McCleary MRSA Prevention

MRSA (pronounced MERSA) is  Methicillin Resistant Staphylococcus Aureus.  It is easy to understand why MRSA is used instead of the long name.  The microorganism is a morphed form of Staph or Staphylococcus Aureus.  Everybody has heard of Staph infections.  They have plagued people for many years. Until MRSA, most staph infections could be effectively treated with Pennicillin and other common antibiotics.  Around 1960, doctors discovered that some Staph infections no longer responded to regular antibiotics, so they discovered a synthetic “cillin” Methicillin.  After too many years of doctors and other prescribers over prescribing antibiotics for viral illnesses and other minor infections, Staph became resistant to Methicillin too.  Thus the title Methicillin Resistant Staphylococcus Aureus.

MRSA can be contracted inside hospitals and in the community, but it is believed the origin of the infections is health care facilities.  Until lately, Community Acquired MRSA had different DNA than Hospital Acquired MRSA.  It is feared that the two are merging.

HA MRSA accounts for about 70% of all Staph infections in hospitals now.  Staph infections are  the most common HA (hospital acquired) infection.  It invades all soft tissue, organs, bone, blood, lungs and airways, nose, throat and ears.  Many (approximately 30%) of us carry MRSA in our noses.  We have healthy immune systems and so it does not cause symptoms of infection, such as fever, swelling or malaise.  If for some reason we become vulnerable to infection, such as after a serious surgery, we can spread our MRSA from the nose to a surgical wound.  Pre surgical nasal cultures for MRSA can help all of us to avoid such a disaster.  Many thousands of serious surgical site MRSA infections have caused patients unnecessary pain and extended recovery periods.  Some get MRSA in their blood streams and they can die.  Once MRSA becomes invasive, it is very difficult to get rid of.  Amputations are sometimes necessary.

Other common sites of MRSA are in Central line IVs, urinary catheters, lungs after tracheotomies or intubations, and in joint replacements.  High risk patients such as Cancer patients, dialysis patients, Long term care patients and others should always be screened when being admitted to the hospital.   All Pre surgical patients should also be screened.  People with known previous MRSA infections and their caregivers should also be screened.

If those screening cultures are positive, there is a simple treatment for it.  Bactroban cream is put into the nose a few times a day for 5 days and then sometimes the patient is recultured. They are also given Chlorhexidine (Phisohex or Hibiclens) baths once day. During that time, it’s best to avoid procedures that could introduce MRSA into deeper parts of the body, unless it is an emergency.  It is also best to isolate people who are positive for MRSA in their noses or other places.

MRSA is spread to patients in hospitals by hands or by contaminated equipment.  The method of spread of MRSA is contact and droplet.  This means that if a patient is coughing and has MRSA in their lungs, MRSA can be propelled by a cough up to 3 feet from the patient.  The droplets will contaminate all of those surfaces.  Health care workers must use contact precautions AND respiratory precautions when caring for patients with MRSA in the lungs. Caregivers and visitors must use both gloves and masks.  If MRSA is in wounds or on the skin, contact precautions  (handwashing and gloves) are sufficient.

Contact Precautions are as follows.  Before and between contact with patients, the caregiver, or other persons entering the room, must wash their hands with soap and water, or use an alcohol bases hand cleanser.  Then non sterile gloves must be worn.  If the caregiver is going to be handling any wet bedding or have close touching contact with the patient then a gown must also be worn.  The germ can get onto caregivers and visitor’s  clothing and be spread to other patients. The hands must be washed and new gloves and gown put on before contact with another patient.  All frequently used items such as a blood pressure cuff, thermometer, IV poles or pumps, must be assigned to MRSA positive patients and not shared with non infected or non colonized patients.

If there is lung invovlement or there will be spraying of infected bodily fluids, a mask must also be worn by the caregivers/visitors.

MRSA is considered an infection when the patient has active signs of infection to include fever, malaise, purulent (pus) drainage, swelling, redness, and other signs of active infection.  My father was treated for his infection and then given the sad news that he would always be colonized in his lungs.  This means the bacteria never goes away and he could become ill again with infection at any time.  Because he had MRSA in his sputum and for the rest of his life, he still needed to stay on respiratory and contact precautions.  We wore masks and gloves every visit until he died.

MRSA is a persistant, invasive and a potentially deadly disease.  In Maine Hospitals are not required to even report these hospital acquired infections to the State CDC.  The purpose of CDC is to Control Disease.  If they are not given the numbers of these infections, how will they know where to concentrate their efforts to control the spread of the disease?  Part of my proposal will be to require all hospitals in the State of Maine to report these infections, and if they were present on the patients hospital admission or if they acquired it while hospitalized.  This will make hospitals accountable for infections that they spread to vulnerable patients.  Publicizing this information will also allow health care consumers a way to make wise health care decisions for themselves and their families.

MRSA can be controlled.  The VA hospitals all over the country require ever single hospital admission be screened, and they follow the other steps I have included in my proposal.  It has been successful enough that they will now expand their program into VA Long Term facilities.

Contact your local senators and representatives to support the McCleary MRSA prevention bill, now known as Maine LD 1038.