As health-care providers, we spend our careers focused on protecting patients from infection transmission. We wear PPE, follow sterilization protocols, disinfect surfaces, and think carefully about cross-contamination. What we discuss far less often is the long-term microbial exposure health-care providers themselves experience after decades in clinical environments.

A personal experience

Recently, I spoke with dental hygienist Michelle Baxter, MPH, BSDH, about her personal experience with nasal methicillin-resistant Staphylococcus aureus (MRSA) colonization, something she never expected to face herself after working more than 30 years in dentistry.

“In 2022, during a routine annual medical exam, I mentioned an unusual amount of thick mucus isolated in my left anterior naris,” Michelle shared. “What initially seemed like simple irritation led to a nasal culture and an unexpected diagnosis: nasal MRSA colonization.”

Like many clinicians, Michelle associated MRSA with hospitals and medically compromised patients, not with otherwise-healthy health-care providers.

“My nurse practitioner explained that nasal MRSA colonization is actually more common among health-care workers than many realize,” she explained. “Repeated occupational exposure, close patient contact, aerosolized droplets, contaminated surfaces, and years spent in clinical environments can increase the likelihood of colonization.”

Connection with public health dentistry

For Michelle, the diagnosis began to make sense after reflecting on more than three decades spent treating patients in public health dentistry, often caring for high-risk and underserved populations. Researchers have studied MRSA nasal carriage in health-care workers (HCWs), including dental professionals, and some studies suggest HCWs may experience higher colonization rates compared with the general population due to repeated occupational exposure.¹ Dental professionals may be uniquely exposed because of aerosols, saliva, respiratory droplets, and prolonged close contact with patients.

Treatment for nasal MRSA

Importantly, colonization is not the same as infection. Many individuals carry S. aureus in the nose without symptoms or illness. MRSA colonization means the bacteria are present but not necessarily causing active disease. However, colonization can sometimes contribute to chronic irritation, crusting, inflammation, or recurrent infections.

Michelle underwent treatment using mupirocin ointment as part of a short decolonization protocol.

“I was prescribed mupirocin ointment and followed the regimen for approximately one week,” she said. “While treatment was effective, I noticed afterward that the nasal membrane remained more delicate and prone to irritation.”

Since then, she has experienced two mild flare-ups, which reinforced how recurrence may occur when the nasal tissues become inflamed or compromised.

Chronic dryness: A contributing factor

Michelle also began reflecting on another possible contributing factor: chronic dryness.

“Living in Utah, I had long struggled with dryness in my nasal passages, especially during the winter months and in heavily climate-controlled environments,” she explained. “At the time, I viewed the dryness as little more than an annoyance associated with the region’s arid climate. In hindsight, I now wonder whether chronic mucosal dryness may have weakened the nasal barrier over time.”

When combined with decades of occupational exposure in dentistry, the connection became difficult for her to ignore.

Shifting the perspective to provider health

This experience shifted Michelle’s perspective not only on infection control, but also on provider health.

“We often focus appropriately on protecting patients from infection transmission,” she said, “but we discuss far less often the long-term microbial burden silently carried by providers themselves.”

While no prevention strategy is perfect, health-care providers can take steps to help protect the nasal barrier and reduce irritation. Saline sprays or gels, humidification in dry climates, hand hygiene, careful PPE practices, avoiding touching one’s nose during work, and early evaluation of persistent nasal symptoms may all play a role.²

Michelle believes one of the most important takeaways is removing stigma from these conversations.

“Colonization with organisms such as MRSA is an occupational reality for many clinicians and should be approached without shame or stigma,” she said.

For me, Michelle’s story highlights an important and often-overlooked aspect of health care: providers are not separate from the environments in which we work. Years of caring for patients may carry invisible occupational exposures that deserve greater awareness and discussion within dentistry and health care.

Editor's note: This article appeared in the November/December 2026 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.

References

1. Albrich WC, Harbarth S. Health-care workers: source, vector, or victim of MRSA? Lancet Infect Dis. 2008;8(5):289-301. doi:10.1016/S1473-3099(08)70097-5
2. Rongpharpi SR, Hazarika NK, Kalita H. The prevalence of nasal carriage of Staphylococcus aureus among healthcare workers at a tertiary care hospital in assam with special reference to MRSA. J Clin Diagn Res. 2013;7(2):257-260. doi:10.7860/JCDR/2013/4320.2741