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Making Sense of ... MRSA

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MRSA

What is MRSA?

Methicillin-resistant Staphylococcus Aureus (MRSA) is a bacteria that is resistant to many antibiotics, including most penicillins.

Staphylococcus Aureus is harmlesly present on about a third of the population, and is a regular cause of skin and wound infections; before the resistant strains, few staph infections caused major concern, and the bacterium was often considered a contaminant.

Now, however, Staphylococcus Aureus wound infections are a significant cause of extended hospital stay - and death. MRSA septicaemia can prove fatal, if untreated, in any patient. In some surgery (eg cardiac surgery), MRSA can be a direct cause of death; in other surgery - eg joint replacement in older people - MRSA is often an indirect cause of death; weakening the patient and delaying rehabilitation and restored mobility, allowing other opportunistic infections to develop, causing (for example) pneumonia.

These 'indirect' deaths were often not reported in mortality statistics, one reason why MRSA was not taken seriously for a lng time. It is impossible to know the extent of current under-reporting, as many people do not challenge certification of death, and the extent to which MRSA has contributed is often not easy to evaluate.

Where is MRSA usually found?

Staphylococcus infections, including MRSA, occur mainly in hospitals and other healthcare facilities (such as nursing homes and dialysis centers).

Staph infections include wound, urinary tract, blood infections, and pneumonia. MRSA pneumonia is uncommon outside of intensive care units.

There is increasing recognition that people living at home can carry the infection (without being infected), providing a reservoir of infection.

How common is MRSA?

Staphylococcus Aureus infections of the skin are common, even in otherwise healthy people. MRSA infection is much less common, and serious or life-threatening MRSA infections are rare. It is important to remember that the majority of people who are described as "MRSA positive" are colonized, rather than infected - they are carrying the bacteria, either on the skin, the membranes of the nose and throat, or possibly on a chronic wound (such as a venous ulcer), without having any symptoms or harm associated with it.

How is MRSA transmitted?

As it is primarily a skin infection, skin-skin contact is bar far the most frequent route of spread. The hands of health-care professionals are undoubtedly responsible in many cases, but family contact is a mjor factor.

I'm always fascinated by the obvious fact that sick patients tend to be hot and sweaty; many health care facilities are seriously overheated, with more hot and sweaty residents. The increased likelihood of happy MRSA bacteria spreading from sweaty palm to sweaty arm (and vice versa) is really frighteneingly obvious.

It seems to me that investigating this local "greenhouse effect" is long overdue, but who am I to state the obvious!!

Who is most at risk?

Staph is an opportunistic infection, so those at greatest risk are older people, very young people, those with reduced immunity to infection (including those living with HIV or anti-cancer therapies), and long-term residents of health care facilities.

One study that set out to identify risk factors found that recent hospitalization, outpatient visit, nursing home admission, antibiotic exposure, chronic illness, injection drug use, and close contact with a person with risk factor(s). Most MRSA colonization occurrs among community members who had health care–associated risk factors or contact with persons with risk factors. The evidence indicated that control of MRSA in the community may require control of MRSA in the health care setting (hospital, health care office, and nursing home).1

What are the symptoms of MRSA?

Staphylococcus Aureus infections of the skin show as spots, pimples or boils, often with local inflammation. in wounds there is no distinctive appearance or odour - but delayed healing is a feature. Blood infection (septicaemia) follows similar pattern to other bacterial blood infections.

How is MRSA diagnosed?

Confirmation of the presence of MRSA is by microbiological testing; microscopy, culture and sensitivity. A specimen - usually a swab - is taken and cultured (allowed to grow in the laboratory) then tested against a range of antibiotics to assess their effectiveness - or the presence of a resistant strain.

Methicillin is an antibiotic used almost entirely within laboratories; methicillin resistance was taken to mean 'resistant to most penecillins'.

Microscopy, used in conjunction with the above, will confirm the presence, and the strain, of MRSA

Is there a treatment for MRSA?

Yes. There are two approaches to this.

1. where there is contamination or colonisation, MRSA may be treated with a strict hygiene regime. This will include care with contact, daily linen and clothes changes, washing and bathing with specific antiseptics, lotions and talc.

Systemic or deep wound MRSA infections are treated with antibiotics.

Skin infections will be observed, possibly drained, but antibiotics will not be used unless this is found to be unavoidable, as there is a serious risk of antibiotics developing further resistance; and many skin infections can be resolved as effectively without antibiotics as with them.

Is there a way to prevent infection?

Good hygiene. It really is that simple.

1. Hand hygiene is vtal, especially for health professionals, and those in close contact with people known to carry the infection.
2. Take cuts and scrapes seriously, cleaning and dressing wounds appropriately with occlusive dressings.
3. Be careful with soiled dressings, and clothes and linen from those with the infection.
4. Never share personal items such as towels, toothbrushes or razors.

What is the mortality rate for MRSA?

Most of the MRSA-related deaths occur in older age groups. In 2004, mortality rates in the '85 and over' group were 546 deaths per million, for males and 258 for females. In the 'under 45s', there were fewer than one death per million of the population.

In individuals, mortality rates are based on those diagnosed with MRSA bacteraemia - blood infection - and most sources estimate this at 30-40%. The risk of bacteraemia in colonized patients is very, very small, rising in those who require surgery, and in particular, those who have MRSA deep wound infections, or infections associated with intravenous or other penetrative devices.

Can MRSA be controlled environmentally?

While MRSA in an individual can be effectively managed with antisptics or antibiotics, MRSA as a public health issue can ONLY be managed environmentally; large scale use of chemicals will ultimately result in greater resistance problems, increasing, rather than decreasing the risks to us all. How do you think MRSA developed in the first place?

Improving compliance with hand hygiene and screening for and decolonization of CA-MRSA carriers are effective strategies. However, hand hygiene has the greatest return of benefits and, if compliance is optimized, other strategies may have minimal added benefit.2

What can I do if MRSA is found on my skin?

Use whatever treatments are provided or recommended by your doctor or pharmacist, and take all the advice you are given - there is no 'magic bullet' for MRSA.

If you have MRSA, and are at risk from its effects, then there are measures you can take to help yourself. These four points may help - but not if they contradict specific advice you have received from health professionals.

First, healthy diet and sufficient vitamins will help, as will plenty of exercise and time outdoors - a healthy body is less prone to these kind of infections.

Second, hygiene is important; it reduces the skin load of bacteria - in many cases, reinfection from the skin is part of the problem. So shower, not bath; use clean dry towels, change underclothes frequently, especially if you sweat a lot.

Third, if you have any co-existing skin conditions - eg eczema - be sure they are treated too, as they can harbor infection. If your skin tends to be dry, use a moisturiser cream. Flaky, dry skin provides places for bacteria to hide.

Fourth, Powerful cleansers are usually NOT the answer; they often damage the skin, and may not be appropriate for your particular infection. More gentle cleansers used regularly, are often better - but see if your doctor or pharmacist can recommend one for you.

None of these points is guaranteed to solve the problem, but they could be a great help.

Is there legal protection for workers and others?

People at risk from MRSA can easily protect themselves with simple hygiene measures; the issue is "who knows" - health care professionals should always know which of their clients carries potentially dangerous infections, and they may have a case against their empoyer if not forewarned, and later harmed.

Visitors (in hospitals, for example) may be faced with the 'confidentiality barrier' - which is fine, so long as ALL visitors are educated on appropriate anti-infection measures.

Bibliography and Further Information Sources

References

  1. Community-Acquired Methicillin-Resistant Staphylococcus aureus: Prevalence and Risk Factors - Joel W Beam and Bernadette Buckley
  2. Modeling the Invasion of Community-Acquired Methicillin-Resistant Staphylococcus aureus into Hospitals - Erica M. et al

If this article hasn't answered your question, email me at the address below, and I'll try to get the information you seek. I regret I cannot assist with individual cases or essays and school projects, but if it's something I've missed, I'll be happy to try and help.

Article written by Andrew Heenan BA (Hons), RGN, RMN

First Published: 22 June 2006
Last updated: 13 March 2012
© Andrew Heenan 2006 et seq.
 

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This site is not - and is not intended to be - a substitute for medical advice.

The information provided here is accurate, to the very best of our knowledge, but it is general facts, never, ever, specific to your circumstances.

If you need medical advice, you need a doctor.

If you need legal advice, you need a lawyer.

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