The healthcare industry is being challenged by an unprecedented problem with Hospital-Acquired Infections (HAIs) including Methicillin-ResistantStaphylococcus aureus (MRSA) infections. MRSA is a potentially dangerous type of staph bacteria that is resistant to most antibiotics and may cause skin and other infections. MRSA can be contracted through direct contact with an infected person or by touching a surface or item that has been in contact by someone with MRSA1.
Methicillin-Resistant Staphylococcus aureus (MRSA) is a bacterium that can cause difficult to treat infections in humans. It is also referred to as multi drug-resistant Staphylococcus aureus or Oxacillin-ResistantStaphylococcus aureus (ORSA).
MRSA by definition is any strain of Staphylococcus aureus that has developed a resistance to beta-lactam antibiotics which includes the class of penicillins and cephalosporins. These were the commonly used antibiotics in the treatment of Staphylococcus infections.
According to the World Health Organization, HAIs can be defined as an infection acquired in a hospital or other healthcare facility by a patient in whom the infection was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility2.
MRSA infections often occur in hospitals and other health facilities such as nursing homes and other long-term care facilities. When it occurs in these facilities it is often referred to as Hospital-Acquired MRSA. HA-MRSA is seen in patients with a weakened immune system or that have had procedures such as surgery for a hip or knee replacement, hernia repair or even had an I.V. started.
A second type of MRSA occurs in the general community in healthy individuals. This type is referred to as Community-Acquired MRSA or CA-MRSA, which can start as a boil or "Riser" that becomes painful. Some patients present with what looks like a spider bite. It can be spread by direct human contact. High risk CA-MRSA settings include child day care centers, dormitories, prisons, military training camps and athletic locker rooms, where individuals are in close quarters with others.
In hospitals and medical facilities nationwide, Skin and Soft Tissue Infections (SSTIs) are becoming widespread with an estimated 14.2 million cases of SSTIs annually3. In many U.S. cities MRSA is now the most common pathogen isolated in the emergency department from patients with skin and soft-tissue infections4.
The Centers for Disease Control and Prevention (CDC) maintain that the main mode of transmission of MRSA is via hands (especially healthcare workers' hands) which may become contaminated by contact with:
- colonized or infected patients;
- colonized or infected body sites of the personnel themselves; or
- devices, items, or environmental surfaces contaminated with body fluids containing MRSA.5
The CDC has instituted a National MRSA Education Initiative to help Americans better recognize and prevent MRSA skin infections. Recent data shows that Americans visit the doctor approximately 12 million times each year to get checked for suspected Staph or MRSA skin infections.
HA-MRSA and CA-MRSA occur in different settings and have different risk factors.
1. Centers for Disease Control and Prevention - Overview of Healthcare-associated MRSA,http://www.cdc.gov/ncidod/dhqp/ar_mrsa.html
2. Benenson AS. Control of communicable diseases manual, 16th edition. Washington, American Public Health Association, 1995.
3. Hersh AL, Chamber HF, Maselli JH, et al. National Trends in Ambulatory Visits and Antibiotic Prescribing for Skin and Soft-Tissue Infection, Arch Intern Med 2008;168:1585–91
4. Moran et al. Methicillin-Resistant S. aureus Infections among Patients in the Emergency Department, N Engl J Med 2006;355:666-74
5. Centers for Disease Control and Prevention - Healthcare-Associated Infections (HAIs)
- Older adults or persons with weakened immune systems, including cancer patients, transplant recipients or HIV/AIDS patients, are more susceptible to infection
- The use of invasive medical devices such as I.V.'s or urinary catheters may increase risk
- The use of quinolone antibiotics while hospitalized may also increase risk
- Living in a nursing home or other long-term care facility
- Working in a healthcare facility
A few simple steps can help prevent and reduce
the spread of MRSA.
You can help prevent CA-MRSA by:
- Washing your hands
- Keeping wounds and cuts covered
- Not sharing personal items like razors, towels, and sheets
- Wiping off athletic equipment
- Showering after athletic games or practices
- Sanitize your linens with added bleach if you have a cut or sore
If you or someone in your family experiences these signs and symptoms, cover the area with a bandage and contact your doctor or other healthcare professional. It is especially important to contact them if signs and symptoms of any infection are accompanied by a fever, or anytime that you have a pimple, boil, cut, scrape or other wound that rapidly becomes larger and more painful. Seek medical treatment if you have any concerns that you might have a MRSA infection.
MRSA infections typically start as a small red bump much like a pimple, spider bite, or boil that may be accompanied by fever and occasionally a rash. MRSA may progress substantially within 24–48 hours. The bumps become larger, more painful, and eventually open into deeper tissues as a pus-filled boil that may require surgical drainage and irrigation. Most CA-MRSA infections are confined to the skin and soft tissue. However, CA-MRSA can invade deep into the body and cause potentially life-threatening infection to the bloodstream, lungs, joints, bones, surgical wounds and other organs.
MRSA can fail to respond to typical antibiotic treatments and thus be very difficult to treat, which may lead to life-threatening complications.
- In hospitals and medical facilities nationwide, Skin and Soft Tissue Infections (SSTIs) are widespread, with an estimated 14.2 million cases of SSTIs annually2.
- In many U.S. cities, Methicillin-Resistant Staphylococcus aureus (MRSA) is now the most common pathogen isolated in the Emergency Department (ED) from patients with SSTIs.3
- MRSA is found in approximately 61% of excised abscesses.3
- 3.4 million ED visits can be attributed to SSTIs each year, and of these, 14% (476,000) result in hospitalization.4
- MRSA infections treated in the ED have increased substantially during the last few years, leading to greater exposure of ED staff. Recent studies report that MRSA nasal colonization for the general public is less than 1.5%, compared to 15% among ED Staff.5,6
- Current studies do not support the routine practice of prescribing prophylactic antibiotics after incision and drainage of simple cutaneous abscesses, even in areas with high MRSA prevalence7.
- 27.4% of ED patients treated for SSTIs were uninsured, according to the Healthcare Cost & Utilization Project (HCUP) National Emergency Department Sample (2007).6
1. Benenson AS. Control of communicable diseases manual, 16th edition. Washington, American Public Health Association, 1995.
2. Hersh AL, Chamber HF, Maselli JH, et al. National Trends in Ambulatory Visits and Antibiotic Prescribing for Skin and Soft-Tissue Infection, Arch Intern Med 2008;168:1585–91
3. Moran et al. Methicillin-Resistant S. aureus Infections among Patients in the Emergency Department, N Engl J Med 2006;355:666-74
4. Pallin DJ et al. Increased ED Visits for SSTI, and Changes in Antibiotic Choices, during the emergence of CA-MRSA. Annals of Emerg Med, 2007
5. Bisaga et al. A Prevalence Study of Methicillin-Resistant Staphylococcus aureus Colonization in Emergency Department Health Care Workers, Annals of Emergency Medicine, 2008
6. Gorwitz RJ, Kruszon-Moran D, McAllister SK, et al. Changes in the prevalence of nasal colonization withStaphylococcus aureus in the United States, 2001–2004. J Infect Dis 2008; 197:1226–34.
7. Hankin, A et al, Are Antibiotics Necessary After Incision and Drainage of a Cutaneous Abscess? Ann Emerg Med, 2007; 50:49-51