by Charles John Palenik, MS, PhD, MBA
Recently, MRSA has been featured in print and electronic media. Much attention has focused on schools and athletics because a Virginia teenager’s death last October involved a methicillin-resistant Staphylococcus aureus (MRSA) infection. A flood of calls has inundated state and local departments of health. Legislative bodies are reviewing courses of action. The following talking points address some issues concerning MRSA transmission, treatment, and prevention.
What is staph?
Staphylococcus aureus is a bacterium commonly found in noses, throats, GI tracts, and the axillas and perineum of 25 to 30 percent of the population. Staph on hands is usually transient. These bacteria enter breaks in the skin to cause localized, usually minor infections such as pimples and boils. First-line treatment is drainage followed by wound care and hygiene advice, but not the use of antibiotics.
What is MRSA?
MRSA is a type of antibiotic-resistant bacteria. MRSA colonization involves about 0.8 percent (2.3 million) of persons in the United States. MRSA is resistant to commonly prescribed antibiotics. However, the term “superbug” is probably better reserved for bacteria (especially certain gram-negative types) resistant to most and possibly all currently available antibiotics. In 1974, it comprised 2 percent of ICU staph infections. Numbers have steadily increased to approach 70 percent today. There are an estimated 300,000 hospitalizations with a diagnosis of S. aureus each year in the United States. Almost half involve MRSA. MRSA invades internal body areas causing serious infections in approximately 95,000 persons each year and results in about 19,000 deaths. Of these infections, 86 percent are health-care-associated while 14 percent are community-associated.
How does MRSA spread?
Until recently, most MRSA cases occurred in hospitals or other health-care facilities, such as long-term care. In recent years, MRSA has emerged as one of the most common skin infections and is now worldwide. MRSA transmission usually involves direct skin-to-skin contact or contact with shared items or contaminated surfaces. Wound pus or drainage is infectious. Skin infections commonly start at sites of visible skin trauma or in body areas covered by hair. Poor hand hygiene and picking at wounds or skin lesions with fingers also can be involved. Certain factors make MRSA spread more easily. These include skin-to-skin contact, compromised skin, contaminated items and surfaces, and a lack of cleanliness. These factors are common in schools, athletic complexes, correctional facilities, military barracks, households, and daycare centers. While many MRSA cases have occurred in these areas, MRSA is also prevalent in the general population and can occur nearly anywhere.
How do you treat MRSA?
Health-care- and community-associated MRSA strains respond to certain medications. The primary antibiotic used in health-care facilities is vancomycin. Treatment of community-associated MRSA involves vancomycin or other antibiotics. There have been outbreaks of vancomycin-resistant MRSA. To help reduce this possibility, it is advised to drain an abscess caused by MRSA and wait for a result rather than treat infections immediately with drugs.
The situation likely will continue to evolve. Most community-associated and almost half of health-care-associated cases of MRSA now involve a single strain, USA 300. The fear is that, in time, all strains of S. aureus will demonstrate some form of resistance. S. aureus is poised to become the leading health-care-associated infection in the U.S.
How do you prevent MRSA?
Prevention is always preferable to treatment. People can take measures to protect themselves. These include:
- practicing frequent and appropriate hand hygiene with alcohol-based hand sanitizers in addition to traditional soap-and-water handwashing.
- covering open skin areas with waterproof or impermeable bandages and avoiding another person’s bandages or open skin areas.
- not sharing personal hygiene items (razors, soap and deodorant), towels, and clothing.
- practicing prompt, effective wound care including good cleaning followed by application of a waterproof bandage.
- visiting a health-care provider immediately upon noticing wounds or skin breaks that are red, swollen, painful, or draining. Students should report such occurrences to their school nurse or athletic coach.
- cleaning and sanitizing surfaces that experience frequent direct skin contact (locker rooms, athletic equipment).
- taking antibiotics responsibly.
- taking the entire course of an antibiotic, even if you feel better.
- not skipping doses of an antibiotic.
- not sharing an antibiotic with others.
Dr. Charles John Palenik is the director of Infection Control Research and Services at the Indiana University School of Dentistry. He is the co-author of the popular “Infection Control and Management of Hazardous Materials for the Dental Team.” In 2003, he was chairman of the Executive Board of OSAP. Infection control questions may be directed to [email protected].