CA-MRSA : Facts, Fiction, and Strategies
by Mitchell Rubin MD
This past summer, a fourteen-year-old came to my adolescent health center complaining of a blistering rash. “Is this the ‘super-bug?’” his trembling Mom cried out. “No,” I reassured her, “it is merely a case of poison ivy.” Many sighs of relief.
As the director of a large ambulatory network in the metropolitan New York region, I hear, on a daily basis questions like:
- Is this “super-bug” new?
- How can I prevent catching this killer strain?
- Should my school shut down since they found MRSA (Methicillin-resistant Staphylococcus aurues) there?
- Is there any treatment for it?
The so-called Methicillin-resistant Staph germ (MRSA) has been around for many, many years. Like the “flesh-eating” hysteria of last year, there are myths and truths that may help to set the record straight.
- Staphylococcus aureus (“staph”) is a common germ (i.e. bacterium) that is carried on the skin or in the nose of approximately 30 percent of healthy people. Most never develop any symptoms or illness. Staph is a leading cause of skin and soft tissue infection and when an infection does occur, it is usually mild and without consequence.
- Infrequently, staph infections may go deeper to form a boil or abscess. Such so-called “invasive” staph infections are different from skin and soft tissue infections and are more serious.
- Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staph which is resistant to some of the antibiotics that typically have been used to treat skin and soft tissue infections. Although commonly and historically found in hospitalized patients, “community acquired” MRSA (CA-MRSA) is showing up outside of hospitals. Although an intuitive link exists between hospital-acquired and community-acquired MRSA, the jury is still out on this causal relationship. As is MRSA, CA-MRSA is resistant to methicillin and other penicillin type antibiotics such as amoxicillin and the cephalosporins, but there are medications which are effective—including vancomycin, clindamycin, and trimethoprim-sulfamethoxazole.
How does CA-MRSA spread?
Staph infections are spread by direct physical contact with the bacteria, almost always person-to-person, but can be spread through contact with contaminated surfaces, personal items, or equipment. Spread of staph infections may occur through skin-to-skin contact when playing sports, such as football or wrestling, or from surfaces in gyms and locker rooms.
Can CA-MRSA be Treated?
Staph infections are treatable. The treatment may include drainage of the infection site and/or treatment with antibiotics as mentioned earlier. Again, there are antibiotics available for all forms of staph infections, including MRSA and CA-MRSA.
Top Three Methods of Prevention
1. Washing hands
2. Washing hands
3. Washing hands
Although medicine is advancing at amazing speed, time-proven, basic washing of one’s hands with warm water and soap (for fifteen to twenty seconds) has been scientifically proven to be the best method to prevent common viral illnesses such as influenza and gastroenteritis—as well as bacteria including staph, MRSA, and CA-MRSA. Washing hands is obviously extremely important at critical points such as after using a toilet, changing a baby, or handling raw foods. But don’t forget to wash hands more than usual during the winter months.
The Soap: Regular or Antibacterial?
- So-called “antibacterial soaps” (i.e. those containing “triclosan”) are no more effective than plain soap and water for killing disease-causing germs. In fact, there is evidence that “antibacterial” soaps may cause come bacteria to become resistant to widely used antibiotics such as amoxicillin.
- If soap is not available, alcohol-based sanitizers should be used. (Editor’s note: just be mindful how much you use and keep bottles out of reach of young children at all times. See: Danger with Sanitizer Gel Use
What’s a Parent to Do?
- Remember … good hygiene is the best prevention! Children should be encouraged to wash their hands frequently with warm water and soap. Parents should educate children about the importance of hand washing, particularly after nose-wiping.
- Skin cuts, scrapes, or breaks should be kept clean and dry to minimize the chance of developing an infection. Proper bandages should be used and changed daily or more frequently, if necessary, to keep all infected wounds clean and covered.
- If your child has a skin infection that is not getting better, contact his or her doctor.
- If your child is taking antibiotics for an infection, make sure he/she completes the full number of doses as prescribed. Antibiotics should not be shared or saved for future use.
- Take your child to see a medical provider if the skin or soft tissue begins to appear infected—red, hot, swollen, tender, or draining pus. This could be a boil.
- Students should shower after every athletic activity using soap and clean towels.
- A first aid kit with ample dressings should be available at all athletic events and on every hall of the school.
- Students should not share personal hygiene or other items such as towels, soap, clothing, and razors. If schools are responsible for washing towels, athletic uniforms, etc., these items should be washed after every use. To avoid sharing of bar soap, schools should consider placing soap dispensers on walls, particularly in locker rooms.
- Schools should have and follow protocols for routine surface cleaning that includes sanitizers and a regular cleaning schedule. Particular attention should be given to damp or wet areas and those areas that may be contaminated by body fluids, such as locker rooms, gym and weight rooms, and showers. It is recommended that a disinfectant such as bleach or an EPA registered-as-effective agent.
- Proper bandages should be used to keep all infected wounds covered. Students should not be allowed to participate in athletics, gym class, etc., if an infected wound is exposed.
- School health services staff and other school personnel who might have contact with students suspected of CA-MRSA infection should use contact precautions, by avoiding contact with the infected student’s bodily fluids by wearing protective, non-porous gloves.
- Staff should report skin and soft tissue infections to the school nurse and to coaches/athletic trainers/physical education teachers so that hygiene practices can be reviewed and corrected if deficient.
- Students should report skin and soft tissue infections to the school nurse and to coaches/athletic trainers/physical education teachers.
- School nurses should consider a CA-MRSA diagnosis in all students who present with signs of skin or soft tissue infection.
- If a student has a skin or soft tissue infection, school health services staff or other designated personnel should clean and cover the wound site and notify the child’s parents. Parents should be advised to seek further evaluation and/or treatment by their child’s doctor.
- School closure is not an appropriate response to CA-MRSA infections in students. Response should focus on following the above measures to prevent and control spread of staph to other students.
Related Story: The Age of the Superbug