NEW YORK NURSE: December 2007

Ask the Experts

MRSA and nursing responsibility

Q.: I have heard reports about MRSA infections showing up in communities, especially in schools. What information can I provide to my family and patients?

A.: Healthcare-associated infection with the bacterium methicillin-resistant Staphylococcus aureus (HA-MRSA) has been a problem in hospitals and long term care facilities since the 1960s (Boyce, 1992). A serious problem may also exist in our communities, referred to as community associated (CA) MRSA. The current media coverage regarding MRSA affords educational opportunities for nurses in our workplaces and in our own homes.

Risk factors for MRSA include recent hospital or nursing home admission, HIV infection, injection drug use, hemodialysis, or previous MRSA infection (Arias, 2007). These risk factors have been complicated by recent reports of community outbreaks. The biological makeup of CA-MRSA is different than the HA-MRSA that healthcare workers are familiar with, possibly causing the shift in the population and disease presentation. Research demonstrates emergence of this pathogen from groups that have frequent skin-to-skin contact, compromised skin surfaces, sharing of personal items, contact with contaminated surfaces, and poor personal hygiene. These groups may include sports teams, day care centers, prisoners, injection drugs users, men who have sex with men, and military personnel living in a dormitory setting. Presently there are no mechanisms in place for tracking single MRSA events, so the actual incidence and prevalence in the U.S. remain unknown.

These reports have raised awareness in the healthcare field; however, they have also increased concern in the general population for those individuals who had been previously considered low risk. As with any research, the results must be re-examined by continued research to statistically verify the basis for the change in population or presentation in the emergence of CA-MRSA.

It is important to educate our families, patients, and colleagues about minimizing transmission. MRSA is commonly spread though skin-to-skin contact such as handshaking or exposure to contaminated surfaces. It may also become airborne through sneezing or coughing.

There are simple steps to reduce your chances for infection:

Hand washing and good hygiene are a crucial part of reducing the disease burden of this and many other pathogens we face on a daily basis. Proper hand hygiene requires soap and warm, running water, and hands should be rubbed together vigorously for at least 20 seconds (CDC, 2007). Teach your family and patients that hand washing is necessary after repeated use of alcohol-based or other hand hygiene products to decrease the potential of skin irritation or allergic reaction to the product (CDC, 2002).
Proper utilization of gloves and other personal protective equipment in your work environment can address and prevent potential exposure and cross contamination of surfaces.
Proper cleaning of visibly soiled surfaces and surfaces that come in contact with many users per day can reduce or eliminate exposure.
Teach your family or patients to cover a cough or sneeze by using a tissue or elbow rather than a bare hand. It is also important to wash hands soon after sneezing, before further contact with any surface.
Teach your family or patients not to share personal items such as razors or towels, and to avoid contact with other’s wounds or open sores.

(To request references, e-mail practice@nysna.org.)

This is a sample of the questions NYSNA’s experts answer each day. The advice given is specific for the situation described and may not be applicable generally. If you have questions about your own work setting, it is recommended that you contact your NYSNA Nursing Representative or the Education, Practice, and Research Program, 11 Cornell Road, Latham, New York 12110-1499 or call 1-800-724-NYRN, ext. 282.