title: MRSA carriage among healthcare workers in non-outbreak settings in Europe and the United States: a systematic review.
abstract: A recent review estimated prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare workers (HCWs) to be 4.6%. However, MRSA carriage in HCWs in non-outbreak settings is thought to be higher than in an outbreak situation, due to increased hygiene awareness in outbreaks, but valid data are missing. The goals of this paper are to summarise the prevalence of MRSA carriage amongst HCWs in non-outbreak situations and to identify occupational groups in healthcare services associated with a higher risk of MRSA colonisation.
  
  
  METHODS
  A systematic search for literature was conducted in the MEDLINE and EMBASE databases. The methodological quality of the studies was assessed using seven criteria. Pooled prevalence rates were calculated. Pooled effect estimates were identified in a meta-analysis.
  
  
  RESULTS
  31 studies were included in this review. The pooled MRSA colonisation rate was 1.8% (95% confidence interval [CI], 1.34%-2.50%). The rate increased to 4.4% (95% CI, 3.98%-4.88%) when one study from the Netherlands was excluded. The pooled MRSA rate was highest in nursing staff (6.9%). Nursing staff had an odds ratio of 1.72 (95% CI, 1.07-2.77) when compared with medical staff and an odds ratio of 2.58 (95%, 1.83-3.66) when compared with other healthcare staff. Seven studies were assessed as being of high quality. The pooled MRSA prevalence in high quality studies was 1.1% or 5.4% if the one large study from the Netherlands is not considered. The pooled prevalence in studies of moderate quality was 4.0%.
  
  
  CONCLUSIONS
  MRSA prevalence among HCWs in non-outbreak settings was no higher than carriage rates estimated for outbreaks. Our estimate is in the lower half of the range of the published MRSA rates in the endemic setting. Our findings demonstrate that nursing staff have an increased risk for MRSA colonisation. In order to confirm this finding, more studies are needed, including healthcare professionals with varying degrees of exposure to MRSA. In order to reduce misclassification bias, standardisation of HCWs screening is warranted.
authors.affiliation: Department of Occupational Health Research, Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services, Pappelallee 33/35/37, 22089 Hamburg, Germany. madeleine.dulon@bgw-online.de.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Dulon
authors.forename: Claudia
authors.initials: C
authors.lastname: Peters
authors.forename: Anja
authors.initials: A
authors.lastname: Schablon
authors.forename: Albert
authors.initials: A
authors.lastname: Nienhaus
mesh_terms: D002353:Carrier State / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D006282:Health Personnel; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D015995:Prevalence; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D014481:United States / Q000453:epidemiology