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What is Staphylococcus aureus?. Staphylococcus aureus (
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1. Community-Acquired Methicillin- Resistant Staph aureus (CAMRSA):What You Need to Know Helene M. Calvet, MD
3. MRSA Overview MRSA has been around for decades in hospitals (hospital-acquired MRSA, or HAMRSA)
Now there are two types of MRSA: HAMRSA and community-acquired MRSA (or CAMRSA)
CAMRSA started to be reported in literature about 10 years ago
Although it is not required to report all MRSA infections (so we dont have accurate statistics about how many infections there are), CAMRSA infections now are very common, and account for more than half of the skin infections seen in ERs in California
4. Comparison of HAMRSA and CAMRSA CAMRSA
Causes skin and soft tissue infections; serious infections rare
Typically affects healthy, community-dwelling persons
Resistant to penicillins (like dicloxacillin) and cephalosporins (like Keflex), but several oral antibiotics do work against it HAMRSA
Serious infections common (pneumonia, blood stream infection, etc.)
Typically affects sick people in hospitals and nursing homes
Resistant to almost all oral antibiotics, usually need intravenous medications
5. Is CAMRSA Really a Superbug?Myths and Realities Is CAMRSA resistant to all antibiotics?
No, there are many antibiotics with which it can be treated
Is CAMRSA killing lots of people (more people in the US dying from MRSA than AIDS) ?
No, most of the deaths reported in studies occurred in older people with lots of medical problems (so they may have died of other medical problems) and most had HAMRSA infections, not CAMRSA
Is CAMRSA tough to get rid of in the environment (do schools need to close down if a student is found to have a CAMRSA infection)?
No, CAMRSA is killed by standard disinfectants, and school closure is not recommended
Do we need to worry about CAMRSA?
Dont lose sleep over it, but learn to recognize it and respect it
6. Staphylococcus aureus Colonization Colonization: bacteria living in an area, but not causing disease
Areas of staph colonization:
Front part of the nose (nostrils) most common place
25-35% healthy adults colonized at any one time
Armpits, groin, back part of nose or throat, damaged skin, vagina or rectum can also be colonized
Hands, intact skin colonized transiently
MRSA can colonize the same areas, but not as commonly as regular staph (less than 1% of people colonized)
7. Transmission of S. aureus (1)
8. Transmission of S. aureus (2)
9. Transmission of CAMRSA From Environmental Surfaces Unclear how much of a role environmental surfaces play
Staph can survive on surfaces from hours to weeks, depending on multiple factors:
Temperature and humidity
Amount of bacteria
Type of surface (porous versus nonporous)
Availability of nutrients
10. Risk Factors for CAMRSA InfectionThe Five Cs Compromised (broken) skin
Contact (skin - to - skin)
Contaminated items or surfaces
Crowding
Difficulty keeping clean (poor hygiene)
11. Recognition of CAMRSA Infections Spider bites: pimples or pustules
Boils: abscesses
Cellulitis: diffuse skin infection
Common signs: redness, swelling and warmth of skin
Common symptoms: tenderness of skin, pain or itching
12. CAMRSA Skin InfectionsSpider Bites
13. CAMRSA Skin InfectionsBoils (Abscesses)
14. CAMRSA Skin Infections Draining Abscesses
15. Cellulitis
16. Treatment of CAMRSA Infections Drainage: most important aspect of treatment of abscesses
Antibiotics: may not be needed for all infections
Wound care
17. Treatment of CAMRSA Are Antibiotics Needed for Abscesses? 69 children with CAMRSA skin and soft tissue abscess
Those with large abscesses (> 5 cm) more likely to be admitted to hospital
Others treated with drainage and antibiotics, but only 5 (7%) received appropriate medications before culture results back
Comparison of those who received appropriate antibiotics (5) with those who did not (15): no significant differences in response!
Drainage without antibiotic therapy effective management of CAMRSA skin and soft tissue abscesses <5 cm
18. Antibiotics for CAMRSA Trimethoprim-sulfamethoxazole (Bactrim, Septra)
Clindamycin (Cleocin)
Doxycycline (Vibramycin)
Rifampin (Rifadin): should not be used alone
Linezolid (Zyvox)
Vancomycin (intravenous only)
19. Wound care Keep infected area covered with bandages if open and/or draining
Change bandage as often as needed to contain drainage (if wet, change it)
Wear gloves if possible when changing bandages
Carefully wash hands after handling bandages or any drainage from wound (even if you used gloves!)
20. Work Settings and MRSA MRSA has been a long term problem in multiple healthcare settings
Acute care hospitals, especially intensive care units
Long term care facilities (nursing homes)
Dialysis centers
Many guidelines available for prevention of MRSA in these settings
Mostly HAMRSA, but now both
21. Work Settings and CAMRSA (2) First large outbreaks of CAMRSA noted in community starting in 2000
Affected groups included:
Prisoners in jails
Athletes in contact sports (football, wrestlers)
Men who have sex with men (MSMs)
School children
Guidelines now available for competitive sports (NCAA), schools, correctional systems and non-healthcare settings (gyms, spas, etc.)
22. Work Settings and CAMRSA (3) Isolate now well-established in the community, and many with infections do not belong to a traditional risk group
Any worker who has significant skin-to-skin contact with others or uses shared equipment is potentially at risk
Workers associated with high risk groups (prisoners, athletes, children) likely at higher risk than others
23. Prevention and Control of CAMRSA Hygiene
Cleaning and disinfection
Surfaces
Laundry
Shared equipment
Management of infected employees
24. Personal Hygiene Frequent handwashing, dry hands with disposable towel, personal towel or air blower (do not share towels)
Shower with soap and water as soon as possible after direct contact sports
Bathe regularly
Do not share personal care items (towels, soap, razors, etc.)
Cover any cuts or scrapes with bandages to avoid infection
25. Proper Handwashing
26. Disinfection of Surfaces Clean surfaces before disinfection
Check to make sure disinfectant is suitable for the type of surface being treated
Check the label to ensure it is effective against Staph (full list of products at http://epa.gov/oppad001/chemregindex.htm)
Follow manufacturers instructions: ensure that it is prepared properly and that it remains on the surface the recommended contact time
27. Shared Equipment Use a towel or clothing as a barrier between surface of equipment and bare skin, if possible
Clean and disinfect touched surfaces of equipment using a commercial Environmental Protection Agency (EPA)-registered disinfectant at least daily
Repair or dispose of equipment or furniture with damaged surfaces that cannot adequately be cleaned
Clean large surfaces (floors, tabletops) daily with an EPA-registered detergent disinfectant
28. Steam Rooms/Saunas Encourage patrons to use towel or clothing as barrier between benches and bare skin
Allow room to dry at least once daily to minimize biofilm production
Clean and disinfect frequently touched surfaces at least daily
Ensure that pools/spas are adequately chlorinated
29. Laundry Wash items (towels, sheets, blankets, clothes, uniforms, etc.) in detergent and water > 160o F for at least 25 minutes
Dry on hot temperature; do not re-use until completely dry
30. Handling of Employees With CAMRSA For draining wounds, employee should not be allowed to return to work until secretions are completely contained by bandages
For suspected or confirmed MRSA infection in a employee who utilizes shared equipment or whose job requires close skin-to skin contact, employee should not be allowed to use shared equipment or engage in close contact until infection is completely resolved (may need work accommodation)
31. Recommendations for Worksites Encourage hand washing, and ensure that soap and warm water or alcohol-based hand sanitizers are available
Not necessary to close worksite or to inform all employees if infection identified
Surfaces or items that are likely to have had contact with uncovered or poorly covered infections should be cleaned and disinfected
Consider educating employees on CAMRSA
32. Sample Policy Fire DepartmentHand Washing Before, during, and after you prepare food
Before and after any patient contact even if gloves are used
Before you eat and after you use the bathroom
After handling animals or animal waste
When your hands are dirty, and
When someone in your home is sick
Soap and water combined with at least 20 seconds of active scrubbing hand surfaces is sufficient. Hand soap does not need be anti-microbial. When soap and water is not available, utilize hand sanitizers or anti-microbial wipes.
33. Sample Policy Fire DepartmentStation Hygiene Liquid soap shall be utilized in any area where items are shared; bar soap should be for individual use only. Other personal items, such as razors and towels should not be shared.
All fire emergency equipment should be cleaned per department cleaning guidelines.
Showers should be cleaned each morning with appropriate cleaning agents that kill staphylococcus aureus
Exercise equipment should be wiped down after use and each morning. Everyone should use a towel barrier between themselves and the workbench.
Utilizing hot water at temperatures of 160 degrees with appropriate laundry detergent followed by hot air dryer will kill Staph and other bacteria on clothing and linens.
34. Websites for More Information State Department of Public Health: www.cdph.ca.gov http://www.cdph.ca.gov/healthinfo/discond/Pages/MRSA.aspx
Centers for Disease Control and Prevention: www.cdc.gov http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca.html