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Health news - MRSA - the facts

9 March 2005 - written by Bupa's Health information team

What is MRSA?

MRSA is the name given to a group of bacteria that belong to the Staphylococcus aureus (SA) family of bacteria.

Most Staphylococcus aureus bacteria can be treated with medicines called methicillin-type antibiotics.

However, certain types of Staphylococcus aureus bacteria cannot be treated with methicillin-type antibiotics - the bacteria are resistant to these drugs. These are called MRSA bacteria:

M - methicillin
R - resistant
S - Staphylococcus
A - aureus¹

How did MRSA become resistant to methicillin-type antibiotics?

Whenever bacteria encounter an antibiotic (such as methicillin) some of the bacteria may be able to survive it. The surviving, methicillin-resistant bacteria can then multiply, potentially producing bacteria with even better resistance.

The chances of resistant bacteria developing have been increased by:^1,4

• failure to finish full courses of antibiotics, allowing bacteria with some resistance to survive and multiply
• overuse of antibiotics, meaning that bacteria encounter and survive a wide range of antibiotics

How common is Staphylococcus aureus?

It's estimated that one in three healthy people carry Staphyloccocus aureus bacteria on their skin, in their noses or in the back of their throats.^1,2

Few UK studies have looked at how many healthy people who are not in hospital carry MRSA - one study estimates about one in 100 people.⁹ This is about the same as US estimates.³

People carrying the bacteria are said to be colonised, but not infected: the bacteria are simply "hitching a lift" on the surface of the body and have not entered their bodies.²

Will carrying Staphylococcus aureus harm me?

While the bacteria are simply being carried on the surface of the skin, all Staphylococcus aureus, including the MRSA strain, are not harmful to a healthy person. Because of this, most people are never aware that they are carrying the bacteria.¹

How does Staphylococcus aureus cause an infection?

Infection happens if the bacteria enter the body through a cut, a graze or any break in the skin - either accidental or deliberate (eg a drip or surgical cut).¹

The bacteria can then cause skin infections or other more severe infections inside the body.¹ (see What types of infection can MRSA cause? below).

The severity of the infection depends on where in the body the bacteria has spread to (see Who is most at risk of developing an MRSA infection? below).

What types of infection can MRSA cause?

If the infection is just under the skin, MRSA can cause pimples or boils. ^3,4 The affected areas may be swollen, painful and red.³

If bacteria get into a person's blood stream, usually through a deep wound, they can spread throughout the body and cause other infections. For example:^3,4,9

• wound infections
• abscesses
• pneumonia (lung infection)
• septicaemia (blood poisoning)
• osteomyelitis (bone infection)
• septic arthritis (joint infection)
• heart valve infections
• urinary tract infections

Implanted devices, such as hip or knee replacements, can also become infected.

Who is most at risk of developing an MRSA infection?

The people who are most at risk of becoming either colonised or infected with MRSA are those in close contact with people who may be carrying the bacteria, for example in hospital wards that care for ill people.

MRSA infection is most likely to develop in people who:^2,4,6

• have weakened immune systems, for example the elderly, premature or newborn babies, or people who already have another infection
• have open wounds, burns or cuts, for example people who have undergone surgery or who have other types of wounds (such as those made by an intravenous drip)

Are MRSA infections more dangerous than other infections?

They can be. Many skin-deep infections, such as boils, clear up without the need for antibiotics once the pus has been drained away. Don't try this yourself: boils should only be drained by a health professional.³

But people in whom MRSA infection has spread further usually need treatments such as antibiotics or surgery.

Normal Staphylococcus aureus infections are treated with methicillin-type antibiotics. But MRSA infections cannot be treated with the usual antibiotics - so longer treatment or newer antibiotics need to be used. This can mean that the bacteria have more time to multiply and spread through the body - resulting in more severe infection.⁴

So can MRSA infections be treated?

Yes, MRSA can be treated. The resistance of the MRSA bacteria to certain types of antibiotics makes treatment more difficult, but not impossible.^2,3,4

Most strains of MRSA can be treated with the antibiotics vancomycin and teicoplanin, which are given by injection or through an intravenous drip.⁴

Surgery may also be needed to remove infected tissue or implanted devices.

How is MRSA spread?

A person can become colonised with MRSA (or infected if the bacteria enters the body) by:

• skin contact with a person carrying MRSA on their skin⁶
• contact with surfaces and objects that have been touched or used by someone carrying MRSA, such as door handles, razors, towels and sheets⁸
• contact with dust that contains skin particles carrying MRSA⁶

By touching an open wound or scratching damaged skin, people who are colonised by MRSA can transfer the bacteria from their hands into their body, leading to infection.⁶

How can we prevent the spread of MRSA and other infections in hospitals?

In hospitals a number of measures have been put in place to reduce the spread of infections:^2,6

• doctors and nurses wash their hands or use alcohol-based hand rubs between patients to avoid transferring bacteria from one patient to the next
• hospital wards, corridors and surfaces are regularly cleaned
• skin wounds are covered with dressings
• patients are asked not to touch their wounds or damaged skin and to regularly wash their hands to prevent self infection (see How can I reduce my risk of developing an MRSA infection? below)
• people visiting patients with MRSA infections are asked to wash their hands before and after visiting
• people who develop an MRSA infection are normally cared for in an isolation room to help prevent the bacteria being easily transferred to others

Will clean hospital wards and corridors make MRSA go away?

No, because MRSA is carried by people. Mopping floors and wiping surfaces will never get rid of all the bacteria, so rigorous basic hygiene measures are still needed. But by keeping down the amount of MRSA-containing dust and keeping surfaces free of MRSA there will be fewer opportunities for it to infect a vulnerable person.

How can I reduce my risk of developing an MRSA infection?

NHS Direct suggests that when you are staying in hospital, you should:⁴

• keep your hands and body clean - take soap, a flannel, moist hand-wipes and your own razor into hospital with you
• not touch any damaged skin or surgical wounds that you have
• always wash your hands after using the toilet or commode
• always wash your hands or clean them with a hand-wipe immediately before and after eating a meal
• make sure that your bed area is cleaned regularly
• report any unclean toilet or bathroom facilities

If you are concerned about hygiene, you should not be afraid to ask your doctor or nurse if they have washed their hands before they touch you.⁴

In day-to-day life, you can avoid MRSA skin infections by:³

• keeping your hands clean by washing them thoroughly
• keeping cuts and scrapes clean and covered with a plaster or dressing
• avoiding touching other people's wounds or dressings
• avoiding sharing personal items such as towels or razors

People have been worried that they could become infected with MRSA at their local gym because some equipment is shared. To minimise any potential risk, the US Centers for Disease Control and Prevention suggest wiping any equipment before and after use, using a barrier (such as a clean towel or clothing) to prevent your skin touching it and showering after your workout.³

References

1. Health Protection Agency, MRSA information for patients
   www.hpa.org.uk
2. Association of Medical Microbiologists - the facts about MRSA
   www.amm.co.uk
3. Centers for Disease Control and Prevention, MRSA information for the public
   www.cdc.gov
4. NHS Direct Online Health Encyclopaedia - MRSA introduction for nursing staff
   www.nhsdirect.nhs.uk
5. Royal College of Nursing, Continuing Professional Development, Bacterial Pathogens, publishing in Nursing Standard, July 16 2003, vol 17, no.45, pages 47-53.
   Royal College of Nursing - MRSA guidance
   www.rcn.org.uk
6. Department of Health, MRSA Surveillance System - results, July 2004.
   www.dh.gov.uk
7. Prodigy patient information leaflet, MRSA, July 2004
   www.prodigy.nhs.uk
8. Department of Health, A simple guide to MRSA
   www.dh.gov.uk
9. Grundmann, H, et al, Nottingham Staphylococcus aureus population study:prevalence of MRESA among elderly people in the community. BMJ 2002; 324: 1365-6
   www.bmj.com

Pages accessed on 03/03/05 or 08/03/05.

Bupa information:

• Bupa article: Antibiotics
  www.bupa.co.uk/health_information/html/medicine/antibiotics.html
• Bupa factsheet: Pneumonia
  hcd2.bupa.co.uk/fact_sheets/html/Pneumonia.html
• Bupa article: Facts about toxic shock syndrome
  www.bupa.co.uk/health_information/html/healthy_living/w_health/periods/toxic_shock_syndrome.html

Further information:

• Health Protection Agency
  www.hpa.org.uk/
• National Patient Safety Agency
  www.npsa.nhs.uk
• UK Department of Health
  www.dh.gov.uk
• US Centers for Disease Control and Prevention
  www.cdc.gov