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Methicillin-resistant Staphylococcus aureus (MRSA)

THIS APPLIES TO ANY PSW/NURSE/FAMILY MEMBER/CAREGIVER WHO ENTERS INTO LONG TERM CARE/HOSPITAL, etc.

Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium responsible for difficult-to-treat infections in humans. It may also be referred to as multiple-resistant Staphylococcus aureus or oxacillin-resistant Staphylococcus aureus (ORSA). The organism is often sub-categorized as Community-Associated MRSA (CA-MRSA) or Hospital-Associated MRSA (HA-MRSA) depending upon the circumstances of acquiring disease, based on current data that these are distinct strains of the bacterial species.

MRSA is a resistant variation of the common bacterium Staphylococcus aureus. It has evolved an ability to survive treatment with beta-lactam antibiotics, including penicillin, methicillin, and cephalosporins.[2] MRSA is especially troublesome in hospital-associated (nosocomial) infections. In hospitals, patients with open wounds, invasive devices, and weakened immune systems are at greater risk for infection than the general public. Hospital staff who do not follow proper sanitary procedures may transfer bacteria from patient to patient.

In healthcare environments, MRSA can survive on surfaces and fabrics, including privacy curtains or garments worn by care providers. Complete surface sanitation is necessary to eliminate MRSA in areas where patients are recovering from invasive procedures. Testing patients for MRSA upon admission, isolating MRSA-positive patients, decolonization of MRSA-positive patients, and terminal cleaning of patients' rooms and all other clinical areas they occupy is the current best practice protocol for nosocomial MRSA.

 What is Vancomycin-Resistant Enterococci (VRE)?
Enterococci are bacteria found in the stomach and bowels of about 19 out of every 20 healthy people. They are also found in the vagina, the mouth and the throat, and on skin around the anal area. Human stools (bowel movements) have the highest levels of these bacteria. The bacteria can be present in or on the body but not cause illness.
Enterococci can get into open wounds and skin ulcers, and cause infection. Less often, they can cause more serious infections of the blood or other body tissues.
Vancomycin (VAN co MY sin) is an antibiotic medication that is used to treat enterococcal infections. Some antibiotics do not work against some Enterococci.
Vancomycin-Resistant Enterococci (VRE) are enterococci that have become resistant to vancomycin. VRE are not easier to catch and do not cause more severe infections than other enterococci.

 Why is VRE a concern?
The antibiotic vancomycin is sometimes the only antibiotic that can treat serious infections caused by some enterococci.
Therefore, serious infections caused by VRE may be very hard to treat because they are resistant to vancomycin.

 How is VRE spread?
The most common way VRE spreads from person to person is by direct contact usually with the hands.
A much less common way it can spread is by touching surfaces, such as railings, faucets or handles that may have been contaminated with VRE.

 What are your chances of Contracting VRE?
If you are healthy and living in the community, your chances of becoming infected with VRE are low, even if you have been in contact with someone with VRE (for example, at work). You may be at higher risk if you have been treated with frequent doses of vancomycin before, or if you have stayed for a long time in a hospital where there have been previous VRE cases. Patients whose immune systems are suppressed are also at greater risk of getting sick from VRE.
At present in Canada, VRE infections are very uncommon. Most people are identified as carriers of VRE by routine testing of skin and anal swabs done before or during a stay in hospital. Others may be identified when testing is done if a VRE infection occurs. In British Columbia, there have been scattered reports of VRE cases from across the province, with several clusters of VRE in patients reported from a few hospitals.

 How long does VRE last?
Healthy people may carry VRE for weeks or even years, and may clear the bacteria from their bodies without treatment. However, if you have had a serious VRE infection, the infection can come back again, particularly after treatment with vancomycin or other antibiotics.

 How are VRE infections treated?
If you are carrying VRE and you are healthy, you do not need treatment. You can continue with your normal activities. Although you do not pose a health risk to your family, co-workers, or to the public, it is important for you to wash your hands regularly using hand soap and water. Using an alcohol hand rub may help stop you from spreading VRE when touching surfaces with your hands. You do not need to disclose the fact that you carry VRE to your workplace, school or daycare setting.
If you have a VRE infection, your doctor will give you the treatment you need. Serious VRE infections, while they are difficult to manage, may still be treated with high doses of vancomycin-like antibiotics. Some new antibiotics may also be effective.

 How can you prevent VRE infections?
There is no vaccine to protect you from VRE. The most important thing you can do is wash your hands before eating, drinking, smoking or applying personal care products, and after using the toilet. Scrub your hands well for at least fifteen seconds using warm water and soap, and use a paper towel to dry your hands. Bacteria can survive on surfaces like railings, faucets and handles for up to seven days. Routine cleaning of these surfaces with regular household cleaners can also help reduce spread of bacteria.

 VRE and hospital visits
While in hospital, visitors will need to follow hospital guidelines to prevent the spread of VRE. This will include washing hands or using alcohol hand rub when entering and leaving the hospital and/or the patients room. Important: If you may be a carrier of VRE and are going to be admitted into hospital, it is very important for you to let hospital admitting staff know. Precautions will be taken to protect other patients and hospital staff from VRE infection.