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Open Access Highly Accessed Research article

Health care workers causing large nosocomial outbreaks: a systematic review

Lisa Danzmann1, Petra Gastmeier2, Frank Schwab2 and Ralf-Peter Vonberg1*

Author Affiliations

1 Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover D-30625, Germany

2 Institute for Hygiene and Environmental Health, Charité – University Medicine Berlin, Berlin, Germany

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BMC Infectious Diseases 2013, 13:98  doi:10.1186/1471-2334-13-98

Published: 22 February 2013

Abstract

Backgrounds

Staff in the hospital itself may be the source of a nosocomial outbreak (NO). But the role of undetected carriers as an outbreak source is yet unknown.

Methods

A systematic review was conducted to evaluate outbreaks caused by health care workers (HCW). The Worldwide Outbreak Database and PubMed served as primary sources of data. Articles in English, German or French were included. Other reviews were excluded. There were no restrictions with respect to the date of publication.

Data on setting, pathogens, route of transmission, and characteristics of the HCW was retrieved. Data from large outbreaks were compared to smaller outbreaks.

Results

152 outbreaks were included, mainly from surgery, neonatology, and gynecology departments. Most frequent corresponding infections were surgical site infections, infection by hepatitis B virus, and septicemia. Hepatitis B virus (27 NO), S. aureus (49 NO) and S. pyogenes (19 NO) were the predominant pathogens involved. 59 outbreaks (41.5%) derived from physicians and 56 outbreaks (39.4%) derived from nurses. Transmission mainly occurred via direct contact. Surgical and pediatric departments were significantly associated with smaller outbreaks, and gynecology with larger outbreaks. Awareness of carrier status significantly decreased the risk of causing large outbreaks.

Conclusions

As NO caused by HCW represent a rare event, screening of personnel should not be performed regularly. However, if certain species of microorganisms are involved, the possibility of a carrier should be taken into account.

Keywords:
Nosocomial outbreak; Staff; Personnel; Health care workers; Health care associated infection