title: Notification card to alert for methicillin-resistant Staphylococcus aureus is stigmatizing from the patient's point of view.
abstract: BACKGROUND
  The importance of alerting health care systems of patients carrying multidrug-resistant bacteria (MRB) is highlighted in numerous guidelines. In the absence of electronic alert systems, notification cards are often recommended, but have rarely been evaluated. We evaluated patient experiences of receiving and using a methicillin-resistant Staphylococcus aureus (MRSA) notification card.
  
  
  METHODS
  Two cohorts of patients given a card when identified for the first time as a carrier in 1999-2003 and 2008-2010, responded to questionnaires distributed in 2004 and 2011, respectively. The response rate in 2004 was 92 (38 females)/129 and in 2011 was 110 (55 females)/209. In addition, 63% and 49%, respectively, followed the encouragement to provide written comments to the questions. These were analysed using a qualitative method.
  
  
  RESULTS
  The patients took responsibility not to infect others, reported high usage, and acknowledged the importance of the card to inform health care institutions about their carrier status, despite experiencing fear, disrespect, lack of knowledge, and unprofessional behaviour when presenting it to personnel. Alarmingly these stigmatizing experiences were more frequent in 2011. Professional behaviour was reported from the infectious disease clinic. A majority of the patients were unaware of how they had acquired MRSA.
  
  
  CONCLUSIONS
  The MRSA notification card was felt to stigmatize the patient, which makes its use questionable. Other alert methods need to be developed. Most importantly, the study demonstrates the importance for these patients to meet staff educated about MRB. Thus, there is an urgent need to educate health care professionals at all levels.
authors.affiliation: From the 1 Infection Control Unit, Institution of Biomedicine, Department of Infectious Diseases, University of Gothenburg.
authors.forename: Eva
authors.initials: E
authors.lastname: Skyman
authors.forename: Ingegerd
authors.initials: I
authors.lastname: Bergbom
authors.forename: Berit
authors.initials: B
authors.lastname: Lindahl
authors.forename: Leif
authors.initials: L
authors.lastname: Larsson
authors.forename: Anna
authors.initials: A
authors.lastname: Lindqvist
authors.forename: Harrieth
authors.initials: H
authors.lastname: Thunberg Sjöström
authors.forename: Christina
authors.initials: C
authors.lastname: Ahrén
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002353:Carrier State / Q000175:diagnosis / Q000382:microbiology / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D003219:Confidentiality / Q000523:psychology*; D018563:Disease Notification; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D057545:Social Stigma; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000382:microbiology / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: MRSA; alerts; experience; notification card; patient