Prevalence of Methicillin – resistant Staphylococcus aureus nasal carriage among patients and healthcare workers in Hemodialysis centers in North West Bank- Palestine

Staphylococcus aureus has long been recognized as important pathogen in hospitalized patients and has severe consequences, despite antibiotic therapy. Hemodialysis patients are immunosuppressed, and this increases their susceptibility to infection. The nasal carriage of MRSA among dialysis patients is significant not only in terms of predisposing to subsequent infections, but also in playing an important role in transmission among dialysis unit staff and their family members. This study aimed to explore the prevalence of Methicillin – resistant S. aureus nasal carriage among patients and healthcare workers in hemodialysis center in Northern West Bank-Palestine, to identify the risk factors associated with MRSA colonization in both patients and HCWs,and to assess the association between lab coat contaminations with S.aureus nasal colonization in healthcare workers. The cross sectional study was conducted in the period between October 2009 and January 2010 on 356 patients and 48 healthcare workers from the five hemodialysis units in governmental hospitals in Northern West Bank, Palestine. This study utilized two main instruments, questionnaire and nasal and HCWs lab coat swabs.The response rates of this study was 82.3% of patients and 75 % of HCWs. Data were analyzed using the Statistical Package for Social Sciences SPSS software (version 17). Evaluations were carried out at 95% confidence level and P < 0.05 was considered statistically significant.The prevalence of S. aureus nasal carriage is 17.9% (17.7% of patients and 19.4% of HCWs) and the prevalence of MRSA nasal carriage is 3.9% (3.75% of patients and 2.6% of HCWs). The percentage of white lab coat contamination with S. aureus was 8.3%, including 5.6% MRSA. S. aureus nasal carriage among patients was statistically associated with previous chronic disease (p=0.004), DM (p=0.020) and previous skin lesion around intravascular device. S.aureus nasal carriage among HCWs was statistically associated with wearing gloves at the working time (p=0.039) and changing gloves when caring for more than one patient(p=0.005). There was no association between S. aureus lab coat contamination with S. aureus nasal colonization in healthcare workers. Our data suggest that HD patients have lower rates of S. aureus nasal carriage compared with other countries. Monitoring and eradication of MRSA from patients, healthcare workers and their family members should be considered to prevent continuous spread between healthcare facilities and the community.