“Is mersa a staff infection?”
“Is mersa a staff infection?” I received a phone call from my mother recently and that was the leading question. Of course, being a nurse, I heard “Is MRSA a Staph hospital-acquired infection?”
It took some conversation to understand what was being asked, which was: 1. What is mersa? (while a search engine brings up MRSA, if you aren’t clinical, you may not know if that is correct) and 2. Was the friend’s infection caused by a staff person? This brings up the issue of how we communicate with our patients and their family.
I have often said the role of the nurse is to interpret “medicalese” into English, but when we convert MRSA, methicillin-resistant Staphylocaucus aureus, into mersa, what I have encountered with multiple friends and family is that the infection state is marginalized. Mersa does not sound as scary as methicillin-resistant Staphylocaucus aureus. As a matter of fact, in another instance, a friend reported to me that when asking what type of infection was cultured from her child’s boil, the nurse’s response was “It’s just mersa.” When did a drug-resistant organism become a non-issue requiring no education? No instructions on preventing contamination with younger children. No education on the disposal of contaminated dressing material. Only, “It’s just mersa.”
According to the Centers for Disease Control and Prevention, methicillin-resistant Staphylocaucus aureus (MRSA) is a high priority for developing effective prevention programs. While hospital-acquired infections have declined 28% from 2005-2008 in the U.S., there is not the same downward trend in community-acquired healthcare infections. While S. aureus is a bacterium found on 30% of peoples’ skin and in their nose, only 1-2% of the population is colonized with MRSA. In Texas, that translates to 230,000-460,000 people may be colonized with MRSA. The resistance to a particular class of antibiotics, beta lactam, which includes methicillin, penicillin and amoxicillin, leads to challenges in treating an infection with an appropriate antibiotic.
MRSA is spread by having contact with someone’s skin infection or personal items that have touched infected skin. That could be anything: razors, towels, Kleenex. MRSA can also be found on surfaces that have been touched by someone with infected skin. While touching those surfaces doesn’t necessarily mean you will contract MRSA, the more concentrated the conditions, such as communal living in a hospital, long-term care facility, dormitory, locker room or apartment, increases the likelihood of coming in contact with the bacteria. As noted in my last blog, one of the main deterrents is hand hygiene and surface decontamination.
As for question 2, was this infection caused by “staff?” The friend may have been colonized with community MRSA, but as the infection occurred in the surgery wound, it is considered a hospital-acquired surgical site infection. This may or may not have been due to inadequate or improper cleansing of the site prior to the incision, but it is the right course for the doctor to indicate “I take full responsibility.” Surgical-Site Infections (SSIs) are reportedly increasing, according to Agency for Healthcare Research and Quality. Up to 30% of surgical sites (10% on average), may develop an infection, but only 1-2% with MRSA. There are many initiatives within the Surgical Care Improvement Project to decrease the incidence of SSIs.
The easiest to remember is CATS decrease SSIs. Back into an acronym, but it stands for Clippers (hair removal with clippers rather than razor to decrease knicks /cuts that increase risk for staph infection), Antibiotics (giving preventive antibiotic within one hour of incision and discontinuing within 24 hours of first dose), Temperature (having a temperature within a normal range within the first hour after surgery), and Sugar (controlled sugar levels on both day one and two following heart surgery even without a diabetes diagnosis). For orthopedic surgery, additional cleansing of the site by the patient the night before and morning of the procedure can decrease the bio burden of normal S. aureus on the skin so that the surgical prep is the third cleansing.
So, to answer the question, “Is mersa a staff infection?” MRSA is definitely a Staphylocaucus aureus infection, and even if it is community acquired, it can also be a staff infection that takes more than just the medical community to address.