Press-Republican

May 25, 2012

Best prevention for MRSA infection is frequent hand-washing

Anthony L. Komaroff, M.D.
Press-Republican

DEAR DOCTOR K: I recently had a skin infection caused by MRSA. I must have picked this up at my mother's nursing home. How can I avoid another MRSA infection, as I hear they can be serious?

DEAR READER: MRSA is short for "methicillin-resistant staphylococcus aureus." Staph aureus is a bacteria. These bacteria are all around us. They live on our skin -- and if they get under the skin and multiply, they can cause a skin infection like the one you had.

But if staph bacteria get into the bloodstream, they can cause serious and potentially fatal infections.

Bacteria are remarkably resilient and can develop ways to survive drugs meant to kill or weaken them. This is called antibiotic- or drug-resistance. MRSA bacteria are resistant to an antibiotic called methicillin -- and methicillin was developed because staph and other bacteria had become resistant to penicillin.

It's a vicious cycle, an arms race. We invent antibiotics; bacteria develop resistance to them. So we invent new antibiotics, and the bacteria develop resistance to them. Sometimes bacteria can change faster than new antibiotics can be developed.

Antibiotic resistance is due largely to the increasing use of antibiotics, which are often prescribed unnecessarily and used inappropriately. You think you may have contracted your infection when you visited your mother's nursing home. One of the reasons MRSA infections are often contracted in health care facilities is that many patients are receiving antibiotics.

In fact, MRSA infections were first noted in the 1960s, in health care facilities. Twenty years later, they started appearing in the general community. Many MRSA infections that start in the community affect people who inject illegal drugs. Even house pets and other animals now sometimes carry MRSA and can pass them to humans.

MRSA infections don't produce worse symptoms than infections with staph that are not drug-resistant. Instead, the problem with MRSA infections is that they are harder to cure. MRSA infections may not respond to most (and in rare cases, any) of the currently used antibiotics.

MRSA infections usually are passed first to your hands. Therefore, the best prevention against MRSA is frequent hand washing. Use soap and water or an alcohol-based hand cleanser. If you're visiting someone in a health care facility, this is especially important. I'm in the hospital every day, and I avoid touching anything I don't need to, such as the railing on the stairs. After I touch something I have to touch, like a doorknob, I use an alcohol-based hand cleanser.

When visiting a person in a hospital or nursing home, thoroughly wash your hands before and after your visit. Strictly follow any instructions posted outside the room. These may cover contact precautions. You may need to wear protective gloves and a full gown during the visit. When leaving the room, leave the gloves and gown inside the room in specially marked containers.

If you take precautions, you'll be safe. I know -- I've worked with patients at risk for carrying MRSA for decades, and I've never had a MRSA infection.

Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.

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