INFECTION CONTROL NEWSLETTER

February 1997
written by and for Long Term Care Infection Control Nurses

Broad Street Solutions
James Marx, RN, MS, CIC Editor
PO Box 16557
San Diego, CA 92176
(619)563-0274 Voice/FAX
jmarx@concentric.net

MRSA: Let's review the Facts

Antibiotic resistant bacteria were identified shortly after the introduction of antibiotics in the 1940's. Penicillin resistant Staphylococcus aureus was one of the first antibiotic resistant bacteria. With the development of improved penicillins, such as methicillin, Methicillin Resistant Staphylococcus aureus (MRSA) was identified. Infections with MRSA were first described in England in the late 1950's and the United States in the late 1960's. Infection with this organism proved troublesome because of the limited treatment options available. Even today, the treatment drug of choice for MRSA infection is intravenous Vancomycin. This antibiotic is both costly and potentially toxic. Infection and colonization of a resident with MRSA is frequently misunderstood by the staff. The following facts may be useful in educating your staff, family and visitors:

What are Antibiotic Resistant Bacteria?
Bacteria are normally found on the skin and in the intestines. Each time a person takes an antibiotic, there is a chance that the bacteria will change and become resistant to the antibiotic. This is why antibiotics should be used only when necessary. One of the more common types of resistant bacteria is MRSA.

What is MRSA?
MRSA stands for Methicillin Resistant Staphylococcus aureus. Methicillin is an antibiotic that was developed when Staphylococcus became resistant to penicillin. Staphyl-ococcus aureus is a bacteria normally found on the skin. It can also be found in the nose and back for the throat. This bacteria is often the cause of skin infections.

How does someone get an infection with MRSA?
Because Staphylococcus aureus is normally found on the body, prolonged use of antibiotics can cause the bacteria to change. If the person is then susceptible to an infection, Staphylococcus aureus can cause an infection. MRSA infection is most often caused by bacteria already on the person¼s skin.

How is MRSA transmitted?
If someone has any type of bacteria on the skin, it can be passed from one person to another by skin contact. This usually does not cause an infection. Bacteria can be found in many body fluids, such as stool, urine and sputum. Good hygiene and cleaning will reduce the number of bacteria which could be passed on.

Is MRSA transmitted in the air?
No. MRSA is passed on from one person to another by contact. Someone who has pneumonia caused by MRSA got the infection by accidentally breathing fluid from the back of their throat. Some people refer to this as "going down the wrong pipe." The medical term is aspiration. Aspiration can occur in people who have swallowing difficulties, stroke, or who are not alert.

How can I avoid getting an infection with MRSA?
Family and visitors of residents have little risk of getting an infection with an antibiotic resistant bacteria. Because family and visitors do not provide care to other residents, it is not necessary for them to wear gloves. Everyone is encouraged to wash their hands after visiting. It is always important to wash your hands before you eat and after using the toilet.

Why are special precautions or isolation taken with someone who has an MRSA infection?
MRSA infection is usually treated with an intravenous antibiotic which is both costly and may be toxic. The facility does not want this bacteria passed on from one resident to another, therefore a Contact Precautions sign may be put up at the door. Healthcare workers will wear protective barriers such as gloves and sometime gowns to prevent their skin and clothes from coming in contact with the bacteria, which could then be passed on to another resident. The use of barriers is not necessary for visitors.

This information is available in an informational booklet for residents and their families. Copies of the pamphlet are 25 cents per copy or 100 for $20.00 plus tax, shipping and handling.

References

Guideline for Prevention and Control of Antibiotic Resistant Microorganisms in California Long-Term Care Facilities, State of California, Department of Health Services, January 17, 1996

Guideline for isolation precautions in hospitals, Hospital Infection Control Practices Advisory Committee, Amer J Infect Control, Feb 199624(1), pp.24-52.

Boyce, JM et al. Methicillin-Resistant Staphylococcus aureus (MRSA): A Briefing for Acute Care Hospitals and Nursing Facilities. Infect Control Hosp Epidem, Feb 1994, 15(2), pp 105-115 .

Employee Illness Prevention

Prevention of employee illness begins with vaccination. Recommeded vaccines for employees are:

Influenza- for all employees of the facility

Varicella (Chicken pox/Shingles)- for suspectable employees with direct resident contact

Hepatitis B- for employees with blood exposure

Tetnus/diphtheria - for all employees who have not had a booster in 10 years

Prevention of tuberculosis should be addressed in the facility's TB Exposure Control Plan. This includes two-step Mantoux skin tests for new hires and residents and annual screening of employees.