Your MRSA Questions Answered

Oct. 31, 2007 — -- Tonight "World News With Charles Gibson" reported on a drug-resistant staph infection that could be putting your family at risk. The bug, called methicillin-resistant Staphylococcus aureus, or MRSA, was once only a threat in hospitals. Now MRSA has spread into communities.

We recently invited you to post your questions about this "superbug" on our message boards. We sent your questions to the ABC News Medical Unit for the expert answers below.

Question: Yesterday a letter was sent home with my children informing us that there are two reported cases of MRSA in our school. I found some information online about it along with prevention help. When I asked some staff members what special cleaning and disinfecting measures were being taken I was told none, just the usual cleaning. On "GMA" I saw a piece on this staph infection at a school and they showed a man in a special suit with gloves cleaning all the desks.

I know this type of thorough cleaning is not happening in our school. I called the CDC to ask them if our school should be doing more and the woman on the phone told me that all people have staph in them and my children are in no danger. She also said the cleaning staff should wear gloves but that is about it. She said that it is not the superbug the media is calling it and I shouldn't worry about it, but if I had further questions I could call back.

Who do I listen to? Should more be being done in the school? Should I worry? Is it just being blown way out of proportion like the schools and CDC say?

Henry Masur, immediate past president, Infectious Disease Society of America: Staph infections have been with us for centuries: We know how to recognize them, we know how to treat them, and we know a lot about how to prevent them. There is no doubt that staph infections are a problem. What is new, however, is public awareness that more and more staph are resistant to the drugs we have used in the past. Your school almost certainly never asked students to report staph infections until recent weeks. Cases have undoubtedly occurred before, and will continue to occur.

There is no reason to panic, but there is need for prudent, common sense approaches. We know that staph is spread by direct skin to skin contact, thus hand washing and showering make sense. We know that abrasions in the skin can get infected. These infections need to be treated promptly so that they do not become serious.

Up to 40 percent of the population do have staph in their nose either persistently or intermittently. Most of the time they do not suffer any illness as a result, even though some of these staph are MRSA.

Cleaning you skin (hand-washing) and cleaning clothes and towels make eminent sense. If some schools wish to disinfect class rooms, computer key boards or benches and other surfaces in locker rooms, they should act as they deem appropriate. However, such environmental cleaning is not likely to have the impact of hand washing, washing towels and athletic uniforms regularly and covering abrasions that may be infected.

If your school is emphasizing hand washing, regular laundering of athletic equipment, and personal responsibility about avoiding sharing towels and clothing, your school is taking a logical and appropriate approach to MRSA.

Question: I am curious if thorough hand washing is a way to prevent contracting an MRSA? Could you let me know if there are other precautions to take?

Dr. Neil Fishman, director of Infection Control at University of Pennsylvania Health System: Good hand hygiene is the best way to prevent the spread of MRSA. You can use either soap and water or an alcohol hand sanitizer. Additionally, always shower after exercising in a gym and never share towels, bar soap or razors.

Question: How quickly does the infection start to show symptoms -- 24 hours or two weeks, a month? What does the sore look like?

Fishman: At the earliest stages, the sores can look like an insect bite. As time goes on, they may look like a pimple or grow to be the size of a boil. If the infection gets more severe, the sore can get red, hot and tender. At later more advanced stages you may develop a fever.

About 30-40 percent of people carry some form of the organism on their bodies, and most people do not develop problems or infections. So it is difficult to say how long it takes for symptoms to appear because you may never show symptoms at all. Once an early sore (which looks like an insect bite) develops it may go away on its own or it may get bigger. If it gets red and hot you should see a doctor. However, it is difficult to predict if this will happen or how long it will take.

Question: My 1-year-old nephew is a carrier of MRSA in his nose. I have a 2-year-old daughter and I am extremely nervous about them playing together. Am I overreacting? What are the chances of transmission among children by playing together?

Fishman: 30-40 percent of the population carry MRSA or some form of staph aureus on their body. Most people never develop any problems. Therefore, we really do not know when we come in contact with the organism. But there is at least a 30 percent chance that we do come in contact with it every day.

Children are at greater risk of passing the organism to one another because they lick things, wipe their noses on their hands and do not wash their hands. I would allow the children to play together because there is no way of knowing who carries MRSA and who doesn't. However, it is reasonable to take some precautions. If your nephew has any draining sores, they should be covered with a bandage. I would also teach your daughter to wash her hands or to use an alcohol hand rub. These can be purchased in any drug store and can be used anywhere.

Tell you daughter it is magic soap -- she puts it on her hands, rubs and it disappears!!

Question: Last year while in the hospital for three weeks due to breast reconstruction surgery I was told I had contracted MRSA. I was also told I was a carrier of it. I was treated with antibiotics and, when sent home, I took a special antibiotic via IV for one week. The issue of MRSA was never discussed by my medical team again, even after I asked several questions.

One year later, the open wound in the area of my right breast has still not healed. This slowness to heal was explained as being because the breast was treated with radiation four years ago while I was being treated for breast cancer. My concern is this: is the slowness to heal and the open wound a result of having MRSA? Am I at risk of spreading this disease and what should I be doing to protect others and myself? I am very concerned.

Masur: There are many different reasons why a surgical site would not heal. It is not likely, after one year, that MRSA is the reason the wound has not healed, but to be certain the wound would have to be carefully examined. If there were evidence of infection by examination, or if an adjacent structure shows any suspicious area on some type of X-ray, a culture should be done. However, the wound could have a small amount of MRSA (colonization) on a chronic basis, but that MRSA might in this situation have no relevance to its failure to heal. A health care provider would have to make a decision about the utility of treatment after carefully reviewing your case.

Many patients who are infected with MRSA lose the organism when they leave the hospital and are no longer receiving antibiotics. Some patients become chronic carriers of MRSA, as do some patients who have never even been in the hospital. Those patients are not likely to spread MRSA if they practice good hygiene in terms of hand washing, showering, and avoiding sharing clothes and personal items such as razors. There is some controversy regarding the utility of screening for MRSA, specifically that it is not certain that a culture of your nose, skin and wound would be helpful if you have no clinical evidence of infection.

To protect others, you should practice good hygiene, keep your wound covered if it is open and draining, and wash your hands after touching your wound or dressing. Dispose of the wound dressings so that others do not come into contact with them. Ask your doctor if there is some special reason why you should be cultured or treated, neither of which is likely to be necessary from your brief description.

Question: I am a phlebotomist at Mercy Hospital in Council Bluffs and this news worries me a great deal. I have three kids and three step kids. I protect myself at work, but because this infection is noncurable, I want to know how it is transmitted. I wear gloves before I touch any of the patients. However, can this spread through droplets or contact? What can I do to better protect myself and my family and all others?

Masur: MRSA is a serious problem, but simple precautions can greatly reduce the likelihood of transmission, and it can be cured with drugs we have available now.

As you know from working in a hospital, the use of gloves followed by careful hand washing will go a long way towards preventing your acquiring MRSA. This organism almost always spreads by person to person contact, or from clothes or personal items such as razors. Spread by droplet rarely happens.

Thus, if you wear gloves and wash your hands, the likelihood that you will acquire this infection in the hospital or spread it to your family, is very, very low.

And remember, if skin abrasions get infected we can cure MRSA if the infection is accurately diagnosed and properly treated. We know how to manage this infection.