Hand and nasal carriage of Staphylococcus aureus and its rate of recolonization among healthcare workers of a tertiary care hospital in Nepal

BACKGROUND: Carriers of Staphylococcus aureus among healthcare workers (HCWs) can spread the bacteria to patients and the environment, in addition to their own risk of infection. OBJECTIVES: To determine the prevalence of S. aureus carriers among HCWs and the rate of recolonization after decolonization therapy with mupirocin. METHODS: Nasal and hand swabs from HCWs of a tertiary care hospital in Nepal were cultured on mannitol salt agar and S. aureus isolated were identified using standard microbiological procedures. Detection of MRSA and mupirocin-resistant S. aureus (MupRSA) isolates were done phenotypically. Identified S. aureus carriers were decolonized with 2% mupirocin nasal ointment. Recolonization of the carriers was assessed monthly for the next 5 months. RESULTS: Among the 213 HCWs, 18.3% were S. aureus carriers (35 nasal carriers, 4 both nasal and hand carriers, and no hand carriers). Overall, 9.4% of the HCWS were MRSA carriers and none were MupRSA carriers. After decolonization, 25.6% of them were recolonized and 50.0% of the recolonization was detected after 3 months of decolonization. All recolonized carriers had only MSSA strains (which colonized only nose), and none were recolonized with MupRSA. CONCLUSIONS: HCWs are frequent carriers of S. aureus and MRSA. Due to their continuous exposure to the hospital environment, they are at risk of colonization by this MDR organism. Regular screening and decolonization of HCWs working with high risk, vulnerable patients would reduce the risk of MRSA transmission from HCWs to patients.