There's been so much written about MRSA in the medical and lay press over the last several years that it's a pervasive presence in the ER now. And lord knows we see enough of it in ourER. At least one patient I see every day, if not more, seems to have MRSA. It's a little exciting, and more than a little scary, seeing an emerging new infectious disease from ground level.
So when I developed a little pustule on my left forearm some time ago, I became concerned. Ten years ago, I wouldn't have given it a second thought -- a little folliculitis, nothing more -- pop the zit and that's that. But now, I looked at it and was certain that it was MRSA. The tiny, punctate pustule on the wide-based erythematous patch -- what else could it be? I wasn't freaked, but resigned, and just to confirm it, I deroofed the blister and sent off a culture. To my relief and surprise, the culture returned a simple pan-sensitive staph species.
Which brings me to wonder: why wasn't it MRSA? I'm in daily contact with dozens of walking MRSA colonies. For that matter, I've not seen a single member of our staff (that I know of) come down with MRSA. I'm sure some do, but why don't ER workers get it more frequently?
They say the plural of anecdote is not data, but there may yet be some role for observation in medicine. Of course, in the ER we do use basic antiseptic techniques including gloves and hand hygiene to prevent transmission of germs. But that's a trivial barrier to MRSA. How often do you casually touch a patient, say to fetch them a new pillow, and then touch your face prior to washing hands? All the time! So what accounts for the additional protective effect? Well, the CDC says that CA-MRSA is actually not particularly transmissible. Unlike the flu or common cold which can be transmitted by sneezing or casual contact, MRSA seems to require prolonged, relatively intimate contact, such as shared living quarters. So that would further reduce the risk to ED staff.
But the single most common, most significant, near-universal factor I have noticed about MRSA patients in our ER is this:
They are all filthy, or live in a dirty environment with dirty people.*
It's really remarkable. I swear to god I can smell MRSA now; it smells like BO. OK, that may be an exaggeration, but not by much. But that seems to be the biggest single risk factor difference between "them" and "us." We use soap and water. And apparently that prevents MRSA. Who'da thunk it?
* note to annoyed persons with MRSA who found this via Google. I am only noting the preponderance of my experience that poor hygiene favors MRSA. Yes, some people with impeccable hygiene do contract this infection. I do not mean to impugn your personal grooming, nor to assign blame. You may be perfectly clean and unlucky, or have a different strain of MRSA. Complain to the CDC, not me. Thank you.
21 comments:
I brought this up to my Emerging Trends in Health Care Class today. It is mostly professional folks who are getting a grad degree.
Based on our experiences, this is somewhat frequently seen in our college health center, especially with those students that live in dorms. Usually most college kids are clean, but they are stacked in like cordwood. Do you see a higher incidence in college kids for those of you who practice in "college towns"? Or with military folks for those great military docs?
You also left out that they smoke. Almost all the community acquired MRSA that I have seen occurs in smokers
Good post. At our hospital people usually don't aquire MRSA until we've been in and out of the room for at least 2 weeks. Then one day I'll come in and see the big MRSA PRECAUTIONS note on the door, and all of a sudden we're supposed to get all dressed up to go into the room.
Either that, or patient has "no documented MRSA", and we have to use precautions "just because." I suppose this way is better than what I wrote above.
Personally, I think universal precautions is all that's really needed. Yet I do as I'm told like a good RT.
Melissa, did it occur to you that you got your MRSA from the geriatric population you work with?
It's true that MRSA is widespread. When I started working out in triage, I was astounded at the number of MRSA abscesses I was seeing--most recently on a young couple. He had it on his hand (it was partially healed), and she had it on her upper inner thigh. They both work in a KITCHEN. Ew.
"I hope I never see you in the ER!"
This is basically why I don't have a blog. Some people can't tell the difference between a single pithy observation and disdain for all humanity.
Tee tree oil should work about as good as antibiotics for an abscess. The only effective treatment of a true abscess is incision and drainage.
I wonder how much self-selection plays into the hygiene-MRSA connection? Perhaps folks with better hygiene who get MRSA are more likely to see their PCPs instead of making an ER trip?
Apparently crazy people are more likely to get MRSA too.
I think this is probably close to right. I'm a freak about germs, but I got MRSA when I had a couple living with me who were major slobs. One of them had it and I ended up getting it because of their personal habits, which were revolting. I was lucky---60 days taking four antibiotics simultaneously--basically chemo-- cleared this up and I've been free of it for a year. But, I do think hygiene is the main reason that you see it passed around locker rooms, etc. Close quarters and bad hygiene. That doesn't preclude other ways of getting it or that some are not responding to any antibiotics. But I do think that some people are getting it this way.
Geriatrics often aren't all that clean.
Showers twice a week at most. If they're in diapers then someone else is washing up and most likely not knocking themselves out doing it.
If they're mobile then they likely can't see real well and wear the same clothes for weeks without washing them.
They aren't "dirty" in the sense that they've been working outside an are dusty and muddy, but close inspection will reveal they're not too fresh.
I've also wondered about the risk of contracting MRSA from one of my pts. There was a study published that showed the prevalence of staph and of MRSA among healthcare workers was higher than the population as a whole, but still low (about 2% for MRSA). I still wash my hands. A lot.
That's interesting. Isn't that consistent with the MRSA prevalence among high school athletes? They are particularly dirty these days because it is not considered "cool" to shower after practice.
Oh well, do a few randomized studies, and you may be onto something.
Eating a clove or two of garlic might help, too.
Hey Melissa - another cure that I've heard works well is high-velocity trans-cortical lead therapy.
*shakes head*
A gunshot to the head . . . nice. Not even brave enough to leave your name posted. Coward. I am just trying to help people which the doctors can't seem to do for me. Don't bother replying to me, it will not be read. I am removing myself from this group. Some of you people are just too disrespectful. I would rather communicate with a better class of individuals.
I would just like to say that with you being in the medical profession you should really have more common sense. I fear for the patients that come into your ER or that have to place their lives or issues into your hands. Before you start running your mouth about your patients you should remember why you got into nursing. Because you cared (I would hope) what happens to people.
I think that you are all a little crazy. My son had it when he was an infant and we are not unclean people. I disinfect everything and have hand sanitizer all over my house. I am sick of all of this crap about MRSA I want the facts! I want to know why some people get it and others don't. I want the truth! Is it contagious or is it not? you are all lame and don;t know what you are talking about!!!!! Normal healthy clean people get it too!
MRSA is very contagious ... hygiene certainly doesn't help. My daughter and I contracted it from my terminally ill brother who had contracted it from the hospital. My daughter had a hell of a time as she has crohns disease and has immune problems to begin with. We were able to erradicate it with oil of oregano. It lives in your sinuses and groin area. The oil of oregano was more effective than antibiotics.
Now I get to see what healthcare professionals really think about their patients. However, I have heard of alot of people getting this after being in the hospital, I wonder why....
It is not only "dirty" people who get mrsa. That comments upsets me greatly. I have an autoimmune disease and recently had a large lymph node cut around and prodded at in my doctors office. Beside that I am a complete home body and have a overly clean house. Yet after that procedure I ended up with near that area. I always wash my hands regularly along with my kids and shower daily. Still I am very confused on how with how clean my family and I are very anti germ that I still got it. Scary shit.
Post a Comment