Staphylococcus - the 'superbug'

Staphylococcus is potentially a huge issue - and hazard - for healthcare workers.

What is Staphylococcus?

First there was Staphylococcus aureus, a bacterium that continues to cause illness. Overprescribing of antibiotics helped change it into a "superbug" that eventually defeated methicillin, the drug that had been most effective in fighting it. This new strain was called methicillin-resistant Staphylococcus aureus (MRSA) and became common in hospitals. Only a few antibiotics are effective against some hospital strains of MRSA infection.

Meanwhile, in the 1990s, staph took on yet another form, community-associated MRSA (CA-MRSA) - infections in healthy people who had not been hospitalized nor had a medical procedure such as dialysis or surgery within the past year. Several drugs continue to work against this strain, but this strain of staph could also become drug-resistant in time.

What are the symptoms?

It is possible to carry the staph bacteria for years without becoming sick. Sometimes it causes a minor skin problem by infecting a cut or wound. The first sign of a staph infection is usually an outbreak of small red bumps on the skin, which can soon become deep, painful abscesses that need to be surgically drained. Other signs of infection are headache, fever and lack of energy.

The bacteria may remain confined to the skin, but in more serious cases, they can go deep into the body, causing potentially life-threatening infections in bones, joints, surgical wounds, the bloodstream, heart valves and lungs. MRSA has also been known to cause urinary tract infections, pneumonia, toxic shock syndrome, and even death.

As a precaution, as soon as a pimple, insect bite, cut or scrape on the skin becomes infected, workers at risk should see their doctor. They should ask to be tested for MRSA, rather than taking antibiotics. Drugs that have no effect against MRSA could lead to serious illness and more resistant bacteria.

How is it spread?

MRSA is usually spread through physical contact - not through the air. The risk factors for hospital and community strains of MRSA are different because they generally occur in different settings, however both strains are spread in the same way, mainly through person-to-person contact or contact with a contaminated item.

Who is at risk?

People who are currently or have recently been hospitalized, or live in long-term care facilities are at risk of hospital-acquired MRSA. Older adults and people with weakened immune systems, burns, surgical wounds or serious underlying health problems are vulnerable as are those on dialysis, who are catheterized, or have feeding tubes or other invasive devices. MRSA is transmitted most commonly by hands (especially health care workers' hands), which may become contaminated by contact with infected patients, or surfaces and medical devices that are contaminated with body fluids containing MRSA.

Community-associated MRSA can be especially dangerous to children, whose immune systems are not yet fully developed or who don't yet have antibodies to common germs. Elderly people and those weakened by pre-existing health issues are also susceptible, as are people whose immune systems are compromised.

Amateur and pro athletes have been known to contract CA-MRSA from cuts, abrasions, skin-to-skin contact, shared towels or athletic equipment, or shared razors. Outbreaks have been also seen among prisoners, military recruits, daycare attendees, and injection drug users. People who have lived in crowded, unsanitary conditions, or have had close contact with health care workers, should be alert for symptoms of CA-MRSA.

How to prevent MRSA skin infections

To prevent infection from MRSA and other strains of staph, good hygiene (hand washing) practices must be followed. Healthcare workers can help prevent the spread of germs by taking standard infection control precautions that include washing hands frequently, properly disinfecting hospital surfaces and taking other precautions such as wearing a mask when working with people with weakened immune systems. Visitors and healthcare workers caring for infected or colonized (bacteria are present but not causing an infection) patients placed in isolation may be required to wear personal protective equipment and garments and to prevent the spread of the bacteria.

To prevent infection from CA-MRSA - in addition to practicing good hygiene - personal items that may be contaminated (towels, razors, clothing, etc.) should not be shared. Skin irritations should be monitored, cuts and scrapes should be kept clean and covered with bandages until healed. Medical attention should be sought at the first sign of skin infection.

Precautions for healthcare workers

It is important to implement and follow standard infection control precautions including:

Hand Washing
Hands must be washed immediately after gloves are removed, between patient contacts and between tasks and procedures.

Gloves must be worn when touching blood, body fluids and contaminated items. Gloves must be removed between patient contacts and hands washed immediately.

A mask and face shield should be worn during procedures that are likely to generate splashes or droplets of blood and body fluids.

Likewise, a gown should be worn during procedures that are likely to generate splashes or droplets of blood and body fluids.

Patient Care Equipment
Appropriate cleaning, disinfection and sterilization of patient care equipment are important in limiting the transmission of organisms.

Handling of Laundry
Used linen soiled with blood or body fluids must be handled, transported, and processed in a manner that prevents skin exposure, contamination of clothing and transfer of microorganisms to other patients.

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Thanks to the CCOHS - Canadian Centre for Occupational Health and Safety

Last amended March 2015