Methicillin-resistant Staphylococcus Aureus

Definition of MRSA

Methicillin-resistant Staphylococcus Aureus (MRSA)is a type of staph bacteria that is resistant to certain antibiotics. These antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin, and amoxicillin. In the community, most MRSA infections are skin infections. Most potentially life-threatening MRSA infections occur most frequently among patients in healthcare settings. While 25% to 30% of people are colonized* in the nose with staph, less than 2% are colonized with MRSA.

*Colonized: When a person carries the organism/bacteria but shows no clinical signs or symptoms of infection. For Staph aureus the most common body site colonized is the nose.

Symptoms of MRSA

Severe Infections

MRSA in healthcare settings usually causes more severe and potentially life-threatening infections, such as bloodstream infections, surgical site infections, or pneumonia. The signs and symptoms will vary by the type and stage of the infection.

Skin Infections

In the community, most MRSA infections are skin infections that may appear as pustules or boils which often are red, swollen, painful, or have pus or other drainage. They often first look like spider bites or bumps that are red, swollen, and painful. These skin infections commonly occur at sites of visible skin trauma, such as cuts and abrasions, and areas of the body covered by hair (e.g., back of neck, groin, buttock, armpit, beard area of men).

Personal Prevention of MRSA Skin Infections

The key to preventing MRSA infections is for everyone to practice good hygiene:

1. Cover your wound.

Keep wounds that are draining, or have pus, covered with clean, dry bandages until healed.

2. Clean your hands.

You should wash their hands frequently with soap and water or use an alcohol-based hand rub, especially after changing the bandage or touching the infected wound.

3. Do not share personal items.

Avoid sharing personal items, such as towels, washcloths, razors, clothing, or uniforms,

4. Maintain a clean environment

Establish cleaning procedures for frequently touched surfaces and surfaces that come into direct contact with your skin.

5. Talk to your doctor.

Talk to your healthcare about the things that can be done to protect people that carry staph/MRSA from getting an infection or spreading it to others when they are in the hospital or have surgery.

Prevention of MRSA Infections in Athletic Facilities

Improve Hygiene Among Athletes

•Make sure supplies are available to comply with prevention measures (e.g., soap in shower and at sinks, bandages for covering wounds, hand hygiene such as alcohol-based hand rubs).

•Enforce policies and encourage practices designed to prevent disease spread. Make sure athletes:

ækeep wounds covered and contained

æshower immediately after participation

æshower before using whirlpools

æwash and dry uniforms after each use

æreport possible infections to coach, athletic trainer, school nurse, other healthcare providers, or parents.

Excluding Athletes with MRSA Infections from Participation

•If sport-specific rules do not exist, in general, athletes should be excluded if wounds cannot be properly covered during participation.

•A healthcare provider might exclude an athlete if the activity poses a risk to the health of the infected athlete (such as injury to the infected area), even though the infection can be properly covered.

•Athletes with active infections or open wounds should not use whirlpools or therapy pools not cleaned between athletes and other common-use water facilities like swimming pools until infections and wounds are healed.

Treatment of MRSA Infections

Treatment of MRSA will vary by the type and location of infection.

MRSA Skin Infections

Treatment for MRSA skin infections may include having a healthcare professional drain the infection and, in some cases, prescribe an antibiotic. Do not attempt to treat an MRSA skin infection by yourself; doing so could worsen or spread it to others. This includes popping, draining, or using disinfectants on the area. If you think you might have an infection, cover the affected skin, wash your hands, and contact your healthcare provider.

If you are given an antibiotic, be sure to take all of the doses (even if the infection is getting better), unless your healthcare professional tells you to stop taking it. Do not share antibiotics with other people or save unfinished antibiotics to use at another time.

It is possible to get repeat infections with MRSA. If you are cured of an infection, you do not become immune to future infections. Therefore, personal prevention steps are key.

Causes of MRSA Infections

How MRSA is Spread in the Community

MRSA infections, as with all staph, are usually spread by having contact with someone’s skin infection or personal items they have used, like towels, bandages, or razors that touched their infected skin. These infections are most likely to be spread in places where people are in close contact with others—for instance, schools and locker rooms where athletes might share razors or towels.

Factors that have been associated with the spread of MRSA skin infections include: close skin-to-skin contact, openings in the skin such as cuts or abrasions, contaminated items and surfaces, crowded living conditions, and poor hygiene. People may be more at risk in locations where these factors are common, including: athletic facilities, dormitories, military barracks, households, correctional facilities, and daycare centers.

Risks from Contaminated Surfaces

MRSA is found on people and not naturally found in the environment (e.g., soil, the ocean, lakes). MRSA could get on objects and surfaces outside the body if someone touches infected skin or certain areas of the body where these bacteria can live (like the nose) and then touches the object or surface. Another way that items can be contaminated with staph and MRSA is if they have direct contact with a person’s skin infection. Keeping skin infections covered with bandages is the best way to reduce the chance that surfaces will be contaminated with MRSA.

Even if surfaces have MRSA on them, this does not mean that you will definitely get an infection if you touch these surfaces. MRSA is most likely to cause problems when you have a cut or scrape that is not covered. That’s why it’s important to cover your cuts and open wounds with bandages. MRSA can also get into small openings in the skin, like the openings at hair follicles. The best defense is good hygiene. Keep your hands clean, use a barrier like clothing or towels between you and any surfaces you share with others (like gym equipment) and shower immediately after activities that involve direct skin contact with others. These are easy ways to decrease your risk of getting MRSA.

Environmental Cleaning & Disinfecting for MRSA

Which disinfectants should I use against MRSA?

Disinfectants effective against Staphylococcus aureus or staph are most likely also effective against MRSA. These products are readily available from grocery stores and other retail stores. Check the disinfectant product’s label on the back of the container. Most, if not all, disinfectant manufacturers will provide a list of germs on their label that their product can destroy. Use disinfectants that are registered by the EPA (check for an EPA registration number on the product’s label to confirm that it is registered).

How should cleaners and disinfectants be used?

Read the label first. Each cleaner and disinfectant has instructions on the label that tell you important facts:

•How to apply the product to a surface.

•How long you need to leave it on the surface to be effective (contact time).

•If the surface needs to be cleaned first and rinsed after using.

•If the disinfectant is safe for the surface.

•Whether the product requires dilution with water before use.

•Precautions you should take when applying the product, such as wearing gloves or aprons or making sure you have good ventilation during application.

Surfaces to Clean

Focus on surfaces that touch people’s bare skin each day and any surfaces that could come into contact with uncovered infections. For example, surfaces such as benches in a weight room or locker room.

Large surfaces such as floors and walls have not been directly associated in the spread of staph and MRSA.

Shared Equipment

Shared equipment that comes into direct skin contact should be cleaned after each use and allowed to dry. Equipment, such as helmets and protective gear, should be cleaned according to the equipment manufacturers’ instructions to make sure the cleaner will not harm the item.

Is it Clean?

Although in most situations you will not know if a surface has been cleaned, it’s important to remember that most surfaces do not pose a risk of spreading MRSA. If cleaning procedures are unknown, take the appropriate precautions such as:

•Using barriers like a towel or clothing between your skin and the surface.

•Showering immediately after activities where you have direct skin contact with people or shared surfaces, such as after exercising at a health club.

•Cleaning your hands regularly.

•Keeping cuts and scrapes clean and covered with bandages or dressing until healed.

These precautions are especially important in settings such as in locker rooms, gyms, and health clubs.

MRSA Statistics

The estimated number of people developing a serious MRSA infection (i.e., invasive) in 2005 was about 94,360; this is higher than estimates using other methods.

Approximately 18,650 persons died during a hospital stay related to these serious MRSA infections.

Serious MRSA disease is still predominantly related to exposures to healthcare delivery:

•About 85% of all invasive MRSA infections were associated with healthcare, and of those, about two-thirds occurred outside of the hospital, while about one third occurred during hospitalization.

•About 14% of all the infections occurred in persons without obvious exposures to healthcare.

Although the rates of disease varied between the geographically diverse sites participating in the surveillance, overall rates of disease were consistently highest among older persons (age >65), Blacks, and males.