The following is an email I received from a fellow night crew member which contained some very valuable information regarding MRSA. I thought I would share it with you (with permission, of course):

MRSA

After some of us ran a code last week at a nursing home, we found out that the patient had methicillin-resistant staphylococcus aureus (MRSA), and questions came up about what that means for us if we are exposed, etc. So, here's some info that I hope is helpful.

Staphylococci are among the hardiest of all the bacteria that infect humans, and can survive harsh environmental conditions. For instance, it can be cultured from dried bodily substances after several months, and is heat resistant. Many neonates, and most children and adults, become intermittently colonized (meaning it's growing on a body surface without infecting the person it's on, but can be transmitted to others and make them sick) by harboring staph either in the nasopharynx, or on skin and clothing. It's also found occasionally in the vagina. Also, infected people have it in exudates, sputum, pus, wound drainage, and other types of gunk.

From any of these sites, the staph can contaminate any site on skin or mucous membrane, or other objects, by air or direct contact. Staph can also be transmitted via contaminated sheets, towels, kleenex, barf bags, bandages, patient clothing and belongings, etc. However, mucuous membranes and the skin are efficient mechanical barriers against tissue invasion and subsequent infections. So, a good skin washing after patient contact will usually do the trick. All the usual stuff that protects us from bugs--don't rub eyes, noses, face, etc.

If there is a break in the skin or mucous membrance, the staph gets into the underlying tissue and causes all types of abscesses, boils, furuncles, carbuncles, etc. The toxins the bacteria releases can cause various types of skin rashes and general symptoms--for example, Toxic Shock Syndrome from tampons is caused by staph. Staph can also invade the bloodstream and cause endocarditis (infection of the heart valves), pneumonia, osteomyelitis (infection of the bones), etc. It can be fatal. The good news is that most staph infections are readily treatable by common penicillin-related antibiotics, especially if caught early. So, see a doc if you develop any redness, swelling, pus draining, etc. even if it looks minor, like around a fingernail, etc. Also, sinus drainage, icky sore throat, productive cough, etc., etc.

MRSA is a specific strain of staph that is resistant to the usual antibiotics--a few cases resistant to all antibiotics have been reported in Japan, but these have not found there way to the U.S. yet. MRSA is found primarily in large referral hospitals (which Suburban is not), burn centers, and also in nursing homes, etc--anywhere patients tend to be immunosuppressed, elderly, etc. and stay a long time. MRSA is treated by a super-expensive antibiotic, vancomycin, if nothing else will work.

Usually, us healthy folks don't get bad staph infections. The bottom line for us is to was our hands, don't rub our faces/noses/eyes, etc.--the usual stuff! Might be a good idea if we get an infection to mention that we hang out at nursing homes a lot, because the doc might want to culture the drainage as a precaution. Also, I think we tend to under-utilize wearing masks and face shields on BCC calls in general--these would protect us against aerosols andairborne exposure to lots of stuff, especially when suctioning, on codes, etc. I know it reduces consumer satisfaction, but maybe it's worth talking about it.

Sandra L. Melnick
Dr.P.H. Acting Chief,
Analytic Epidemiology Research Branch Division of Cancer Control & Population Sciences