MRSA

Description

Garden-variety staph are common bacteria that can live in our bodies. Plenty of healthy people carry staph without being infected by it. In fact, 25%-30% of us have staph bacteria in our noses.

But staph can be a problem if it manages to get into the body, often through a cut. Once there, it can cause an infection. Staph is one of the most common causes of skin infections in the U.S. Usually, these are minor and don't need special treatment. Less often, staph can cause serious problems like infected wounds or pneumonia.

Staph can usually be treated with antibiotics. But over the decades, some strains of staph -- like MRSA -- have become resistant to antibiotics that once destroyed it. MRSA was first discovered in 1961. It's now resistant to methicillin, amoxicillin, penicillin, oxacillin, and many other antibiotics.

While some antibiotics still work, MRSA is constantly adapting. Researchers developing new antibiotics are having a tough time keeping up.

Cause

Community-associated MRSA is easily spread from person to person, either through direct contact or through contact with surfaces contaminated with the bacteria. A single infected athlete can quickly become the source of an outbreak that can affect the entire team. It is essential that the Athletic Trainer and coaches know about every skin infection as soon as it occurs, and that every athlete knows to be evaluated at the first sign of a possible infection

• Skin-to-skin contact: MRSA can be transmitted from one person to another by skin-to-skin contact. While MRSA skin infections can occur in participants of many types of sports, they're much more likely to occur in contact sports — such as football, wrestling and rugby.

• Touching contaminated objects: If drainage from an MRSA skin infection comes into contact with an object — like a towel, weight training equipment or a shared jar of ointment — the next person who touches that object may become infected with MRSA bacteria.

Symptoms

The symptoms of MRSA infection depend on where you've been infected. MRSA most often appears as a skin infection, like a boil or abscess. It also might infect a surgical wound. In either case, the area would look:

• Swollen

• Red

• Painful

• Pus filled

Many people who have a staph skin infection often mistake it for a spider bite. If staph infects the lungs and causes pneumonia, you might have:

• Shortness of breath

• Fever

• Cough

• Chills

MRSA can cause many other symptoms, because it can infect the urinary tract or the bloodstream. Very rarely, staph can result in necrotizing fasciitis, or "flesh-eating" bacterial infections. These are serious skin infections that spread very quickly. While frightening, only a handful of necrotizing fasciitis cases has been reported.

Examination

Most doctors start with a complete history and physical exam to identify any skin changes that may be due to MRSA, especially if the athlete or parent mentions a close association with a person who has been diagnosed with MRSA. A skin sample, sample of pus from a wound, or blood, urine, or tissue sample is sent to a lab and cultured . If S. aureus is isolated (grown on a Petri plate), the bacteria are then exposed to different antibiotics, including methicillin. S. aureus bacteria that grow well when methicillin is in the culture are termed MRSA, and the patient is diagnosed as MRSA infected. These tests help distinguish MRSA infections from other skin changes that often appear initially similar to MRSA, such as spider bites and skin changes that occur with Lyme disease. These tests are very important, as misidentification of a MRSA infection may cause the patient to be treated incorrectly. This can result in progression of the MRSA infection and other complications.

In 2008, theFDA approved a rapid blood test (StaphSR assay) that can detect the presence of MRSA genetic material in a blood sample in as little as two hours. The test is also able to determine whether the genetic material is from MRSA or from less dangerous forms of staph bacteria. In addition, there are new screening tests that detect or rule out MRSA infections in about five hours.

Treatment

Fortunately, many MRSA infections still can be treated by certain specific antibiotics (for example, vancomycin [Vancocin], linezolid [Zyvox], and others, often in combination with vancomycin). Most moderate to severe infections need to be treated by intravenous antibiotics, usually given in the hospital setting. Some CA-MRSA strains are susceptible to trimethoprim-sulfamethoxazole (Bactrim), doxycycline (Vibramycin), and clindamycin (Cleocin); although reports suggest clindamycin resistance is increasing rapidly. In addition, some strains are now resistant to vancomycin. In 2011, researchers developed a chemical change in the antibiotic vancomycin that rendered vancomycin-resistant MRSA susceptible to the drug. It is not available commercially, but this discovery, along with ongoing research, is important because it may expand treatment possibilities for MRSA and other drug-resistant bacteria such as VRE (vancomycin-resistant enterococci). Another drug, Teflaro, has been approved for treatment by the FDA for MRSA infections. (©1996-2013 MedicineNet, Inc. All rights reserved)

Taking Care Of Wounds At Home:

• The wound must remain covered. The dressing must be changed at least twice a day or more frequently if drainage is apparent or as directed by the clinician. Consider using clean, disposable, non-sterile gloves to change bandages.

• The athlete must was hands frequently, especially before and after changing bandaids, bandages, or wound dressings.

• Isopropyl alcohol and friction should be used to disinfect reusable materials, such as scissors or tweezers

• Reusable equipment that comes in contact with the wound must be disinfected with a fresh (daily) mix of one tablespoon of household bleach to one quart of water or a phenol-containing product such as Lysol® or Pinesol®. Contact time of the item in the disinfectant solution should be limited to manufacturer’s recommendations so as to not corrode the reusable item. A phenol-containing spray can also be used to disinfect any cloth or upholstered surface

• Place disposable items that have come in contact with the infected site, including soiled dressings, in a separate trash bag and close the bag before placing in the common garbage or household trash.

Taking Care Of Wounds At School:

• Instruct the athlete to carry and use an alcohol-based hand sanitizer when soap and water are not available.

• Clean and disinfect sports equipment or any part of the athletic area that comes in contact with the wound with commercial disinfectant or fresh solution of diluted bleach before any other athlete comes in contact with the equipment or area.

• Athletic trainers or others who care for the wound should use clean non-sterile gloves.

• Put on clean gloves just before touching broken skin.

• Remove gloves promptly after use and discard.

• Wash hands immediately after contact with the wound even if gloves were worn.

• Cover treatment tables. Discard or launder coverings after each use, and disinfect the treatment table.

• Place disposable items that have come in contact with the infected site in a separate trash bag and close the bag before placing in the common garbage.

• Do not give other team members prophylactic antibiotics.

Prevention

Hand washing is the single most important behavior in preventing the spread of infectious disease. Parents, coaches and medical staff should emphasize this with athletes. Hands must be clean before touching eyes, mouth, nose, or any cuts or scrapes on the skin. Wash hands or use an alcohol based hand sanitizer frequently. If hands are visibly soiled, wash with soap and water rather than hand sanitizer.

HANDWASHING PROCEDURE

1. Use warm water.

2. Wet hands and wrists.

3. Use a bar or liquid soap. Antimicrobial soap is not necessary to disinfect against MRSA. Work soap into a lather and wash palms, back of hands up to wrists, between fingers, around thumbs, and under fingernails for at least 15 seconds.

4. Dry hands, using a disposable paper towel or hand-dryer.

5. Provide and encourage the use of alcohol-based hand sanitizers to wash hands in places where hand-washing facilities are not available or to wash hands immediately if personnel or athletes come in contact with any body fluid on the playing field.

Personal Hygiene

· Shower with soap and water as soon as possible after direct contact sports.

· Dry using a clean, dry towel.

· Do not share towels (even on the sidelines of games), soap, or other personal care items.

Laundry and Linens

· When handling dirty laundry or clothing, it should be held away from the body to keep the handler from contaminating their clothing.

· Prewash or rinse items that have been grossly contaminated with body fluids.

· Wash towels, uniforms, scrimmage shirts, and any other laundry in hot water (>160°F for at least 25 minutes) and ordinary detergent and dry on the hottest cycle the fabric will tolerate. Items that can be bleached should be bleached. Alternatively, shared linens may be washed at a lower temperature if an oxygenated detergent is used.

· Dry linens with a mechanical dryer. Distribute towels, uniforms, etc. only when they are completely dry.

· Inform parents of these precautions if laundry is sent home (laundry must be in an impervious container or plastic bag for transporting home).

Athletic Equipment

· Athletes should use a towel or clothing to act as a barrier between surfaces of shared equipment and bare skin.

· Disinfect frequently touched areas on shared equipment and in the athletic area daily using a commercial EPA registered detergent/disinfectant with a label claim for Staphylococcus aureus, or a fresh (mixed daily) solution of one part bleach and 100 parts water (1 tablespoon bleach in one quart of water). For disinfection to occur, the surface must be clean, and there must be 10 minutes wet contact time.

· Equipment that comes into contact with bare skin such as training tables should be thoroughly cleaned between each use. Consider making spray bottles of disinfectant active against Staphylococcus aureus available for use; provide instructions for safe use. Alternately, containers of disinfectant wipes may be used.

· Treatment tables used for infected athletes should be covered before each use (see below).

· Repair or dispose of equipment and furniture with damaged surfaces that cannot be adequately cleaned. .

· Participate in an ongoing assessment and training for appropriate cleaning and disinfection practices at the facility.