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1.  Involvement of occupational physicians in the management of MRSA-colonised healthcare workers in Germany – a survey 
Colonisation of healthcare workers (HCWs) with methicillin-resistant Staphylococcus aureus strains (MRSA) is a challenge for any healthcare facility. Persistent carriage of MRSA among HCWs causes special problems, particularly in occupational-medical care. German occupational physicians responsible for healthcare facilities were therefore asked about their experience in managing MRSA-colonised HCWs.
In May 2012, 549 occupational physicians were asked in writing about in-house management of MRSA-colonised HCWs. The semi-standardised survey form contained questions about collaboration between the infection control team and the occupational physician, the involvement of the occupational physician in in-house management of MRSA carriers and the number of persistently colonised HCWs in 2011. The answers were intended to apply to the largest facility cared for by the occupational physician.
207 occupational physicians took part in the survey (response rate 38%). In 2011, 73 (35%) occupational physicians were responsible for the occupational-medical management of an average of four MRSA-colonised HCWs. Eleven doctors (5.3% of 207) managed a total of 17 persistently colonised HCWs. One of these 17 employees was dismissed. In the case of MRSA carriage among HCWs, most occupational physicians cooperated with the infection control team (77%) and 39% of occupational physicians were responsible for the occupational-medical management of the affected carrier. 65% of facilities had specified policies for the management of MRSA-colonised HCWs. After the first MRSA-positive screening result, 79% of facilities attempt to decolonise the affected employee. In 6% of facilities, the colonised HCWs were excluded from work while receiving decolonisation treatment. In 54% of facilities, infection control policies demand the removal of MRSA carriers from patient care.
Not all facilities have policies for the management of MRSA-colonised HCWs and there are major differences in occupational consequences for the affected HCWs. In order to protect both the employees and the patients, standards for the in-house management of MRSA colonisation in HCWs should be developed.
PMCID: PMC3668962  PMID: 23710905
Methicillin-resistant Staphylococcus aureus; Colonisation; Persistent carriage; Healthcare worker; Occupational disease
2.  Frequency of Thyroid Dysfunctions during Interferon Alpha Treatment of Single and Combination Therapy in Hepatitis C Virus-Infected Patients: A Systematic Review Based Analysis 
PLoS ONE  2013;8(2):e55364.
Thyroid dysfunction is the commonest endocrinopathy associated with HCV infection due to interferon-based treatment. This comprehensive and systematic review presents the available evidence for newly developed thyroid antibodies and dysfunctions during interferon treatment (both single and combination) in HCV patients.
Methodology/Principal Findings
This systematic review was conducted in accordance with the PRISMA guidelines. The data generated were used to analyze the risk for thyroid dysfunctions during interferon (IFN) treatment in HCV patients. There was a wide range in the incidence of newly developed thyroid dysfunctions and thyroid antibodies in HCV patients during IFN treatment (both single and combination). The wide range of incidence also denoted the possibility of factors other than IFN treatment for thyroid-related abnormalities in HCV patients. These other factors include HCV viral factors, genetic predisposition, environmental factors, and patho-physiological factors. Variations in IFN dosage, treatment duration of IFN, definition/criteria followed in each study for thyroid dysfunction and irregular thyroid function testing during treatment in different studies influence the outcome of the single studies and jeopardise the validity of a pooled risk estimate of side effects of thyroid dysfunction. Importantly, reports differ as to whether the thyroid-related side effects disappear totally after withdrawal of the IFN treatment.
The present review shows that there is a wide range in the incidence of newly developed thyroid dysfunctions and thyroid antibodies in IFN treated HCV patients. This is a comprehensive attempt to collate relevant data from 56 publications across several nations about IFN (both mono and combination therapy) related thyroid dysfunction among HCV patients. The role of each factor in causing thyroid dysfunctions in HCV patients treated with IFN should be analyzed in detail in future studies, for a better understanding of the problem and sounder clinical management of the disease.
PMCID: PMC3562313  PMID: 23383326
3.  Radiation exposure of eyes, thyroid gland and hands in orthopaedic staff: a systematic review 
Various procedures, especially minimal invasive techniques using fluoroscopy, pose a risk of radiation exposure to orthopaedic staff. Anatomical sites such as the eyes, thyroid glands and hands are more vulnerable to radiation considering the limited use of personal protective devices in the workplace. The objective of the study is to assess the annual mean cumulative and per procedure radiation dose received at anatomical locations like eyes, thyroid glands and hands in orthopaedic staff using systematic review.
The review of literature was conducted using systematic search of the database sources like PUBMED and EMBASE using appropriate keywords. The eligibility criteria and the data extraction of literature were based on study design (cohort or cross-sectional study), study population (orthopaedic surgeons or their assistants), exposure (doses of workplace radiation exposure at hands/fingers, eye/forehead, neck/thyroid), language (German and English). The literature search was conducted using a PRISMA checklist and flow chart.
Forty-two articles were found eligible and included for the review. The results show that radiation doses for the anatomical locations of eye, thyroid gland and hands were lower than the dose levels recommended. But there is a considerable variation of radiation dose received at all three anatomical locations mainly due to different situations including procedures (open and minimally invasive), work experience (junior and senior surgeons),distance from the primary and secondary radiation, and use of personal protective equipments (PPEs). The surgeons receive higher radiation dose during minimally invasive procedures compared to open procedures. Junior surgeons are at higher risk of radiation exposure compared to seniors. PPEs play a significant role in reduction of radiation dose.
Although the current radiation precautions appear to be adequate based on the low dose radiation, more in-depth studies are required on the variations of radiation dose in orthopaedic staff, at different anatomical locations and situations.
PMCID: PMC3554445  PMID: 23111028
Radiation; Dose; Orthopaedic
4.  Infectious diseases in healthcare workers – an analysis of the standardised data set of a German compensation board 
Healthcare workers (HCW) are exposed to infectious agents. Disease surveillance is therefore needed in order to foster prevention.
The data of the compensation board that covers HCWs of non-governmental healthcare providers in Germany was analysed for a five-year period. For hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, the period analysed was extended to the last 15 years. The annual rate of occupational infectious diseases (OIDs) per 100,000 employees was calculated. For needlestick injuries (NSI) a rate per 1,000 employees was calculated.
Within the five years from 2005 to 2009 a total of 384 HCV infections were recognised as OIDs (1.5/100,000 employees). Active TB was the second most frequent cause of an OID. While the numbers of HBV and HCV infections decreased, the numbers for active TB did not follow a clear pattern. Needlestick injuries (NSIs) were reported especially often at hospitals (29.9/1,000 versus 7.4/1,000 employees for all other HCWs).
Although they are declining, HCV infections remain frequent in HCWs, as do NSIs. Whether the reinforcement of the recommendations for the use of safety devices in Germany will prevent NSIs and therefore HCV infections should be closely observed.
PMCID: PMC3474162  PMID: 22553942
Healthcare workers; Infections; Tuberculosis; Needlestick injuries; Blood-borne virus infections
5.  MRSA prevalence in european healthcare settings: a review 
BMC Infectious Diseases  2011;11:138.
During the past two decades, methicillin-resistant Staphylococcus aureus (MRSA) has become increasingly common as a source of nosocomial infections. Most studies of MRSA surveillance were performed during outbreaks, so that results are not applicable to settings in which MRSA is endemic. This paper gives an overview of MRSA prevalence in hospitals and other healthcare institutions in non-outbreak situations in Western Europe.
A keyword search was conducted in the Medline database (2000 through June 2010). Titles and abstracts were screened to identify studies on MRSA prevalence in patients in non-outbreak situations in European healthcare facilities. Each study was assessed using seven quality criteria (outcome definition, time unit, target population, participants, observer bias, screening procedure, swabbing sites) and categorized as 'good', 'fair', or 'poor'.
31 observational studies were included in the review. Four of the studies were of good quality. Surveillance screening of MRSA was performed in long-term care (11 studies) and acute care (20 studies). Prevalence rates varied over a wide range, from less than 1% to greater than 20%. Prevalence in the acute care and long-term care settings was comparable. The prevalence of MRSA was expressed in various ways - the percentage of MRSA among patients (range between 1% and 24%), the percentage of MRSA among S. aureus isolates (range between 5% and 54%), and as the prevalence density (range between 0.4 and 4 MRSA cases per 1,000 patient days). The screening policy differed with respect to time points (on admission or during hospital stay), selection criteria (all admissions or patients at high risk for MRSA) and anatomical sampling sites.
This review underlines the methodological differences between studies of MRSA surveillance. For comparisons between different healthcare settings, surveillance methods and outcome calculations should be standardized.
PMCID: PMC3128047  PMID: 21599908
6.  MRSA as an occupational disease: a case series 
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.
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.
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.
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.
PMCID: PMC3037496  PMID: 21212973
MRSA; Occupational disease; Infection; Healthcare worker; Surveillance

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