The U.S. Centers for Disease Control and Prevention (CDC) came right out and said it: MRSA infections, primarily those related to health care, are a “major public health problem.” Upfront in its report in the October 17 issue of the Journal of the American Medical Association, the CDC acknowledged that what was once a problem linked to health care facilities has now moved into the community. In places where close contact is common between individuals (such as schools, athletic facilities, and prisons), MRSA has become a threat requiring closer attention—and better hygiene.

Deaths from MRSA infections were far more common than previously thought, the CDC observed in its first benchmarking report. The CDC studied nine U.S. communities representing 16 million people and calculated national projections from the data. Although the news was not good, the country now has a baseline of information from which to track new MRSA cases. The report estimated that nation-wide in 2005 (the latest year for which information is available) drug-resistant MRSA caused the following:

More than 94,000 invasive infections (in which sterile body fluids, not skin or tissue, were affected)

Nearly 19,000 deaths

About 85% of the worrisome infections in 2005 could be linked to patients’ exposure to the bacteria in a health care setting (for example, a hospital, nursing home, dialysis center, or other facility providing care), the CDC emphasized. News media, meanwhile, have brought to light another aspect of MRSA in America: the deaths of otherwise healthy children and the antibiotic-resistant bacteria they may have picked up in their schools, sports activities, and locker rooms.

In the Community, Watch Those “Spider Bites”
In community settings, the bacteria are most often spread by direct skin-to-skin contact or contact with items or surfaces contaminated by someone with MRSA. Community-acquired infections are usually mild, involving a minor skin infection that may look like a spider bite or pimple (red and swollen, may be painful or pus-filled) or an ingrown hair. Although these bacteria are resistant to a widely used antibiotic, they remain susceptible to other antimicrobial agents that can be used and, therefore, death from these MRSA infections is unusual and can be avoided with a few common-sense actions:

Use basic hygiene: Wash hands often and shower after sports activities. Don’t share towels, washcloths, soaps, razors, athletic gear, soiled uniforms, or other items that have had contact with other people’s skin. For more on the proper way to wash your hands, click here.

Attend to wounds, broken skin, and minor infections: Keep damaged skin clean. Apply antibiotic ointment. Keep broken skin covered with a clean, dry bandage.

Seek prompt treatment: If skin is inflamed or possibly infected, seek medical attention early. Doing so helps you avoid serious and costly problems and obtain effective treatment (draining the pus and/or receiving appropriate antibiotic therapy).

Avoiding MRSA in Health care Settings
As noted in the CDC report, the risk of MRSA infection is highest when undergoing an invasive medical procedure such as surgery or when an open wound, cut, or abrasion comes in contact with a contaminated surface. A weakened immune system increases susceptibility to developing an infection.

There are recommendations on hygiene and ways to detect, prevent, and control these infections, but the CDC noted in its report that “Interventions for MRSA prevention are inconsistently implemented in U.S. hospitals.”

Finding the Infected: Who Should be Screened?
Some health care facilities screen high-risk patients for MRSA when they are first seen for care, whether they are seen in the emergency department or for planned procedures. States have passed legislation mandating MRSA screening of patients as one of the steps to control the spread of MRSA infection.

Screening high-risk patients identifies when extra infection control precautions are required to lessen the chances that MRSA infections might occur. Intensive-care units and acute-care hospitals used to be the primary concern, but the problem, the CDC notes, is no longer limited to these areas.

A few health care facilities in the United States now conduct MRSA surveillance testing on all patients. The first to do so were in major metropolitan areas. The 155 Veterans Affairs medical centers began phasing in MRSA testing in the spring of 2007 and in 2008 plan to test each patient. Critics argue that universal screening of hospital patients for MRSA may not be the best approach, that it may waste resources and time and interfere with the quality of care of an isolated patient. Supporters say that when universal screening has been used, MRSA infection rates have dropped substantially.

Steps You Can Take
Patients are being asked to help address the problems at the point of care, so don’t be afraid to speak up or ask questions about what should be done to best protect you. Health care providers should adhere to key practices to reduce the risk of transmission for all health care-acquired infections, not just MRSA infections. These include:

Hand washing: Personnel need to use soap and water or an alcohol-based cleanser before and after contact with each patient or items in a patient's room.

Cleaning and correctly disinfecting all patient care areas and supplies are critical, including radiology departments, outpatient imaging suites, and waiting areas.

Clean gloves and gowns are appropriate to wear when the patient is known to have MRSA. These must be disposed of promptly and properly.

Extra care in intensive care is required. Ventilators, central lines, and other equipment can house harmful bacteria.

You can ask caregivers to wash their hands before touching you or any equipment or supplies used for you. Ensure health care workers and any facilities staff put on clean gloves before they touch an opening in your body (including your mouth when they are taking a throat culture, your skin where they are inserting a needle to obtain a blood sample, and any place where the skin is broken). You can ask for a clean, unused tourniquet when getting your blood drawn, or ask when surfaces or equipment were last cleaned or disinfected.

Information is available to help you protect yourself and others. See the links below. Be sure to ask at your health care facilities (and, when appropriate, the community facilities your family uses—e.g., schools, daycares, fitness and sports centers) what the facility and its personnel do and don’t do to protect you from infection during your visits. Learn also the best ways to protect yourself.

Sources

S1
Klevens RM et al. 17 Oct 2007. Invasive methicillin-resistant staphylococcus aureus infections in the United States. JAMA 2007;298:1763-1771.

S2
Protecting 5 million lives from harm (fact sheet). Institute for Healthcare Improvement. PDF for download . Accessed 1 Nov 2007.

S3
Hand hygiene in healthcare settings. US Centers for Disease Control and Prevention. On the Internet: http://www.cdc.gov/handhygiene Accessed 8 Nov 2007.

S4
Summary of MRSA prevention guidelines from the Association for Professionals in Infection Control and Epidemiology. Association for Professionals in Infection Control and Epidemiology, Inc. PDF for download . Accessed 7 Nov 2007.

S5
About the Speak Up program. Joint Commission. On the Internet: http://www.jointcommission.org/GeneralPublic/Speak+Up/about_speakup.htm. Accessed 7 Nov 2007.

S6
FitzGerald S. Jul 2007. More hospitals fight MRSA with universal screening. ACP Hospitalist. On the Internet: http://www.acponline.org/hospitalist/july07/mrsa.htm. Accessed 1 Nov 2007.

S7
CDC estimates 84,000 invasive drug-resistant staph infections occurred in the US in 2005 (press release). 15 Oct 2007. US Center for Disease Control and Prevention. On the Internet: http://www.cdc.gov/od/oc/media/pressrel/2007/r071016.htm. Accessed 1 Nov 2007.

S8
Invasive MRSA (fact sheet). 17 Oct 2007. Centers for Disease Control and Prevention. On the Internet: http://www.cdc.gov/ncidod/dhqp/ar_mrsa_Invasive_FS.html. Accessed 1 Nov 2007.

S9
Questions and answers about methicillin-resistant Staphylococcus aureus (MRSA) in schools. 19 Oct 2007. US Centers for Disease Control and Prevention. On the Internet: http://www.cdc.gov/Features/MRSAinSchools/#q6. Accessed 2 Nov 2007.

S10
Community-associated MRSA information for the public. 3 Feb 2005. US Centers for Disease Control and Prevention. On the Internet: http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_public.html. Accessed 1 Nov 2007.