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September 2007

MRSA Lives Among Us

Jean Svendsen, RN
Chief Nurse Consultant

Tracy Powell, MPH
Advanced Analysis Epidemiologist

Staphylococcus aureus, or “staph”, is a common bacterium that lives on the human skin (armpit, groin, and genital areas) and in the nasal passageways of many people. Although staph bacteria are usually harmless, they can cause skin and soft tissue infections, such as pimples, boils, and cellulitis. Staph is one of the most common causes of skin infections in the U.S.

MRSA (Methicillin-resistant Staphylococcus aureus) is a strain of staph that is resistant to methicillin and other related antibiotics. The first reported U.S. outbreak of MRSA occurred in 1968 in a Boston hospital, seven years after the first reported case. Since MRSA can be resistant to several different antibiotics, infections can be difficult to treat.1

MRSA is most commonly associated with hospitalized patients, long-term care facilities, and healthcare workers (healthcare acquired or HA-MRSA). HA-MRSA infections have risen sharply in recent years. In the U.S. in 1972, HA-MRSA accounted for only 2 percent of all healthcare-acquired infections. reported to the Centers for Disease Control and Prevention (CDC). Recent data show that HA-MRSA now accounts for 50-70 percent of healthcare-acquired infections.2

In the past several years, MRSA has emerged into the community, where its incidence has greatly increased.3 The CDC defines community-acquired MRSA (CA-MRSA) as MRSA infections that are acquired by individuals who have not been hospitalized within the last year or had a medical procedure. Most CA-MRSA infections are seen as skin and soft tissue infections such as pimples, boils, abscesses, and cellulitis and occur in otherwise healthy people. MRSA skin infections often appear red, swollen, painful, and have a pus-like discharge. More serious infections may cause pneumonia and bone, bloodstream, or surgical wound infections.

In Indiana, most CA-MRSA cases originate in correctional facilities and competitive sports teams4 in high schools and colleges. Infections have been associated with direct skin-to-skin contact through cuts and abrasions and indirect contact, such as sharing contaminated sports equipment, towels, and clothing as well as crowded living conditions, and poor hygiene. Individual cases of MRSA are not reportable in Indiana, because the infection is so common. However, any suspected clusters or outbreaks are immediately reportable to local health departments for investigation.

As with any infectious disease, prevention is key. The CDC recommends the following practices to help prevent spreading staph or MRSA skin infections:

  1. Clean your hands. Hand hygiene plays a vital role in reducing the transmission of infection. Wash hands frequently with soap and water or use an alcohol-based hand sanitizer, especially after changing bandages or touching an infected wound.

  2. Cover your wounds. Wounds that are draining or have pus should be covered with clean, dry bandages. Follow your healthcare provider’s instructions on proper wound care. Pus from infected wounds can contain staph and MRSA, so keeping the infection covered will help prevent the spread to others. Bandages or tape can be discarded in the regular trash.

  3. Do not share personal items. Avoid sharing personal items such as towels, washcloths, razors, clothing, or uniforms that may have had contact with infected wounds or bandages. Use hot water and laundry detergent to wash soiled sheets, towels, and clothing. Dry items in a clothes dryer on the hottest setting possible, rather than air-dry, to help kill bacteria.

  4. Talk to your healthcare provider. Tell your healthcare providers who treat you that you have or have had a staph or MRSA skin infection. See your healthcare provider promptly if you have wounds that do not heal or appear red, swollen, draining, or painful.

You can learn more about MRSA by visiting the following Web sites:
http://www.in.gov/isdh/healthinfo/mrsa.htm
http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_public.html

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References

  1. Barrett FF, McGehee RF Jr, Finland M. Methicillin-resistant Staphylococcus aureus at Boston City Hospital: bacteriologic and epidemiologic observation. New England Journal of Medicine 1968; 279:441-448.

  2. Siegel JD, Rhinehart E, Jackson M, Chiarello L; Healthcare Infection Control Practices Advisory Committee. Management of multi-drug resistant organisms in healthcare settings, 2006. US Centers for Disease Control and Prevention. Available at http://www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf (accessed September 19, 2007)

  3. Chambers HF. The changing epidemiology of Staphylococcus aureus? Emerging Infectious Disease 2001;7:178-82. Available at http://www.cdc.gov/ncidod/eid/vol7no2/chambers.htm (accessed September 19, 2007)

  4. Centers for Disease Control and Prevention. Methicillin-resistant Staphylococcus aureus among competitive sports participants—Colorado, Indiana, Pennsylvania, and Los Angeles County, 2000-2003. MMWR Morbidity and Mortality Weekly Report 2003;52:793-5. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5233a4.htm (accessed September 19, 2007)