MRSA Methicillin Resistant Staph Aureus

MRSAMethicillin Resistant Staph Aureus Terry Wardinsky MD Carla Hutchison RN Alta California Regional Center “Medical Moment”

What we will learn! • Introduction “The Problem” • Definitions • Who gets MRSA • Prevention • Treatment • Quiz and Conclusions

MRSA “The Problem” • Staph aureus are common bacteria that live on our skin • Staph a. can be a problem if it manages to get into our bodies often through a cut or skin break and causes infection • Over many decades these infections were treated by penicillin antibiotics • In 1961 MRSA or resistant Staph a. were 1st detected • While some of the antibiotics still work, MRSA is constantly adapting resistance • Historically these infections occurred in hospital patients, but now these infections are common in the community (1990)

Definitions • Staph aureus: common bacteria living on our skin that may cause skin and other body area infections…25-30% of humans are colonized especially in the nose • MRSA: Methicillin Resistant Staph Aureus staph aureus bacteria that have become resistant to common antibiotics. Also called “MERSA”, “super bugs”, “flesh eating bacteria” • HA-MRSA Hospital Associated MRSA • CA-MRSA Community Associated MRSA • Carrier: People who are not infected but are colonized with the bacteria on their body especially harbored in the nose (<2%)

MRSA • Lately, the Media has focused on spread of skin infections caused by MRSA especially the community type CA-MRSA causing increased health concerns and much anxiety… • Until recently, most MRSA infection occurred among hospitalized patients & in nursing homes • CA-MRSA now is also showing up in healthy people who have not been hospitalized and contacted it outside the health care setting, especially with poor hygiene, & close contact, or crowded living conditions

MRSA • Why the emergence of these new community strains of CA-MRSA is not immediately clear… • It is known that they have not originated from HA-MRSA since the biologic qualities are different

HA-MRSA & CA-MRSA • These bacteria cause skin infections but if they manage to invade into the body i.e. through skin breakdown (cuts, rash i.e., psoriasis) can cause more serious infections, i.e. boils, abscesses, cellulitis, wounds, joints, pneumonia, and even sepsis of the blood stream • Infections can appear around surgical wounds or invasive devices, like catheters or implanted feeding tubes

Who gets MRSA? The “C’s” • Spread by contact i.e. touching another person who has it on their skin or objects that have bacteria (contaminated) on them • More common among people with weak immune systems or chronic diseases in hospitals, nursing homes, and health care centers • Compromised (skin cuts, abrasions) • Crowding athletic teams, military, inmates, daycare • Not cleaning skin, skin cuts & abrasions

MRSA diagnosis • Most are diagnosed by culture and antibiotic sensitivity testing of Staph aureus bacteria isolated from and infected site: A PCR test is also available for more rapid ID • MRSA bacteria are almost always found to be resistant to multiple antibiotics

Prevention of MRSA • Prevention is possible by good hygiene practices, avoiding skin contact with infected people or items they have touched, and by wearing disposable gloves , gowns, and masks when treating or visiting hospitalized MRSA patients • Keeping skin abrasions and minor cuts covered with bandages till healed may prevent MRSA infections

MRSA Treatment • Treatment of HA-MRSA frequently involves use of vancomycin, often in combination with other antibiotics given by IV and surgical drainage • CA-MRSA can often be treated on an outpatient basis with specific oral or topical antibiotics, but some serious CA-MRSA i.e. pneumonia often require appropriate antibiotics by IV • Be sure the patient gets a complete course of antibiotics

MRSA • MRSA also has been isolated from the environment i.e. beach sand and water, occasional pets and animals (livestock)

MRSA screening • CDC does not recommend (2010 guidelines) general screening of patients for MRSA • However, CDC does recommend that high-risk patients who are being admitted to the hospital be screened for MRSA and then if +positive for MRSA, follow infection-control guidelines during the hospital stay

MRSA • A recent study has revealed that the number of infections with both HA and CA MRSA has declined since 2005-2008 with speculation that better hospital and home care control measures have been successful

How should care givers treat MRSA at home” • CDC states healthy care workers are unlikely to become infected while caring for MRSA patients at home by following: • Patient and staff education about MRSA • Wash hands with soap and water after physical contact with infected or colonized person and before leaving the home • Towels used for drying hands after contact should be used only once • Disposable gloves should be worn if contact with body fluids is expected and hands should be washed after removing the gloves • Linens should be changed and washed on a routine basis, especially if they are soiled • The patient’s environment should be cleaned routinely and when soiled with body fluids (cleaning detergents, sanitizers, disinfectants) • Notify doctors & other health care personnel who provide care for the patient that the patient is colonized or infected with multi-drug resistant organism • Personal items should not be shared

Hand Washing Procedures • Use warm water & wet hands & wrists • Use bar or liquid soap (antimicrobial soap is not necessary) • Work soap into a latter & wash palms, back of hands up to wrist, between fingers, around thumbs & under finger nails (for about the time to sing) “Happy Birthday” or “Row, Row, Row your Boat” • Rinse well under warm, running water & dry hands, using a disposable paper towel or hand dryer

MRSA Quiz • MRSA describes a specific type of bacteria that are resistant? T or F • Is MRSA contagious? Y or N • A commonly used word to describe MRSA is super bug? T or F • MRSA bacteria are most likely found 1) in the air, 2) hospitals? • Some of us carry MRSA bacteria in our 1) mouths, 2) nose, 3) eyes, 4) throats • The skin condition cellulitis can be caused by MRSA or by other bacterial types? T or F

MRSA Quiz • What is the best defense against MRSA? 1) good hygiene, 2) avoiding Antibiotics, 3) vaccines? • MRSA most often enters the body through droplets from coughing or sneezing? T or F • MRSA can cause sepsis, which is an infection of the blood stream? T or F • MRSA infections can cause complications such as 1) “Flesh eating bacteria”, 2) pneumonia, 3) death, 4) all of the above

Resources for information • www.emedicinehealth.com/slideshow_mrsa-pictures/article_em..htm/ • www.pnas.org/cgi/content/full/99/11/7687 • www.cdc.gov//ncidod/EID/vol11no06/04_0831.htm • www.cdc.gov/mrsa/index.html • www.Kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=45809 • www.cdc.gov/ncidod/dhqp/ar_multidrugFAQ.html

MRSA Methicillin Resistant Staph Aureus