Methicillin Resistant Staphylococcus Aureus

Methicillin Resistant Staphylococcus Aureus - What it is

What is MRSA?

There are many germs (micro-organisms) on our skin and in the environment around us. Most are harmless, some are beneficial while others can be harmful.

Staphylococcus aureus (or “golden staph”) is a common germ found on our skin and in the noses of a third of healthy people. While harmless most of the time, it can cause infections (e.g. when there is a break in the skin) but these are usually easily treatable either with simple surgery and / or common antibiotics (such as penicillins, the most common class of antibiotics).

MRSA stands for Methicillin Resistant Staphylococcus Aureus. MRSA are varieties of Staphylococcus aureus that have developed resistance to methicillin (a type of penicillin) and several other classes of antibiotics. MRSA is not new. It was first found in the 1960s following the widespread use (and abuse) of antibiotics including methicillin and penicillin. MRSA is now found in many countries worldwide.

How common is MRSA?

MRSA can be acquired in the community (e.g. homes and public areas). However, it is also found (and acquired) in healthcare facilities such as hospitals, nursing homes or dialysis centres. In some parts of the world, MRSA has become so prevalent that it is as common as non-MRSA. In Singapore, MRSA is less common but still accounts for a proportion of all documented infections by Staphylococcus aureus.

How does MRSA spread?

MRSA, like all Staphylococcus aureus, is spread usually by touch. A person with MRSA on his or her hands can pass it to people and things he or she touches. The risk of spreading increases when there are open wounds or cuts in the skin, in crowded living conditions and when hygiene standards are poor.

Methicillin Resistant Staphylococcus Aureus - Symptoms

How can we know someone has MRSA?
What are the symptoms of MRSA?

People who carry MRSA do not look or feel different and they do not have symptoms. They are known as “MRSA carriers”. MRSA is usually harmless to healthy people.

Only people who have an infection with MRSA may display signs and symptoms. The most common site of infection is the skin, where people may develop painful, red and warm pimples or “boils” with or without pus. In rare instances, MRSA may get into the bloodstream and other parts of the body, causing pneumonia or severe illness.

Some risk factors include long-term health problems that require frequent visits to healthcare facilities (e.g. patients with kidney, lung or heart problems), chronic skin conditions or presence of indwelling medical devices such as venous catheters or dialysis catheters.

Unless there are other underlying risk factors, compared with people who carry non-MRSA Staphylococcus aureus, MRSA carriers in Singapore do not necessarily have an increased risk of infections from MRSA.

MRSA can only be diagnosed through examination of infected specimens in the laboratory. The diagnosis is sometimes only confirmed after the infection fails to respond to common antibiotics.

Methicillin Resistant Staphylococcus Aureus - How to prevent?

How do hospital staff keep MRSA from spreading?

There are already several measures in place to prevent the spread of MRSA in hospitals.

Proper hand hygiene is very important. Staff either wash their hands or use alcohol-based handrubs before and after attending to patients and after touching objects in contact with patients. Proper hand hygiene is required for contact with all patients, not just those with MRSA.
Additional “contact precautions” are required when staff come into contact with patients who are MRSA carriers. These include the wearing of gowns and gloves, or a mask if a patient carries MRSA in their sputum. Patients carrying MRSA may also need to be separated from other patients to prevent spreading of the germs.
Patient rooms and supplies are regularly cleaned and disinfected with appropriate solutions. This prevents MRSA (or other potentially harmful bacteria) from getting on people’s hands and clothes.
Hospital staff adopt defined integrated practices for high-risk patients, which include specific equipment and processes (e.g. ventilators and urinary catheters). These have been shown to reduce the risk of the spread of MRSA.
Hospitals may perform “screening cultures” for admitted or pre-surgical patients. This is done by taking a swab (on a cotton stick) of the patient’s nose or other body area. If a patient is found to carry MRSA, additional contact precautions are taken and treatment may be required prior to surgery.

How do you help prevent the spread of MRSA in the hospital?

Use alcohol-based handrubs before and after entering the ward, before touching the person you are visiting, after coming into contact with a patient or objects in contact with a patient. Dispensers of alcohol gel or handrubs are often placed by patients’ beds and at the entrance to clinical areas.
Wash your hands with soap and water before and after eating a meal and after using the toilet.
Avoid walking around to touch other people or other people’s items unnecessarily. Do not sit on other patients’ beds.
Do not share personal items like towels or shavers.
If you are a patient, advise visitors who are unwell or who are young not to visit you if possible.
Do not feel shy to remind everyone to use the alcohol- based handrubs before and after attending to you.

Methicillin Resistant Staphylococcus Aureus - Causes and Risk Factors

Methicillin Resistant Staphylococcus Aureus - Diagnosis

Methicillin Resistant Staphylococcus Aureus - Treatments

How is MRSA treated?

As its name implies, MRSA is more resistant to common antibiotics than non-MRSA infections and hence can be more difficult to treat. However, infections caused by MRSA can usually be treated with a few specific antibiotics. Treatment may require an intravenous drip or hospitalisation and can be more costly or have more side effects. Surgery or drainage of pus may be necessary if present. It is important to complete the antibiotic course as recommended by your doctor even if the infection is improving.

Methicillin Resistant Staphylococcus Aureus - Preparing for surgery

If you are an MRSA carrier…

People who are carriers of MRSA usually do not need to be treated unless they are going for an operation. Pre-operation treatment involves applying topical antibiotic creams to the inside of the nose and using a special antiseptic shampoo and body wash. In rare cases, oral antibiotics may be necessary. Your doctor will be able to advise you.

The treatment has few side effects. Generally, any side effects will be mild, such as skin irritation. If you develop a rash, stop treatment and ask your clinic or doctor for advice.

Methicillin Resistant Staphylococcus Aureus - Post-surgery care

If I have MRSA, what precautions should I follow when I go home?

MRSA carriers are not a hazard to the public or family members as long as good personal hygiene is practised.

Wounds and cuts should be cleansed and covered as much as possible.
Maintain good hand hygiene at all times to prevent the spread of germs.
Do not share personal items.
Maintain a clean environment at home; a diluted bleach solution works well as a cleaning agent.
Complete the course of antibiotics as prescribed by your doctor.
Follow the decolonisation protocol if ordered by your doctor. Use the nasal antibiotic cream twice daily, antiseptic body wash daily, and shampoo at least twice weekly with antiseptic lotion.

Unless soiled by infected material, laundry can be washed as per normal. You can wash your dishes and utensils with the rest of the family and resume normal daily activities as soon as you are well.

Methicillin Resistant Staphylococcus Aureus - Other Information

Overview

Article contributed by Infectious Disease Service, KK Women's and Children's Hospital

The information provided is not intended as medical advice. Terms of use. Information provided by SingHealth

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