MRSA: A 'Super' Problem

The stubborn staph infection with a mouthful of a name — Methicillin-resistant Staphylococcus aureus, dubbed MRSA for short — has recently been considered “endemic, and in some cases epidemic,” in many hospitals, long-term care facilities and communities across the United States according to the Centers for Disease Control (CDC).

Researchers say control of the infection should be made a “national priority.” In fact, the statistics associated with the “superbug” echo from coast to coast. The CDC estimates that MRSA strikes 31.8 out of every 100,000 Americans, making it more common than flesh-eating strep infections, bacterial pneumonia and meningitis combined. Ninety-four thousand serious infections and 19,000 deaths each year can be attributed to the bacterium, making it more deadly than Acquired Immune Deficiency Syndrome (AIDS).

Referred to as the “silent epidemic,” MRSA is a bacterium that is resistant to most common antibiotics and causes staph infections on various parts of the human body. Most often, the bacterium causes mild infections on the skin, causing pimples or boils. MRSA can also lead to more serious skin infections or infect surgical wounds, the bloodstream, the lungs or the urinary tract. Depending on where the MRSA infection occurs, it can be life threatening.

As of late, MRSA infections are forcing school districts to call off classes, cancel sporting events, and bring in cleaning crews to disinfect buildings from top to bottom.

The ABCs Of MRSA
MRSA is by no means a new threat to society. The staph infection has been circulating in the U.S. for at least 30 years, primarily in healthcare settings. MRSA occurs most frequently among patients who undergo invasive medical procedures or who have weakened immune systems. However, everyone in the community can be at risk of catching MRSA.

In fact, hospitalizations related to MRSA more than doubled — from 127,000 to nearly 280,000 — between 1999 and 2005, according to a recent study released in the journal Emerging Infectious Diseases. During that same period, hospitalizations of patients with general staph infections increased 62 percent across the country. Researchers say MRSA infections are spreading like wildfires in both hospitals and communities and are complicating efforts to prevent infections in hospital patients.

MRSA invades the body via cuts or abrasions in the skin, causing an infection that can be debilitating if not treated early and with the appropriate antibiotics. The bacterium is spread mostly through personal skin-to-skin contact and through the sharing of personal items such as towels, razors or athletic equipment. The best defensive measure against coming down with and spreading MRSA is through good hygiene — frequent and thorough handwashing and caring for and covering open wounds, says Nicole Coffin, spokeswoman for the CDC.

“Skin-to-skin contact is the most important contributor to transmission,” Coffin says. “People need to know that hygiene is really important. It’s not really sexy but it can stop an outbreak.”

Patients who already have a MRSA infection, or carry the bacteria on their bodies but do not have symptoms, are the most common sources of transmission. The main mode of the spread of the bacterium to other patients is through human hands, especially healthcare workers’ hands. Hands may become contaminated with MRSA bacteria by contact with infected or colonized patients (those who do not have symptoms) or by devices, items or environmental surfaces contaminated with skin squames or bodily fluids containing MRSA. If appropriate hand hygiene such as washing with soap and water or using an alcohol-based hand sanitizer is not performed, the bacteria can be spread when the healthcare worker touches other patients.

MRSA In The Community
In 1998 health officials began seeing a new MRSA strain in people with no ties to healthcare settings.

“Early on we thought what we saw in the hospital and then what we saw in the community was linked — that it was sort of leaking out of hospitals,” Coffin says. “But what is happening in the community was separate and distinct and the MRSA strains have actually emerged in the community outside the hospital.”

Unlike the hospital-based MRSA, the community-based strain (CA-MRSA) affects otherwise healthy people. Community-based MRSA infections, however, are usually more superficial and easier to treat than those in hospitals. But doctors are mystified by how quickly and widely the health risk has spread. Once seen only in sick hospital patients, drug-resistant MRSA infections are now being diagnosed in the community — in healthy children, teens and adults.

Some schools have gone to extreme measures and have cancelled classes to disinfect the premises after a student or staff member had come down with a MRSA infection. Coffin says closing a school’s doors because of a MRSA infection may be too drastic.

“Ultimately that’s a decision that’s going to be made ideally involving the Health Department,” says Coffin. “In general, we tell people it’s not necessary to close a school because of a MRSA infection in a student.”

Hospitals on the other hand, have no choice but to remain open. So, if MRSA is detected on or in a patient, that patient is isolated and special clean-room precautions are initiated, where anyone who enters must first wear sterile garments over their clothes and must wash their hands with a special cleanser.

Combating MRSA in schools, however, is beginning to pose a much larger problem as many MRSA infections are being spread in school gyms and locker rooms, where athletes — perhaps suffering from cuts and abrasions — share athletic equipment and lack proper hygiene. Increased pressure has been put on cleaning staffs to clean and disinfect all surfaces where the bacterium is likely to reside.

The Role Of Cleaning Professionals
For years healthcare facilities have been able to successfully combat and control MRSA outbreaks. Now, as community-based MRSA has begun to infect occupants at educational facilities at an alarming rate, cleaning staffs are looking to their distributors for training and help on quelling MRSA infections.

Distributors say their phones have been ringing off the hook, especially the last couple of months, as MRSA-related infections and deaths have made national headlines. Customers mostly are searching for ways to MRSA-proof their facilities, says Larry Johnson, product manager at S. Freedman & Sons Inc., Landover, Md.

“They’re trying to make sure they have policies in place and make sure they’re cleaning correctly,” says Johnson. “So when they get asked if they have a policy in place they can say yes.”

Schools are also looking for immediate help in times of crisis, says Ryan Myers, vice president of sales at Little Rock, Ark.-based Myers Supply. Myers says his company has helped numerous schools revisit their cleaning procedures where students and staff have come down with MRSA infections. The first line of business Myers Supply does with its clients is outfit them with alcohol-based hand sanitizer stations and antimicrobial soaps with quick kill time, which Myers says encourages good hand hygiene. The company then dives in to how the building is being cleaned.

“We basically go in and do an evaluation of their procedures as a whole,” says Myers. “We educate everybody in the building and get them aware of how MRSA spreads.”

According to the CDC, along with skin-to-skin contact, the lack of cleanliness and contaminated items and surfaces in facilities are the main factors in MRSA transmission in schools.

With that in mind, sales of disinfectants and cleaners that kill the MRSA strain have escalated. Cleaning staffs are being told to pay particular attention to high-touch areas in schools as the MRSA strain can live for up to 24 hours on just about any surface, says Tad Vonachen, vice president of sales at AmSan in Peoria, Ill. This includes disinfecting in areas or on surfaces where pathogens can collect and breed, such as in restrooms or on door handles, bathroom faucets and other fomites.

“The biggest thing you want to address is contact surfaces that people are constantly touching,” says Johnson. “If people are going to touch it on a regular basis, then you want to make sure it’s cleaned as often as you can.”

But Johnson says he has to remind customers that if they’re cleaning like they’re supposed to everyday they can control and prevent a MRSA outbreak from occurring.

“This should be all of your normal cleaning everyday,” Johnson says. “It shouldn’t be an additional task.”

Education And Training
Educating customers on the seriousness of MRSA has been at the top of the list for many distributors across the country. Distributors also recognize that re-educating their own sales staff on the topic is extremely important.

“It doesn’t hurt to say, listen, while you’re out there, this is a very hot topic right now and let your people know we can help them with procedures, with products, any way they want to go — with training,” says Johnson.

The majority of the training of customers for MRSA is related to what chemicals to use and proper procedures — making sure they are giving the chemicals enough dwell time, says Johnson.

“We make sure they are using the chemicals the right way and not skipping surfaces in a hurry,” he says. “It’s a basic training that we’ve been doing all along on the proper way to clean. Nothing has really changed. There’s just better, proper ways to clean and making sure they are using the proper chemical, the proper dilution and giving it the proper dwell time.”

Distributors recommend when using chemical disinfectants or cleaner/disinfectants, to follow the product label directions for preparation of disinfecting solutions and the appropriate disinfecting and cleaning method for the area to be cleaned.

Most distributors are also going beyond the cleaning aspect and are providing educational material for building occupants.

“We basically provide all the information back to the schools,” says Vonachen. “It becomes letters for parents, letters for coaches on what MRSA is, how it can be combated and how it is prevented.”

As hospitals and schools have been feeding grounds for MRSA infections, the risk of it expanding into other community settings is not out of the question. In the end, what matters most is if a facility has a cleaning staff that takes the time to clean for health.

“Take time to clean properly,” Johnson stresses. “Follow the procedures, follow the directions on the labels of the products and don’t cut corners.”