Please read this text carefully

as it is important prior to your arrival in Denmark .

Meticillinresistent Staphylococcus aureus (MRSA) among health care personnel.

The Organizing Committee of ENTOG 2006 in Denmark advises foreign trainees applying for the ENTOG exchange programme in Denmark during the 27 th of November until 30th of November 2006 to make a test for MRSA before entering Denmark and the clinical departments.

TO PARTICIPATE IN THE ENTOG EXCHANGE PROGRAM
IT IS OBLIGATORY FOR YOU TO MAKE A TEST FOR MRSA!

Background: In Scandinavia and a few other regions, a low incidence of endemic spreading of MRSA is found. In most European countries and in other parts of the world, a high incidence of endemic spreading along with episodes of epidemic spreading is found. This high incidence results in numerous nosocomial MRSA-infections with a high mortality, a high morbidity, prolonged hospitalisation, isolation of patients and need for expensive antibiotics.

Once a high endemic level is reached, it has been shown difficult to reduce the prevalence of MRSA and, as a consequence, broadspectred antibiotics have to be used leading to rising expenses.

Danish Authorities find it of great importance that Scandinavia remains a low MRSA-endemic area. A rational policy of antibiotics, isolation of patients from high MRSA-endemic areas, and action towards potential MRSA-carriers can hopefully lead to such a result.

Healthcare personnel are all potential MRSA-carriers. Therefore, the following instructions have been made concerning foreign health care personnel visiting a Danish health care unit:

All visiting personnel are to be screened for MRSA prior to visiting a clinical department.

Please follow the following instructions carefully:

• The test should be performed about two weeks - up to a month - before your arrival to Denmark.
  

•  A specimen is taken from 1) both nostrils, and 2) the pharynx or the perineum. Further more, specimens are also taken from possible skin changes or acute or chronic foci of infection. The specimens are sent to the nearest laboratory of microbiology and tested for MRSA. Very important : The specimens are to be taken by a staff member, not by the person to be tested him-/herself.

•  Following the bacterial test, a “MRSA document” or “MRSA letter” is filled in by the local microbiological department. This letter should certify that the person has been tested, which anatomical locations have been used for testing, the date of testing and the results of the test with regard to MRSA status. This certificate must be signed by the local microbiological department. Thus, a test result from e.g. a specimen from the nostrils is not enough - the local microbiological department must construct a seperate certificate concluding on the test results.

The MRSA letter or certificate should state (in english language)
1) that the exchange trainee (giving personal data as e.g. year and date of birth) has been tested microbiologically,
2) the date of testing the exchange trainee,
3) which anatomical locations have been tested (either a) nostrils and pharynx or b) nostrils and perineum), and
4) whether MRSA has been detected or not in these tests.

•  The results from the tests are to be presented to the gynaecological/obstetrical department in Denmark , in which the tested person will stay during the exchange period.

If MRSA are found in one or more of the specimens, the “tested person” has to be treated with Chlorhexidin gel 1% 2 times daily for 1 week in the positive-tested area, ie. the nostrils.

Further more, use of Chlorhexidin-soap and -shampoo is recommended as is regular changing of bedsheets.

Should a MRSA–colonization reoccur, the local treatment can be used again.

For further assistance contact the local department of microbiology in your home country before entering Denmark .

- October, 2006
ENTOG 2006 Organizing committee