Wednesday, October 17, 2007

Revisit of Community Acquired MRSA--Prevention Tips

With the recent death of the Bedford County, Virginia student and today's closing of the schools there for cleaning, I thought it would be prudent to revisit MRSA.  This was first posted on July 30, 2007.
 
Staphylococcus aureus, or “staph” as it is sometimes called, is a common bacterium found on the skin or in the nose of ~25-30% of humans. Staph aureus is usually harmless, but in certain instances it may cause moderate to severe skin infections. Less commonly, it causes more serious systemic infections: bloodstream, surgical wound and pneumonia requiring hospitalization. One group of staph known as MRSA (methicillin-resistant Staphylococcus aureus) was first identified in the 1960’s. It is now prevalent in most hospitals. The organisms are resistant to multiple antibiotics (specifically, all antibiotics known as beta lactams, as well as other antibiotic families), and are therefore cause for considerable concern. Photo credit
A newer form of staph infection, known as CA-MRSA (for community-acquired, or community-associated Staphylococcus aureus) has appeared with increasing frequency and is now epidemic within certain community populations. Whereas hospital MRSA is almost always found in persons with established risk factors associated with prior medical treatment, these are not present in CA-MRSA. Today, in the U.S. a little more than 10% of all MRSA infections are CA-MRSA. This form causes serious skin and soft tissue infections in otherwise healthy persons who have not been recently hospitalized or undergone invasive medical procedures. Hospitalization is required in approximately one out of five cases.

CA-MRSA has been identified most frequently among specific populations, including prisoners, athletes, children, men who have sex with men, military recruits, Pacific Islanders, Alaskan Natives and Native Americans.

Rather than getting into treatment, I want to highlight was that can help PREVENT getting or spreading CA-MRSA.
  1. Clean your hands frequently with soap and warm water or an alcohol-based hand rub.
  2. Keep your linens and clothes clean. Wash sports clothing and washable athletic gear with laundry detergent after each use (not after a week or two of use).
  3. Do not share personal care items. At home this includes washcloths, towels, and razors. At the gym or school this includes sports towels, sports equipment (helmets, gym mats), uniforms/clothing. Equipment that can't be washed should be cleaned with an antibacterial solution after each use.
  4. Take care of skin cuts or abrasions before they get infected. Wash them with soap and water, then cover with a dry, sterile bandage daily. Promptly throw away the old bandage. Wash your hands before and after changing the bandages.

If you are given antibiotics for an infection, it is important to take ALL of the doses. Don't quit "when you feel better" or the skin "looks better". Finish all the doses. The bacteria that don't get killed by the missed doses can morph into tomorrow's superbugs.

Staph Infections--e-Medicine article by Robert W Tolan Jr, MD

Community-Associated MRSA Information for the Public --Centers for Disease Control

Staphylococcus aureus Section--Minnesota Department of Health

APUA Newsletter on CA-MRSA--2003

Digital Photos of CA-MRSA Infections

4 comments:

Chrysalis Angel said...

I like how you focus on prevention.

Femail doc said...

I had two patients in just today with a 'is it a spider bite or is it a MRSA infection' question. The bottom line, fortunately, on both was it is not a big deal. MRSA is certainly in the press and on our patients' minds; thanks for the update.

Anonymous said...

doc, do you stitch the wound up if it is the size of a quarter and at least 0.5 inch deep? if there is a time and place to stitch up the wound from a MRSA soft tissue infection when do you go for it and when do you leave it to heal on its own? assuming that the antibiotics are already on-board.

rlbates said...

Anon, that's not a simply question to answer. It would depend on where the wound was, how "clean" it looked, if it was showing good signs (granulation, shrinking, etc) of healing. Only then might I do a secondary wound closure on it.