Methicillin-Resistant Staphylococcus aureus (MRSA)
What is MRSA?
Staphylococcus aureus bacteria or “staph” are common germs. They are normally found on the skin or in the nose of many people. Usually, the bacteria cause no problem. Occasionally, they can cause mild skin infections. Or severe infections of the skin, lungs, blood, or other organs or tissues may develop. Some staph infections can be easily treated with antibiotics. But one type of staph infection, methicillin-resistant staphylococcus aureus (MRSA) cannot. It is called methicillin-resistant because the antibiotic, methicillin, which used to be effective treatment, no longer works. MRSA is common in hospitals and nursing homes or long-term care facilities. It is also spreading among healthy children and adults outside the healthcare system. A person may be a carrier. Or he or she may have the infection.
Colonization. When a person carries the MRSA bacteria but is healthy, it's called being colonized. This person can spread MRSA to others but has no infection.
Infection. When a person gets sick because of the bacteria, it's called being infected with MRSA. This person can also spread MRSA to others. If not treated properly, MRSA infections can be very serious and even cause death.
What are the risk factors for MRSA?
Anyone can get MRSA, although there are factors that increase the risk. Some of these include:
Recent or lengthy hospital stay
Having a surgical wound or intravenous (IV) line
Having a weakened immune system due to a medical condition or its treatment
Living in a nursing home or long-term care facility
Recent antibiotic therapy
Injection drug use or sharing needles
Jail or prison time
Living in any crowded facility, such as a dormitory
Sharing sports equipment, razors, or other sharp objects
How does MRSA spread?
People who are colonized with MRSA have MRSA in their noses or on their skin. Though they may not be sick themselves, they can spread the germs to others.
In hospitals and long-term care facilities, MRSA can spread from patient to patient on the hands of healthcare workers. It can also spread on objects, such as cart or door handles and bedrails.
Outside healthcare settings, MRSA usually spreads through skin-to-skin contact, shared towels or athletic equipment, or through close contact with an infected person.
What are the symptoms of MRSA infection?
MRSA skin infections start as small red bumps on the skin that look like pimples or spider bites. The small bumps usually get larger and become swollen, painful, warm to the touch, and filled with pus. Fever may be present. MRSA can also start in other ways. And it can spread deeper into the body where it can cause one or more of the following:
Infections in bones, muscles, and other tissues
Pneumonia, an infection in one or both lungs
Infection of a surgical wound
Infection in the bloodstream (bacteremia)
Infection of the lining of the heart (endocarditis)
Infection of the urinary tract (bladder and kidneys)
How is MRSA diagnosed?
A sample of blood, urine, or infected tissue may be taken to diagnose a MRSA infection. A swab of the inside of the nose is taken to diagnose colonization. The sample is then sent to a laboratory and tested for MRSA. if the infection involves bone, joint, or other organs, a blood test may be done. Imaging studies, such as an X-ray or CT scan, may also be needed.
How is MRSA treated?
MRSA infections are usually treated with antibiotics. It may be given by mouth in pill form or into a vein (intravenous or IV). If a skin abscess is present, it may be drained.
Patients who test positive for MRSA colonization may undergo a process called decolonization. A topical antibiotic is applied inside the nose or in the nostrils to kill the bacteria. A special soap may be used to cleanse the skin.
Can MRSA be prevented?
Hospitals and nursing homes help prevent MRSA by doing the following:
Handwashing. This is the single most important way to prevent the spread of germs. Healthcare workers should wash their hands with soap and water or an alcohol-based hand cleaner before and after treating each patient. They also should clean their hands after touching any surface that may be contaminated.
Protective clothing. Healthcare workers and visitors may wear gloves and a gown when entering the room of a patient with MRSA. They remove these items before leaving.
Private rooms. Patients with MRSA infections are placed in private rooms or in a room with others who have the same infection.
Personal care items. Patients with MRSA may have their own patient care items, such as thermometers and stethoscopes.
Monitoring. Hospitals monitor the spread of MRSA and educate all staff on the best ways to prevent it.
Patients can help prevent MRSA by doing the following:
Ask all hospital staff to wash their hands before touching you. Don’t be afraid to speak up!
Wash your own hands frequently with soap and water. Or use an alcohol-based hand gel.
Ask that stethoscopes and other instruments be wiped with alcohol before they are used on you.
Be sure you’re tested for MRSA if you have a skin infection.
If you are taking care of someone with MRSA:
Wash your hands well with soap and water before and after any contact with the person.
Wear gloves when changing a bandage or touching an infected wound. Discard gloves after each use. Then wash your hands well.
Wash the patient's bed linens, towels, and clothing in hot water with detergent or liquid bleach.
Everyone can help prevent MRSA by doing the following:
Wash your hands often with warm water and soap.
Rub your hands together.
Clean the whole hand, under your nails, between your fingers, and up the wrists.
Wash for at least 15 to 20 seconds.
Rinse, letting the water run down your fingers, not up your wrists.
Dry your hands well. Use a paper towel to turn off the faucet and open the door.
If soap and water aren't available, use an alcohol-based hand cleaner.
Squeeze about a tablespoon of cleaner into the palm of one hand.
Rub your hands together briskly, cleaning the backs of your hands, the palms, between your fingers, and up the wrists.
Rub until the cleaner is gone and your hands are completely dry.
Keep cuts and scrapes clean and covered until they heal.
Avoid contact with the wounds or bandages of others.
Avoid sharing towels, razors, clothing, and athletic equipment.
November 13, 2017
Patient Information: Methicillin-resistant Staphylococcus aureaus (MRSA) (Beyond the Basics), UpToDate.
Lentnek, Arnold, MD,Sather, Rita, RN