MRSA: Still a threat

COVID-19 has dominated the news since January, and rightly so. Yet MRSA – short for methicillin-resistant Staphylococcus aureus – remains a threat in the community, in physicians’ offices, and in hospitals and nursing homes. As with COVID-19, the keys are early detection, treatment, disinfection … and knowledge.

A well-informed sales rep can initiate dialogue and appropriate action among caregivers. With that in mind, The Journal of Healthcare Contracting offers some factual points about MRSA from the Centers for Disease Control and Prevention (CDC).

What is MRSA?
MRSA stands for methicillin-resistant Staphylococcus aureus, a type of bacteria that is resistant to several antibiotics.

How common is it?
Studies show that about one in three (33%) people carry S. aureus bacteria in their nose, usually without any illness. About two in every 100 people carry MRSA. Although many people carry MRSA bacteria in their nose, most do not develop serious MRSA infections.

Who is at risk?
Anyone can get MRSA. The risk increases with activities or places that involve crowding, skin-to-skin contact, and shared equipment or supplies. Some of the people who carry MRSA contract a MRSA infection. Non-intact skin, such as when there are abrasions or incisions, is often the site of such an infection. Athletes, daycare and school students, military personnel in barracks, and those who receive inpatient medical care or have surgery or medical devices inserted in their body are at higher risk of MRSA infection.

How is MRSA spread in the community?
MRSA is usually spread in the community by contact with infected people or things that carry the bacteria. This includes contact with a contaminated wound or sharing personal items – such as towels or razors – that have touched infected skin. The opioid epidemic may also be connected to the rise of staph infections in communities. People who inject drugs are 16 times more likely to develop a serious staph infection.

How serious is MRSA?
Staphylococcus aureus (staph) has become resistant to several antibiotics, making MRSA and other types of resistant staph major antibiotic-resistance problems.

In the community (that is, where people live, work, shop, and go to school), MRSA most often causes skin infections. In some cases, it causes pneumonia (lung infection) and other infections. If left untreated, MRSA infections can become severe and cause sepsis – the body’s extreme response to an infection. In healthcare settings, such as a hospital or nursing home, MRSA can lead to bloodstream infections, pneumonia or surgical site infections.

How is MRSA identified?
Recent data suggest that MRSA as a cause of skin infections in the general community remains a high probability. CDC encourages clinicians to consider MRSA in the differential diagnosis of skin and soft tissue infections (SSTIs) compatible with S. aureus infections, especially those that are purulent (fluctuant or palpable fluid-filled cavity, yellow or white center, central point or “head,” draining pus, or that are possible to aspirate with needle or syringe). A patient who complains of “spider bite” should raise suspicion of an S. aureus infection.

How about point-of-care testing?
Rapid tests are available. One such test identifies S. aureus and PBP2a, a common marker for MRSA, from blood culture. Another identifies PBP2a in S. aureus culture isolates. In December 2019, the U.S. Food and Drug Administration authorized marketing of a test that uses a bacteriophage technology based on bioluminescence to detect MRSA from nasal swab samples.

How is MRSA typically treated on an outpatient basis?
If the lesion is purulent (e.g., fluid-filled, has a yellow or white center, is draining pus, etc.), the clinician typically:
1. Drains the lesion.
2. Sends wound drainage for culture and susceptibility testing.
3. Advises patient on wound care and hygiene.
4. Discusses follow-up plan with patient, including the possibility of antimicrobial therapy if incision and drainage don’t work. MRSA skin infections can develop into more serious infections. It is important that the physician discuss a follow-up plan with the patient in case they develop systemic symptoms or worsening local symptoms, or if symptoms do not improve within 48 hours.

What safeguards should physician practices put in place to prevent the spread of MRSA among healthcare workers or patients?
MRSA can survive on some surfaces, like furniture, towels, razors, and athletic equipment, for hours, days or even weeks. It can spread to people who touch a contaminated surface and can cause infections if MRSA gets into a cut, scrape or open wound.

Keeping one’s hands clean is one of the most important steps office staff can take to avoid getting sick and spreading germs like MRSA. Soap and water should be used, if available. After wetting hands and adding soap, scrub hands for at least 20 seconds. If soap and water cannot be accessed, staff and patients should use an alcohol-based hand sanitizer that contains at least 60% alcohol to clean hands. Apply the sanitizer to one hand, rub hands together, covering all surfaces of hands and fingers until hands are dry.

How can the physician practice clean and disinfect surfaces to prevent MRSA infection?
Cleaners or detergents are products that remove soil, dirt, dust, organic matter and germs (like bacteria, viruses, and fungi). They lift dirt and germs off surfaces so they can be rinsed away with water. Cleaning with a detergent is necessary to remove dirt, which can prevent disinfectants from working. Some disinfectants have a cleaning agent mixed in.

Disinfectants are chemical products that are used to kill germs in healthcare settings. Disinfectants effective against S. aureus are also effective against MRSA. The disinfectant’s label will have a list of germs that the product can kill, along with an Environmental Protection Agency (EPA) registration number.

What should be cleaned to prevent MRSA from spreading?
When cleaning and disinfecting, focus on surfaces that frequently contact people’s bare skin, like desks, chairs, light switches, faucets, remote controls, benches, gym equipment and lockers. In particular, clean any surfaces that could come into contact with uncovered wounds, cuts, or boils. In addition to cleaning surfaces, frequently cleaning hands and keeping wounds covered keeps MRSA from spreading.

Large surfaces, such as floors and walls, have not been associated with the spread of staph and MRSA. There is no evidence that spraying or fogging rooms or surfaces with disinfectants prevents MRSA infections more effectively than the targeted approach of cleaning frequently touched surfaces and surfaces that have been exposed to open wounds.

Primary source: Centers for Disease Control and Prevention, www.cdc.gov/mrsa/

Sidebar:

Best way to prevent a MRSA infection?
• Maintain good hand and body hygiene. Clean hands often, and clean your body regularly, especially after exercise.
• Keep cuts, scrapes, and wounds clean and covered until healed.
• Avoid sharing personal items, such as towels and razors.
• Get care early if you think you might have an infection.