Abstract
Nosocomial infections cause considerable morbidity and mortality. Healthcare workers (HCWs) may serve as vectors of many infectious diseases, many of which are not often primarily considered as healthcare-associated. The probability of pathogen transmission to patients depends on several factors, such as the characteristics of a pathogen, HCW and patient. Pathogens with high transmission potential from HCWs to patients include norovirus, respiratory infections, measles and influenza. In contrast, human immunodeficiency virus (HIV) and viral hepatitis are unlikely to be transferred. The prevention of HCW-associated transmission of pathogens include systematic vaccinations towards preventable diseases, continuous education, hand hygiene surveillance, active feedback and adequate staff resources.
Similar content being viewed by others
References
Albrich WC, Harbarth S (2008) Health-care workers: source, vector, or victim of MRSA? Lancet Infect Dis 8:289–301
Bryant KA, Humbaugh K, Brothers K, Wright J, Pascual FB, Moran J et al (2006) Measures to control an outbreak of pertussis in a neonatal intermediate care nursery after exposure to a healthcare worker. Infect Control Hosp Epidemiol 27:541–545
Bertin ML, Vinski J, Schmitt S, Sabella C, Danziger-Isakov L, McHugh M et al (2006) Outbreak of methicillin-resistant Staphylococcus aureus colonization and infection in a neonatal intensive care unit epidemiologically linked to a healthcare worker with chronic otitis. Infect Control Hosp Epidemiol 27:581–585
Danzmann L, Gastmeier P, Schwab F, Vonberg RP (2013) Health care workers causing large nosocomial outbreaks: a systematic review. BMC Infect Dis 13:98
Faibis F, Laporte C, Fiacre A, Delisse C, Lina G, Demachy MC et al (2005) An outbreak of methicillin-resistant Staphylococcus aureus surgical-site infections initiated by a healthcare worker with chronic sinusitis. Infect Control Hosp Epidemiol 26:213–215
Kakis A, Gibbs L, Eguia J, Kimura J, Vogelei D, Troup N et al (2002) An outbreak of group A Streptococcal infection among health care workers. Clin Infect Dis 35:1353–1359
Sukhrie FH, Teunis P, Vennema H, Copra C, Thijs Beersma MF, Bogerman J et al (2012) Nosocomial transmission of norovirus is mainly caused by symptomatic cases. Clin Infect Dis 54:931–937
Otter JA, Yezli S, French GL (2011) The role played by contaminated surfaces in the transmission of nosocomial pathogens. Infect Control Hosp Epidemiol 32:687–699
Tang JW, Li Y, Eames I, Chan PK, Ridgway GL (2006) Factors involved in the aerosol transmission of infection and control of ventilation in healthcare premises. J Hosp Infect 64:100–114
Belani A, Sherertz RJ, Sullivan ML, Russell BA, Reumen PD (1986) Outbreak of staphylococcal infection in two hospital nurseries traced to a single nasal carrier. Infect Control 7:487–490
Botelho-Nevers E, Gautret P, Biellik R, Brouqui P (2012) Nosocomial transmission of measles: an updated review. Vaccine 30:3996–4001
Weber DJ, Rutala WA, Miller MB, Huslage K, Sickbert-Bennett E (2010) Role of hospital surfaces in the transmission of emerging health care-associated pathogens: norovirus, Clostridium difficile, and Acinetobacter species. Am J Infect Control 38:S25–S33
Pittet D (2001) Compliance with hand disinfection and its impact on hospital-acquired infections. J Hosp Infect 48:S40–S46
Parmeggiani C, Abbate R, Marinelli P, Angelillo IF (2010) Healthcare workers and health care-associated infections: knowledge, attitudes, and behavior in emergency departments in Italy. BMC Infect Dis 10:35
Pittet D, Hugonnet S, Harbarth S, Mourouga P, Sauvan V, Touveneau S et al (2000) Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet 356:1307–1312
Allegranzi B, Pittet D (2009) Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect 73:305–315
Ho ML, Seto WH, Wong LC, Wong TY (2012) Effectiveness of multifaceted hand hygiene interventions in long-term care facilities in Hong Kong: a cluster-randomized controlled trial. Infect Control Hosp Epidemiol 33:761–767
McNeil SA, Nordstrom-Lerner L, Malani PN, Zervos M, Kauffman CA (2001) Outbreak of sternal surgical site infections due to Pseudomonas aeruginosa traced to a scrub nurse with onychomycosis. Clin Infect Dis 33:317–323
Gupta A, Della-Latta P, Todd B, San Gabriel P, Haas J, Wu F et al (2004) Outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit linked to artificial nails. Infect Control Hosp Epidemiol 25:210–215
Moolenaar RL, Crutcher JM, San Joaquin VH, Sewell LV, Hutwagner LC, Carson LA et al (2000) A prolonged outbreak of Pseudomonas aeruginosa in a neonatal intensive care unit: did staff fingernails play a role in disease transmission? Infect Control Hosp Epidemiol 21:80–85
Parry MF, Grant B, Yukna M, Adler-Klein D, McLeod GX, Taddonio R et al (2001) Candida osteomyelitis and diskitis after spinal surgery: an outbreak that implicates artificial nail use. Clin Infect Dis 32:352–357
Valenti V (1998) In: Bennett JV, Brachman PS (eds) Hospital infections, 4th edn. Lippincott-Raven, Philadelphia, pp 299–324
Advisory Committee on Immunization Practices; Centers for Disease Control and Prevention (CDC) (2011) Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 60:1–45
Mereckiene J, Cotter S, D’Ancona F, Giambi C, Nicoll A, Levy-Bruhl D et al (2010) Differences in national influenza vaccination policies across the European Union, Norway and Iceland 2008–2009. Euro Surveill 15. pii: 19700
Maltezou HC, Gargalianos P, Nikolaidis P, Katerelos P, Tedoma N, Maltezos E et al (2012) Attitudes towards mandatory vaccination and vaccination coverage against vaccine-preventable diseases among health-care workers in tertiary-care hospitals. J Infect 64:319–324
Almuneef MA, Memish ZA, Balkhy HH, Otaibi B, Helmi M (2006) Seroprevalence survey of varicella, measles, rubella, and hepatitis A and B viruses in a multinational healthcare workforce in Saudi Arabia. Infect Control Hosp Epidemiol 27:1178–1183
Loulergue P, Moulin F, Vidal-Trecan G, Absi Z, Demontpion C, Menager C et al (2009) Knowledge, attitudes and vaccination coverage of healthcare workers regarding occupational vaccinations. Vaccine 27:4240–4243
Lu PJ, Euler GL (2011) Influenza, hepatitis B, and tetanus vaccination coverage among health care personnel in the United States. Am J Infect Control 39:488–494
Maltezou HC, Wicker S, Borg M, Heininger U, Puro V, Theodoridou M et al (2011) Vaccination policies for health-care workers in acute health-care facilities in Europe. Vaccine 29:9557–9562
The BCG World Atlas. A database of global BCG vaccination policies and practices. Available online at: http://www.bcgatlas.org/index.php
Monto AS, Rotthoff J, Teich E, Herlocher ML, Truscon R, Yen HL et al (2004) Detection and control of influenza outbreaks in well-vaccinated nursing home populations. Clin Infect Dis 39:459–464
Wicker S, Marckmann G (2013) Vaccination of health care workers against influenza: Is it time to think about a mandatory policy in Europe? Vaccine. pii: S0264-410X(13)01338-8
Salgado CD, Farr BM, Hall KK, Hayden FG (2002) Influenza in the acute hospital setting. Lancet Infect Dis 2:145–155
Eibach D, Casalegno JS, Bouscambert M, Bénet T, Regis C, Comte B et al (2014) Routes of transmission during a nosocomial influenza A(H3N2) outbreak among geriatric patients and healthcare workers. J Hosp Infect 86:188–193
Vanhems P, Voirin N, Roche S, Escuret V, Regis C, Gorain C et al (2011) Risk of influenza-like illness in an acute health care setting during community influenza epidemics in 2004–2005, 2005–2006, and 2006–2007: a prospective study. Arch Intern Med 171:151–157
Maltezou HC (2008) Nosocomial influenza: new concepts and practice. Curr Opin Infect Dis 21:337–343
Chu TP, Li CC, Wang L, Hsu LW, Eng HL, You HL et al (2012) A surveillance system to reduce transmission of pandemic H1N1 (2009) influenza in a 2600-bed medical center. PLoS One 7:e32731
Ahmed F, Lindley MC, Allred N, Weinbaum CM, Grohskopf L (2014) Effect of influenza vaccination of healthcare personnel on morbidity and mortality among patients: systematic review and grading of evidence. Clin Infect Dis 58:50–57
Thomas RE, Jefferson T, Demicheli V, Rivetti D (2006) Influenza vaccination for healthcare workers who work with the elderly. Cochrane Database Syst Rev (3):CD005187
Osterholm MT, Kelley NS, Sommer A, Belongia EA (2012) Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis. Lancet Infect Dis 12:36–44
Centers for Disease Control and Prevention (CDC) (2011) Increased transmission and outbreaks of measles—European Region, 2011. MMWR Morb Mortal Wkly Rep 60:1605–1610
Alp E, Cevahir F, Gökahmetoglu S, Demiraslan H, Doganay M (2012) Prevaccination screening of health-care workers for immunity to measles, rubella, mumps, and varicella in a developing country: What do we save? J Infect Public Health 5:127–132
Wu MF, Yang YW, Lin WY, Chang CY, Soon MS, Liu CE (2012) Varicella zoster virus infection among healthcare workers in Taiwan: seroprevalence and predictive value of history of varicella infection. J Hosp Infect 80:162–167
Bechini A, Tiscione E, Boccalini S, Levi M, Bonanni P (2012) Acellular pertussis vaccine use in risk groups (adolescents, pregnant women, newborns and health care workers): a review of evidences and recommendations. Vaccine 30:5179–5190
Pawloski LC, Queenan AM, Cassiday PK, Lynch AS, Harrison MJ, Shang W et al (2014) Prevalence and molecular characterization of pertactin-deficient Bordetella pertussis in the United States. Clin Vaccine Immunol 21:119–125
Lyytikäinen O, Kanerva M, Agthe N, Möttönen T, Ruutu P; Finnish Prevalence Survey Study Group (2008) Healthcare-associated infections in Finnish acute care hospitals: a national prevalence survey, 2005. J Hosp Infect 69:288–294
Jroundi I, Khoudri I, Azzouzi A, Zeggwagh AA, Benbrahim NF, Hassouni F et al (2007) Prevalence of hospital-acquired infection in a Moroccan university hospital. Am J Infect Control 35:412–416
Castle SC (2000) Clinical relevance of age-related immune dysfunction. Clin Infect Dis 31:578–585
Moore C, Dhaliwal J, Tong A, Eden S, Wigston C, Willey B et al (2008) Risk factors for methicillin-resistant Staphylococcus aureus (MRSA) acquisition in roommate contacts of patients colonized or infected with MRSA in an acute-care hospital. Infect Control Hosp Epidemiol 29:600–606
Groothuis J, Bauman J, Malinoski F, Eggleston M (2008) Strategies for prevention of RSV nosocomial infection. J Perinatol 28:319–323
Kramer A, Schwebke I, Kampf G (2006) How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis 6:130
Snyder GM, Thom KA, Furuno JP, Perencevich EN, Roghmann MC, Strauss SM et al (2008) Detection of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on the gowns and gloves of healthcare workers. Infect Control Hosp Epidemiol 29:583–589
Hayden MK, Blom DW, Lyle EA, Moore CG, Weinstein RA (2008) Risk of hand or glove contamination after contact with patients colonized with vancomycin-resistant enterococcus or the colonized patients’ environment. Infect Control Hosp Epidemiol 29:149–154
Baran J Jr, Ramanathan J, Riederer KM, Khatib R (2002) Stool colonization with vancomycin-resistant enterococci in healthcare workers and their households. Infect Control Hosp Epidemiol 23:23–26
Kane RL, Shamliyan TA, Mueller C, Duval S, Wilt TJ (2007) The association of registered nurse staffing levels and patient outcomes: systematic review and meta-analysis. Med Care 45:1195–1204
Beggs CB, Shepherd SJ, Kerr KG (2010) Potential for airborne transmission of infection in the waiting areas of healthcare premises: stochastic analysis using a Monte Carlo model. BMC Infect Dis 10:247
Pearson A, Chronias A, Murray M (2009) Voluntary and mandatory surveillance for methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) bacteraemia in England. J Antimicrob Chemother 64(Suppl 1):i11–i17
Reducing healthcare associated infections in hospitals in England (2009) Report. National Audit Office, London
Srinivasan A, Craig M, Cardo D (2012) The power of policy change, federal collaboration, and state coordination in healthcare-associated infection prevention. Clin Infect Dis 55:426–431
Kane RL, Shamliyan T, Mueller C, Duval S, Wilt TJ (2007) Nurse staffing and quality of patient care. Evid Rep Technol Assess (Full Rep) (151):1–115
Penoyer DA (2010) Nurse staffing and patient outcomes in critical care: a concise review. Crit Care Med 38:1521–1528; quiz 1529
Bray K, Wren I, Baldwin A, St Ledger U, Gibson V, Goodman S et al (2010) Standards for nurse staffing in critical care units determined by: The British Association of Critical Care Nurses, The Critical Care Networks National Nurse Leads, Royal College of Nursing Critical Care and In-flight Forum. Nurs Crit Care 15:109–111
Clean Your Hands Campaign (2003) National Patient Safety Agency. Available online at: http://www.npsa.nhs.uk/cleanyourhands/
Mota NV, Lobo RD, Toscano CM, Pedroso de Lima AC, Souza Dias MB, Komagata H et al (2011) Cost-effectiveness of sick leave policies for health care workers with influenza-like illness, Brazil, 2009. Emerg Infect Dis 17:1421–1429
LaVela S, Goldstein B, Smith B, Weaver FM (2007) Working with symptoms of a respiratory infection: staff who care for high-risk individuals. Am J Infect Control 35:448–454
Turnberg W, Daniell W, Duchin J (2010) Influenza vaccination and sick leave practices and perceptions reported by health care workers in ambulatory care settings. Am J Infect Control 38:486–488
Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA et al (2011) Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 52:e56–e93
Hawkins G, Stewart S, Blatchford O, Reilly J (2011) Should healthcare workers be screened routinely for meticillin-resistant Staphylococcus aureus? A review of the evidence. J Hosp Infect 77:285–289
Prato R, Tafuri S, Fortunato F, Martinelli D (2010) Vaccination in healthcare workers: an Italian perspective. Expert Rev Vaccines 9:277–283
Jeffries DJ (1995) Viral hazards to and from health care workers. J Hosp Infect 30(Suppl):140–155
Ersoy Y, Otlu B, Türkçüoğlu P, Yetkin F, Aker S, Kuzucu C (2012) Outbreak of adenovirus serotype 8 conjunctivitis in preterm infants in a neonatal intensive care unit. J Hosp Infect 80:144–149
Esbenshade JC, Edwards KM, Esbenshade AJ, Rodriguez VE, Talbot HK, Joseph MF et al (2013) Respiratory virus shedding in a cohort of on-duty healthcare workers undergoing prospective surveillance. Infect Control Hosp Epidemiol 34:373–378
Johnston CP, Qiu H, Ticehurst JR, Dickson C, Rosenbaum P, Lawson P et al (2007) Outbreak management and implications of a nosocomial norovirus outbreak. Clin Infect Dis 45:534–540
Khanna N, Goldenberger D, Graber P, Battegay M, Widmer AF (2003) Gastroenteritis outbreak with norovirus in a Swiss university hospital with a newly identified virus strain. J Hosp Infect 55:131–136
Heijne JC, Rondy M, Verhoef L, Wallinga J, Kretzschmar M, Low N et al (2012) Quantifying transmission of norovirus during an outbreak. Epidemiology 23:277–284
Baussano I, Nunn P, Williams B, Pivetta E, Bugiani M, Scano F (2011) Tuberculosis among health care workers. Emerg Infect Dis 17:488–494
Borroto S, Gámez D, Díaz D, Martínez Y, Ferrer AI, Velásquez Y et al (2011) Latent tuberculosis infection among health care workers at a general hospital in Santiago de Cuba. Int J Tuberc Lung Dis 15:1510–1514
Guidelines for the prevention of tuberculosis in health-care facilities in resource-limited settings (2009) WHO/CDS/TB/99.269. World Health Organization (WHO), Geneva, Switzerland
Dorman SE, Belknap R, Graviss EA, Reves R, Schluger N, Weinfurter P et al (2014) Interferon-gamma release assays and tuberculin skin testing for diagnosis of latent tuberculosis infection in healthcare workers in the United States. Am J Respir Crit Care Med 189:77–87
Jarand J, Shean K, O’Donnell M, Loveday M, Kvasnovsky C, Van der Walt M et al (2010) Extensively drug-resistant tuberculosis (XDR-TB) among health care workers in South Africa. Trop Med Int Health 15:1179–1184
Maartens G, Wilkinson RJ (2007) Tuberculosis. Lancet 370:2030–2043
He GX, van den Hof S, van der Werf MJ, Wang GJ, Ma SW, Zhao DY et al (2010) Infection control and the burden of tuberculosis infection and disease in health care workers in china: a cross-sectional study. BMC Infect Dis 10:313
O’Donnell MR, Jarand J, Loveday M, Padayatchi N, Zelnick J, Werner L et al (2010) High incidence of hospital admissions with multidrug-resistant and extensively drug-resistant tuberculosis among South African health care workers. Ann Intern Med 153:516–522
Centers for Disease Control and Prevention (CDC) (2008) Hospital-acquired pertussis among newborns—Texas, 2004. MMWR Morb Mortal Wkly Rep 57:600–603
Landelle C, Verachten M, Legrand P, Girou E, Barbut F, Buisson CB (2014) Contamination of healthcare workers’ hands with Clostridium difficile spores after caring for patients with C. difficile infection. Infect Control Hosp Epidemiol 35:10–15
Friedman ND, Pollard J, Stupart D, Knight DR, Khajehnoori M, Davey EK et al (2013) Prevalence of Clostridium difficile colonization among healthcare workers. BMC Infect Dis 13:459
van Nood E, van Dijk K, Hegeman Z, Speelman P, Visser CE (2009) Asymptomatic carriage of Clostridium difficile among HCWs: Do we disregard the doctor? Infect Control Hosp Epidemiol 30:924–925
Apisarnthanarak A, Kitphati R, Tawatsupha P, Thongphubeth K, Apisarnthanarak P, Mundy LM (2007) Outbreak of varicella-zoster virus infection among Thai healthcare workers. Infect Control Hosp Epidemiol 28:430–434
Centers for Disease Control and Prevention (CDC) (2011) Preventing varicella-zoster virus (VZV) transmission from zoster in healthcare settings. Available online at: http://www.cdc.gov/shingles/hcp/HC-settings.html
Adams G, Stover BH, Keenlyside RA, Hooton TM, Buchman TG, Roizman B et al (1981) Nosocomial herpetic infections in a pediatric intensive care unit. Am J Epidemiol 113:126–132
Outbreak Database: worldwide database for nosocomial outbreaks. Available online at: http://www.outbreak-database.com/Home.aspx
Sakaoka H, Saheki Y, Uzuki K, Nakakita T, Saito H, Sekine K et al (1986) Two outbreaks of herpes simplex virus type 1 nosocomial infection among newborns. J Clin Microbiol 24:36–40
Buster EH, van der Eijk AA, Schalm SW (2003) Doctor to patient transmission of hepatitis B virus: implications of HBV DNA levels and potential new solutions. Antiviral Res 60:79–85
[No authors listed] (1991) Recommendations for preventing transmission of human immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive procedures. MMWR Recomm Rep 40:1–9
Buster EH, van der Eijk AA, de Man RA, Schalm SW (2004) Doctor-to-patient transmission of hepatitis B virus: the potential of antiviral therapy for prevention. Scand J Gastroenterol Suppl (241):45–49
Gunson RN, Shouval D, Roggendorf M, Zaaijer H, Nicholas H, Holzmann H et al (2003) Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in health care workers (HCWs): guidelines for prevention of transmission of HBV and HCV from HCW to patients. J Clin Virol 27:213–230
Centers for Disease Control and Prevention (CDC) (2012) Updated CDC recommendations for the management of hepatitis B virus-infected health-care providers and students. MMWR Recomm Rep 61:1–12
Winchester SA, Tomkins S, Cliffe S, Batty L, Ncube F, Zuckerman M (2012) Healthcare workers’ perceptions of occupational exposure to blood-borne viruses and reporting barriers: a questionnaire-based study. J Hosp Infect 82:36–39
Maltezou HC, Ftika L, Theodoridou M (2013) Nosocomial pertussis in neonatal units. J Hosp Infect 85:243–248
Weber DJ, Rutala WA (1994) Management of healthcare workers exposed to pertussis. Infect Control Hosp Epidemiol 15:411–415
Centers for Disease Control and Prevention (CDC) (2012) Measles outbreaks. Available online at: http://www.cdc.gov/measles/outbreaks.html
Centers for Disease Control and Prevention (CDC) (2014) Vaccines and immunizations. Chapter 7: measles. Available online at: http://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html#control
Weber DJ, Rutala WA, Hamilton H (1996) Prevention and control of varicella-zoster infections in healthcare facilities. Infect Control Hosp Epidemiol 17:694–705
Clark TA, Slavinski SA, Morgan J, Lott T, Arthington-Skaggs BA, Brandt ME et al (2004) Epidemiologic and molecular characterization of an outbreak of Candida parapsilosis bloodstream infections in a community hospital. J Clin Microbiol 42:4468–4472
Viviani MA, Cogliati M, Esposto MC, Prigitano A, Tortorano AM (2006) Four-year persistence of a single Candida albicans genotype causing bloodstream infections in a surgical ward proven by multilocus sequence typing. J Clin Microbiol 44:218–221
Steer JA, Lamagni T, Healy B, Morgan M, Dryden M, Rao B et al (2012) Guidelines for prevention and control of group A streptococcal infection in acute healthcare and maternity settings in the UK. J Infect 64:1–18
Tacconelli E, Cataldo MA (2008) Vancomycin-resistant enterococci (VRE): transmission and control. Int J Antimicrob Agents 31:99–106
Acknowledgements
This work was supported by a grant from the Medical Research Fund of Tampere University Hospital. The authors’ work was independent of the funder (the funding source had no involvement).
Conflict of interest
The authors declare that they have no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Huttunen, R., Syrjänen, J. Healthcare workers as vectors of infectious diseases. Eur J Clin Microbiol Infect Dis 33, 1477–1488 (2014). https://doi.org/10.1007/s10096-014-2119-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10096-014-2119-6