Concern has been growing for years about increasing rates of a type of staph infection — methicillin-resistant Staphylococcus aureus, or MRSA — that can cause serious illness and death. But even experts were surprised by the recent announcement that rates of MRSA are nearly double what was previously believed.
According to the Centers for Disease Control and Prevention (CDC), MRSA caused serious illness in 95,000 people in the U.S. in 2005, and killed approximately 19,000. That is more than the 17,000 Americans killed that year by complications from AIDS.
An 11-year-old girl who attended Vancleave Middle School on the Coast may be one of the latest victims of MRSA. The girl died at a Mobile hospital after antibiotic treatment failed.
Margaret Bush, acting superintendent of education for the Jackson County School District, said the district has not officially been notified that the student died of a staph infection. Staph infections are not a disease that is required to be reported to the health department.
“We don’t know if the cause of death for this child is staph,” Bush said. “We haven’t been given medical reports. We have not had an outbreak of staph. Everyone seems to think we have.
“We are continuing to disinfect like we have always done. Our nurses at the schools continually log in and keep data on any child who comes to them with a sore or anything that looks suspicious, and parents are contacted. We have given our schools information on cleanliness and information on what is involved with staph.”
There was public concern on the Gulf Coast about the number of staph infections following Hurricane Katrina. But Dr. Skip Nolan, a professor of medicine at University of Mississippi Medical Center, said staph infections were already widespread on the Coast before the hurricane.
“I was going down to the Coast to talk to doctor groups about it before the hurricane,” Nolan said. “Katrina didn’t help things. It disrupted things. People were living in tents and without running water, so it was difficult to have access to appropriate hygiene. But I don’t think we have solid numbers to know if it got a lot worse after Katrina. There was already a problem down there before Katrina hit.”
MRSA first appeared in 1998, and spread very quickly and widely across the U.S. Nolan said in the earlier years it was primarily seen in close populations like hospital patients, sports teams, inmates in prison and children in daycare centers.
“Now, it is being spread by normal contact from one person to another,” Nolan said. “It is a common cause of skin and soft tissue infections. In many emergency rooms, it now accounts for 50% to 70% of soft tissue infections being seen. Normally these are trivial infections where people come in and say they think they have a spider bite. Usually doctors drain the abscess, treat it with antibiotics, and it will go away. Occasionally we do see much more serious infections and sometimes deaths.”
While the medical community has known for years that MRSA is a growing problem, Nolan said most people were taken aback by the recent numbers released by the CDC.
It isn’t known for certain what causes MRSA. But overuse of antibiotics helping to develop “superbugs” is the suspected source.
“A number of years ago, strains of staph resistant to antibiotics showed up at bigger hospitals,” Nolan said. “That had a lot to do with the overuse of antibiotics and the lack of good hygiene from patient caregivers. MRSA has gone from bigger hospitals to smaller hospitals and nursing homes. It is now a big issue for virtually every hospital in the country.”
Passing it along
Nolan said approximately a third of people carry some type of staph on their skin at any one time. As long as the skin is intact, staph usually isn’t a problem. But someone who has staph might pass it along to someone with a cut or break in their skin, which allows it to enter the body and start reproducing.
The result can be what is called “boils.” Or, in Mississippi, it is often referred to as “pones” or “risings.”
“The majority of these infections are trivial,” Nolan said. “They respond to antibiotics and usually heal nicely with antibiotic therapy and drainage of the abscess. They do tend to recur and can spread within families.”
On the job
His recommendation for employers — especially those with workers who come into frequent contact with the public — is to pay good attention to hand hygiene. Alcohol-based hand cleaners are a good idea. But don’t overdo it spraying disinfectant everywhere. That can actually backfire.
Nolan said the disinfectants kill good bacteria along with bad bacteria. But the bad bacteria can come back more quickly. That is also true with bacteria in the body.
“People want antibiotics when they don’t really need them,” Nolan said. “The body is covered on the outside and lots of time inside with bacteria. Everyone has a lot of bacteria and most of it probably serves a purpose. These things may well keep out disease causing bacteria. Antibiotics disrupt bacteria and all of the sudden pathogens set up housekeeping.
“There is nothing wrong with taking antibiotics if you need them. But so often people with a cold or bronchitis think they need antibiotics and they don’t. My kids rarely ever take antibiotics with a sore throat or chest cold because I want antibiotics to work when they need them. People should avoid antibiotics unless there is a very good reason to take them. Instead of asking a doctor for an antibiotic and insisting on getting one, ask the doctor, ‘Do I really need this?’”
Priority for hospitals
Although staph is a “hot topic” in the media due to the recent report of higher incidences of MRSA than previously believed, MRSA has been an ongoing concern for hospitals for several years and continues to be a high priority issue in infection control, said Marcella L. McKay, PhD, RN, vice president for nursing and professional affairs, Mississippi Hospital Association.
“Hospitals consider MRSA prevention a high priority,” McKay said. “Infection control guidelines produced by the CDC and the Healthcare Infection Control and Prevention Advisory Committee (HICPAC) help guide activities to prevent and control infections in healthcare settings. CDC has extensive resources.”
Hospitals have mandatory and ongoing in-service education for staff members regarding infection control and MRSA prevention and treatment. McKay said when patients are diagnosed with infections, physicians order medications and treatments based upon specific clinical findings for that individual patient. Policies and protocols help guide care and assure consistency of quality care. Physicians, nurses, laboratory professionals, pharmacists and other health professionals work as a team to determine the best course of treatment for each individual situation. If patients come into the hospital at risk for infections, special protective practices are put into place to guard against infections.
“Hospitals employ RNs who are specialists in infection control and oversee the education of staff and communicate ‘best practices’ for prevention and treatment,” McKay said. “Larger hospitals have physicians on their medical staffs who specialize in the treatment of infectious diseases and work closely in consultation with other physicians who treat patients. Smaller hospitals refer patients for specialized care as needed. All hospitals have standard policies and procedures for infection control.”
Contact MBJ contributing writer Becky Gillette at email@example.com.
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