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Common sense about Staphylococcus
aureus infections
Russell Eggert, MD, MPH,
Director, Division of Disease Control, Florida Department of Health
As the
Florida Department of Health’s Director of Disease Control, I have been very
concerned about recent articles and media reports about infections due to
methicillin-resistant Staphylococcus aureus (MRSA). In order to clarify
some misconceptions and ease some fears, I would like to provide some important
facts and some recommendations to lower the risk of infection. In particular,
I would like to help direct attention away from schoolchildren as a high-risk
group – because they are not – and towards practical prevention measures for
everyone.
Staphylococcal infections have been around forever. They cause boils and other
skin and soft tissue infections. They can also cause serious infections -- and
in severe cases even death -- if the infection spreads widely beyond its
original location. People who are not in good health or whose immune systems
are compromised are particularly at risk for severe infections.
When
antibiotics were first introduced in the 1930s and 1940s, staphylococcal
infections were the most important targets of these new ‘miracle’ drugs.
Staphylococcus aureus has repeatedly developed resistance to the most
commonly used antibiotics as they were introduced – first to penicillin, then to
methicillin, now even to more recently introduced antibiotics. This is one of
the strongest reasons for physicians, patients and parents to use antibiotics
only when they are necessary and not for common viral infections. The Florida
Department of Health, in collaboration with the U.S. Centers for Disease Control
and Prevention, started the Florida Schools Get Smart program in the fall of
2007, working with school nurses in over 400 schools all across Florida, to
educate parents and children about appropriate antibiotic use.
Most
infections with Staphylococcus aureus have no symptoms. As many as a
quarter of all healthy children and adults may be carriers of this organism in
their noses at any time. According to a recent article in the Journal of the
American Medical Association (JAMA), most infections (85%) with this
organism occur in people who have had recent contact with a health care
facility.
According to the Centers for Disease Control and Prevention (CDC),
staphylococcal infections, including MRSA, that are acquired outside the health
care setting occur most frequently among persons where the
5
C's
are present:
1)
Crowding
2)
Contact
(Frequent skin-to-skin)
3)
Compromised
skin (cuts or abrasions)
4)
Contaminated
items and surfaces,
5) Lack of
Cleanliness.
Settings where
these 5 C’s may be present include workplaces where cuts and abrasions are
common, crowded living and working spaces like fishing boats, jails and prisons,
and sports settings where athletes have frequent physical contact and share
equipment. Because so many infections are in people without symptoms, and the
infections may be from the organisms they were already carrying, we cannot
identify a source patient for most cases.
We can determine that schools are an uncommon setting for
transmission of Staphylococcus aureus, including MRSA, for several
reasons. First, we do not see a decline in MRSA infections among children
during the summer when school is out of session. Second, the
JAMA article shows that the incidence rate for severe infections due to MRSA is
lowest among school-age children, compared to adults and seniors. The overall
incidence rate of severe MRSA infections for persons of all ages is 31.8 cases
per 100,000 per year, but it ranges from 1.4 in persons aged 5 to 17, to 127.7
in those aged 65 and over. Third, outbreaks in schools are rare, and when they
do occur are among members of certain sports teams.
In Florida, the rate of hospital discharges (representing serious
and invasive disease) where Staphylococcus aureus infection was the
primary reason for the hospital stay has remained steady over the last seven
years, rising only slightly from 34.24 discharges per 100,000 population in 1999
to 35.68 in 2006. Similarly, death rates due to Staphylococcus aureus infection
have remained stable over the same interval.
However, the percentage of a
statewide sample of outpatient illnesses (representing milder, non-invasive
disease) due to Staphylococcus aureus that are methicillin-resistant (MRSA)
has risen from 35.1% in 2003 to 50.0% in 2006.
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Prevention of
staph infections is so simple that many people do not imagine it could be
effective – but it is:
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Wash hands
frequently, both children and adults, whenever they are soiled or have been
exposed to materials that may be contaminated.
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Schools should
provide soap and towels in rest rooms so children can wash their hands
effectively.
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Be careful when
doing activities that may result in cuts and scratches.
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Wash cuts and
scratches with soap and water and then keep them clean and dry
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Keep skin
infections such as boils or infected wounds covered and treat them promptly
with both local care (such as drainage of boils) and appropriate antibiotics
for the entire duration, as prescribed by your healthcare provider
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Do not participate
in contact sports if you have a skin infection unless the lesions can be
securely covered
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Avoid sharing personal items
such as towels or razors, or sports equipment that touches skin
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Clean locker rooms and
sports equipment routinely with a disinfectant
Precautions like these can help Floridians avoid infection with
Staphylococcus aureus, avoid increasing the rate of antibiotic resistance
in our staph infections, and reduce illness and hospitalizations due to this
sometimes serious disease.
If you have more questions, these web
site may be helpful:
http://www.doh.state.fl.us/Disease_ctrl/epi/index.html
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