October 29, 2007 Staff and community members have expressed concern after reading recent media coverage relating to methicillin-resistant staphylococcus aureus (MRSA). CVMC’s Infection Control and Prevention Committee’s chair Dr. Peter Dale and Cathi Dages, RN, CIC recently sat down with us to help inform and educate CVMC staff and the central Vermont community on this bacterium that is becoming more prevalent nationally and internationally. Peter Dale MD an Internist at Mountain View Medical and is certified by the American Board of Internal Medicine with a subspecialty in Infectious Diseases. Cathi Dages, RN, CIC is infection control nurse at Central Vermont Medical Center.
Q. What is Methicillin Resistant Staphylococcus aureus (MRSA)?
A. A virulent bacterial organism, resistant to certain antibiotics, that commonly lives in the nose and on the skin of nearly 20 percent of the population without causing harm. When a bacterium is living in our body but not causing a clinical illness it is called colonization.
Q. Why is MRSA suddenly getting headlines?
A. There are several reasons:
(1).Increasing documentation in the literature that MRSA is far more prevalent that was previously realized.
(2). For decades MRSA was only seen in hospitals, usually academic medical centers and tertiary care hospitals. In more recent years it started being seen in community-based hospitals and in the community itself, meaning that patients showed up at the hospital or doctor’s office with a MRSA infection acquired in the course of their daily activities.
(3). Invasive MRSA (MRSA in the blood stream or other sterile sites) is occurring in otherwise healthy people.
(4). Regular Staph infections have the potential to cause life-threatening infections but MRSA is a more virulent strain that is resistant to certain antibiotics.
Q. How do you get MRSA? How is the infection transferred from person to person?
A. Skin–to-skin contact (not necessarily intimate contact), crowded conditions or sharing contaminated personal items.
Q. How do you know if you have MRSA? What are the symptoms?
A. It is primarily a skin infection which can resemble a pimple, boil or a spider bite. If you have a sore that won’t heal, is red or has pus you should see a doctor and have it cultured. You can’t look at someone and know if they have MRSA
Q. Can MRSA be treated?
A. Yes. You may have heard in the media that MRSA cannot be treated. This is not true. It may be more difficult to treat and you may see a strain where there used to be a choice of three to five antibiotics and now there is only a choice of two or three. There has never been case that couldn’t be treated.
Q. Is this an issue at CVMC?
A. Absolutely because it is an issue in the community as documented by the data.
Q. What is the rate of infection at CVMC?
A. Our rate is very low although following national trends, it is increasing. At CVMC the rate has gone from 0.1 per 1,000 patient days in 2003 to 0.5 in 2007.
Q. What if an employee is infected with MRSA or colonized?
A. There is a policy specific to employee infection or colonization.
Q. What steps are being taken at CVMC to ensure that if a case of MRSA is diagnosed in a hospital patient it will be contained?
A. We have to assume that any skin or soft tissue infection is MRSA and take the following steps:
(1). Universal precautions
(2). Patients are isolated, the room is labeled and gowns and gloves are required before entering the room.
(3). Hand-washing
(4). There is a specific policy on handling employees who are known to be infected or colonized.
(5) Once a patient is known to have MRSA or be colonized with MRSA their chart is flagged and if there are subsequent hospitalizations they will be isolated when readmitted.
Q. How can I protect my family to ensure nobody gets infected with MRSA?
A. Be vigilant about hand-washing. Practice good personal hygiene more frequently and better than you might otherwise. Avoid sharing makeup, towels, brushes, razors, cell phones, etc. Become more conscientious about scrapes & cuts ensuring that they are treated and covered until they heal. If a wound gets infected, see a doctor and have it diagnosed.
Q. Do no-water instant hand antiseptic lotions work?
A. Yes, if it contains 60% alcohol (at CVMC we use Avagard D).
Q. Is the problem of MRSA confined to hospitals and other institutional settings?
A. Although the majority of cases occur in hospital settings, a recent Centers for Disease Control (CDC) report identified 14% of MRSA infections were determined to occur in the community at large. These are known as community-acquired Methicillin Resistant Staph aureus (CA-MRSA).
Q. Can pets get MRSA
A. Yes. Talk to your vet to get more information.
Q. Can MRSA infections be a problem among athletes who play on school sports teams?
A. Yes. Infections can readily spread among people who are prone to cuts and scrapes and are in crowded conditions sharing contaminated personal items.
Q. How long can MRSA survive in the environment?
A. MRSA can easily be found in the environment and its survival depends on a few things. If the surface is dry and the temperature is warm MRSA may survive for a few hours, but germs generally prefer a moist dark environment like your nose or a wound and can live there much longer. However proper cleaning with a detergent will solve the problem. Use a cleaning product that states on the label that it kills Staph aureus.
Q. Can a person die from MRSA?
A. Yes. According to a study recently published in the Journal of the American Medical Association MRSA killed an estimated 19,000 people in 2005.
Q. Is it true that MRSA might be killing more Americans each year than AIDS?
A. Yes, if mortality estimates are correct, MRSA kills more people than AIDS, emphysema or homicide.
Q. How can I protect our patients and my family?
A. Be passionate about hand hygiene, always practice good infection control techniques when patient are on precautions, be sure all medical equipment is cleaned between patient contact, and report skin and wound infections to your supervisor or the infection control nurse.
Q. Who should I contact if I have questions?
A Call your physician’s office or contact CVMC’s infection control nurse Cathi Dages at 371-4184 or email her at cathi.dages@hitchcock.org. or visit www.cdc.gov
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