Prevention and Detection of Community-Acquired MRSA Infections

Recently there has been much publicity about the increase in the numbers of cases of community-acquired methicillin-resistant staph. aureus (CA-MRSA) infections locally, regionally and nationally. Because this infection can be difficult to treat and is a serious infection, it is a reason for concern, but it is not a reason to panic. Shepherd University is working in concert with community healthcare officials to prevent, detect and treat any CA-MRSA on campus.

Briefly, the emergence of CA-MRSA is attributed to overuse and inappropriate use of antibiotics over the past decades that led to the rise of antibiotic-resistant strains of staphylococcal bacteria. Staph aureus has always been with us, and is a bacteria all of us have with us on our skin and tissues that are in contact with the outside world, such as inside our noses. Usually, it is harmless, and cannot be completely eliminated-in fact, eliminating it would leave us vulnerable to other infections. However, the presence of antibiotic-resistant strains (MRSA) can cause serious infection when it is introduced to breaks in the skin, such as cuts, abrasions, boils or pimples.

Jefferson County, the county in which Shepherd University is located, has tracked a rise in cases of CA-MRSA since mid-summer, and current statistics show an average of about seven new cases per week for the last several weeks. Some of those infected have had to be hospitalized for treatment with intravenous antibiotics, but most have been successfully treated with oral antibiotics. Since the first week of August, Shepherd University has had two proven cases of CA-MRSA (proven by culture and resistance testing by a laboratory); these students required brief hospitalization. In addition, six other cases have been treated presumptively-that is, the signs and symptoms were highly suggestive of MRSA and those students were treated on the assumption that they had MRSA. All the presumptive cases were successfully treated with oral antibiotics on an out-patient basis.

At the request of Student Health Services, a member of the Jefferson County Health Department conducted a site visit to Shepherd University on October 17. She reviewed the case records of the eight cases noted above and inspected various parts of the campus including the Health Center, Dining Facility, a residence hall (looking at student rooms, common bathrooms, lobby, laundry room and kitchen), and spent considerable time at the Butcher Center (athletic center). She paid particular attention to the training room, weight rooms, locker rooms, laundry facility and bathrooms used by student-athletes. While the final, written report of her observations and recommendations will not be received until the week of October 22, she did make the following comments at the end of her visit:

Shepherd University is not experiencing a surge in CA-MRSA cases that exceeds that of the local community or public schools in the county despite a somewhat higher risk of transmission because of residential living and multiple athletic teams sharing limited facilities.

Student Health Services and the Health Clinic is fully aware of the local, regional and national trend of increasing CA-MRSA cases and acts aggressively when the infection is suspected. Information about the infection, including individual preventive measures and what to do if a student suspects possible infection, has been widely disseminated.

Residential halls, the Dining Facility, the Health Center and the training room in the Butcher Center were all commended for having readily accessible hand-washing facilities, waterless hand sanitizers, disinfecting wipes or combinations of these approaches. Appropriate policies and procedures for wiping down (disinfecting) surfaces regularly are in place and followed.

As a general rule, the suggestion was made to consider placement of even more motion-activated soap and paper towel dispensers to promote more frequent hand-washing, THE most important tool in preventing spread of CA-MRSA.

Continued education of students, faculty, staff and parents regarding CA-MRSA should be the cornerstone of preventive measures, and a variety of approaches should be used: posters, brochures, small-group information sessions, e-mail communication, etc.

Most cuts, rashes, or skin eruptions are not MRSA, and should not be treated with antibiotics ­ such an approach increases the problem rather than solves it. Keeping minor injuries clean and covered decreases the likelihood of becoming infected and spreading any infection to others.

The Student Health Center is an acute minor illness and minor injury treatment center. Students are welcome to obtain over-the-counter medications or supplies free of charge from the Self-Care Center, with no appointment required. The staff is limited, however: two full time Registered Nurses and one Nurse Practitioner (Tues. and Fri. only). While urgent cases are worked in as quickly as possible, appointments with the RNs are usually readily available on the same day or within 24 hours. Whenever a student condition is beyond the scope of the Health Center's ability to diagnose or treat, appropriate referrals are made: urgent care, emergency room, or further evaluation by a local physician or even the student's own provider, depending on distance.

Finally, it is important to remember that most cases of MRSA occur in a hospital or extended-care facility setting. That is where the mortality rate is the highest-not in the community. A great deal of information about MRSA is available from the Centers for Disease Control and Prevention through their Web site, www.cdc.gov.

For more information see:

Letter to Shepherd Community

FAQs on CA-MRSA