StaphylococcuS aureuS carriage among health care workers at the regional hospital of korca, albania

background. Health care workers (HCWs) are considered as one of the main sources of nosocomial infections. Staphylococcus aureus associated nosocomial infection remains a major health challenge. These infections continues to increase worldwide, particularly in poor countries where infection prevention is more difficult due to lack in hygiene and logistics. Aim. This study aimed to make evident the prevalence of Staphylococcus aureus in nose among HCWs at the Regional Hospital of Korca Albania. Methods. A total number of 102 swabs were collected from the HCWs of different departments of the hospital. Staphylococcus aureus identification was based on the classics methods of microbiology: culture characteristics, microscopy after Gram stain and biochemical tests. results. The swabs resulted positive for Staphylococcus aureus in 44 (43.1%) samples. Conclusions. The prevalence of Staphylococcus aureus in HCWs of the Regional Hospital of Korca is high. This is an indication of potential risk for nosocomial infections in the hospital.


bAcKGrOUND
HCWs are considered as one of the main sources of nosocomial infections. Staphylococcus aureus associated nosocomial infection remains a major health challenge. These infections continue to increase worldwide, particularly in poor countries where infection prevention is more difficult due to lack in hygiene and logistics [1].
Staphylococcus aureus is the main microbial agent that cause nosocomial infections. This problem becomes more serious because of the increasing resistance of this pathogen to various antibiotic, which complicates treatment of Staphylococcus aureus infections. Studies have shown that nasal and throat carrier of Staphylococcus aureus have an important role in acquiring and transmitting infections with this pathogen [2][3][4].
HCWs in hospitals especially serve as reservoir of multiresistant strains of Staphylococcus aureus [5,6]. This is associated with high risk of developing morbidity and mortality especially in postoperative patients. Therefore, infection prevention remains the most important thing to do.
Is evident that in healthy people, can be distinguished three patterns of Staphylococcus carriers: about 20% of people are persistent carriers, 60% are intermittent carriers, and approximately 20% almost never carry Staphylococcus aureus [2].

AIM
This study aimed to make evident the prevalence of Staphylococcus aureus in nose among HCWs at the Regional Hospital of Korca Albania.

MEtHODs
A total number of 102 swabs were collected from the HCWs of different departments of the hospital. 28 samples were collected from the surgery department, 14 samples from orthopedic department, 12 samples from the Intensive Care Unit, 18 samples from obstetric department, 20 samples from gynecology department and 10 samples from neonatology department. 38 samples were collected from the doctors and 64 samples from the nurses of the hospital. 52 samples were collected from male HCWs and 50 from female HCWS. The collected swabs were cultured in Agar blood and incubated in 37°C for 18-24 hours. The next step was the microbial identification of the positive samples. Staphylococcus aureus identification was based in the methods of classic microbiology: colonies characteristic, microscopy after Gram stain and biochemical tests.
Staphylococcus aureus produces white 1-2 mm in diameter colonies or yellow to cream. Some strains are beta-haemolytic in the presence of oxygen. Colonies are easily emulsified and slightly raised. In microscopy after Gram stain were observed Gram-positive cocci in grape-like clusters [7].
The biochemical test used for the identification of Staphylococcus aureus were the catalase test which distinguished catalase positive bacteris (staphylococci) from catalase negative bacteria (streptococci) and the slide coagulase test to distinguish Staphylococcus aureus from the other staphylococci.

Statistical analysis
Chi-square analysis was used. The analysis was conducted using the SPSS version 20.0. Statistical significance was considered to be the value of p ≤ 0.05. The highest prevalence of Staphylococcus aureus resulted from the samples of obstetric department (55.5%). The lowest prevalence resulted in the Intensive Care Unit (16.6%). The prevalence of Staphylococcus aureus in orthopedic department was 42.8%, in the obstetric department 55.5%, in gynecology department 45.0% and in neonatology department 20.0%. The prevalence of Staphylococcus aureus among doctors was 34.2% and among nurses was 48.4%. The prevalence of Staphylococcus aureus in male HCWs (48.0%) was higher than in female HCWs (38.0%).

DIscUssIONs
The percentage of positive isolates from Staphylococcus aureus in nose of HCWs at the Regional Hospital of Korca is high (43.1%). The high percentage of positive results indicate a potential risk for nosocomial infections, especially surgical site infections at the operating theatres.
If we make a comparative analysis we can find studies with similar results in Saudi Arabia 40% [11] and in Benghazi 47.5% [12]. We can find also studies with contrast findings in Nigeria 50% [9], Ghana 25.5% [13] and Nepal 15.7% [14].
The highest prevalence of Staphylococcus aureus in the hospital resulted from the samples of obstetric department (55.5%). This is a high prevalence considering the risk for infection transmission to mother and child in the maternity units. Contrast results were reported from other studies in Nepal 12.5% [14] and in India 30.3% [15].
The lowest prevalence of positive samples resulted in the Intensive Care Unit (16.6%). This result is similar with the findings of the study in Nepal 14.3% [14] and contrast with the results in Italy 38.1% [16].
Prevalence of Staphylococcus aureus isolates was higher from the samples of nurses (48.4%) comparing to doctors. Contrast results are reported in India 22.86% [15], in Argentina 22% [17] and 14.4% in Kuwait [18].
Prevalence of Staphylococcus aureus isolates was higher from the samples of male HCWs (48.0%) comparing with female. These findings are similar with the studies in Saudi Arabia 48% [11] and contrast with studies in Argentina 36% [17] and Ethiopia 36.8% [20].

cONcLUsIONs
The percentage of Staphylococcus aureus among HCWs of the Regional Hospital of Korca was high. Nosocomial infections can be prevented, therefore measures should be taken for infection prevention especially in the departments where the percentage of positive isolates was higher and the risk for developing infection after surgery procedures is high. Some of the measures include: compilation and practical implementation of protocols used in hospitals, surveillance of infections and antibiotic resistance, use of protective masks and hand washing, avoiding touching one's nose during work.