title: MRSA as an occupational disease: a case series.
abstract: OBJECTIVE
  Occupationally acquired infection with methicillin-resistant Staphylococcus aureus (MRSA) is an issue of increasing concern. However, the number of cases of occupational disease (OD) due to MRSA in healthcare workers (HCWs) and the characteristics of such cases have not been reported for Germany.
  
  
  METHODS
  Cases of OD due to MRSA were identified from the database of a compensation board (BGW) for the years 2006 and 2007 and the individual files analyzed. The variables extracted from these data were occupation, workplace, workplace exposure, and the reasons for recognizing a claim as an OD. Seven cases were selected due to the specific characteristics of their medical history and described in more detail.
  
  
  RESULTS
  Over a 2-year period, a total of 389 MRSA-related claims were reported to the BGW, of which 17 cases with infections were recognized as an OD. The reasons for not recognizing claims as an OD were either a lack of symptomatic infection or lack of a work-related MRSA exposure. The recognized cases were predominantly among staff in hospitals and nursing homes. The most frequent infection sites were ears, nose, and throat, followed by skin infections. Three cases exhibited secondary infection of the joints, associated with skin damage primarily caused by trauma. There was only one case in which a genetic link between an MRSA-infected index patient and MRSA in a HCW was documented. MRSA infections were recognized as an OD due to known contact with MRSA-positive patients or because workplace conditions were presumed to involve increased exposure to MRSA. Long-term incapacity resulted in four cases.
  
  
  CONCLUSIONS
  MRSA infection can cause severe health problems in HCWs that may lead to long-term incapacity. As recognition of HCW claims often depends on workplace characteristics, improved surveillance of MRSA infections in HCWs would facilitate the recognition of MRSA infections as an OD.
authors.affiliation: Institution of Statutory Accident Insurance of the Health and Welfare Services, Pappelallee 35/37, 22089, Hamburg, Germany. Frank.Haamann@bgw-online.de
authors.forename: Frank
authors.initials: F
authors.lastname: Haamann
authors.forename: Madeleine
authors.initials: M
authors.lastname: Dulon
authors.forename: Albert
authors.initials: A
authors.lastname: Nienhaus
mesh_terms: D000328:Adult; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D010564:Personnel, Hospital; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology