Tuesday, September 9, 2008

Health Care and MRSA

Over the past couple of years, Americans have been dealing with an increasingly more vicious health bug--MRSA. According to the Mayo Clinic, MRSA infection is caused by Staphylococcus aureus bacteria — often called "staph." MRSA stands for methicillin-resistant Staphylococcus aureus. It's a strain of staph that's resistant to the broad-spectrum antibiotics commonly used to treat it. MRSA can be fatal. Most MRSA infections occur in hospitals or other health care settings, such as nursing homes and dialysis centers. It's known as health care-associated MRSA, or HA-MRSA. Older adults and people with weakened immune systems are at most risk of HA-MRSA.

More recently, another type of MRSA has occurred among otherwise healthy people in the wider community. This form, community-associated MRSA, or CA-MRSA, is responsible for serious skin and soft tissue infections and for a serious form of pneumonia. Staph bacteria, according to the CDC, including MRSA, can cause skin infections that may look like a pimple or boil and can be red, swollen, painful, or have pus or other drainage. More serious infections may cause pneumonia, bloodstream infections, or surgical wound infections. The CDC has investigated clusters of CA-MRSA skin infections among athletes, military recruits, children, Pacific Islanders, Alaskan Natives, Native Americans, men who have sex with men, and prisoners. Factors that have been associated with the spread of MRSA skin infections include: close skin-to-skin contact, openings in the skin such as cuts or abrasions, contaminated items and surfaces, crowded living conditions, and poor hygiene.

The Center for Disease Control (CDC) also reports that people with weakened immune systems, which include some patients with HIV infection, may be at risk for more severe illness if they get infected with MRSA. People with HIV should follow the same prevention measures as those without HIV to prevent staph infections, including practice good hygiene, cover wounds (e.g., cuts or abrasions) with clean dry bandages, avoid sharing personal items such as towels and razors, and contact their doctor if they think they have an infection. In the outbreaks of MRSA, the environment has not played a significant role in the transmission of MRSA. MRSA is transmitted most frequently by direct skin-to-skin contact. You can protect yourself from infections by practicing good hygiene (e.g., keeping your hands clean by washing with soap and water or using an alcohol-based hand rub and showering after working out); covering any open skin area such as abrasions or cuts with a clean dry bandage; avoiding sharing personal items such as towels or razors; using a barrier (e.g., clothing or a towel) between your skin and shared equipment; and wiping surfaces of equipment before and after use.

Most staph and MRSA infections are treatable with antibiotics as indicated by the CDC. If you are given an antibiotic, take all of the doses, even if the infection is getting better, unless your doctor tells you to stop taking it. Do not share antibiotics with other people or save unfinished antibiotics to use at another time. However, many staph skin infections may be treated by draining the abscess or boil and may not require antibiotics. Drainage of skin boils or abscesses should only be done by a healthcare provider. If after visiting your healthcare provider the infection is not getting better after a few days, contact them again. If other people you know or live with get the same infection tell them to go to their healthcare provider.

The Mayo Clinic reports that both hospital- and community-associated strains of MRSA still respond to certain medications. In hospitals and care facilities, doctors often rely on the antibiotic vancomycin to treat resistant germs. CA-MRSA may be treated with vancomycin or other antibiotics that have proved effective against particular strains. Although vancomycin saves lives, it may become less effective as well. Some hospitals are already seeing strains of MRSA that are less easily killed by vancomycin. In some cases, antibiotics may not be necessary. For example, doctors may drain a superficial abscess caused by MRSA rather than treat the infection with drugs. Hospitals are fighting back against MRSA infection by using surveillance systems that track bacterial outbreaks and by investigating products such as antibiotic-coated catheters and gloves that release disinfectants. Still, the best way to prevent the spread of germs is for health care workers to wash their hands frequently, to properly disinfect hospital surfaces and to take other precautions, such as wearing gowns and gloves when working with people infected with resistant bacteria. In the hospital, people who are infected or colonized with MRSA are placed in isolation to prevent the spread of MRSA. Visitors and health care workers caring for people in isolation may be required to wear protective garments and must follow strict hand-washing procedures.

The Mayo Clinic offers several suggestions to prevent the spread of MRSA:
--Ask all hospital staff to wash their hands or use an alcohol-based hand sanitizer before touching you — every time.
--Make sure that intravenous tubes and catheters are inserted under sterile conditions, for example, the person inserting them wears a gown, gloves and mask and sterilizes your skin first.
--Wash your hands. Careful hand washing remains your best defense against germs. Scrub hands briskly for at least 15 seconds, then dry them with a disposable towel and use another towel to turn off the faucet. Carry a small bottle of hand sanitizer containing at least 60 percent alcohol for times when you don't have access to soap and water.
--Keep personal items personal. Avoid sharing personal items such as towels, sheets, razors, clothing and athletic equipment. MRSA spreads on contaminated objects as well as through direct contact.
--Keep wounds covered. Keep cuts and abrasions clean and covered with sterile, dry bandages until they heal. The pus from infected sores may contain MRSA, and keeping wounds covered will help keep the bacteria from spreading.
--Shower after athletic games or practices. Shower immediately after each game or practice. Use soap and water. Don't share towels.
--Sit out athletic games or practices if you have a concerning infection. If you have a wound that's draining or appears infected — for example, is red, swollen, warm to the touch or tender — consider sitting out athletic games or practices until the wound has healed.
--Sanitize linens. If you have a cut or sore, wash towels and bed linens in a washing machine set to the "hot" water setting (with added bleach, if possible) and dry them in a hot dryer. Wash gym and athletic clothes after each wearing.
--Get tested. If you have a skin infection that requires treatment, ask your doctor if you should be tested for MRSA. Doctors may prescribe drugs that aren't effective against antibiotic-resistant staph, which delays treatment and creates more resistant germs. Testing specifically for MRSA may get you the specific antibiotic you need to effectively treat your infection.
--Use antibiotics appropriately. When you're prescribed an antibiotic, take all of the doses, even if the infection is getting better. Don't stop until your doctor tells you to stop. Don't share antibiotics with others or save unfinished antibiotics for another time. Inappropriate use of antibiotics, including not taking all of your prescription and overuse, contributes to resistance. If your infection isn't improving after a few days of taking an antibiotic, contact your doctor.

MRSA can be life threatening if not treated in a timely fashion. Simple prevention methods will help keep the risk of getting the disease. Use common sense when in a common area. If you get it, see a doctor right away and finish the course of treatment as prescribed. Don't let a bug get you that you can prevent.

Until next time. Let me know what you think. Thanks.

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