Methicillin-resistant Staphylococcus aureus (MRSA):

Overview for health care professionals

Resistant Staphylococcus aureus has become a concern not only for health care professionals but to the general public as well. Reports in the lay press have focused substantial attention on the issue. AFMC is working to help health care professionals deal appropriately with MRSA, in health care settings as well as in the community — and to prepare clinicians to respond to questions and concerns from patients and the general public.

Currently, our best defenses are:

• Early identification of suspicious lesions
• Appropriate use of select antibiotics
• Regular handwashing after patient contact
• Targeted advice to schools and other high-traffic facililities in coping with local outbreaks

An estimated 20 percent to 40 percent of the population carries Staphylococcus on their hands, in their nose, or other regions of the body, and about 10 percent of this population is carrying MRSA. Patients with MRSA-positive nasal cultures have a significantly increased risk for subsequent staph infection. Carriage status can spontaneously resolve in half of these individuals over a period of several months.

Screening all patients and health care workers for carrier status is not currently recommended. Such screening might be appropriate in response to local outbreaks in particular units or preoperatively before high-risk procedures. Patients and family members who suffer recurrent staph infections should be screened for carrier status and treated with intranasal muciprocin.

Patients with carrier status can be safely transferred to a new clinical setting, but should be identified and subject to appropriate isolation procedures. The patient, visitors and care attendants should wash hands before and after contact. Patients with active upper airway secretions should be placed under respiratory isolation.

Not all soft-tissue MRSA infections require hospitalization and intravenous antibiotics. Oral tetracyclines and sulfonamides can control early infections. However, MRSA lesions can abscess quickly and severely. Such patients, especially if they are diabetic, deserve hospitalization, drainage consideration and aggressive antimicrobial therapy.

Prevention, in health care settings and in the community, should focus on:

• Avoiding sharing towels, razors and other personal items
• Careful cleaning of surfaces subject to skin contact
• Diligent attention to hand hygiene

Cleansing of walls and other objects that do not come in contact with bare skin probably results in minimal protection for future infections.

We will continue to work with different health care settings to agree on common protocols for the transfer and care of patients with MRSA and other resistant infections. Refer questions and comments to our health care quality improvement team.