Healthcare workers and the incidence of nosocomial infection: can treatment of one influence the other?--a brief review

Abstract

Nasal carriage by health care workers represents an important hospital reservoir of Staphylococcus aureus. Approximately 25% of all hospital-based healthcare workers are stable nasal carriers. Several studies in the US and UK have shown that following treatment of this group with a single 5-day course of intranasal mupirocin, nasal carriage was usually eradicated within 24 hours, and after 12 weeks was only present in 25% of participants. Long-term follow-up in one institution after 52 weeks showed that there were significantly fewer carriers in the mupirocin group than in the group receiving identical placebo. In the same study, between 30% and 50% of those hospital workers who carried S. aureus in their nose, before the start of therapy, were also hand carriers. After treatment, a dramatic reduction in hand carriage of S. aureus was noted, in contrast to no change in the placebo group. After 6 months, the level of hand carriage was still statistically lower in the mupirocin group than in those given placebo. The association between nasal carriage and hand carriage makes it important that health care workers decontaminate their hands effectively between patients. Current evidence suggests, however, that compliance with such control measures is low. Other studies examining the role of S. aureus nasal carriage in the development of post-operative wound infection, have shown that almost half of those isolates recovered from the wound site were present in the nose of the patient pre-operatively. Due to its ability to eliminate nasal carriage of S. aureus, current studies are investigating whether intranasal mupirocin can prevent post-operative wound infections in patients undergoing surgery.