Methicilllin-resistant Staphylococcus aureus (MRSA) (pronounced MUHR-sa) infection is caused by staphylococcus aureus bacteria. Decades ago, a strain of staph emerged in hospitals that was resistant to the broad-spectrum antibiotics commonly used to treat it. Dubbed methicillin-resistant Staphylococcus aureus (MRSA), it was one of the first germs to outwit all but the most powerful drugs.
Staph bacteria are normally found on the skin or in the nose of about one-third of the population.
Preventing MRSA Video
Proper Hand Hygiene Video
If patients have staph on your skin or in their nose but aren't sick, they are said to be "colonized" but not infected with MRSA. Healthy people can be colonized with MRSA and have no ill effects, however, they can pass the germ to others. Staph bacteria are generally harmless unless they enter the body through a cut or other wound, and even then they often cause only minor skin problems in healthy people. But in older adults and people who are ill or have weakened immune systems, ordinary staph infections can cause serious illness called methicillin-resistant Staphylococcus aureus or MRSA. In a health care environment and among already ill or immune challenged patients, this can prove deadly.
The following photos of MRSA infections are provided through the courtesy of the U.S. Centers for Disease Control and Prevention.
Each year more than 18,000 American patients die from MRSA infections.
This number equates to more deaths from MRSA in the U.S. than from fatalities of those who die every year from AIDS.
A fast and painless test is available to determine if a patient is colonized with MRSA; this is particularly important prior to an upcoming
In the 1990s, a type of MRSA began showing up in the wider community. Today, that form of staph, known as community-associated MRSA, or
CA -MRSA, is responsible for many serious skin and soft tissue infections and for a serious form of pneumonia.
When not treated properly, MRSA infections can wind up to be fatal.
Vancomycin is one of the few antibiotics still effective against hospital strains of MRSA infection, although the drug is no longer effective in every case. Several drugs continue to work against CA-MRSA, but CA-MRSA is a rapidly evolving bacterium, and it may be a matter of time before it, too, becomes resistant to most antibiotics.
CAUSES AND HISTORY OF MRSA
Staph infections, including MRSA, generally start as small red bumps that resemble pimples, boils or spider bites. These can quickly turn into deep, painful abscesses that require surgical draining. Sometimes the bacteria remain confined to the skin. But they can also burrow deep into the body, causing potentially life-threatening infections in bones joints, surgical wounds, the bloodstream, heart valves and lungs.
Although the survival tactics of bacteria contribute to antibiotic resistance, humans bear most of the responsibility for the problem. Leading causes of antibiotic resistance include unnecessary antibiotic use in humans. Like other superbugs, MRSA is the result of decades of excessive and unnecessary antibiotic use. For years, antibiotics have been prescribed for colds, flu and other viral infections that don't respond to these drugs, as well as for simple bacterial infections that normally clear on their own.
Antibiotics are shown to be appearing in food and water. Prescription drugs aren't the only source of antibiotics. In the United States, antibiotics can be found in beef cattle, pigs and chickens. The same antibiotics then find their way into municipal water systems when the runoff from feedlots contaminates streams and groundwater. Antibiotics given in the proper doses to animals who are sick don't appear to produce resistant bacteria.
Germs are mutating. Even when antibiotics are used appropriately, they contribute to the rise of drug-resistant bacteria because they don't destroy every germ they target. Bacteria live on an evolutionary fast track, so germs that survive treatment with one antibiotic soon learn to resist others. And because bacteria mutate much more quickly than new drugs can be produced, some germs end up resistant to just about everything. That's why only a handful of drugs are now effective against most forms of staph but CA-MRSA is a rapidly evolving bacterium, and it may be a matter of time before it too, becomes resistant to most antibiotics.
THE VERY LEAST PATIENTS SHOULD KNOW ABOUT MRSA (Excerpted directly from the CDC website)
What is Staphylococcus aureus (staph)?
Staphylococcus aureus, often referred to simply as "staph," are bacteria commonly carried on the skin or in the nose of healthy people. Approximately 25% to 30% of the population is colonized (when bacteria are present, but not causing an infection) in the nose with staph bacteria. Sometimes, staph can cause an infection.
Staph bacteria are one of the most common causes of skin infections in the United States. Most of these skin infections are minor (such as pimples and boils) and can be treated without antibiotics (also known as antimicrobials or antibacterials). However, staph bacteria also can cause serious infections (such as surgical wound infections,
bloodstream infections, and pneumonia).
What is MRSA (methicillin-resistant Staphylococcus aureus)?
Some staph bacteria are resistant to antibiotics. MRSA is a type of staph that is resistant to antibiotics called beta-lactams. Beta-lactam antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin and amoxicillin. While 25% to 30% of the population is colonized with staph, approximately 1% is colonized with MRSA.
Who gets staph or MRSA infections?
Staph infections, including MRSA, occur most frequently among persons in hospitals and healthcare facilities (such as nursing homes and dialysis centers) who have weakened immune systems. These healthcare -associated staph infections include surgical wound infections, urinary tract infections, bloodstream infections, and pneumonia.
What is community-associated MRSA (CA-MRSA)?
Staph and MRSA can also cause illness in persons outside of hospitals and healthcare facilities. MRSA infections that are acquired by persons who have not been recently (within the past year) hospitalized or had a medical procedure (such as dialysis, surgery, catheters) are know as CA-MRSA infections. Staph or MRSA infections in the community are usually manifested as skin infections, such as pimples and boils, and occur in otherwise healthy people.
How common are staph and MRSA infections?
Staph bacteria are one of the most common causes of skin infection in the United States and are a common cause of pneumonia, surgical wound infections, and bloodstream infections. The majority of MRSA infections occur among patients in hospitals or other healthcare settings; however, it is becoming more common in the community setting. Data from a prospective study in 2003, suggests that 12% of clinical MRSA infections are community-associated, but this varies by geographic region and population.
What does a staph or MRSA infection look like? (See photos at top of this page)
Staph bacteria, including MRSA, can cause skin infections that may look like a pimple or boil and can be red, swollen, painful, or have pus or other drainage. More serious infections may cause pneumonia, bloodstream infections, or surgical wound infections. Most staph infections, including MRSA, will grow as a bump or infected area on the skin. You should look for skin that is:
Warm to the touch
Full of pus or other drainage
Accompanied by a fever
Are certain people at increased risk for community-associated staph or MRSA infections?
CDC has investigated clusters of CA-MRSA skin infections among athletes, military recruits, children, Pacific Islanders, Alaskan Natives, Native Americans, men who have sex with men, and prisoners. 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.
How to prevent staph or MRSA skin infections:
Practice good hygiene:
Keep your hands clean by washing thoroughly with soap and water or using an alcohol-based hand sanitizer.
Keep cuts and scrapes clean and covered with a bandage until healed.
Avoid contact with other people’s wounds or bandages.
Avoid sharing personal items such as towels or razors.
Are people who are positive for the human immune deficiency virus (HIV) at increased risk for MRSA? Should they be taking special precautions?
People with weakened immune systems, which include some patients with HIV infection, may be at risk for more severe illness if they get infected with MRSA. People with HIV should follow the same prevention measures as those without HIV to prevent staph infections, including practice good hygiene, cover wounds (e.g., cuts or abrasions) with clean dry bandages, avoid sharing personal items such as towels and razors, and contact their doctor if they think they have an infection.
Can I get a staph or MRSA infection at my health club?
In the outbreaks of MRSA, the environment has not played a significant role in the transmission of MRSA. MRSA is transmitted most frequently by direct skin-to-skin contact. You can protect yourself from infections by practicing good hygiene (e.g., keeping your hands clean by washing with soap and water or using an alcohol-based hand rub and showering after working out); covering any open skin area such as abrasions or cuts with a clean dry bandage; avoiding sharing personal items such as towels or razors; using a barrier (e.g., clothing or a towel) between your skin and shared equipment; and wiping surfaces of equipment before and after
What should I do if I think I have a staph or MRSA infection?
See your healthcare provider.
Are staph and MRSA infections treatable?
Yes. Most staph and MRSA infections are treatable with antibiotics. If you are given an antibiotic, take all of the doses, even if the infection is getting better, unless your doctor tells you to stop taking it. Do not share antibiotics with other people or save unfinished antibiotics to use at another time.
However, many staph skin infections may be treated by draining the abscess or boil and may not require antibiotics. Drainage of skin boils or abscesses should only be done by a healthcare provider. If after visiting your healthcare provider the infection is not getting better after a few days, contact them again. If other people you know or live with get the same infection tell them to go to their healthcare provider.
Is it possible that my staph or MRSA skin infection will come back after it is cured?
Yes. It is possible to have a staph or MRSA skin infection come back (recur) after it is cured. To prevent this from happening, follow your healthcare provider’s directions while you have the infection, and follow the prevention steps after the infection is gone.
If I have a staph, or MRSA skin infection, what can I do to prevent others from getting infected?
You can prevent spreading staph or MRSA skin infections to others by following these steps:
Cover your wound. Keep wounds that are draining or have pus covered with clean, dry bandages until healed. Follow your healthcare provider's instructions on proper care of the wound. Pus from infected wounds can contain staph, including MRSA, so keeping the infection covered will help prevent the spread to others. Bandages and tape can be discarded with the regular trash.
Clean your hands. You, your family, and others in close contact should wash their hands frequently with soap and water or use an alcohol-based hand sanitizer, especially after changing the bandage or touching the infected wound.
Do not share personal items. Avoid sharing personal items, such as towels, washcloths, razors, clothing, or uniforms, that may have had contact with the infected wound or bandage.
Wash sheets, towels, and clothes that become soiled with water and laundry detergent. Use a dryer to dry clothes completely.
Talk to your doctor. Tell any healthcare providers who treat you that you have or had a staph or MRSA skin infection.
What should I do if someone I know has a staph or MRSA infection?
If you know someone that has a staph or MRSA infection you should follow the prevention steps.
FOOD FOR THOUGHT:
WHY MRSA TESTING MAKES SENSE MEDICALLY AND FINANCIALLY
A simple, painless diagnostic test exists for the direct detection of methicillin-resistant Staphylococcus aureus (MRSA) from a nasal specimen. The test procedure time is under two hours. It enables hospitals to dramatically improve the identification of MRSA, which can effectively result in the prevention and control of MRSA infections. You can request this test prior to a scheduled surgery.
Rates of S. aureus infection have increased during the past two decades in North America and many European countries. Bacteremia due toS. aureus has been reported to be associated with higher mortality rates (15%-60%). Resistance to methicillin among S. aureus isolates is also a growing problem: up to 60% of nosocomial infections in patients in the intensive care unit (ICU) are due to methicillin-resistant S. aureus.
In fact, MRSA has been identified by the Society for Healthcare and Epidemiology of America (SHEA) as one of the two “most out of control” antimicrobial-resistant pathogens in U.S. hospitals (VRE is the other). A 2004 study of a surgical ICU that implemented an active surveillance and contact precautions program found that the use of these methods decreased transmission of MRSA from 5% to 0.9%.
Government and professional organizations are increasingly recommending more proactive procedures to identify, prevent, and control multi-drug resistant organisms (MDROs) such as MRSA.
CDC guidelines from 2002 recommend:
Proper use of antimicrobials – know when to say “no” to vanco (vancomycin)
Preventing transmission – identify and isolate the pathogen
Diagnosing and treating effectively – target the pathogen
SHEA 2003 guidelines go further by recommending:
Persistent barrier and contact precautions for patients known or suspected to be colonized or infected
Proper hand hygiene for health-care workers
More importantly: active surveillance cultures to identify and control the reservoir of carriers
Prevention and Control of MRSA: Use of the test
Extensive studies have demonstrated the advantages of a stringent infection control program including decreased hospital-acquired MRSA infections, length of stay, number of isolated patients, and significant savings from the decreased use of antibiotics. The availability of a definitive test result for MRSA within two hours of receiving the specimen enables decisions and actions one to three days earlier than standard culture -based methods.
Remarkable annual cost savings have been demonstrated in hospitals implementing active MRSA surveillance programs. With surveillance, hospitals were able to better identify and control the reservoir of MRSA which resulted in significantly reduced rates of infection.
One study (Jernigan) estimated that an active surveillance culture program could save between $20,062 and $462,067 annually while preventing 8 to 41 MRSA infections. In another study (Chaix) concluded that targeted screening (identification) and isolation (prevention) are the most cost-effective strategies over a range of MRSA carriage rates on admission.
By offering the capability of delivering definitive MRSA results in less than two hours, the test has the potential to dramatically improve the cost-effectiveness of an infection control program.
How do I protect myself from getting MRSA and other skin infections?
Practice good personal hygiene. Keep your hands clean by washing frequently with soap and water or using an alcohol -based hand rub.
At a minimum, hands should be cleaned before and after playing sports and
activities such as using shared weight-training equipment, when caring for
wounds including changing bandages, and after using
Both plain and antimicrobial soap are effective for hand washing, but liquid soap is preferred over bar soap in these settings to limit sharing.
If hands are not visibly dirty and sinks are not available for hand washing, for example, while on the field of play or in the weight-room, alcohol based hand rubs and sanitizers can be used. Alcohol-based hand
rubs with at least 60% alcohol content are preferred.
Shower immediately after exercise. Do not share bar soap and towels.
Wash your uniform and clothing after each use.
Follow the clothing label's instructions for washing and drying. Drying clothes completely in a dryer is preferred.
Take care of your skin
Wear protective clothing or gear designed to prevent skin abrasions or cuts.
Cover skin abrasions and cuts with clean dry bandages or other dressings recommended by your team’s healthcare provider (e.g., athletic trainer, team doctor) until healed.
Follow your healthcare provider’s instructions for when and how often to change your bandages and dressings.
Do not share items that come into contact with your skin.
Avoid sharing personal items such as towels and razors that contact your bare skin.
Do not share ointments that are applied by placing your hands into an open-container.
Use a barrier (such as clothing or a towel) between your skin and shared equipment like weight-training, sauna and steam-room benches.
What should I do if I think I have an MRSA infection?
Tell your parent, coach, athletic trainer, school nurse, team doctor or other healthcare provider if you think you have an infection so it can be treated quickly. Finding infections early and getting care will reduce the amount of playing time lost and decrease the chance that the infection will become severe.
Pay attention for signs of infections such as redness, warmth, swelling, pus, and pain at sites where your skin has sores, abrasions, or cuts. Sometimes these infections can be confused with spider bites.
Infections can also occur at sites covered by body hair or where uniforms or equipment cause skin irritation or increased rubbing.
Do not try to treat the infection yourself by picking or popping the sore.
Cover possible infections with clean dry bandages until you can be seen by a healthcare provider (e.g., doctor, nurse, athletic trainer).
I have an MRSA skin infection. How do I prevent spreading it to others?
Get medical care for your infection. Do not try to treat it yourself.
Cover your wounds. Keep wounds covered with clean, dry bandages until healed. Follow your healthcare provider's instructions on proper care of the wound. Pus from infected wounds can contain staph and MRSA, so keeping the infection covered will help prevent the spread to others. Bandages and tape can be thrown away with the regular trash.
Clean your hands often. You, your family, and others in close contact should wash their hands often with soap and water or use an alcohol-based hand rub, especially after changing the bandage or touching the infected wound.
Do not share personal items. Personal items include towels, washcloths, razors, clothing, and uniforms. Wash used sheets, towels, and clothes with water and laundry detergent. Use a dryer to dry clothes completely.
How should athletic facilities be managed when an MRSA infection occurs?
Athletic facilities such as locker rooms should always be kept clean whether or not MRSA infections have occurred among the athletes.
Review cleaning procedures and schedules with the janitorial/environmental service staff.
Cleaning procedures should focus on commonly touched surfaces and surfaces that come into direct contact with people's bare skin each day.
Cleaning with detergent-based cleaners or Environmental Protection Agency (EPA) -registered detergents/disinfectants will remove MRSA from surfaces.
Cleaners and disinfectants, including household chlorine bleach, can be irritating and exposure to these chemicals has been associated with health problems such as asthma and skin and eye irritation.
Take appropriate precautions described on the product's label instructions to reduce exposure. Wearing personal protective equipment such as gloves and eye protection may be indicated. .
Follow the instruction labels on all cleaners and disinfectants, including household chlorine bleach, to make sure they are used safely and correctly.
How should sports equipment be cleaned?
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.
Shared equipment should be cleaned after each use and allowed to dry.
Should athletes with MRSA skin infections be excluded from participation?
If sport-specific rules do not exist, in general, athletes should be excluded if wounds cannot be properly covered during participation.
The term "properly covered" means that the skin infection is covered by a securely attached bandage or dressing that will contain all drainage and will remain intact throughout the activity. If wounds can be properly covered, good hygiene measures should be stressed to the athlete such as performing hand hygiene before and after changing bandages and throwing used bandages in the trash.
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.
What should I do if I notice an athlete with a possible infection?
Refer athletes with possible infections to a healthcare provider such as team physician, athletic trainer, school nurse, or primary care doctor.
If the athlete is less than 18 years old, notify parents/guardians of the athlete with the possible infection.
Educate athletes on ways to prevent spreading the infection.
Using the criteria above, consider excluding the athlete from participation until evaluated by a healthcare provider.
How can I improve hygiene among my 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:
- keep wounds covered and contained
- shower immediately after participation
- shower before using whirlpools
- wash and dry uniforms after each use
- report possible infections to coach, athletic trainer, school nurse, other healthcare providers, or parents.
Who should be contacted if an outbreak occurs?
Contact local public health authorities.