Marc I. Leavey, M.D. 2014-07-03 04:05:53
MRSA: PROPER PRECAUTIONS MRSA: What You Do (and Don’t) Have to Worry About WHEN PEOPLE COME TOGETHER IN GROUPS, one of the concerns is often dealing with the possibility of passing a disease from one to another. Infectious diseases, those caused by microorganisms ranging from virus to fungus to bacterium, cause considerable morbidity within such populations, and one such microbe, in particular, causes significant pathology: methicillin resistant staphylococcus aureus, commonly known by its initials — MRSA. A Brief History Among infectious agents, staphylococcus aureus, staph for short, has a history of causing illness and death. Bacteria are one-celled, living microorganisms, which metabolize, reproduce and can destroy host tissues in which they grow. Discovered soon after microbiology became a science, staph was recognized as the agent behind boils and pustules, as well as more serious infections including pneumonia. Efforts to control this infection became more effective with the discovery of antibiotics shortly before World War II. Through the use of the sulfa group of antibiotics, and later penicillin, infections which would have been critical became controllable. Repeated exposure to these antibiotics over the next 10 years or so would result in the selection of staph microbes which were resistant to penicillin, formerly the most effective tool being used. By the end of the 1950s, methicillin, a form of penicillin which was resistant to an enzyme secreted by staph, called beta-lactamase, was synthesized. Within one year, however, staph that was resistant to methicillin was discovered. There were sporadic outbreaks of MRSA over the subsequent five to eight years all over the world. From the late 1960s through the 1990s MRSA became a significant pathogen among populations including drug users and some hospitalized patients, and eventually became a common cause of hospital-acquired infection. Now ubiquitous in society, MRSA has been brought under reasonable control in the hospital, but lurks in other situations, ready to infect the unsuspecting. MRSA in the Sports Setting In the community, MRSA has been an issue since the 1990s. Without the clear vectors of contact present in a hospital situation, community-acquired MRSA, or CA-MRSA, seems to Spread without a focal source. This can make identification of a central source for infection difficult, and control of such an infection nearly impossible. Sports settings, such as locker rooms, are prime areas for the spread of MRSA. Along with the possibility of direct skinto- skin contact in many sports, items such as sporting equipment, towels and razors may be contaminated with the microbe. Sharing such items vastly increases the risk of spreading an infection, and should be avoided. What Precautions Should You Take? While recognizing the threat of MRSA is important, reacting to that threat needs to be in a directed and measured fashion, since creating a sterile living environment is hardly a practical goal. There are some direct actions which can go a long way to prevent or mitigate MRSA and other infections. It may seem obvious, but instruments which contact the skin should not be shared between or among individuals. Razors, combs, brushes, tweezers, curling irons, nail scissors and files, and even make-up can all carry a wide variety of microbes on their surfaces. In the case of items such as razors, disposables allow a new item to be used each time, both insuring a sharp edge and clean tool, and preventing the use of one carrying disease-causing microbes. It should be noted that most disposables are just that – disposable – and are not designed to be cleaned and reused. Sharp edges will likely not remain sharp, hinges and levers will likely not operate correctly, and injury is likely. Hand washing is also an important practice, but it is not necessary to use an antibacterial soap. In fact, many sources suggest that the use of such products helps lead to further bacterial resistance. Instead, very warm water and plain soap should be used to thoroughly cleanse the hands, including the nails and backs of the hands. One practical technique to ensure adequate handwashing is to allot the time to sing “Happy Birthday” to each hand, in succession, while washing. A clean, dry cloth should be used for drying, not a communal towel. Disposable towels or even hot air driers are very good solutions too. You don’t have to go very far these days to see antiseptic hand gel or foam for sale. It is both good and bad. First of all, be clear that all hand sanitizers are not alike. There are at least two basic types of hand sanitizer, those based on alcohol, and other based on triclosan. There is a lot of chatter around the Internet and organizations interested in health expressing concern over triclosan sanitizers. The active ingredient has been suggested as a cause of increased bacterial resistance, as well as hormonal issues within the body. In some parts of the world, use of this product is even banned. On the other hand, alcohol-based sanitizers really do kill germs, and can disinfect your hands. But if there Is dirt on your hands, you still have to wash it off first. And if you wash it off first, and do a good job, you don’t need the sanitizer at all. Sources of infection may or may not be obvious. Pimples, boils, scrapes and cuts may all represent places where MRSA and other organisms grow, either as an overt infection or just as colonization. The latter can serve as a source of germs that infect others, while the host does not seem to be affected. These skin openings can also provide entry for microorganisms in the environment to gain entry to the body, causing new infections. These issues, then, also require attention. Any open wounds should be adequately treated, if infected, and measures taken to Prevent the spread of infection. Techniques from simple adhesive bandages (like Band-Aids) to medical dressings (DuoDerm) to full gauze and tape wraps may be used, depending on the extent and nature of the injury. Don’t Go Overboard So what about those surfaces and fomites — objects which are handled and may carry germs? These would include counter tops, sinks, toilets, showers, walls and chairs; as well as balls, bats, clubs, weights, exercise equipment – and of course, the list can go on and on. Just how vigilant does one need to be to disinfect all of this, and is that even practical? Just as with objects, sterilization of the environment is not only overkill, it is impractical. There are plenty of products on the market that could be used in the locker room, the bench, the dugout or the team bus, but do you really need them? Wetting every visible surface or object with spray disinfectant (like Lysol) will create a cloud of cough-provoking fumes. Not only that, but if any food or drink will contact those surfaces, such as the countertop where the lunch is spread out, they may present a toxic condition if residual disinfectant gets ingested. Striking the Balance It is important to clean those objects with common cleaning products (meaning soap and water) to remove any residual or extraneous material, such as sweat or other body secretions, and then disinfect them with a suitable product. There are many disinfectants which rely on more natural germicides than the alcohols, phenols, and other chemicals present in heavy-duty commercial products, and quite a few of these are food safe. One should clearly do due diligence with the products that are used, read the label, understand the method and technique of their application, and use them precisely as instructed. No doubt about it, methicillin resistant staphylococcus aureus, MRSA, is one of a group of microorganisms that can cause significant illness in people. It is ubiquitous in our environment, and likely on our skin and items on our person. But with appropriate precautions and techniques, as described above, its impact on our daily lives, activity and recreation can be minimal.
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