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Methicillin Resistant Staphylococcus Aureus (MRSA)
by Bronwen Edgar1
Staphylococcus aureus bacteria is found on skin and can be part of the normal skin flora. Over time, S. aureus has acquired resistance to commonly used antibiotics. This resistant type of S. aureus is known as Methicillin Resistant Staphylococcus Aureus (MRSA).
MRSA is most often acquired in a healthcare setting (hospital, nursing home, group home, home care), however, community acquisition of MRSA has become more prevalent over recent years particularly among people sharing close living quarters such as soldiers, prisoners, aboriginal populations; people who participate in sport activities that encounter skin-to-skin contact; and people in other high-risk groups such as IV drug users.
Most people who have MRSA are colonized with the bacteria, meaning that it is benign or not causing any symptoms in the patient. On occasion the bacteria can enter a sterile body site and cause an infection such as in a wound. In healthcare settings this may include surgical wound infections, urinary tract infections, bloodstream infections, and pneumonia. The Canadian Nosocomial Infection Surveillance Program (CNISP), which gathers data from 48 sentinel hospitals across 9 provinces has identified the overall national rate of MRSA to be 8.04 per 1,000 admissions (up from less than 1 per 1,000 admissions in 1995).
Over recent years, the issue of MRSA has expanded beyond the healthcare setting to the community at large. Cases of MRSA are now occurring in people who have never been hospitalized. With this emergence of cases, public health professionals should be prepared for increasing requests for information and education on MRSA in various community settings.
Compliance with hand hygiene is the best method of preventing the spread of MRSA in all settings. Hand hygiene is the term used to describe the process for the care and maintenance of clean hands. Hand hygiene can be performed with soap and water (preferred when hands are visibly soiled) or alcohol-based hand rub for 15 seconds. Either soap and water or alcohol-based hand rub are the preferred methods of removal of the day-to-day bacteria we pick up on our hands. The use of antibacterial soaps is not recommended for routine daily use as it eliminates the natural microflora or protective barrier from our skin.
In an effort to improve patient and healthcare provider safety, the Ontario Ministry of Health and Long-Term Care has launched the Just Clean Your Hands program. Over 99% of Ontario hospitals have signed on to participate in this evidence-based multi-faceted program designed to improve hand hygiene compliance at Ontario hospitals.
On May 28th, 2008, the Ontario government announced that they will require Ontario hospitals to report a number of infection prevention and control related indicators including incidence of MRSA, Vancomycin-resistant Enterococci (VRE) and Clostridium Difficile associated disease (CDAD) by the end of December 2008. In addition, the Ontario government has mandated public reporting of hand hygiene compliance rates among healthcare workers by April 2009.
These and other patient safety indicators will be accessible from a public website.
Additional information can also be found at these websites:
1 Bronwen Edgar, Epidemiologist, is an Infection Prevention & Control Coordinator at the Sunnybrook Health Sciences Centre and a former Member of the Board of Directors of OPHA.
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