MRSA in the Workplace: The Staph Youd Like to Fire

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MRSA in the Workplace The Staph Youd Like to
Fire

• DOA Risk Management Conference
• November, 2008

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Disclaimer

• The reference to brand names in this
  presentation does not constitute endorsement by
  the Wisconsin Division of Public Health

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Abbreviations/Definitions

• MRSA methicillin resistant Staphylococcus
  aureus
• MSSA methicillin sensitive S. aureus
• HA healthcare associated
• CA community associated
• Colonization organism is on or in the body but
  not causing disease
• Infection organism is present and causing signs
  and symptoms of disease

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History
1928
Serendipitous discovery of penicillin
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Penicillium notatum
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History
1942 Antibiotics touted as the magic bullet
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History

• 1950s staph resistant to penicillin
• 1959 methicillin introduced
• 1961 MRSA appears in UK
• 1970s MRSA in US hospitals
• 1990s Community associated MRSA

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"At the dawn of a new millennium, humanity is
faced with another crisis. Formerly curable
diseases...are now arrayed in the increasingly
impenetrable armor of antimicrobial
resistance." --Director-General, WHO-- 2000
Margaret Chan, MD
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Characteristics of staph
Reservoirs
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Characteristics of staph

• Causes minor infections such as pimples, boils,
  other skin conditions
• Impetigo
• Major infections include bacteremia, cellulitis,
  pneumonia, osteomylitis
• Major cause of health care associated infections

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MRSA
Methicillin resistant Staphylococcus aureus
is the form of the staph bacterium that is
resistant to a variety of antibiotics
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MRSA

• 2 types
• HA health care associated
• CA community associated

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Differences between HA and CA MRSA
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Total MRSA
HA MRSA
CA MRSA
Klevens et al. Invasive MRSA infections in the
US. JAMA 2007298 (15) 1763-1771.
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Wisconsin Estimated Incidence

• 1,700 cases of invasive HA MRSA annually, with
  approximately 300 deaths

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MRSA and Pediatric Influenza Deaths
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Signs/symptoms of CA MRSA infections

• Pustules, boils, abscesses
• Redness, swelling
• Pain
• Pus, drainage
• Appearance of spider bite

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How CA MRSA is Spread

• Skin to skin contact with
• infected person
• Contact with a carrier
• Contact with contaminated personal items (towels,
  clothing, razors, used bandages)

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Risk Factors

• Close skin to skin contact
• Crowded conditions
• Compromised skin
• Contaminated items
• Cleanliness (lack of)

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Preventing Spread of CA MRSA

• Hand and personal hygiene
• Prevention of injuries to skin
• Appropriate treatment
• Exclusion
• Cleaning/disinfection
• Management of outbreaks

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Hygiene

• Hand hygiene
• Regular showers, baths
• No sharing of personal items (razors, towels,
  equipment, uniforms, water bottles)
• Do not touch others wounds
• Liquid soap dispensers
• Alcohol gel

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Prevention of skin injuries

• Safety equipment
• Treatment of injuries
• Clean with soap and water
• Cover with a bandage or clean, dry dressing

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Wound care

• Wear gloves and wash hands after touching wounds
  or dressing
• Place bandages/dressings that are saturated with
  wound drainage in sealed plastic bags and discard
  into regular trash

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Appropriate treatment

• Abscesses and boils are drained
• Purulent material is cultured
• Antibiotics may or may not be prescribed
• clindamycin
• trimethoprim sulfamethoxazole
• tetracyclines

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Exclusion

• When to stay home from work
• If wounds cannot be kept covered/wound drainage
  contained
• If appropriate hand/personal hygiene cannot be
  assured
• Refrain from activities that involve contact with
  the affected area

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Environmental cleaning/disinfection

• Regular, routine cleaning is usually sufficient
• Disinfect items and surfaces contaminated with
  wound drainage
• clean first, then disinfect
• follow disinfectant manufacturers directions for
  contact time
• use EPA registered disinfectants
  http//www.epa.gov/oppad001/chemregindex.htm

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Managing outbreaks

• Outbreak three or more cases of confirmed MRSA
  among close contacts
• contact local health department
• begin active screening for more cases
• review prevention measures

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Gymnasiums/health clubs/spas

• Hand hygiene
• Liquid soap dispensers/alcohol gel
• Air dryers or disposable paper towels
• Protective clothing
• Cover woundsdo not visit if cannot
• Shower after exercise
• Do not share items
• Clean equipment surfaces
• Launder towels/linens and dry in hot dryer

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Day care centers

• Hand hygiene
• Standard precautionswear gloves when touching
  someones wounds
• Cover lesions/wounds
• Exclude attendees/staff who cannot contain wound
  drainage
• Routine cleaning of environment/shared items

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Households

• Hand and personal hygiene
• Cover wounds
• Gloving/hand washing when doing wound care
• Do not touch others wounds
• Do not share towels, personal items
• Launder contaminated items in hot water and dry
  in hot dryer
• Clean/disinfect areas contaminated with wound
  drainage
• Dispose of soiled dressings in sealed bag

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Households

• Use of antibacterial soaps during active
  infection
• Tea tree oil
• 5 solution
• Decolonization of household members
• Clinical indications
• Chronic transmission/recurrent infections

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Us vs. MRSA
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Keep skin clean
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Keep skin intact
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Moisturize and maintain proper pH
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Do not share personal items
X
X
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Keep environment clean
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• Main Messages about CA MRSA
• Most infections are mild skin infections
• Infections are treatable
• Risk of infection can be reduced by keeping skin
  clean and healthy

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DPH Resources
___________________________________ Guidelines
for Clinical Management ? CA MRSA Patient
Pamphlet ? Guidelines for Controlling
Transmission among Students and
Athletes ? FAQs http//dhs.wisconsin.gov/communic
able/MRSA/index.htm
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CDC MRSA Education

• http//www.cdc.gov/Features/MRSA
• Infections/

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Gwen Borlaug, CIC, MPHDivision of Public
Health1 West Wilson Street Room 318Madison, WI
53702608-267-7711gwen.borlaug_at_wisconsin.gov