Methicillin-Resistant Staphylococcus Aureus (MRSA) in a Portuguese hospital and its risk perception by health care professionals

Abstract

Objective: To describe the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) and to assess its perception by healthcare professionals. Design: Survey, through a two-part questionnaire. Setting: A 441-bed district general hospital. Participants: Part I - Inpatients over 16 years of age, in whom a non-nasal MRSA was isolated between February and August of 2005. Part II - nurses and doctors responsible for these patients. Methods: Part I - Demographic and clinical data collected from medical notes. Part II - Perception of doctors and nurses. Observed agreement and "Kappa" statistic were used to compare perceptions. A P value lower than 0.05 was considered to be statistically significant. Results: Of the 111 patients identified, 50.9% had history of hospitalization during the previous year, with high exposure to antimicrobial therapy and invasive procedures. Hospital stay was 4.5 times higher than the average inpatients and mortality 5.5 times higher. Proportion of MRSA was 60.0%, with an incidence density of 1.66%. Although agreement between nurses and doctors was low, the majority admitted nosocomial origin of the MRSA and its transmission through the hands of professionals. Reinforcement of hand hygiene was considered important to manage these patients by 69.4% of nurses and 64.9% of doctors. Additionally, all nurses and 89.4% of doctors agreed on the need to isolate these patients. Conclusions: High endemic level of MRSA detected in a susceptible population, associated with a lower awareness of management of these patients by doctors, compared with nurses, justifies a global programme to control MRSA. This programme should include consensus-based measures for management of patients, rational use of antimicrobials, and dynamic and focused educational programmes. © 2011 Sociedade Portuguesa de Cardiologia.