- THE MAGAZINE
Q: One of our employees has raised the issue of working on a job site where one of the occupants had MRSA. I am concerned about what we should do to protect our workers. Are there any guidelines that will help us?
A: Staphylococcus aureus or “staph” infection is not a new disease. Actually, it is a bacterium that has been around for a long time and can cause mild to severe illnesses. Methicillin-Resistant Staphylococcus aureus (MRSA) is a kind of staph infection that is more difficult to treat due its resistance to antibiotics. It has been reported that MRSA is resistant to synthetic penicillins such as methicillin; cephalosporins; and sometimes to other antibiotics including erythromycin.
According to the Centers for Disease Control, “While 25 percent to 30 percent of the population is colonized with staph (meaning that bacteria are present, but not causing an infection with staph), approximately 1 percent is colonized with MRSA.” Historically, most of these infections were confined to healthcare facilities. Recently, infections have begun being reported among individuals that have not been exposed to a healthcare facility. It has been reported that, “These community-acquired MRSA (CA-MRSA) strains differ from healthcare-associated MRSA (HA-MRSA) strains. Mild infections might look like a pimple or a boil. Its appearance may be red or swollen; and it may have pus. More serious infections can result in pneumonia or bloodstream infections.”
Staph bacteria are primarily passed from person to person through direct contact with skin or through contact with contaminated surfaces. It can remain viable for long periods of time in linen, clothing, and dust. However, it is thought that inanimate objects or environmental surfaces do not represent significant sources for transmission infection if appropriately handled. The bacteria can also be found in the nose or on the skin. A nasal carrier often contaminates his/her own hands by hand-to-nose contact and transmits the organism in the course of routine activities.
The primary means of prevention is good personal hygiene, e.g., washing your hands clean with soap and water or an alcohol-based hand sanitizer. Staph can enter the body through openings in the skin such as cuts or abrasions, resulting in infection if not attended to. In such cases the area of the cut or abrasion should be promptly flushed with water, treated with a topical anitbiotic and then covered with a clean, dry bandage until healed.
Factors that increase the risk of MRSA transmission include working in crowded areas; frequent skin-to-skin contact; having cuts or abrasion that are not appropriately protected; working with contaminated items and a lack of good personal hygiene practices.
The following are a collection of recommendations from various sources that can be used as general guidance for employers and employees.
- Provide employees with the needed training in the recognition and avoidance of environmental exposures.
- Provide employees with training in the appropriate personal protective equipment (PPE) that should be worn when performing cleaning or restoration services in areas that are suspected of being contaminated.
- Ensure the availability of adequate facilities and supplies that encourage workers to practice good personal hygiene.
- Employees with skin infections may need to be referred to a licensed health care provider for diagnosis and treatment.
- Employees with weakened immune systems may be at risk for more severe illness if they get infected with MRSA.
- Practicing good hygiene (e.g., washing your hands clean with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer with at least 60% alcohol concentration.
- Cover skin traumas such as abrasions or cuts with a clean dry bandage until healed.
- Avoiding sharing personal items.
- Maintain a clean environment by establishing cleaning procedures for frequently touched surfaces and surfaces that come into direct contact with other people’s skin.
- Gloves should be worn if employees are expected to have contact with contaminated surfaces. Hands should be washed immediately after removing gloves
Clean surfaces with detergent-based cleaners or Environmental Protection Agency (EPA)-registered disinfectants to effectively remove MRSA from the environment. It is important to read the instruction labels on all cleaners to make sure they are used safely and appropriately.
Environmental cleaners and disinfectants – those that are registered for use on surfaces and not for topical dermal application – should not be used to treat infections. The EPA provides a list of EPA-registered products effective against MRSA at http://epa.gov/oppad001/chemregindex.htm.
If soiled linens and clothing are washed, use a laundry detergent in hot water, minimum 160°F – add one cup of bleach if water is not 160°F – and dry in a hot dryer.
As with other exposures, adverse reactions to “staph” can be minimized or avoided by providing the appropriate training combined with good personal hygiene. For more information go to the CDC web site at www.cdc.gov/ncidod/dhqp/ar_mrsa_ca.html.