Healthcare-Associated Antibiotic-Resistant Staph Infection (HA-MRSA)

What is antibiotic-resistant staph infection?

Antibiotic-resistant staph infection, also called methicillin-resistant staph infection, or MRSA, is an infection caused by a type of bacteria that is resistant to many commonly used antibiotics. Resistance means that antibiotics are not able to kill the bacteria and stop the infection. The bacteria causing these infections are a type of Staphylococcus aureus bacteria. They are often simply called staph.

Antibiotic-resistant staph infections are commonly categorized as either community-acquired (CA-MRSA) or healthcare acquired (HA-MRSA). Community-acquired is usually caught from activities such as athletes sharing sports clothing or equipment, or children sharing toys. Healthcare-associated (which is also sometimes called hospital-acquired) is MRSA infection that happens after:

• at least 72 hours in the hospital
• treatment in a dialysis center, or
• use of medical equipment such as a catheter.

How does it occur?

Staph bacteria are commonly carried on the skin or in the nose. They are one of the most common causes of skin infections in the US. Most of these skin infections are minor (such as pimples and boils) and heal on their own without antibiotics. However, staph bacteria can also infect the blood, urinary tract, lungs, or surgical wounds, causing very serious illness. When an infection is caused by antibiotic-resistant bacteria, it can be hard to cure.

Resistant staph bacteria result from the widespread use of antibiotics. MRSA infections have been a problem in hospitals and nursing homes for about 20 years. Usually the people who get these infections are elderly or very sick or have an open wound or a tube going into their body. But these infections are being seen more often in healthy people in the community. MRSA infections that are acquired by people who have not been recently hospitalized (within the last year) or have not had a medical procedure (such as dialysis, surgery, or catheters) are called community-associated MRSA infections, or CA-MRSA. These infections in the community are usually skin infections, such as pimples and boils.

The ways that healthcare-associated MRSA skin infections may spread are:

• on the hands of healthcare workers
• on poorly cleaned medical equipment that is shared with others, such as a stethoscope
• from other items and surfaces contaminated with the bacteria
• from contact with healthcare workers who are staph carriers
• from contact with visitors who are staph carriers.

What are the symptoms?

CA-MRSA skin infections may look like a pimple or boil. They may be red, swollen, painful, or have pus or other drainage. They can also look like a rash, with redness and oozing or crusting. In contrast, healthcare-associated MRSA infections are usually internal infections, such as a surgery wound infection, pneumonia, or infection that has spread into the blood. The symptoms can be very different, depending on the type of internal infection and the location. Symptoms can include high fever, pain, trouble breathing, confusion or loss of consciousness, and very low blood pressure. These symptoms together can lead to shock. If they cannot be treated, they can lead to death.

How is it diagnosed?

Tests (cultures) will be done of the infected area: for example, with:

• a swab of the surgical wound
• a sample of sputum (fluid coughed up from the lungs)
• a blood sample.

These tests are done to see if bacteria can be grown in the lab from the sample. If bacteria do grow in the lab, the bacteria are tested to see what antibiotics will work against them.

How is it treated?

The infection will be treated with the antibiotic that tests show to be the best to kill the bacteria. If the cultures fail to grow bacteria, then the infection will be treated with the antibiotic that is best for the bacteria most likely causing the infection in that specific hospital. Hospitals and health departments keep track of the infection-causing bacteria in their area and document patterns of antibiotic resistance. Healthcare providers use this information to choose antibiotics when specific culture results are not available.

How long will the effects last?

How long it takes to cure the infection depends on many factors, especially your condition before the infection.

How can HA-MRSA infections be prevented?

The Centers for Disease Control and Prevention (CDC) is working with hospitals, nursing facilities, dialysis centers, and health departments to ensure that they are doing everything they can to prevent HA-MRSA. Examples are:

• education and training of all personnel on prevention techniques, including such simple tasks as correct handwashing procedures after caring for each patient
• checking how well healthcare workers, including doctors, are following recommended prevention practices
• taking special precautions with patients known to be infected with staph
• using antibiotics only when medically needed
• teaching visitors about hygiene measures they need to take when they visit a healthcare facility
• ongoing careful monitoring of trends, keeping track of both staff hygiene practices and facility rates of infections.

How can I help prevent HA-MRSA?

You and your family members need to advocate for your good care when you are in the hospital. You may need to remind the hospital staff to wash their hands, clean their stethoscope, and not use any supply that has fallen on the floor. Offering these reminders can be very uncomfortable, but it is in your best interest. You can let them know that you are aware of HA-MRSA and you want to work with them to avoid getting infected while you are in the hospital. You can also remind visitors to practice good hygiene when they are with you.

Here are some other guidelines for preventing HA-MRSA and CA-MRSA infections:

• Do not overuse antibiotics. Take them only when necessary and exactly as instructed. If you are having problems with an antibiotic, ask your healthcare provider what you should do.
• Wash your hands regularly with soap and warm water.
• Clean your hands and your children's hands in public places with alcohol-based hand sanitizer.
• Use separate towels for each family member, especially if someone has a rash. Consider single-use paper towels or hand wipes in the bathroom and kitchen; or change cloth hand towels every day.
• Do not visit at the hospital if you have a rash.
• If a family member develops a large pimple or crusty rash that does not heal within a few days, see your healthcare provider to learn whether it needs treatment for MRSA. Treating such infections right away helps prevent their spread.

Written by Dee Ann DeRoin, MD
Published by RelayHealth.
© 2009 RelayHealth and/or its affiliates. All Rights Reserved.