Health care workers dodging resistant bugs
February 1, 1997 3 minutes read
Health care workers dodging resistant bugs
No enteric colonization found in tested workers
Health care workers treating patients with resistant bacteria appear generally safe from acquiring the organisms themselves, researchers are finding. While it has long been known that the unwashed hands of health care workers can become transiently colonized long enough to carry pathogens from patient to patient, a recent study found no evidence of long-term carriage in the digestive tract.
"Health care workers do carry resistant organisms on their hands, but our question was, do they also self-inoculate themselves in the same way they inoculate the patients," says Yehuda Carmeli, MD, principal investigator and an infectious disease physician at Deaconess Hospital, in Boston.
In a study of 52 health care workers at the hospital, no evidence of carriage was found for four of the most significant bacteria resistant to antibiotics vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), enteric bacteria resistant to ceftazidime, and Clostridium difficile, the most common cause of diarrhea in hospitalized patients.
"All of these organisms can be carried in the GI tract," Carmeli tells Hospital Infection Control. "There is no reason that health care workers would be protected against inoculating themselves."
Workers fear participating in studies
The potential for acquisition and carriage of resistant bacteria by health care workers is a cause of concern and anxiety among both health care workers and public health authorities, he notes. Yet the question is difficult to study because of participants’ fears of possible personal and professional consequences if they are found to be carriers, and the possible legal and public-relations consequences to the hospital participating in the study, Carmeli observes. The study was conducted only after consulting with hospital legal advisors and receiving authorization from hospital administration, he adds.
In the study, 28 nurses, 14 physicians, and 10 others (nursing assistants and microbiology laboratory workers) participated. Patient care participants worked in four different wards, all areas that included patients who carried resistant bacteria. The laboratory workers worked directly with clinical specimens of organisms in the microbiology laboratory. Participants’ age averaged 35 years, and their average length of patient contact was 12 years (range 1.5 to 30 years). In order to ensure there would be no repercussions if tests were positive, participation in the study was voluntary and anonymous. Participants filled out a short questionnaire and submitted a stool sample. Colonization with the aforementioned pathogens was not found.
The results are encouraging to health care workers exposed daily to patients with bacteria, and provide some evidence that they may not be the source of transmission in hospitals, Carmeli argues. Most studies have uncovered health care worker colonization as part of epidemiologic outbreaks, rather then looking for carriage in a hospital in a non-outbreak setting.
"I personally expected that a relatively high rate of the health care workers would be asymptomatically colonized with these organisms," Carmeli says.
Though the reason for the results is not completely clear, immune-competent protective factors like stomach pH may be a more likely explanation than high compliance with infection control measures, he adds.
"Our observations were about 70% [compliance with] hand washing and glove use," he says. "It may be a little bit better than other places, but I don’t think it’s a major difference."
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