Orellana Robert C, Hoet Armando E, Bell Christopher, Kelley Christina, Lu Bo, Anderson Sarah E, Stevenson Kurt B
Prehosp Emerg Care. 2016;20(2):184-90. doi: 10.3109/10903127.2015.1076098. Epub 2015 Oct 30.
The objective was to determine the nasal carriage prevalence of methicillin-resistant Staphylococcus aureus (MRSA) among emergency medical service (EMS) personnel and the associated risk factors. A cross-sectional study was conducted among Ohio EMS personnel randomly sampled from 84 urban and rural agencies. Surveys assessing demographics, occupational history, health, cohabitation status, and hygiene practice were collected with nasal swabs from those who enrolled. Survey weight adjusted analysis was performed (1) to estimate MRSA nasal carriage prevalence of Ohio EMS providers, and (2) to identify variables associated with MRSA. MRSA was detected in 4.6% (13/280) EMS personnel sampled. After employing a survey-weighted analysis the following risk factors associated with MRSA carriage were identified: those who did not practice frequent hand hygiene after glove use (OR, 10.51; 95% CI, 2.54-43.45; P = 0.0012), living with someone with a recent staphylococcal infection (OR, 9.02; 95% CI, 1.03-78.98; P = 0.0470), and individuals with low frequency of hand washing (< 8 times per shift) (OR, 4.20; 95% CI 1.02-17.27; P = 0.0468). An additional risk factor identified through the logistic regression analysis on the study population was EMS workers with an open wound or skin infection (OR, 6.75; 95% CI, 1.25-36.36; P = 0.0262). However, this was not significant in the survey-weighted analysis. The high prevalence of MRSA in Ohio EMS personnel is both an occupational hazard and patient safety concern. Implementing methods to reinforce CDC guidelines for proper hygiene could decrease MRSA found in the EMS setting. Previous literature suggests that a reduction in MRSA colonization can lead to decreases in transmission and improved health for both patients and personnel.
目的是确定急诊医疗服务（EMS）人员中甲氧西林耐药金黄色葡萄球菌（MRSA）的鼻腔携带率及其相关危险因素。对从84个城乡机构中随机抽取的俄亥俄州EMS人员进行了一项横断面研究。收集了评估人口统计学、职业史、健康状况、同居状况和卫生习惯的调查问卷，并对入选者进行鼻腔拭子采样。进行了调查权重调整分析：（1）估计俄亥俄州EMS提供者的MRSA鼻腔携带率；（2）确定与MRSA相关的变量。在采样的280名EMS人员中，4.6%（13/280）检测出MRSA。采用调查加权分析后，确定了以下与MRSA携带相关的危险因素：手套使用后不经常洗手的人员（比值比[OR]，10.51；95%置信区间[CI]，2.54 - 43.45；P = 0.0012）、与近期有葡萄球菌感染的人同住的人员（OR，9.02；95% CI，1.03 - 78.98；P = 0.0470）以及洗手频率低（每班<8次）的人员（OR，4.20；95% CI，1.02 - 17.27；P = 0.0468）。通过对研究人群进行逻辑回归分析确定的另一个危险因素是有开放性伤口或皮肤感染的EMS工作者（OR，6.75；95% CI，1.25 - 36.36；P = 0.0262）。然而，在调查加权分析中这并不显著。俄亥俄州EMS人员中MRSA的高携带率既是一种职业危害，也是患者安全问题。实施强化美国疾病控制与预防中心（CDC）正确卫生指南的方法可以减少EMS环境中发现的MRSA。既往文献表明，MRSA定植的减少可导致传播减少，并改善患者和工作人员的健康状况。
