Saturday, January 10, 2009

MRSA: Healthcare vs. Community Acquired

Where did it come from?!!

In the last few years, Methacillin-resistant Staphylococcus Aureus (MRSA) has gotten just a bit more complicated. Now it is common for physicians to attempt to make a distinction as to how the infection was acquired. While the healthcare setting (hospitals and nursing homes in particular) have long been known to harbor Super Bugs like MRSA, this infection is now showing up in the community at large.

Healthcare-Associated MRSA is also called "healthcare acquired" and HA-MRSA. Super Bugs like MRSA live in the hospital setting for a lot of good reasons. There are plenty of vulnerable individuals--often with weakend immune systems--for the germs to infect. Patients with bacterial infections are routinely treated with strong antibiotics while in-hospital. But, not every germ is killed with the first dose of an antibiotic. That's why antibiotics are continued over a designated period of time--so that the reproducing generations of bacteria can be targeted at regular intervals until they are all gone. Meanwhile, some of the bacteria that survived the initial doses of antibiotics will be shed from the infected patient through body secretions (like mucus, urine, etc.) The bacteria that have survived have learned a thing or two from their near-fatal antibiotic exposure.  They learned ways to dodge the effects of that antibiotic, and these bacteria are ready to reproduce into entire colonies of "strong bacteria" once they find a "host" to infect. The bacteria live on hard surfaces and can be easily passed from person to person. Patients with catheters in their bladders, breathing tubes, central IV lines, and fresh surgical incisions are particularly vulnerable to bacteria "walking in" to their bladder, airway, bloodstream, or wound if proper hygiene is not meticulously attended to. (When patients acquire an infection in the hospital setting--one that they didn't come in with--any infection, not just MRSA--it is called a nosocomial infection.)


Community-Associated MRSA: Also called "community-acquired" or CA-MRSA. MRSA that infects individuals who have not been hospitalized within the past a year and who haven't had a recent medical procedure is described as community-associated. CA-MRSA frequently causes skin infections like boils, pimples, or abcesses. Some patients initially mistake these skin lesions as a spider bite. (It's important to be skeptical of the spider bite theory and have any suspicious boils examined and treated.) CA-MRSA has resulted in outbreaks of skin infections among atheletes who share equipment and personal items.


Here is an excerpt of the CDC's guidelines for cleaning and disinfecting to reduce transmission of CA-MRSA:

"What can I do to keep surfaces free from staph and MRSA?
  • Cover your infections. Covering infections with bandages or dressings is the best way to keep surfaces from becoming contaminated with staph and MRSA.
  • Clean your hands often. Wash your hands often with soap and water or use an alcohol-based hand rub when a sink is not available. Always clean your hands after changing bandages or touching infected skin.
  • Keep the environment clean. Regularly clean frequently touched surfaces and other items that come into direct contact with infected skin.
  • In gyms, locker rooms, and other places where many people come and go, repair or throw out equipment and furniture with damaged surfaces that cannot be thoroughly cleaned.
What surfaces should be the focus of my cleaning efforts?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 and equipment in the weight room or locker room. Large surfaces, such as floors and walls, have not been directly involved in the spread of staph and MRSA . . .

Which disinfectants should I use against staph and 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 . . . Most, if not all, disinfectant manufacturers will provide a list of germs on their label that their product can destroy . . .

How do I know if the surfaces or equipment are properly cleaned?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 staph and MRSA. If cleaning procedures are unknown, taking 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.
How should shared equipment like sports gear be cleaned?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.

Will routine laundry processes, detergents, and laundry additives remove staph and MRSA from towels, clothes, linens, and uniforms?Yes. Routine laundry procedures, detergents, and laundry additives will all help to make clothes, towels, and linens safe to wear or touch. If items have been contaminated by infectious material, these may be laundered separately, but this is not absolutely necessary."

Visit the CDC's MRSA site for an abundance of information on community and hospital-acquired infection.

Just in case I forget to post it elsewhere--a few more words of advice from me:
  • don't share towels and washcloths (period)
  • don't share razors--and replace your razor or blade if you have had a recent skin infection

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