MRSA Infections (Methicillin-Resistant Staph Aureus)
by Dr. Christopher Chang, last modified on
There have been increasing numbers of a type of staph aureus infection that is resistant to most antibiotics known as MRSA that have been garnering attention in the news recently. Historically, MRSA has only been found in sick patients in the hospital, but in the past few years, there have been increasing numbers of MRSA infections in patients who have never been in the hospital for extended periods of time. Such MRSA infections outside the hospital setting is known as Community-Acquired MRSA or ca-MRSA.
Whether a patient has MRSA or not is determined by culture.
What exactly is MRSA?
Well, MRSA is just another type of germ just like staph or strep, but is unique in that most antibiotics will not work to kill the infection. This situation may arise when somebody does not take the full course of prescribed antibiotics or has been on multiple courses of antibiotics for the wrong reason (ie, antibiotics for a cold, antibiotics for a viral pharyngitis, antibiotics for fluid in the ears, etc). Eventually, chronic use of antibiotics will result in "tolerance" of germs in the human body leading to MRSA (and other types of drug resistant infections):
A more involved explanation for not just MRSA infections but other types of drug resistant infections can be illustrated in the following infographic below:
HOWEVER, MRSA is just another type of germ. Humans can become carriers where the germ exists on their body, but doesn't cause any problems. But, if a person has an active MRSA infection with open wounds or sores that are draining, the person is considered "contagious" in that it can jump from one person to another mainly by direct contact. As such, it is important to immediately see a physician for any open wounds or sores or other type of infection. The physician will obtain a culture in order to diagnose MRSA. If MRSA is diagnosed, there are only a few antibiotics that will work. Unfortunately, these antibiotics are not considered "powerful" in the traditional sense of the word. Indeed, antibiotics used to treat MRSA are not nearly as effective as more traditional antibiotics if used to treat non-MRSA infections.
How can one prevent from getting MRSA in the first place? In essence, wash your hands regularly and avoid any contact with any individuals with an active MRSA infection (ie, avoid touching surfaces they have touched, their clothing, direct skin to skin contact, etc). As implied already, do NOT take any antibiotics unless absolutely necessary for bacterial type infections. Antibiotics will NOT work for viral infections like the flu or cold symptoms.
If you and/or a family member has an active MRSA infection, there are certain precautions everybody must take in the same household to prevent spread. Click here to download a printable version.
(1) If there is an active infection:
• Treat with antibiotics based on cultures and sensitivities per protocol.
• Abscesses treated with Incision & Drainage
• Clean wound and change dressings with bandages several times a day. If necessary, packing dressing changes may be prescribed (watch YouTube video on how packing dressing changes are performed).
• Patient and caretakers to wash their hands with warm water and soap after every dressing change or contact with infected site.
• Use of an antiseptic gel containing Benzethonium Chloride over active skin wounds such as StaphASeptic MRSA Gel.
(2) Bactroban to nares and infected site q8h X 14 days. When applying Bactroban ointment to the nares, put a small amount on the end of a Q-tip and place just on the front, inside hairy part of both nostrils.
(3) Bath Soaks for ALL Household Members and Patient. Particular attention to all hair-bearing areas (scalp, armpits, groin)
• Clorox baths 1 tsp per gallon water for at least 15 minutes three times a week for 30 days AND
• Hibiclens (OTC) whole body washes daily for 30 days OR
• PhisoHex (Rx) whole body washes daily for 30 days OR
• Daily use of Sage (2% Chlorhexidine impregnated wash clothes) Bath Clothes when taking a shower
Be aware that Hibiclens and Phisohex are drying to the skin. When using soap products (Hibiclens, Phisohex, etc), apply the soap and lather all areas of your body from head (include hair) to toes (do not put in eyes or ears just like you normally wouldn’t put soap in these places). After wetting your skin, turn the water in the shower off and let the soap lather sit on your skin for about one minute before rinsing it off.
(4) ALL household members and patient to go swimming daily in chlorinated swimming pools or ocean-water for 30 days
(5) ALL household members and patient to keep fingernails cut short.
(6) ALL household members’ and patient’s clothing and bedding washed in HOT water bleach weekly or more often if needed for 30 days. Dry items in hot dryer. Do NOT air dry. Do not use large towels (i.e. shower) more than once. Clothes that have been worn and hung up in the closet also should be washed. Clothes that cannot be machine-washed can be dry-cleaned.
(7) Try to clean areas in the home that ALL household members and patient touch, sit, or lie on frequently in the first few days of treatment and again about midway through treatment. These surfaces can be cleaned with the disinfectant Lysol Disinfectant Spray. This product should not damage cloth the way bleach does. Don’t forget the doorknobs and car seats! Spray furniture that are frequently used. A walker or wheelchair should be disinfected weekly.
Fauquier Hospital's MRSA protocol can be downloaded here.
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