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Workplace Worry: BringingHome the Bacteria

Jeffrey Zurlinden, RN, MSMasthead Date September 23, 2002

Hospitals are crawling with germs. Each year more andmore hospitalized patients harbor strains of bacteriaresistant to conventional antibiotics - a circumstancethought to be spurred by overreliance on antibiotics andoverworked healthcare workers who fail to follow basicisolation precautions or even wash their hands. As everynurse knows, patients are clearly at risk of infection.

But what about the general public or the loved ones ofnurses who bring methicillin-resistant Staphylococcus aureus(MRSA) home on their uniforms or stethoscopes, in theirnostrils, or on their hands? If nurses carry hidden dangers,shouldn't they be cultured and treated for bad bugs?

Since it was first detected in 1961, MRSA has grown morecommon each year. Its prevalence, however, varies fromhospital to hospital and even from unit to unit within thesame hospital. A recent survey reported in EmergingInfectious Diseases estimated only 20% of patients inhospitals with fewer than 200 beds harbored MRSA, whilemore than 40% did so in large urban hospitals. Overall,ICUs and long-term care units claim the highest rates-often exceeding 50%, In hospitals, MRSA is typicallyspread from patient to patient on the hands andstethoscopes of healthcareworkers, including nurses.

Nurses expect to come into contact with MRSA bytouching infected patients or their dressings, catheters,and linens. But germs hide in patients' rooms more thanmany nurses realize. A 1997 study of patients colonized orinfected with MRSA published in Infection Control and

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Hospital Epidemiology foundthe beds,floors,linens,overbed tables, and blood pressure C(uffsof 73% of theinfected patients and 69% of the colonized patients werecontaminated. Forty-two percent of hospital personnelwithout direct contact with patients had MRSA on theirgloves after they touched contaminated items in infectedpatients'rooms.

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No wonder nurses draw criticism for wearing theirunsanitary uniforms home from their jobs in hospitals,especially if they stop to buy groceries along the way. Astudy of nurses in the United Kingdom published last yearin the Journal of Hospital Infection found S.aureus,Clostridium difficile, and vancomycin-resistant Enterococcuscling to nurses' uniforms following the end of their shifts;they also linger on the unlaundered uniforms of nurseswho report to work the next day. In a study of Americannurses reported in Emerging Infectious Diseases' March-April2001 issue, researchers cultured MRSA on nurses'uniforms or cover gowns after they completed theirmorning care tasks on patients who had MRSA in theirwounds or urine.

But not every nurse poses a direct threat to the public. Thespread of antibiotic-resistant bacteria from hospitals tocommunities requires special circumstances, says GeorgiaDash, RN,

MS, CIC, president of the Association for Professionals inInfection Control and Epidem-iology, Inc., and the directorof epidemology and infection control at the MedicalCollege of Pennsylvania Hospital in Philadelphia. "Nurseswho work in general medical units who go home in theirscrubs are not a risk to the public," she says. Even so,Dash insists nurses wear clean uniforms laundered inbleach; and she prefers nurses go straight home afterwork, change out of their uniforms, and shower.

Instead, transmission of MRSA requires nurses to come incontact with immune-compromised people who haveportals of entry for bacteria, such as open wounds, IVaccesses, or urinary catheters. Many nurses pull doubleduty, caring for critically ill patients in hospitals and helpingailing loved ones at home - elderly parents, friends withcancer, or sick infant grandchildren. To minimize the risk ofMRSA transmission, Dash recommends nurses followbasic precautions - thoroughly washing their hands andchanging out of their uniforms - before caring for sickloved ones.

Though they carry the risk of transmitting germs, nursesare seldom cultured for organisms, except during difficult-to-control outbreaks. Dash advises against widespread

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culturing for MRSA because test results can be difficult tointerpret. A positive result means a nurse harbored MRSAat the time of the culture, but the bacteria could betransient. Other nurses might remain colonized yet posescant risk of infecting others, she says.

Culturing for MRSA carries other risks to nurses, Dashsays. Until their cultures become negative, nurses who testpositive for the bacteria would be unable to work.

But an infection control nurse, who asked to remainnameless, thinks hospitals frown on culturing nurses forMRSA because of the economics of the nursing shortage."Hospitals don't want to screen nurses more often becausethey don't want to find MRSA and force nurses withpositive cultures to stay away from work," she says. "Theydo everything they can to keep units open and nursesworking." .

Dash wants greater attention paid to finding colonized andinfected patients. "The best method for preventing thespread of MRSA," she says, "is to identify infectedpatients, isolate them, culture their hospital roommates,and then be very stringent about following isolationprecautions."

Jeffrey Zurlinden, RN, MS, is a contributing writerfor NursingSpectrum.

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