Methicillin-Resistant Staphylococcus aureus Carriage on The Hands of Healthcare Workers: An Assessment for Hand Hygiene Practices in Jos, Nigeria.
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Introduction Methicillin-resistant Staphylococcus aureus (MRSA) is capable of causing a wide range of infections. Contaminated hands of healthcare workers (HCWs) act as a potential source of MRSA transmission in hospitals. Aim This study aims at detecting the carriage of MRSA on the hands of HCWs during patient care and the evaluation of the effective practice of hand hygiene protocol. Methodology This study was a cross-sectional point (prevalence) study done in wards and intensive care units (ICUs) of a tertiary care hospital. Cultures from hand swabs were obtained from HCWs during clinical rounds without prior information about the procedure. A second culture was also taken after the use of an alcohol-based hand rub or handwash (after 1 minute of use). Result Of a total of 145 HCWs screened, 24 (17%) were positive for MRSA. Doctors were 9 while nurses were 10. Six (4%) HCWs remained positive for MRSA after washing their hands or using an alcohol-based hand rub. Conclusion Commitment to preventing healthcare-associated infections requires that regular monitoring of hand hygiene practices be in place. A rapid diagnostic protocol such as MRSA chromogenic agar has a shorter turnaround time compared to standard laboratory workflow in identifying MRSA. Evaluation of the transmission rate of MRSA from HCWs to patients will be encouraged in further studies.
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This is a study that would be of interest to the field and community. The research you have presented is not scientifically sound. The reviewers have highlighted major concerns with the work presented. Please ensure that you address their comments. The reviewers raise concerns regarding the scientific rigour and experimental design of the work.
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Comments to Author
Methodology Methodology missing sampling timeline (single snapshot - one day, 2-3 hours, multiple consecutive days?), time from sampling to culture and storage conditions, molecular methods for detecting mecA gene. MSA plates used should give yellow S. aureus colonies, other Staphylococcus species will stay pink. MRSA agar mentioned in conclusion but not utilised in methods. Results Tables do not have clear grouped headings, may be fixed when formatted. Graphs presented without clear key/labels. Results written out twice using different wording (nurses/doctors/HCWs). Breakdown of male to female participants is not necessary (not in aim, does not affect hand washing). Unusual/unjustified breakpoint for young adults (47 years old). Key findings Aim, results and discussion not well linked together, …
Comments to Author
Methodology Methodology missing sampling timeline (single snapshot - one day, 2-3 hours, multiple consecutive days?), time from sampling to culture and storage conditions, molecular methods for detecting mecA gene. MSA plates used should give yellow S. aureus colonies, other Staphylococcus species will stay pink. MRSA agar mentioned in conclusion but not utilised in methods. Results Tables do not have clear grouped headings, may be fixed when formatted. Graphs presented without clear key/labels. Results written out twice using different wording (nurses/doctors/HCWs). Breakdown of male to female participants is not necessary (not in aim, does not affect hand washing). Unusual/unjustified breakpoint for young adults (47 years old). Key findings Aim, results and discussion not well linked together, conclusions drawn that do not answer the question in the aim. Results support the aim, and the methodology was well setup to answer the research question, so both results and discussion can be re-written to give a concise finding about the study. Handwashing practices of the sample participants are not clearly articulated - were they surveyed about their handwashing practices? If yes, include the survey given to participants. Is it self reported or observed? In the discussion there is comparison between previous studies and this study, but the comparison only included percentages for the previous study without making reference to the study sample sizes.
Please rate the manuscript for methodological rigour
Satisfactory
Please rate the quality of the presentation and structure of the manuscript
Poor
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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Comments to Author
1. Study should have been performed with blinding. Excluding individuals who recently washed their hands led to bias towards MRSA carriage. This study sought to detect the carriage of MRSA on the hands of HCW during patient care and to evaluate the effectiveness of practicing hand hygiene protocol, and as such, HCW who had recently washed their hands should not have been discounted. 2. Presentation of the results is poor. For graphs; remove horizontal lines and label clearly, Y-axis should be labelled on one side only. Add more descriptive titles for X and Y axes and a descriptive figure legend. Add error bars if possible. It is unclear what gels are showing, these need to be more clearly labelled and have a more descriptive figure legend. 3. Paper contains many spelling and grammatical errors …
Comments to Author
1. Study should have been performed with blinding. Excluding individuals who recently washed their hands led to bias towards MRSA carriage. This study sought to detect the carriage of MRSA on the hands of HCW during patient care and to evaluate the effectiveness of practicing hand hygiene protocol, and as such, HCW who had recently washed their hands should not have been discounted. 2. Presentation of the results is poor. For graphs; remove horizontal lines and label clearly, Y-axis should be labelled on one side only. Add more descriptive titles for X and Y axes and a descriptive figure legend. Add error bars if possible. It is unclear what gels are showing, these need to be more clearly labelled and have a more descriptive figure legend. 3. Paper contains many spelling and grammatical errors which must be revisited. 4. Conclusion is clear but data itself needs work.
Please rate the manuscript for methodological rigour
Poor
Please rate the quality of the presentation and structure of the manuscript
Poor
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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