Methicillin-resistant Staphylococcus aureus (MRSA) is a type of Staph bacteria that has developed resistance to several common antibiotics, including methicillin. This antibiotic resistance means that infections caused by MRSA are more difficult to treat, often requiring specialized antibiotics or procedures. MRSA can cause issues ranging from minor skin infections to severe, life-threatening conditions like pneumonia or bloodstream infections. The most effective strategy for managing MRSA is actively preventing its spread through a combination of personal and environmental control measures.
Understanding Transmission Routes
MRSA spreads primarily through direct physical contact with an infected or colonized person. The bacteria naturally colonize the skin or nose of about one-third of the population; these carriers show no symptoms of infection. Transmission often occurs when a person touches a contaminated wound or an area of the skin where the bacteria resides.
The bacteria can also be picked up from contaminated objects or surfaces, known as fomites. MRSA is known to survive on surfaces like towels, athletic equipment, and doorknobs for extended periods. Transmission is significantly more likely when the bacteria enters the body through a break in the skin, such as a cut, scrape, or wound, leading to infection.
Essential Personal Hygiene Practices
Maintaining hand hygiene is the most significant individual action to control MRSA transmission. Hands should be washed frequently with soap and water, scrubbing briskly for a minimum of 20 seconds, paying attention to the backs of the hands, between the fingers, and under the nails. When soap and water are unavailable, an alcohol-based hand sanitizer containing at least 60% alcohol should be used, applying enough product to cover all hand surfaces until they are dry.
Proper management of skin wounds is necessary. All cuts, scrapes, and abrasions should be cleaned thoroughly with soap and water and kept covered with a clean, dry bandage until fully healed. The pus or drainage from an infected sore contains high concentrations of MRSA, so covering the area prevents contamination of hands and surfaces. Avoid touching, picking at, or popping any suspected sores or boils, as this can worsen the infection or spread the bacteria to other parts of the body or to others.
Environmental Control in Community Settings
Controlling the spread of MRSA in community environments like homes, gyms, and schools requires a focus on shared spaces and items.
Preventing Sharing and Contact
A strict rule against sharing personal items is necessary, including towels, washcloths, razors, clothing, and athletic gear, as these can easily transfer the bacteria from person to person. In settings like locker rooms, using a barrier, such as clothing or a towel, between bare skin and shared surfaces like benches or gym equipment is a simple precaution.
Surface Disinfection
Regular disinfection of frequently touched surfaces is necessary because MRSA can persist in the environment. Surfaces that contact bare skin, such as athletic equipment, light switches, keyboards, and remote controls, should be cleaned consistently. For disinfection, an EPA-registered product labeled effective against Staphylococcus aureus is recommended, ensuring proper attention is paid to the product’s contact time to ensure germ inactivation. A household chlorine bleach solution, mixed at a ratio of two teaspoons of bleach per quart of water, can also be used as a broad-spectrum disinfectant on compatible surfaces.
Laundry Procedures
Laundry handling requires specific steps to eliminate the bacteria from fabrics. Clothing, towels, and bed linens, especially those that have come into contact with a sore or wound, should be washed using the hottest water setting appropriate for the fabric. Adding bleach to the wash cycle, if possible, provides an additional layer of disinfection. Thorough drying in a hot dryer is equally important, as the heat helps to kill any remaining bacteria.
Decolonization Procedures for Carriers
For individuals who are recurrently infected or known carriers of MRSA, medical decolonization may be recommended by a healthcare provider. Decolonization is a targeted, short-term medical regimen designed to eliminate MRSA bacteria from common colonization sites, such as the nasal passages and skin folds. This is not a general preventative measure but a specific clinical intervention.
The standard decolonization protocol typically involves a two-pronged approach lasting five days. This includes applying a topical antibiotic ointment, such as mupirocin, to the nostrils twice daily. The second component involves daily bathing or showering with an antiseptic body wash, most commonly chlorhexidine gluconate (CHG), to reduce the bacterial load on the skin.
Decolonization is often prescribed before certain surgeries or for patients with recurrent skin and soft tissue infections. Mupirocin use is monitored because prolonged use carries the risk of developing antibiotic resistance. Patients are also advised to change bed linens and towels daily during the five-day period to prevent recontamination.