MRSA information

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Definition of MRSA

Methicillin-resistant Staphylococcus Aureus (MRSA) is a type of staph bacteria that is resistant to certain antibiotics called beta-lactams. These antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin, and amoxicillin. In the community, most MRSA infections are skin infections. More severe or potentially life-threatening MRSA infections occur most frequently among patients in healthcare settings. While 25% to 30% of people are colonized* in the nose with staph, less than 2% are colonized with MRSA (Gorwitz RJ et al. Journal of Infectious Diseases. 2008:197:1226-34.).

*Colonized:
When a person carries the organism/bacteria but shows no clinical signs or symptoms of infection. For Staph aureus the most common body site colonized is the nose.

Symptoms of MRSA

As with all regular staph infections, recognizing the signs and receiving treatment for MRSA skin infections in the early stages reduces the chances of the infection becoming severe.

Severe Infections

MRSA in healthcare settings usually causes more severe and potentially life-threatening infections, such as bloodstream infections, surgical site infections, or pneumonia. The signs and symptoms will vary by the type and stage of the infection.

Skin Infections

In the community, most MRSA infections are skin infections that may appear as pustules or boils which often are red, swollen, painful, or have pus or other drainage. They often first look like spider bites or bumps that are red, swollen, and painful. These skin infections commonly occur at sites of visible skin trauma, such as cuts and abrasions, and areas of the body covered by hair (e.g., back of neck, groin, buttock, armpit, beard area of men).

Personal Prevention of MRSA Skin Infections

Protect yourself through good hygiene.

The key to preventing MRSA infections is for everyone to practice good hygiene:

Keep your hands clean by washing thoroughly with soap and water or using an alcohol-based hand rub.

Keep cuts and scrapes clean and covered with a bandage until healed.

Avoid contact with other people’s wounds or bandages.

Avoid sharing personal items such as towels or razors.

Prevent the spread of MRSA if you have it.

Prevent spreading MRSA skin infections to others by following these steps:

Cover your wound.
Keep wounds that are draining, or have pus, covered with clean, dry bandages until healed. Follow your healthcare provider’s instructions on proper care of the wound. Pus from infected wounds can contain staph, including MRSA, so keeping the infection covered will help prevent the spread to others. Bandages and tape can be discarded with the regular trash.

Clean your hands.
You, your family, and others in close contact should wash their hands frequently with soap and water or use an alcohol-based hand rub, especially after changing the bandage or touching the infected wound.

Do not share personal items.
Avoid sharing personal items, such as towels, washcloths, razors, clothing, or uniforms that may have had contact with the infected wound or bandage. Wash sheets, towels, and clothes that become soiled with water and laundry detergent. Use a dryer to dry clothes completely.

Maintain a clean environment
Establish cleaning procedures for frequently touched surfaces and surfaces that come into direct contact with your skin.

Talk to your doctor.
Tell any healthcare providers who treat you that you have or had a staph or MRSA skin infection. There are things that can be done to protect people that carry staph/MRSA from getting an infection or spreading it to others when they are in the hospital or have surgery.

Environmental Cleaning & Disinfecting for MRSA

What’s the difference between cleaners, sanitizers, and disinfectants?

Cleaners or detergents are products that are used to remove soil, dirt, dust, organic matter, and germs (like bacteria, viruses, and fungi). Cleaners or detergents work by washing the surface to lift dirt and germs off surfaces so they can be rinsed away with water. The same thing happens when you wash your hands with soap and water or when you wash dishes. Rinsing is an important part of the cleaning process. Use these products for routine cleaning of surfaces.

Sanitizers are used to reduce germs from surfaces but not totally get rid of them. Sanitizers reduce the germs from surfaces to levels that considered safe.

Disinfectants are chemical products that destroy or inactivate germs and prevent them from growing. Disinfectants have no effect on dirt, soil, or dust. Disinfectants are regulated by the U.S. Environmental Protection Agency (EPA). You can use a disinfectant after cleaning for surfaces that have visible blood or drainage from infected skin.

Which disinfectants should I use against MRSA?

Disinfectants effective against Staphylococcus aureus or staph are most likely also effective against MRSA. These products are readily available from grocery stores and other retail stores. Check the disinfectant product’s label on the back of the container. Most, if not all, disinfectant manufacturers will provide a list of germs on their label that their product can destroy. Use disinfectants that are registered by the EPA (check for an EPA registration number on the product’s label to confirm that it is registered).

How should cleaners and disinfectants be used?

Read the label first. Each cleaner and disinfectant has instructions on the label that tell you important facts:

How to apply the product to a surface.

How long you need to leave it on the surface to be effective (contact time).

If the surface needs to be cleaned first and rinsed after using.

If the disinfectant is safe for the surface.

Whether the product requires dilution with water before use.

Precautions you should take when applying the product, such as wearing gloves or aprons or making sure you have good ventilation during application.

Laundry

Routine laundry procedures, detergents, and laundry additives will all help to make clothes, towels, and linens safe to wear or touch. If items have been contaminated by infectious material, these may be laundered separately, but this is not absolutely necessary.

Facility Cleaning & Disinfection after a MRSA Infection

When MRSA skin infections occur, cleaning and disinfection should be performed on surfaces that are likely to contact uncovered or poorly covered infections.

Cleaning surfaces with detergent-based cleaners or Environmental Protection Agency (EPA)-registered disinfectants is effective at removing MRSA from the environment.

It is important to read the instruction labels on all cleaners to make sure they are used safely and appropriately.

Environmental cleaners and disinfectants should not be used to treat infections.

The EPA provides a list of EPA-registered products effective against MRSA

Surfaces to Clean

Focus on surfaces that touch people’s bare skin each day and any surfaces that could come into contact with uncovered infections. For example, surfaces such as benches in a weight room or locker room.

Large surfaces such as floors and walls have not been directly associated in the spread of staph and MRSA.

There is no evidence that spraying or fogging rooms or surfaces with disinfectants will prevent MRSA infections more effectively than the targeted approach of cleaning frequently touched surfaces and any surfaces that have been exposed to infections.

Shared Equipment

Shared equipment that comes into direct skin contact should be cleaned after each use and allowed to dry. Equipment, such as helmets and protective gear, should be cleaned according to the equipment manufacturers’ instructions to make sure the cleaner will not harm the item.

Cleaning Keyboards and other Difficult Surfaces

Many items such as computer keyboards or handheld electronic devices may be difficult to clean or disinfect or they could be damaged if they became wet. If these items are touched by many people during the course of the day, a cleanable cover/skin could be used on the item to allow for cleaning while protecting the item. Always check to see if the manufacturer has instructions for cleaning.

Is it Clean?

Although in most situations you will not know if a surface has been cleaned, it’s important to remember that most surfaces do not pose a risk of spreading MRSA. If cleaning procedures are unknown, take the appropriate precautions such as:

Using barriers like a towel or clothing between your skin and the surface.

Showering immediately after activities where you have direct skin contact with people or shared surfaces, such as after exercising at a health club.

Cleaning your hands regularly.

Keeping cuts and scrapes clean and covered with bandages or dressing until healed.

These precautions are especially important in settings such as in locker rooms, gyms, and health clubs.

Cleaning & Disinfecting Athletic Facilities for MRSA

Athletic facilities such as locker rooms should always be kept clean whether or not MRSA infections have occurred among the athletes.

Review cleaning procedures and schedules with the janitorial/environmental service staff.

Cleaning procedures should focus on commonly touched surfaces and surfaces that come into direct contact with people’s bare skin each day.

Cleaning with detergent-based cleaners or Environmental Protection Agency (EPA)-registered detergents/disinfectants will remove MRSA from surfaces.

Cleaners and disinfectants, including household chlorine bleach, can be irritating and exposure to these chemicals has been associated with health problems such as asthma and skin and eye irritation.

Take appropriate precautions described on the product’s label instructions to reduce exposure. Wearing personal protective equipment such as gloves and eye protection may be indicated.

Follow the instruction labels on all cleaners and disinfectants, including household chlorine bleach, to make sure they are used safely and correctly.

Some key questions that should be answered by reading the label include:

How should the cleaner or disinfectant be applied?

Do you need to clean the surface first before using the disinfectant (e.g., precleaned surfaces)?

Is it safe for the surface? Some cleaners and disinfectants, including household chlorine bleach, might damage some surfaces (e.g., metals, some plastics).

How long do you need to leave it on the surface to be effective (i.e., contact time)?

Do you need to rinse the surface with water after using the cleaner or disinfectant?

If you are using household chlorine bleach, check the label to see if the product has specific instructions for disinfection. If no disinfection instructions exist, then use 1/4 cup of regular household bleach in 1 gallon of water (a 1:100 dilution equivalent to 500-615 parts per million [ppm] of available chlorine) for disinfection of pre-cleaned surfaces.

Environmental cleaners and disinfectants should not be put onto skin or wounds and should never be used to treat infections.

The EPA provides a list of registered products that work against MRSA (List H):

There is a lack of evidence that large-scale use (e.g., spraying or fogging rooms or surfaces) of disinfectants will prevent MRSA infections more effectively than a more targeted approach of cleaning frequently-touched surfaces.

Repair or dispose of equipment and furniture with damaged surfaces that do not allow surfaces to be adequately cleaned.

Covering infections will greatly reduce the risks of surfaces becoming contaminated with MRSA.

Treatment of MRSA Infections

Treatment of MRSA will vary by the type and location of infection.

MRSA Skin Infections

Treatment for MRSA skin infections may include having a healthcare professional drain the infection and, in some cases, prescribe an antibiotic. Do not attempt to treat an MRSA skin infection by yourself; doing so could worsen or spread it to others. This includes popping, draining, or using disinfectants on the area. If you think you might have an infection, cover the affected skin, wash your hands, and contact your healthcare provider.

If you are given an antibiotic, be sure to take all of the doses (even if the infection is getting better), unless your healthcare professional tells you to stop taking it. Do not share antibiotics with other people or save unfinished antibiotics to use at another time.

If within a few days of visiting your healthcare provider the infection is not getting better, contact them again. If other people you know or live with get the same infection tell them to go to their healthcare provider.

It is possible to get repeat infections with MRSA. If you are cured of an infection, you do not become immune to future infections. Therefore, personal prevention steps are key.

Causes of MRSA Infections

How MRSA is Spread in the Community

MRSA infections, as with all staph, are usually spread by having contact with someone’s skin infection or personal items they have used, like towels, bandages, or razors that touched their infected skin. These infections are most likely to be spread in places where people are in close contact with others—for instance, schools and locker rooms where athletes might share razors or towels.

Factors that have been associated with the spread of MRSA skin infections include: close skin-to-skin contact, openings in the skin such as cuts or abrasions, contaminated items and surfaces, crowded living conditions, and poor hygiene. People may be more at risk in locations where these factors are common, including: athletic facilities, dormitories, military barracks, households, correctional facilities, and day-care centres.

Risks from Contaminated Surfaces

MRSA is found on people and not naturally found in the environment (e.g., soil, the ocean, lakes). MRSA could get on objects and surfaces outside the body if someone touches infected skin or certain areas of the body where these bacteria can live (like the nose) and then touches the object or surface. Another way that items can be contaminated with staph and MRSA is if they have direct contact with a person’s skin infection. Keeping skin infections covered with bandages is the best way to reduce the chance that surfaces will be contaminated with MRSA.

Even if surfaces have MRSA on them, this does not mean that you will definitely get an infection if you touch these surfaces. MRSA is most likely to cause problems when you have a cut or scrape that is not covered. That’s why it’s important to cover your cuts and open wounds with bandages. MRSA can also get into small openings in the skin, like the openings at hair follicles. The best defence is good hygiene. Keep your hands clean, use a barrier like clothing or towels between you and any surfaces you share with others (like gym equipment) and shower immediately after activities that involve direct skin contact with others. These are easy ways to decrease your risk of getting MRSA.

Hospitals and Healthcare Settings

Healthcare procedures can leave patients vulnerable to MRSA, which is typically spread in healthcare settings from patient to patient on unclean hands of healthcare personnel or through the improper use or reuse of equipment.

Hands may become contaminated with MRSA 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.
Appropriate hand hygiene such as washing with soap and water or using an alcohol-based hand rub can prevent the spread of MRSA.

MRSA information