MRSA and the Workplace: What you need to know.

By Judith F. Strauss, MD and Roslyn Stone, MPH,
5/22/06

Antibiotic resistant staph infections continue to be an emerging employee health issue.

Over the past several years, and especially in the last several months, there has been increasing concern in the workplace because a common bacteria has developed resistance to the antibiotics usually used to treat it. The bacteria is called Staphylococcus aureus, or Staph for short. The antibiotic is called Methacillin; and the newly resistant bacteria is called Methacillin Resistant Staphylococcus aureus or MRSA.

Bacteria are all around us. Approximately 25 to 30% of us have Staph bacteria on our skin and in our noses that are not causing infection.i When they do cause infection, it is usually minor, on the skin, and easily treated with or without antibiotics by a healthcare provider. However Staph can also cause severe infection on the skin, or in the blood stream, bones or lungs.

Less than 1% of the Staph we carry is MRSAii . Most of it is Staph that is easily treated with antibiotics. Infections with MRSA bacteria are more difficult to treat, and may require hospitalization. Very rarely they can be lethal. However there are effective methods to prevent these infections in the workplace, and to identify and treat them if they do appear.

Who gets Staph or MRSA infections?

Staph infections, including MRSA, occur most frequently among people who are in the hospital for other illnesses, such as surgical procedures or diabetes. They also occur in nursing homes and dialysis centers.iii Workplace transmission is extremely rare. The patients who develop these infections may have decreased ability to fight infection, often because of an underlying condition or medications.

Recently infections have been occurring in otherwise healthy people who are not and have not been in the hospital. This is called community acquired infection, sometimes called CA-MRSA. It can sometimes be spread to other people at home, at work and other places such as health clubs. It is more common among people who receive injections, such as for allergies or diabetes; and among closely knit groups such as in day care centers, among athletic teams and on military bases..

What do Staph infections look like?

Staph skin infections, whether Methacillin sensitive or resistant, may look like a pimple, spider bite or boil.iv They can be a single wound or in groups, and can be red, swollen, painful, or tender to the touch. The skin around the infection site may also be red. The infection may start in a cut, scratch or injection site. In gyms the infections may locate in areas of the body where there is sweat, such as the thighs, armpit and buttock.v

How are Staph infections spread?

Staph infections are spread by “direct skin to skin contact with infectious lesions or drainage, skin damage that facilitates the entry of bacteria, and sharing of infected equipment, clothing, or personal items. “vi Skin to skin contact is rare in the workplace.

How can we prevent spreading infections to others?

1. If you think you have an infection, see your healthcare provider and follow their instructions. Employees will need a note before returning to work. Take all antibiotics as prescribed, and for the full length of time prescribed. (DOH).

2. Cover the infection with a clean, dry bandage. Bandages or tape can be discarded with the regular trash. If the wound is in an exposed part of the body, the employee should not be permitted to work unless it can be covered by a bandage.

3. Wash hands frequently with soap and warm water or use an alcohol-based hand sanitizer, especially after changing the bandage or touching the infected wound. People in contact with the infections should also wash frequently.

4. Do not share personal items such as towels, washcloths, razors, clothing, or uniforms that may have had contact with the infected wound or bandage. Wash sheets, towels, and clothes that become soiled with water and laundry detergent. Drying clothes in a hot dryer, rather than air-drying, also helps kill bacteria in clothes. vii

What can we do to prevent infections, and when should it be done?

Handwashing is the best means for preventing infections, and also effective for containing infections once they have occurred. The Center for Disease Control and Prevention has issued guidelines that significantly decrease the spread of infection. “Hands should be washed using soap and warm, running water.

Proper Handwashing Technique

1. Hands should be rubbed vigorously during washing for at least 20 seconds with special attention to the backs of the hands, wrists, between the fingers and under the fingernails.

2. Hands should be rinsed well while leaving the water running.

3. With the water running, hands should be dried with a single use towel.

4. Turn off the water using a paper towel, covering washed hands to prevent contamination.” viii

Hand sanitizers containing 60-90% ethyl alcohol or isopropanol may be used as an adjunct to handwashing. ix This is good, for example, before and after using a telephone or headset others use. Many people keep these at their desk, and use them frequently during the day. They are safe and effective, but are only a supplement to handwashing. Apply the product “to palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry.” x When deciding which product to buy, remember that at least 60% should be the disinfecting alcohol or isopropanol.

War Stories from Corporate Wellness’ Client Call Reports:

Concern in the Board Room

 On a Friday night in early January, we received an emergency call from the president of a major wireless carrier. His own administrative assistant had been out sick for several days and on his way home on Friday evening, he gave her a call to see how she was feeling. He could tell she was upset when she answered the phone. She had just gotten off the phone with her physician who had told her that the wound on her arm was infected with MRSA and that since she hadn't responded to the heavy duty antibiotics he had already prescribed for her, he wanted to admit her immediately for IV antibiotics. The president, who had already done some quick web research on MRSA and had been following media coverage on it, was alarmed. He was concerned about himself and his family, the other officers of the company who had attended a meeting with his AA preparing and distributing materials and the other members of his immediate team.

The employee’s wound was not exposed and no co-workers or contacts were at risk; but the concern level was high and the concern real.

News travels fast in Call Centers

When an employee of a call center was admitted to the hospital recently, within a matter of hours, nearly all his co-workers at the call center had heard rumors that he had MRSA. One co-worker, undergoing chemo, wanted to go home. Another wanted to know when the company was closing the call center. A third wanted to know if the chemicals that would be used to "fog" the call center were toxic to her unborn child.

It turned out that the employee did not have MRSA.

The Center for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the World Health Organization (WHO) are among many organizations working to manage this problem. They are researching a vaccine for primary prevention of infections. This is important now, because some of the MRSA organisms are becoming resistant to Vancomycin, the primary drug used to treat MRSA. With multiply drug resistant bacteria, some infections will be even harder to treat.

Conclusion:

MSRA in the workplace is an important and increasing problem. With good hygiene and prompt medical care, most infections will be few and promptly treated. High risk groups and behaviors need special attention. Finally, all wounds should be covered when at work; regardless of the job.

References:

1. Health Advisory: Prevention of Methacillin Resistant Staphylococcus aureus (MSRA) Infections in the School Setting. NY State Department of Health 2007; Oct. 25:1-27.

2. Knehnert MJ, Kruszon-Moran D, Hill HA, McQuillan G, McAllister SK, Fosheim G, McDougal LK, Chaitram J, Jensen B, Fridkin SK, Killgore G, Tenover FC. Prevalence of Staphylococcus aureus nasal colonization in the United States, 2001-2002. J Infect Dis. 2006 Jan 15;193(2):172-9.

3. Stone R. Questions and Answers on MRSA 2007: 1-4.

4. Larson E. Community Factors in the Development of Antibiotic Resistance. Ann Rev Public Health. 2006;28:2.1-2.13.

5. Stone R. Questions and Answers on MRSA 2007: 1-4.

6. Cohen PR Cutaneous Community-Acquired Methicillin-Resistant Staphyloccus aureus Infection in Participants of Athletic Activities South Med J. 2005;Jun:98 (6): 596-602.

7. Larson E Community Factors in the Development of Antibiotic Resistance. Ann Rev Public Health 2006;28:2.1-2.13.

8. OPRP – Handwashing Guidelines, CDC www.cdc.gov/nceh/vsp/cruiselines/handwashing_guidelines.htm

9. ibid.

10. Hand Hygiene Guidelines Fact Sheet CDC Media Relations Press Release. www.cdc.gov/od/oc/media/pressrel/fs021025.htm

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