Methicillin-resistant Staphylococcus Aureus
March 12, 2008 of MWAOHN Dinner Meeting Presentation "MRSA Implications for the Occupational Health Nurse"
Charlotte
Carneiro RN,MS, COHN-S, CIC
April 4, 2008
In
the Journal of Infectious Diseases (JID 2008:197 suppl 1) this month, Dr.
Charles Rosenberg of Harvard University wrote, “invoking the term ‘epidemic’
still mobilizes social action and consumer behavior.” Certainly that was true
in October 2007 when the news media went
into a frenzy following CDC’s report of 8,987 cases of MRSA in the previous 18
months, in 9 targeted cities in the United States. This, coupled with
clusters of cases in schools and a couple of sudden deaths in the greater
Washington Metro area, had us all searching for answers.
And
we will continue to search the literature, answer some epidemiological
questions and help our clients and others who seek health information on how to
prevent and perhaps curb this epidemic.
At the
March 12, 2008 MWAOHN dinner meeting, I presented a brief overview of some 250 articles that
seem to birth more articles on a daily basis. In essence, the information is
that MRSA is spread person to person, mostly by close skin contact, but also
through sharing of towels, clothes, sports mats and equipment, and from health
care workers who fail to wash their hands prior to providing health care.
Children in day care are at risk for MRSA, as well as sports teams, military
recruits, institutionalized disabled and homeless. Clusters of cases have
been reported in men who have sex with men and Alaskan Native Americans.
The
epidemic stems from the use of antibiotics originally in animals and then to
humans. CAMRSA (community acquired MRSA) is defined as originating in the community with no associated
health care risk factor. HAMRSA (hospital acquired MRSA) has two types, one originating in the community
with some recent risk factor such as surgery, dialysis or long-term care in the last year.
The other is traditionally nosocomial, or a positive culture from a sterile
site, such as blood 48 hours after
admission to a hospital.
The
talk focused on the clinical environment as having a role in the transmission
of MRSA. I said that MRSA can live on hard surfaces for at least 30 days. A
more recent article said the duration is from 7 days to 7 months. Most
pathogens persist with high humidity but Staphylococcus aureus was found to
persist longer at low humidity (BMC Infectious Disease 2006, 6:130)
Citing
the Infectious Disease Society of America, I stressed that for the most part,
infections can be managed and cured. Workers can return to work provided any
wound is covered and not draining. Recurrent infections in the same worker or
his family may need a discussion of decolonization. A cluster of infections
exceeding the norm in the workplace should be reported to the Department of
Health for a collaborative consultation.
OHN’s
can encourage early medical intervention for wounds that do not heal or rapidly progressing pimple or “spider
bite”. One nurse shared a clinical
situation where she was challenged in dealing with the heightened anxiety of
co-workers and managers when one worker announced she had MRSA. The dinner
meeting attendees participated in a lively discussion of strategies to keep
with facts, seek information, maintain the worker’s confidentiality and help
other workers with reasonable cleaning of their office space.
While
environmental cleaning was emphasized for the clinical spaces, the best
prevention remains regular hand hygiene with soap and water or alcohol-base hand gel.
Worker’s
compensation was discussed but for MRSA to be compensable, a direct
exposure must occur.
For questions or comments contact Charlotte Carneiro.
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