MRSA
Or Methicillin-resistant staphylococcus aureus
February 2013 – Staff Education from HS/MS Health Clinic
First, what is MRSA? It is a bacterium that causes infections in different parts of the body. It is tougher to treat than most strains of staph,
because it is resistant to some commonly used antibiotics. It is also called multi-drug-resistant staph. This has been a process of evolution. It
was first discovered in 1961 and not only it is a super bug, it is a smart bug. MRSA is constantly adapting to the treatments that we have
available to treat it. It has not become immune to methicillin, amoxicillin, penicillin, oxacillin and many other antibiotics. While some
antibiotics still work, MRSA is constantly adapting. Researchers that develop antibiotics are having trouble keeping up.
MRSA is especially troublesome in hospitals (surgical wounds, joint replacements weakened immune systems) , prisons, military recruits,
homeless, schools, nursing homes, and people with contact with live food producing animals (because of antibiotics that are being given to our
food sources), athletes, children and any other location where patients with open wounds, invasive devises (intravenous tubing – urinary
catheters, feeding tubes) and weakened immune systems (chemo therapy patients, HIV, AIDES, lupus, transplant patients, and severe
asthmatics) are at greater risk of infection than the general public.
So how do you get it? Contact! You can get MRSA from another person who has it on their skin! Or you could get MRSA by touching objects
that have the bacteria on them AND about 1% of the population carries MRSA in their nose and they don’t even know it! There are 2 names for
how/where you contract MRSA. One is HA-MRSA or Hospital acquired. The other is CA-MRSA or community acquired. This is where children,
schools, athletics plays a large part. School is a close community of touching – if not each other, then where someone has touched. Small
children seem to always be in skin to skin contact, rolling around of the floor or playgrounds with each other (hence the prevalence for head
live as well). At-risk populations include groups such as football players, and school wrestlers. MRSA causes 60% of all staph infections!
Alarmingly, MRSA is showing up in healthy people who have not been in the hospital! Statistics are showing that the CA-MRSA has increased
14-fold in just a 3 year period! The average age of a person with HA-MRSA is 68, however, the average age of a person with CA-MRSA is 23!!!
So what do I look for? MRSA commonly colonizes in the nose. The rest of the respiratory tract, open wounds, IV catheters and the urinary
tract are also potential sites for infection. A healthy person can carry MRSA from a few weeks to many years without any symptoms of
infection at all. In most people MRSA can be detected by swabbing the inside of their nose and isolating the bacteria found, in the lab.
Screening people who are admitted to the hospital is resulting in a lower spread rate, because the new admit can be treated right away. MRSA
is fast spreading – the first 24 to 48 hours it grows very rapidly. After 72 hours, MRSA can take hold in human tissues and eventually become
resistant to treatment. Initially, there may be a small red bump that resembles a pimple, spider bite, or a boils. There may or may not be a
fever and sometimes there can be a rash. Within a few days the bumps become larger and more painful, they eventually open into deep pusfilled boils. Most (75%) are localized to the skin and soft tissue. The other 25% will show signs of virulent spreading and can effect vital organs
and lead to a wide spread infection (sepsis), toxic shock syndrome, and necrotizing (flesh eating) pneumonia. The National Institute of Allergy
and Infectious Diseases is studying, but is currently unable to determine why some people can be treated and others deteriorate and die.
MRSA and our population – children and athletes: In the U.S. there has been increasing numbers of reports of outbreaks of MRSA colonization
and infection through skin contact in locker rooms, gyms, and even among healthy populations. A study published in the New England Journal
of Medicine linked MRSA to the abrasions caused by artificial turf. Infection among football players is 16 times higher than the rest of the
school population. The study also cited a football player in 2006, was temporarily paralyzed from MRSA infected turf burns. His infection
returned in 2007 and required 3 surgeries to remove all the infected tissue, as well as 3 weeks of hospital stay. All children run a higher risk
because of their tendency to have a higher rate of cuts, scrapes, bruises, and bug bites. We work in a population that is at risk for MRSA
contact through playgrounds, locker rooms, camps, classrooms and other school settings. Parents and teachers should be especially cautions
of the children who participate in activities where shared sports equipment such as football helmets and uniforms are used.
In June 2011, the discovery of a new strain of MRSA was announced by 2 separate teams of researchers in the UK. Its genetic make-up more
resembles the strains found in animals – most commonly pigs, and calves, it has been found in pneumonia, endocarditis, and necrotizing
fasciitis. The testing kits designed to detect MRSA are unable to identify it!
Clean up: Alcohol! Our much relied upon Clorox wipes won’t kill it! Clorox will kill Influenza A, Rhinovirus, E Coli, Strep, Klebsiella Pneumonia
and Staph, but not MRSA. MRSA can survive on surfaces, fabrics, privacy curtains, and garments worn by healthcare providers. Complete
surface sanitation is required to eliminate MRSA in areas where colonization is possible. However, Lysol spray has the alcohol component
needed and will kill: in 30 seconds: Avian flu, campylobacter, Coxsackie virus, Cytomegalovirus (popular in newborns, newborn parents and
newborn grandparents), Hantavirus, Hepatitis B, Herpes Simplex 1 & 2 ,HIV/Aides, Influenza B, and Rhinovirus; In 5 minutes: Enterobacter,
VRE, E. Coli, Listeria, Pseudomonas, Salmonella, Staph, and Trichophyton mentagrophytes (athlete’s foot). And here is the good news!!! In 10
minutes Lysol spray will kill MRSA among others. Spray liberally and let completely dry.
Hand washing: We have all heard hand washing, hand washing until we can scream. Here is some news: Hand washing alone, will not kill
MRSA! Alcohol based hand sanitizer is showing to be “somewhat” effective and way more so than regular hand soap. Four anti-microbial
cleansers were tested for their effectiveness against MRSA: chlorhexidine (Hibiclens), p-chloro-m-xylenol (Acute-Kare), hexachlorophene
(Phisohex) and providone-iodine (Betadine). Of the 4 Betadine proved to be the most effective against MRSA. The down side, we cannot all
walk around with orange hands from washing with Betadine! DO NOT give up hand washing for all of the other microbes that it does kill – the
secret is FRICTION and 15 to 20 seconds duration – and use the alcohol based hand sanitizers in between. As poor hygiene habits remain the
principal barrier to significant reductions in the spread of MRSA.
Decolonization: Care should be taken when trying to drain pimples or boils, as disruption of the surrounding tissue can lead to larger
infections, or even infection in the blood stream (OFTEN FATAL). Drainage should be disposed of quickly – in a health care setting, hospitals,
clinics, etc this should be in biohazard bags – and very carefully. After the drainage and treatment for MRSA, patients should shower at home
using Hibiclens or Phisohex (available over the counter) from head to toe. An alternative is to use ½ cup of bleach per ¼-full bathtub of water.
Towels, wash cloths, and bed linens should never be shared with a MRSA infected person. (These items should always be laundered – every day
– in hot water and bleach, during and immediately following an infection.) Care should be taken to use a clean towel, and to ensure that nasal
drainage (i.e. snot) does not infect the towel. ALL infectious lesions should be kept covered with a dressing. Bactroban 2% ointment can be
effective in reducing the size of the lesions. In diabetics, a topical mixture of 70% sugar and 30% of 3% providone-iodine paste is an effective
agent for the treatment of diabetic ulcers with MRSA infections. Remember the nose is a common refuge for MRSA colonization, so if you are
being treated for a MRSA infection, the treatment should include Bactroban ointment to be applied to the inside of the nose every 12 hours for
7 days, using a cotton tipped swab. Household members are urged to use the same de-colonization protocol.
The toilet seat boogie man!!!! Toilet seats are common vectors for infection, and wiping seats clean before and after use can help to prevent
the spread of MRSA. Door handles, faucets, light switches can be disinfected with wipes. Sprays can be used on upholstery and carpets.
Hardwood floors can be cleaned with diluted tea tree oil (Melaleuca). Laundry soap containing tea tree oil can be effective in decontaminating
clothing and bedding, especially if hot water and heavy soil cycles are used. USE WITH CAUTION because in some, tea tree oil can cause a rash
that can be re-colonized by MRSA. Place alcohol based sanitizers near bedsides, sitting area, in classrooms, lunch rooms, and in vehicles (buses)
to encourage their use.
Doctors will also prescribe antibiotics such as clindamycin, doxycycline, or trimethoprim/sulfamethoxazole.
Schools and community settings: Wash your hands AND use alcohol based hand sanitizers frequently, keep wounds covered, avoid contact
with other people’s wounds (at school: all open wounds must be kept covered), avoid sharing personal items such as razors or towels, shower
before entering a public pool, or whirlpool, shower after exercising at athletic facilities (including weight rooms, gyms, and school facilities and
locker rooms) and maintain a clean environment.
I hope that this information proves to be informative and helpful to you. The following page will be for information to help you in recognizing a
possible MRSA infected lesion.
Melody Parton RN
HS/MS Health Office
February 2013