

• The use of protective eyewear and facemasks could be improved.

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is an increasing health concern across the globe and is often prevalent at long-term care facilities, such as nursing homes. However, we know little of whether nursing home staff is exposed to MRSA via air and surfaces. We investigated whether staff members at nursing homes are colonised with and exposed to culturable MRSA, and assessed staff members’ self-reported knowledge of MRSA and compliance with infection hygiene guidelines. Five nursing homes with MRSA positive residents were visited in Copenhagen, Denmark. Personal bioaerosol exposure samples and environmental samples from surfaces, sedimented dust and bioaerosols were examined for MRSA and methicillin-susceptible S. aureus (MSSA) to determine occupational exposure. Swabs were taken from staffs’ nose, throat, and hands to determine whether they were colonised with MRSA. An online questionnaire about MRSA and infection control was distributed. No staff members were colonised with MRSA, but MRSA was detected in the rooms of the colonised residents in two out of the five nursing homes. MRSA was observed in air (n = 4 out of 42, ranging from 2.9–7.9 CFU/m³), sedimented dust (n = 1 out of 58, 1.1 × 10³ CFU/m²/d), and on surfaces (n = 9 out of 113, 0.04–70.8 CFU/m²). The questionnaire revealed that half of the staff members worry about spreading MRSA to others. Identified aspects for improvement were improved availability and use of protective equipment, not transferring cleaning supplies (e.g., vacuum cleaners) between residents’ rooms and to reduce worry of MRSA, e.g., through education.

Graphical abstract

Keywords

Antibiotic resistance / Airborne MRSA / Bioaerosols / Healthcare-associated infections / Healthcare worker / Occupational health

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Acknowledgements

We would like to thank all the participants in the study. We would also like to thank Prof. Dr. Monika Raulf for EDC supply. We acknowledge Margit W. Frederiksen, the National Research Institute of the Working Environment, Denmark, for excellent technical assistance. This work was supported by grant 16-B-0239 from Helsefonden and by the Danish Government through a grant to the FOR-SOSU program (SATS 2004) at the National Research Centre for the Working Environment, Denmark.

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