Methicillin Resistant Staphylococcus Aureus, more commonly known as MRSA, has become a common bacteria found in all communities and is no longer limited to just health care settings or chronic care facilities. It gets its name from the fact that the bacteria initially could be treated by methicillin, a form of penicillin. Over time and with indiscriminate use of antibiotics, the bacteria has become resistant to methicillin, and sensitive to very few available antibiotics available.
MRSA infections can be seen in the very young, the very old, and in all ages in between. Some individuals can be silent carriers and have the bacteria on their skin even though they might not show signs of infection. These individuals can serve as vectors or carriers of the bacteria and spread it to others in their home, office or school.
MRSA is spread by physical contact and can survive on inanimate objects such as furniture for short periods. At some point, carriers can become infected if they scratch or have a break in the skin, which then allows the bacteria to enter into the body and establish an infection. Occasionally, bacteria trapped in a broken hair tube or in a sweat gland can serve as the initial site for a skin infection.
Preventative measures that can be taken in the home include using good hygiene. Gently washing the skin with a washcloth will remove the bacteria from the skin. Basic home cleaning also is necessary.
What does the infection look like?
When a MRSA infection begins, it starts as a painful reddened bump. It is frequently thought to be an insect or spider bite because of how rapidly it appears. The bumb usually is about the size of the average insect or mosquito bite and appears without any other logical explanation. In comparison to MRSA, insect bites rarely are painful and are not hot to touch. They also are not associated with fever or chills.
When should I contact my physician?
The longer you wait, the better the chance the infection will develop into an abscess that might need to be drained. However, waiting overnight to see your physician in the office rarely is dangerous if the area is simply red and sore to touch with a small white head or pimple. You should contact your physician as soon as possible if the infection has the appearance of what could be an abscess and any of the following:
- Fever of 102°F or higher, especially if you have a chronic disease or are on steroids, chemotherapy, or dialysis
- A red streak leading away from the sore or with tender lymph nodes (lumps) in an area anywhere between the abscess and your chest area (for example, an abscess on your leg can cause swollen lymph nodes in your groin area)
- Any facial abscess larger than 1 cm or a half-inch across
- You have a sore larger than 1 cm or a half-inch across
- The sore continues to enlarge or becomes more painful
- You have an underlying illness such as AIDS, cancer, diabetes, leukemia, sickle cell disease, or have poor circulation. You are an IV drug abuser
- You are on steroid therapy or chemotherapy
- The sore is on or near your rectal or groin area
The doctor said it’s MRSA – now what?
Your physician will provide you with specific intervention recommendations and infection/wound care instructions. Some infections will abscess and require surgical drainage (some are drained under local anesthesia, while others must be drained under general anesthesia). Some infections will be so severe they will require intravenous antibiotics administered in either the hospital or the home. Other people will be adequately treated with oral medications. Regardless of the treatment plan, be sure to follow your physician’s instructions closely to assure heal properly.
Abscess/wound care general measures
Any time you or a caregiver handles bandages, touches the wound or handles soiled clothing hand washing is necessary. Person to person contact due to inadequate hygiene measures during an infection is the most risky period for spreading the bacteria or establishing asymptomatic colonized carriers. Soiled clothing should be washed immediately in hot soapy water and any bandages that are changed should be placed immediately in a disposable plastic garbage bag so they can be isolated and not contaminate home waste cans. Early on, any soiled bed sheets should be washed in hot water and soap. If the infection is abscessed and surgically opened, the wound may drain for several days. Therefore, using towels or disposable, waterproof pads on the bed sheets to help absorb any drainage and protect the mattress is advised.
General measures in the patient’s home
MRSA bacteria cannot survive for long on furniture or other dry surfaces, therefore infections are not regularly spread by these means. Initially, due to moist conditions after a shower or bath, more attention maight be appropriate. Once the tub or shower has become relatively free of water droplets, apply a light spray of Lysol® on the tub or shower, and then allow the Lysol® to completely dry. This will kill most staphylococcal germs. However, spraying all of the contents of one’s home and all of the belongings of the patient is not necessary. Furthermore, as the wound’s drainage stops, the infectivity also goes away.
Personal care measures
Someone infected with MSRA should shower daily for seven days with Hibiclens®, a soap that is bought at any pharmacy. The entire body should be scrubbed, including the hair. A thin swipe of mupirocin (Bactroban) 2 percent ointment, which is available only by prescription, should be applied in the crease behind each ear and each nostril should be rimmed twice daily during the same seven days that one is showering with Hibiclens. To apply mupirocin into the nostril, a small dot should be applied to one end of a cotton tip applicator (like a Q-Tip®) and applied just inside the nostril. Then use the cotton tip on the other side for the other nostril. As a guide, not more than ½ of the cotton tip should be inserted in the nostril of children under the age of five and for all other children and adults, no further than the length of the cotton tip itself.
What about the rest of the family?
Each family member should be treated as if they might be a carrier. However, for children under 1 year of age, you should consult your pediatrician for specific instructions. The rest of the family should shower with Hibiclens® and use the mupirocin (Bactroban) 2 percent ointment for seven days as noted above. No other special measures for family members are necessary with the exception of good hand washing and general hygiene after assisting the infected individual.