Mrsa

[joo]

I'v been doing some reading on WebMD and a few other sites to get a better understanding o MRSA.

From what I understand MRSA is spread by contact. So you could get MRSA by touching another person who has it on the skin. Or you could get it by touching objects that have the bacteria on them.

So my question becomes if I'm moving a paient, and my forearm skin touches there skin am I at a serious risk? Do I need to decontaminate my stretcher now?

Granted I take pre-caution any exposed skin after I've come in contact with the patient and wash up. I see some nurses in gowns when we get a MRSA patient, should we be doing the same?

 

[Ridryder911]

You should be decontaminating your stretcher no matter what. As well, you should had been educated in MRSA, VRSA and other popular bacterial and viral diseases in your training, as well as in orientation period of your company.

I would hope you wash up, glove up, and yes if contact MRSA active (non-colonized) wear appropriate attire (glove, gown, even shoe covers if it is fluid, mask if air borne).

This does make me wonder if your service is OSHA or NIOSH compliant? Do you not have protective wear inside each and every truck? As well, as hand disinfectant for each person? If not, they have to. Period.

Please remember, MRSA is usually caused by staph (bacteria, not staff) (which everyone has) and like other bacteria can spread by touching, direct contact, or by spreading from a source to another. It is YOUR duty to be sure to wash your hands, disinfect your equipment (including inside your unit, steering wheel, radio, etc.) between each and every patient. It is not the ones that has a label that will get you!

* now, I am very scared, of what EMS might be doing to promote this disease!

 

[JJR512]

...As well, you should had been educated in MRSA, VRSA and other popular bacterial and viral diseases in your training...

I wonder if perhaps you meant VRE (Vancomycin-resistant enterococci)? Unless you're referring to the newer strain of S. aureus that is becoming resistant even to Vancomycin, but that's called VISA (Vancomycin resistant-Intermediate Staphylococcus Aureus), and I haven't even heard this talked about yet in a clinical setting.

It's my understanding that everybody has S. aureus present on and in their bodies, and many, possibly most people also have the methicillin resistant form of S. aureus as well (in smaller quantities). Most people aparently carry MRSA for weeks to years before that form goes away on its own, probably having been crowded out. Most people who carry MRSA will never show symptoms and will never actually be infected with it. It's just along for the ride with the millions of other bacteria on and in you.

Personally, I wonder if perhaps using Vancomycin to treat MRSA increases the chances that the enterococci naturally present in your digestive tract will become resistant to Vancomycin, thus leading to an increased chance of the patient developing VRE.

 

[Ridryder911]

We have several patients in my area with VRSA or VISA ( we use VRSA) although the same resistant strain. Unfortunately, this is the end of the trail for these folks. Now, the scary part is one can contract this (like MRSA) with the same routes as MRSA. Usually, it is MRSA that is resistant to Vanco and there is nothing to kill it.

I believe the CDC is now aware of the pandemic situation we will be in. With the increasing age, the rate will increase...Now, the scary thing, nothing kills it! (Remember amoeba strain movie?) Heck with the avian flu, HIV, etc.. this kills, and NOTHING stops it or even delays it...

Now, another alarming factor is MRSA is now >70% OUTSIDE of the hospital setting... yep, restaurants, restrooms, theatres, schools, etc...

Makes, you think how much a problem this will be.. and if it could be catastrophic?

 

[Mercy4Angels]

i have MRSA patient all the time. if your smart youll be fine. if its airborne MASK the patient and yourself. if its bloodborne BSI like crazy

 

[BossyCow]

I remember an inservice with our local Infection Control person. She was asked about the need for us to be informed which patients have particular infectious diseases, she replied it doesn't matter. Universal precautions means everyone does. Sort of like the every gun is loaded theory!

 

[So. IL Medic]

* now, I am very scared, of what EMS might be doing to promote this disease!

I think that's a valid fear. Remember the study of hospital stethescopes and the nasty little cultures they produced....

More alarming to me are the number of transfer pts I've picked up lately in which I find from the receiving facility that the sending facility failed to inform or document the presence of MRSA on the pt. Makes me wonder how many unknowing exposures are occurring.

 

[DisasterMedTech]

Please remember, MRSA is usually caused by staph

Just to be clear, MRSA is ALWAYS caused by staph. Hence its name...methocillin resistant staphylococcus aureus. There is no cause of MRSA other than staph. It is a staph infection. And right now the CDC estimates that it is killing 19,500 Americans per year. As R/r rightly points out, we needn't be worrying so much about avian flu as a pandemic. MRSA/VRSA as a pandemic is already occurring and has been since it was first discovered in the UK in 1961. We would all benefit from having as many facts as we can. On the services with which I work, we always wear gloves pulled over the sleeves of our gowns (those nifty little papery ones), masks and eye protection. Its really a new twist on scene safety. If you know the patient has MRSA, watch where you are stepping, determine whether or not there are any fluids on the floor, know where the patient may have open/active lesions (sometimes referred to as boils). These boils often start out looking like a spider bite. The exudate from these boils is EXTREMELY infectious. One agency here in my city even puts masks on the patients when they are transporting them. As far as MRSA/VRSA goes, there is no such thing as being too careful. A recent case here in Illinois began with a small child with a cough and slight fever upon waking at about 7am. By 0130 the next morning, the child was deceased. MRSA/VRSA is the superbug that doctors and infectious disease specialists have been warning about for decades and it recently closed down an entire school district (23 schools, about 11,000 students) in Eastern Kentucky yesterday after one diagnosed case. The health department in that county determined that it wanted the entire school district decontaminated. This includes ripping up carpeting, disposing of curtains and wall coverings, bulletin boards, etc. Anything cloth (ie porous surface) was ordered to be disposed of by incineration.

I had a paramedic the other day tell me to "be afraid, be very afraid." Id rather say "be careful, be very, VERY careful."

 

[BossyCow]

Can't say it enough.... UNIVERSAL PRECAUTIONS!!!!!

So, we 'glove up like crazy' when we know there's MRSA, we 'really clean' the stretcher when we have someone we know to be carrying a specific nasty.... what about the next nasty that we don't know about yet? What about the undiagnosed pt? We need to be absolutely meticulous with our infection control. Remember, it's not paranoia if they are really out to getcha!

 

[EMTryan]

Given how common MRSA is I find it really suprising that they didn't mention it at all in our EMT book and not once in our EMT class.

I first learned about MRSA during clinicals and I couldn't believe that I had never heard of it before. This is a HUGE issue in EMS. There is so much attention on preventing bloodborne pathogen transmission but so little information about MRSA and staph infections.

 

[DisasterMedTech]

EMTRyan-

You're right. I took an infectious disease module class before EMT school or I never would have heard about it either until about 8 months ago when I transferred a patient with it. I have to say my first encounter with it (elderly male, multiple open and active infection sites, both legs amputated below the knee the try and stop it.

Point is, in EMT school, they figure they have covered it when they tell us about universal precautions, BBPs and BSIs. Go back to your instructor and say "Hey, why didnt we hear a word about this MRSA thing?" Won't fix what your class doesnt know but it might help when they remember to teach it to the next class or at least spark enough interest to get folks in the class to do a google search. For EMS providers, MRSA is a biohazard situation to be dealth with, cause we sure as hell arent going to treat it pre-hospital.

R/r- with your emphasis on education, what would you say is the bare minimum that new students need to be taught about M/VRSA?

 

[Ridryder911]

There is only so much that be covered in <200 hr course. That is why it is essential to have as much education as possible. Even unintentional ignorance can be harmful. Communicable diseases, viruses, etc. have no discremination on whom they will affect, host, or be in contact with.

I agree you should had been taught this, as well as many other subjects. That is part of the problem with abbreviated health care programs.

R/r 911

 

[EMTryan]

My EMT class was great but you are right there is only so much you can teach in a 120 hour class! It is kind of scary that in my state of WA you need only 120 hours of training to be an EMT and save lives but you need over 1000 hours to be a hair stylist! Heaven forbid if someone gets a bad haircut!

I teach CPR for the Professional Rescuer for the Red Cross and this is a prequisite class for all of the EMT classes. In my classes I always mention MRSA when we talk about Bloodborne Pathogens and Disease Transmission. I try not to freak people out to much but you do have to admit flesh eating bacteria that kills more people per year than AIDS is just a little bit scary.

 

[Arkymedic]

Remember a couple of the commandments of EMS

Thou shalt wash thy hands, wear thy gloves, and wear protective equipment when necessary.

Thous shalt decontaminate your equipment after EVERY single patient regardless.

 

[disassociative]

For those interested, I have recently been fortunate enough to come across the following article whilst viewing various journals from science direct.


E. faecalis vancomycin-sensitive enterococcal bacteremia unresponsive to a vancomycin tolerant strain successfully treated with high-dose daptomycin
Heart & Lung: The Journal of Acute and Critical Care
Volume 36, Issue 6, November-December 2007, Pages 456-461

Click here for the article

 

[JJR512]

It looks like you need to have paid access to that site to see the article.

 

[disassociative]

I think the link function of the forum cut off the url after a certain amount of characters. Click here:

http://www.sciencedirect.com/scienc...=590719&md5=72766ba3438566e4ef1685d15d7a077f#

 

[natrab]

Another good note is to decon all aspects of your work environment. Many people I see just decon the pt area, but remember that often times gloved EMS workers who have been in a pts house or touched a pt can be grabbing door handles, putting people in the front seat of the ambulance, etc. etc. One of the medics where I used to work got a MRSA infection on his right forearm on the lateral side...right where he sets it on the arm rest in the same seat that riders go in. Wonder where he got it....

I start out every shift going to town disinfecting my entire rig (including door handles, steering wheels, radios and mics, arm rests, etc. I also hit the door handles after any call where they have been touched and I try not to have riders in the front seat....ever.

Another medic where I work now caught antibiotic-resistant pneumonia. He's been out for several months already and he may not be returning to work at all. I usually put on a hepa mask on any pt with a bad cough (mainly from TB training, but seems like it may be necessary for more now).

It's dangerous out there. It doesn't hurt to be paranoid about this kind of stuff.

 

[Airwaygoddess]

Patient area, all equipment. How about those EKG cables to the Life Pak 10 or 12!! It is a very nasty infection, I have seen it too many times in too many places. We need to protect ourselves and our patients.....

 

[katgrl2003]

Patient area, all equipment. How about those EKG cables to the Life Pak 10 or 12!! It is a very nasty infection, I have seen it too many times in too many places. We need to protect ourselves and our patients.....

Don't even mention those EKG cables! We used to have a Lifepak 12 assigned to each truck, so I knew the one on my truck was clean. Now that they switch at least every shift, I can't even begin to tell you how nasty they are. I spent 10 minutes cleaning just the cables last shift, not counting the rest of the monitor.

I've had people ask me why I'm so anal about keeping my truck clean. This is why.

-Kat