Table 2.
Studies reporting methicillin-resistant Staphylococcus aureus (MRSA) colonisation in healthcare workers (HCWs) in non-outbreak situations in Europe and The United States
| Reference | Study year (duration of the screening period) | Country |
Study population |
Swabbing methods |
Results |
Quality scoring b | |||
|---|---|---|---|---|---|---|---|---|---|
| Sample size | Profession, Healthcare setting a | Anatomic sampling sites | Screening strategy | No. (%) of subjects with MRSA | Related to occupation or specialty - % of subjects with MRSA | ||||
|
Quality level: high | |||||||||
| Baldwin 2009 [31] |
2005-2006 (9 months) |
Northern Ireland |
563 |
Nurses, care and domestic assistants, kitchen and clerical staff; nursing home (n = 45) |
Nose |
On one day in each nursing home |
43 (7.5) |
Nurses 8.7 |
1:Y; 2:Y; |
| Care assistants 10.2 |
3:Y; 4:N; |
||||||||
| Others 3.5 |
5:Y; 6:Y; |
||||||||
| 7:Y | |||||||||
| Elie-Turenne 2010 [32] |
2008 (4 weeks) |
US, New York |
256 |
Nurses/therapists, physicians, clerical staff, paramedics; hospital (emergency department (ED), ICU, pre-hospital emergency medical service (EMS) |
Nose |
Swabs taken between 5:00–11:00 to gain participation of staff who worked during night, day & mid-day shifts |
17 (6.6) |
Nurses/ther. 10.5 |
1:Y; 2:Y; |
| Physicians 3.8 |
3:N; 4:N; |
||||||||
| Clerical 3.6 |
5:Y; 6:Y; |
||||||||
| Paramedics 1.9 |
7:Y |
||||||||
| ED 9.6 |
|
||||||||
| ICU 5.1 | |||||||||
| EMS 1.9 | |||||||||
| Eveillard 2004 [33] |
1998-1999 (7 months) |
France |
965 |
Nursing, medical, laboratory, radiology, engineering and administrative staff; hospital (ICU, medical ward, LTCF-E) |
Nose |
ND |
60 (6.2) |
Nursing 9.6 |
1:Y; 2:Y; |
| Medical 6.3 |
3:Y; 4:N; |
||||||||
| Lab./radio. 2.7 |
5:Y; 6:Y; |
||||||||
| Engineering 2.0 |
7:Y |
||||||||
| Admin. 0.8 |
|
||||||||
| LTCF-E 36.0 |
|
||||||||
| Medical ward 12.5 | |||||||||
| ICU 3.0 | |||||||||
| Jager 2010 [34] |
2008 (4 months) |
The Netherlands |
266 |
Employees; medical microbiology laboratory (n = 5) |
Nose, throat |
Self-swabbing |
1 (0.4) |
|
1:Y; 2:Y; |
| 3:Y; 4:N; | |||||||||
| 5:Y; 6:Y; | |||||||||
| 7:N | |||||||||
| Johnston 2007 [35] |
2004-2005 (6 months) |
US, Baltimore |
200 |
Nurses and physicians; hospital (medical ICU and inpatient HIV infection unit) |
Nose |
Once a month |
4 (2.0)c |
|
1:Y; 2:N; |
| 8 (4.0)d |
3:Y; 4:N; |
||||||||
| 5:Y; 6:Y; | |||||||||
| 7:Y | |||||||||
| Suffoletto 2008 [36] |
2006 (3 months) |
US, Pittsburgh |
255 |
Nurses, nursing assistants, radiology and respiratory technicians, physicians, clerical staff; hospital (n = 5 (emergency departments) |
Nose |
Swabs taken at the beginning of the shift |
11 (4.3) |
Nursing/medical |
1:Y; 2:Y; |
| technicians 6.9 |
3:N; 4:N; |
||||||||
| Physicians 0.0 |
5:Y; 6:Y; |
||||||||
| Clerical 0.0 |
7:Y |
||||||||
| Vos 2009 [37] |
2000-2004 (4 years)c |
The Netherlands |
13.195 |
HCWs involved in the care of MRSA positive patients; hospital (medical centre) |
Nose, throat, skin lesions |
Routine personnel screening |
31 (0.2)d |
|
1:Y; 2:Y; |
| 3:Y; 4:N; | |||||||||
| 5:Y; 6:Y; | |||||||||
| 7:N | |||||||||
|
Quality level: moderate |
|
|
|
|
|
|
|
||
| Amorim 2009 [38] |
2003-2005 (26 months) |
Portugal |
126 |
HCWs (nurses, nurse aids, physician, administrative and technical staff); hospital (vascular surgery, endocrinology ward) |
Nose |
3 screening sessions per year |
6 (4.8)c |
Nurses 8.9 |
1:Y; 2:N; |
| Nurse aids 4.4 |
3:Y; 4:N; |
||||||||
| Physicians 2.5 |
5:Y; 6:Y; |
||||||||
| Admin/techn 0.0 |
7:N |
||||||||
| Becker 2013 [39] |
ND |
Germany |
13 |
Nursing staff; LTCF-E (n = 2) |
Nose |
ND |
1 (7.7) |
|
1:Y; 2:N; |
| 3:N; 4:N; | |||||||||
| 5:Y; 6:N; | |||||||||
| 7:N | |||||||||
| Berthelot 2004 [40] |
2000 (1 month) |
France |
333 |
Fellows, nursing and medical students; control group of HCWs; hospital |
Nose |
ND |
14 (2.5) |
Students 2.4 |
1:Y; 2:Y; |
| Control group 2.6 |
3:N; 4:N; |
||||||||
| 5:N; 6:N; | |||||||||
| 7:Y | |||||||||
| Bisaga 2008 [41] |
2006 (5 months) |
US, Chicago |
105 |
Nurses, physicians, technicians; hospital (emergency department) |
Nose |
Swabs taken during the shift at times convenient to the subjects |
16 (15.0) |
Nurses 17.0 |
1:Y; 2:N; |
| Physicians 8.0 |
3:N; 4:N; |
||||||||
| Technicians 18.0 |
5:Y; 6:Y; |
||||||||
| 7:Y | |||||||||
| Boisseau 2012 [42] |
2010 (1 day) |
France |
152 |
Physicians, paramedical HCWs; attendees of a medical conference |
Nose |
ND |
4 (2.4) |
|
1:Y; 2:N; |
| 3:N; 4:N; | |||||||||
| 5:Y; 6:Y; | |||||||||
| 7:N | |||||||||
| Brady 2009 [43] |
2008 (1 day) |
United Kingdom |
260 |
Surgical and non-surgical physicians (phys.); attendees of a medical conference (n = 2) |
Nose |
ND |
6 (2.0) |
Surgical phys. 4.8 |
1:Y; 2:Y; |
| Non-surgical phys. 0.6 |
3:N; 4:N; |
||||||||
| 5:N; 6:Y; | |||||||||
| 7:N | |||||||||
| Edmundson 2011 [44] |
2005-2008 (4 years) |
Ireland |
566 |
Nurses, doctors, radio-graphers, occupational therapists, porters, physiotherapists; hospital (orthopaedic unit) |
Nose |
Twice a year as far as possible |
27 (4.8)c |
|
1:Y; 2:Y; |
| 3:N; 4:N; | |||||||||
| 5:N; 6:Y; | |||||||||
| 7:N | |||||||||
| Garcia Lozano 2012 [45] |
2011 (1 month) |
Spain |
62 |
HCWs involved in treat-ment of MRSA-positive patients; hospital; (ICU in an institute of oncology) |
Nose, pharynx |
ND |
1 (1.6) |
|
1:Y; 2:N; |
| 3:N; 4:N; | |||||||||
| 5:Y; 6:N; | |||||||||
| 7:N | |||||||||
| Gruber 2013 [46] |
2006-2007 (6 months) |
Germany |
64 |
Staff members; nursing home (n = 8), geriatric clinic (n = 2) |
Nose, throat |
ND |
2 (3.1) |
Nursing home 4.0 |
1:Y; 2:N; |
| Geriatric clinic 0.0 |
3:N; 4:N; |
||||||||
| 5:Y; 6:N; | |||||||||
| 7:N | |||||||||
| Heudorf 2002 [47] |
2000-2001 (6 months) |
Germany |
158 |
Staff members; nursing home and geriatric rehabilitation unit |
Nose, throat |
ND |
1 (0.6) |
|
1:Y; 2:N; |
| 3:N; 4:N; | |||||||||
| 5:N; 6:N; | |||||||||
| 7:N | |||||||||
| Ibarra 2008 [48] |
2006-2007 (16 months) |
US, South Texas |
257 |
Nurses, physicians, other health care personnel; paediatric hospital |
Nose |
ND |
30 (12.0) |
Nurses 12.0 |
1:Y; 2:Y; |
| Physicians 13.0 |
3:N; 4:N; |
||||||||
| Other HCWs 11.0 |
5:Y; 6:Y; |
||||||||
| |
7:N |
||||||||
| Kaminski 2007 [49] |
2001-2002 (4 months) |
Germany |
324 |
Nurses and physicians involved in the treatment of MRSA-positive patients; hospital (trauma unit) |
Nose, throat |
ND |
17 (5.3) |
|
1:Y; 2:Y; |
| 3:N; 4:N; | |||||||||
| 5:Y; 6:N; | |||||||||
| 7:N | |||||||||
| Kampf 2003 [50] |
1995-1996 (12 months) |
Germany |
447 |
Nursing and medical staff); hospital (ICU and general ward) |
Nose, oro-pharynx |
Episodal staff screening |
3 (0.7) |
Nursing 0.8 |
1:Y; 2:Y; |
| Medical 0.0 |
3:N; 4:N; |
||||||||
| General ward 0.7 |
5:Y; 6:Y; |
||||||||
| ICU 0.6 |
7:N |
||||||||
| March 2010 [51] |
2008 (1 month) |
Italy |
69 |
Nurses, physicians and other staff; LTCF-E (n = 5) |
Nose, oro-pharynx, inguinum |
ND |
10 (14.5) |
|
1:Y; 2:N; |
| 3:Y; 4:N; | |||||||||
| 5:Y; 6:N; | |||||||||
| 7:N | |||||||||
| Monaco 2009 [52] |
2005 (2 days) |
Italy |
51 |
Staff members; nursing home |
Nose |
ND |
3 (5.8) |
|
1:Y; 2:N; |
| 3:N; 4:N; | |||||||||
| 5:Y; 6:N; | |||||||||
| 7:N | |||||||||
| Neuhaus 2002 [53] |
2000-2001 (12 months) |
Germany |
193 |
Nursing staff; nursing home (n = 61) |
Nose, throat |
ND |
1 (0.5) |
|
1:Y; 2:N; |
| 3:N; 4:N; | |||||||||
| 5:Y; 6:N; | |||||||||
| 7:Y | |||||||||
| Nulens 2005 [54] |
2003 (1 day) |
United Kingdom |
335 |
Physicians and non-physicians; attendees of a medical congress |
Nose |
Swabs taken by HCWs them-selves during the congress |
1 (0.3) |
Physicians 0.5 |
1:Y; 2:N; |
| Non-physicians 0.0 |
3:N; 4:N; |
||||||||
| |
5:Y; 6:N; |
||||||||
| 7:N | |||||||||
| Orsi 2008 [55] |
ND |
Italy |
200 |
Nurses and physicians; hospital (general ward, ICU, cardio- and neurological surgery unit) |
Nose |
Swabs taken at the beginning of the shift |
3 (1.5) |
Nurses 1.6 |
1:Y; 2:N; |
| Physicians 1.3 |
3:N; 4:N; |
||||||||
| 5:N; 6:Y; | |||||||||
| 7:Y | |||||||||
| Prior 2011 [56] |
2003 [2003–2010] |
Ireland |
172c [2.048]d |
Nurses, physicians, other staff; hospital (orthopaedic surgery unit) |
Nose |
Routine pre-employment screening |
3 (1.7)c [47 (2.3)]d |
|
1:Y; 2:Y; |
| 3:N; 4:N; | |||||||||
| 5:N; 6:Y; | |||||||||
| 7:N | |||||||||
| Reich-Schupke 2010 [57] |
2008 (8 weeks) |
Germany |
83 |
Employees; hospital (dermatological ward) |
Nose |
Swabs taken before starting work |
4 (4.8) |
|
1:Y; 2:N; |
| 3:N; 4:N; | |||||||||
| 5:Y; 6:Y; | |||||||||
| 7:N | |||||||||
| Sassmannshausen 2011 [58] |
2010 (ND) |
Germany |
726 |
HCWs (nurses, physicians, other staff); hospitals (n = 9) |
Nose, pharynx |
Swabs taken after a non-working weekend |
33 (4.5) 23 (3.2%)e |
|
1:Y; 2:Y; |
| 3:N; 4:N; | |||||||||
| 5:N; 6:N; | |||||||||
| 7:N | |||||||||
| Scarnato 2003 [59] |
2000 (12 months) |
France |
193 |
Nursing staff, physicians, physical therapists, office staff; geriatric wards (acute medical care and long-term care units) |
Nose |
Once a month |
4 (2.1)c |
|
1:Y; 2:N; |
| 3:N; 4:Y; | |||||||||
| 5:Y; 6:Y; | |||||||||
| 7:N | |||||||||
| Schwarzkopf 2010 [60] |
ND (12 months) |
US, New York |
135 |
Surgeons (resident and attending surgeons); hospital (orthopaedic surgery) |
Nose |
ND |
2 (1.5) |
Attending surgeons 2.7 |
1:Y; 2:N; |
| Resident surgeons 0.0 |
3:Y; 4:Y; |
||||||||
| |
5:N; 6:N; |
||||||||
| 7:N | |||||||||
| Stahl 2011 [61] | ND | France | 565 | Physicians (phys.); attendees of medical conferences in France | Nose | ND | 29 (5.1)f | Intensive care phys. 8.0 |
1:Y; 2:Y; |
| Infect. disease phys. 2.4 |
3:N; 4:N; |
||||||||
| Hygiene phys. 1.6 |
5:Y; 6: N; |
||||||||
| 7:N | |||||||||
aAbbreviations: ICU intensive care unit, LTCF-E long-term care facility for the elderly, ND not documented.
bDetails for criteria see Table 1.
cData related to the baseline screening.
dData related to the total study period (with repeated screening surveys).
ePositive on two consecutive swabs.
fNumber and percentage calculated by MD.