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MRSA

Methicillin resistant Staphylococcus aureus (MRSA) is a type of bacteria known as a superbug.

​​​For information about preventing and dealing with MRSA at home, in school and in childcare and athletic settings, and about environmental cleaning, see the In the community tab. 

About

MRSA are hardy bacteria and can survive in many environments. Even though you can’t see them, MRSA can be found on doorknobs, sheets, clothing as well as your skin. 

Although many of us may have MRSA on our skin from time to time without making us sick, MRSA can  cause infections that are difficult to treat. If a cut or scrape becomes red and sore, it may be caused by an MRSA infection. MRSA infections can occur in both the hospital and the community. 

MRSA infections are resistant to some antibiotics – which means the medication prescribed by a doctor may not always cure the infection. 

Washing your hands, not sharing personal items like towels and razors, and covering cuts and scrapes with a bandage can reduce the spread of MRSA.

Definition 

Staphylococcus aureus (S. aureus) is a bacteria normally found on skin or in the noses of healthy people.

Methicillin-resistant Staphylococcus aureus (MRSA) infection is caused by a strain of Staphylococcus bacteria that are resistant to the antibiotics commonly used to treat them, (examples: cloxacillin or cefazolin).

Most MRSA infections occur in people who have been in hospitals and other healthcare settings, such as nursing homes and dialysis centers. More recently, MRSA has been found in people who have had no contact with the healthcare system and are otherwise healthy. In the community, MRSA mostly causes skin and soft tissue infections, such as boils or abscesses. 

For more information on MRSA click here.

 

In 2012/2013 there were over 2,700 MRSA cases in BC hospitals. Laboratories in British Columbia have reported that about 1 in 4 S. aureus infections (25%) are caused by MRSA. Hospitals report that CA-MRSA strains have started to appear alongside HA-MRSA in healthcare settings. In British Columbia, the prevalence of MRSA in the general community is unknown as the disease is non-reportable, but we do know the strain circulates in the community. 

In 2012, researchers from the University of British Columbia and BC Centre for Disease Control conducted a study that showed the rate of physician visits for skin and soft tissue infections increased by 12% from 1996 to 2008. This likely represents the increased cases of CA-MRSA that we are seeing in Western Canada. For more information click here.


Anyone can get MRSA. But some groups of people are at higher risk. There are five “C’s” that describe risk factors for MRSA: 

  • Crowded living conditions, such as athletic facilities, military training camps, child care centers
  • Close skin-to-skin contact
  • Contaminated items and poor hygiene (lack of cleanliness)
  • Common personal item sharing
  • Compromised or broken skin (examples: cuts, abrasions or puncturing skin with needles)  

MRSA infections are also more likely to occur in:

  • Hospitals. MRSA remains a concern in hospitals, where it can attack those most vulnerable — older adults, people with weakened immune systems and patients that are critically ill.
    • Invasive medical procedures or devices. Patients in the healthcare facilities often undergo procedures, such as surgery or insertion of intravenous lines or urinary catheters. These can provide a pathway for MRSA to travel into the body.
  • Long-term care facilities. MRSA is prevalent in nursing homes. Carriers of MRSA have the ability to spread it, even if they have no symptoms of infection.     
 

An MRSA infection is more likely if you have open or broken skin (such as a cut, scrape or surgical wound).  MRSA infections can also occur on areas of the skin where there is no obvious wound or break in the skin.

MRSA bacteria are spread through direct person-to-person contact (examples: touching, handshakes, hugging) with a person who is colonized with the bacteria. The bacteria can also be passed from individuals with the bacteria to an object or surface that they touch (examples: towel, clothing, door knob, or sports equipment). MRSA bacteria can survive on surfaces and objects for long periods of time. When hands are cleaned with soap and water or alcohol-based hand hygiene products, MRSA will be removed or reduced in number and less likely to spread. 

When visiting a person with an MRSA infection, you should follow the facility’s visitor policy. Casual contact—such as kissing, hugging, and touching—is usually okay. Visitors should avoid touching catheters or wound/infection sites and should clean their hands before and after visiting an infected person's room.   

In the community, MRSA infections typically begin as skin infections. These infections commonly occur at sites of visible skin trauma, such as cuts and scrapes, or areas of the body covered by hair (e.g., back of neck, groin, buttock, armpit, men’s beard area).   

What to look for: 

  • Red areas that look like pimples, spider or insect bites.
  • These red areas that become boils or abscesses with:
    • Fever
    • Pus
    • Swelling
    • Pain

M – warM 
R – Red 
S – Swelling 
A – Abscess   

If the bacteria go deeper into the body (past the skin), they can cause potentially life-threatening infections such as:  

  • Blood  (e.g. septicemia or bacteremia)
  • Bone and joints (e.g. osteomyelitis, septic arthritis)
  • Lung (pneumonia)
  • Heart valves (endocarditis)

These infections require long treatment with intravenous antibiotics within the hospital or at home (Home IV antibiotics).

 

Doctors diagnose MRSA infection by swabbing the affected site (e.g., wound, tissue sample, blood, sputum, urine, or nasal secretions) for presence of the bacteria. 

The sample is sent to a microbiology laboratory where it's placed in a dish of nutrients that encourage bacterial growth. If S. aureus is isolated, the organism will be tested to determine which antibiotics will be effective for treating the infection.  

 

In hospital

In the healthcare settings, people colonized or infected with MRSA are usually placed on precautions to  help prevent spread of MRSA within the healthcare facility. Healthcare workers  wear protective garments and must follow the infection prevention and control procedures of the facility. Friends and family may be asked to follow special precautions as well.  


At home & in the community 

 

Prevent MRSA in five easy steps


 



Differences between soap & hand sanitzers

Soaps (aka cleaner or detergent) works by removing soil, dirt, dust, organic matter and germs off surfaces so they can be rinsed away with water. 

Alcohol-based hand sanitizers are used to reduce germs to levels considered safe from the surface of the hands.     

    • Sanitizers will not remove dirt, soil, or dust 
    • Hands that are visibly soiled need to be washed with soap and water to mechanically remove the dirt, soil etc.

For more information on using soaps and alcohol-based sanitizers, please click here.

Depending on the type of MRSA infection you have, the treatment you receive will be different. 


In hospital 

If you develop an MRSA infection in hospital, the infected site will need to be properly drained. If needed, IV (intravenous) antibiotics may be given. 

Patients may be treated in the hospital or, if you require treatment for a long period of time, your doctor may send you home with a home IV antibiotic program.  


In the community 

When left untreated, MRSA infections can progress to serious complications that require hospitalization. If you think you may have an infection:

  • Soak the infected area in warm water
  • You can also gently clean the infected area with alcohol or antiseptic
  • Cover the affected area with a bandage
  • Clean your hands
  • Contact your healthcare provider or doctor

Do not attempt to treat an MRSA skin infection by yourself; doing so could make it worse or spread it to others. 


Do NOT 

  • Pop
  • Drain
  • Use disinfectants on the injury  

At the doctor’s office, MRSA skin infections can be treated by draining the pus from a boil or abscess – this may improve the infection without the need for further treatment. Not all infections require antibiotics. 

If antibiotics are necessary, they may be given topically (cream or ointment), orally (pills) or intravenously (IV), depending on the severity of the infection.

   

Things to remember when taking antibiotics

  • If you are given an antibiotic, take all of the doses even if the infection is getting better or appears to be gone.
  • Only stop taking an antibiotic if your doctor or healthcare professional tells you to stop.
  • Do not share antibiotics with other people or save unfinished antibiotics. If you have leftover medication, return it to your local pharmacy/drug store.
  • If within a few days of visiting your healthcare provider the infection is not getting better, contact them again.
  • If other people you know or live with develop similar symptoms tell them to go to their healthcare provider.  Do not share your antibiotics with them.
  • For more information click here. 

It is possible to get repeat MRSA infections. If you are cured of an infection, you do not become immune to future infections. 

 

In the community

There are many things you can do as an individual or organization to protect yourself, staff, students, participants, family members and others from MRSA infections. 

What to do with an MRSA infection

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Things to avoid
  • Using antibacterial soaps 
  • Sharing clothing, makeup, lotions or food.
 

Athletes who participate in close contact sports are at higher risk of getting an MRSA infection. 

Close Contact sports include: 

  • Football
  • Basketball
  • Rugby
  • Wrestling
  • Martial Arts (e.g. judo, karate, taekwondo, etc)

Athletes 

Practice good health:

  • Shower or bathe daily and after you exercise
  • Avoid sharing equipment that comes in direct contact with your skin
  • Report skin infections to your athletic trainer or coach
  • Keep infected areas clean and covered. If an infection gets worse, visit your doctor. When in doubt – get it checked out.
  • Recognize the signs of infection:

M – warM
R – Red
S – Swollen
A – Abscess


Athletic coaches, groups & associations

  • Keep athletic equipment clean, including pads and helmets
  • Equipment should be washed at least once a week.
  • Have showers and hand cleaning stations available to athletes
  • Provide alcohol based hand rub as an alternative to soap and water
  • Alcohol based hand rubs will not remove dirt. If hands are visibly dirty soap and water is preferred
  • Create club policies regarding participation in sports with open wounds and infectionsAthletes

Posters 

You can place these posters in schools, locker rooms and athletics areas. 

 

Families 

Keeping your house clean, washing sheets and towels regularly can reduce the spread of MRSA. Other ways to help keep your family healthy: 

  • Clean your hands often with plain soap and water or alcohol-based hand rub.
  • Give each family member their own towel and face cloth.
  • Wash your bed sheets and pillowcases once every two weeks.
  • Wash laundry regularly.

Schools & childcare centres

All students attending high school, elementary school, preschool or a child care facility,  are susceptible to MRSA infections. School hygiene practices should include:

  • Scrub Up — Keep your hands clean by washing with soap and water or using an alcohol-based hand rub. Shower immediately after exercising.
  • Cover Your Cuts — Cover skin trauma such as scrapes or cuts with a clean dry bandage until healed.
  • Keep it to Yourself — Avoid sharing personal items that come into contact with bare skin (razors, towels). Use a barrier (e.g., clothing or a towel) between your skin and shared equipment such as weight-training benches.
  • Wipe it Down — Use a disinfecting solution to wipe down and disinfect hard surfaces. Make sure to use clean cloths to avoid spreading MRSA from one surface to another. See Environmental Cleaning.

Keeping kids infection-free

  • Provide opportunities for children to clean their hand before and after meals, snacks and physical activities.
  • Ensure soap is available for hand washing.
  • Have alcohol-based hand rub available as an alternative to soap and water.
  • Alcohol based hand rubs will not remove dirt. If hands are visibly dirty soap and water is preferred.
  • Allow children to bring their own alcohol-based hand rub to place on their desk.
  • Clean and disinfect objects in the rooms such as toys, educational materials, gym equipment, water faucets, light switches, bathroom fixtures, paper towel dispensers, cafeteria areas, etc. on a regular basis.
 

Soaps (or detergents) and disinfectants are used to reduce the amount of MRSA and other bacteria in the environment. Alcohol-based hand rubs are an antiseptic and should not be used for environmental cleaning. 

Any surface or object that is likely to come in contact with skin should be cleaned. This includes:  

  • Towels or wash cloth
  • Clothes 
  • Bedding (sheets and linens)
  • Razors, nail files, tweezers
  • Counters
  • Chairs and benches (e.g. gym benches)
  • Shared equipment

Soaps 

(aka cleaner or detergent) works by removing soil, dirt, dust, organic matter and germs off surfaces so they can be rinsed away with water. 

  • Use a bar of soap or plain liquid soap for everyday washing
  • Do NOT use antibacterial or antibiotic soaps – these chemical are not effective, are not needed and are harmful to the environment. They can increase bacterial resistance to antibiotics  

Disinfectants 

(e.g. bleach) are chemicals that destroy or inactivate germs (bacteria) and prevent them from growing. Disinfectants can be used on surfaces etc but should not be used on skin. Disinfectants will not remove dirt, soil, or dust.

Disinfecting detergents should be used to sanitize surfaces that have come in contact with the infected area. The BCCDC recommends using Health Canada approved disinfectants.

  • Disinfecting products are readily available from grocery stores and other retail stores.
  • Check the disinfectant product’s label on the back of the container. Most, if not all, disinfectant manufacturers will provide a list of germs on their label that their product can kill. 
  • Read the label first. Each cleaner and disinfectant has instructions on the label that tell you important facts:
    • How to apply the product to a surface
    • How long you need to leave it on the surface to be effective (contact time)
    • Many disinfectants need to stay in contact with the surface for several minutes; just applying and wiping right away may not work if the surface needs to be cleaned first and rinsed after using
    • If the disinfectant is safe for the surface
    • Whether the product requires dilution with water before use 
    • Precautions you should take when applying the product, such as wearing gloves or aprons, and making sure you have good ventilation during application
 


Resources

Video

Skin & soft tissue infections (SSTIS) due to Staphylococcus aureus
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