How many Responders have come in contact with possible MRSA patients

[Guest]

I am curious with the rise of cases of MRSA (Methicillin-resistant Staphylococcus aureus), what type of precautions you take for a known case that you are responding to. What precautions are taken when it is suspected and what precautions are taken when it is known and whether they are the same?

[Guest]

I know for us as an FD unit responding we were given a "Head's up" that we should suit up. So we went in with tyvec suits and gloves for a lift assist that turned into a transport, it was kind of funny though had a cop there with a full face APR on even though MRSA is only a contact hazard not airborne. We got called back for a lift assist at the hospital for the same Pt but after already seeing the patient we went with just gloves.

[irishfire2491 24]

The nursing home are filled with MRSA i work by it all the time and use the same BSI as if it were a 3 year old kid that does not feel well. MRSA Has been out there for awhile. Along with other diease that has not made to the media YET

[Guest]

The nursing home are filled with MRSA i work by it all the time and use the same BSI as if it were a 3 year old kid that does not feel well. MRSA Has been out there for awhile. Along with other diease that has not made to the media YET

Yeah someone hit the panic button somewhere in my municipality, being a contact only hazard with a lift assist I had no problem dressing out in TYVEC but the Cops APR was excessive. And no one is absolutely sure that this guy actually has MRSA. But we were told to protect ourselves. And the last thing I want to do is bring something home with me after work.

And is MRSA that rampant in nursing homes? I wasn't aware of that, thanks for responding

[ny10570 745]

For a couple of reasons, MRSA has been an issue in nursing homes for 10 years now. Its gotten more common in that time and there is some worrying news about how the bacteria has changed, but there is nothing to justify the recent panic being fed by the media. We should be treateing every patient contact like they have MRSA because we really don't know what anyone has. That means gloves on every job and handwashing after every job. If there isn't a sink available then get out the skell gel (antibacterial gel). Wipe down equipment that has touched the patient (scope, BP cuff, stretcher, etc) with alcohol or any other anitseptic wipe. This is all about the safety of redundancy. Truth is MRSA is a relatively low risk exposure without coming into contact with fecal matter, puss, or saliva. A little bonus that I picked up on the other day...even fido can give you MRSA sp just be careful and wash-up.

[Guest]

Here in South Texas, MRSA is a part of everyday life. I heard a statistic somewhere that somewhere upwards of 80% of the people have it harmlessly growing on their skin. Yeah it sucks, but it is almost unavoidable. If you were to really try to avoid it, you would have to wear a suit to every call. I agree with Irish, normal BSI should be sufficient enough. Just remember to wash your work clothes in hot water.

Everyone down here knows someone who had a MRSA infection that required medical attention, usually something that started on the skin and grew into a pore (or slid down a hair and under the skin). I was exposed to it from my roommate. After I got it lanced, the docs told us to use a chlorohexadine soap like hibaclense and put muporocin ointment in our nostrils. It was a hassle, but it is still something with in the realm of being taken care of. There are a couple antibiotics that are still effective against it. However, if you get what looks like an ingrown hair that continues to grow and becomes painful to the touch, might want to get that checked out. That is just one incarnation of a MRSA infection, I cant speak to any other symptoms.

Edited November 17, 2007 by cisforsmasher

[Ladder44 73]

so in laymans terms what is MRSA??????????? people run around school saying it, its like the new thing in school, soposibly if u get a cut u have it????

[grumpyff 1,159]

Take your normal precautions. My 11 year old daughter had MRSA earlier this year, in March. Like it was mentioned before, it started off like an ingrown hair/pimple near her elbow. After a day she was complaining that it hurt, and was warm to the touch. The next morning it was even larger. Her pediatrician had me draw a circle around the swollen area with a pen, and monitor it through the day. By the end of the day it was hot to the touch, and had expanded in size. We took her to the doctor, who looked at it and drew another circle around it, and took a sample of the puss. It continued to grow, until the evening, when after conferring with her doctor, she went to the hospital. She ended up being admitted, and stayed almost a week. The first sample came back negative. It wasn't until the second or third day in the hospital that the puss tested positive for MRSA. She was treated with hot soaks, and a really strong antibiotic. We were referred to a specialist, who told us to wash our hands after any contact, and to get her the soap, hibiclense, as mentioned above. Her school was notified as soon as we found out what we were dealing with, and it no one made a big deal about it. For some reason, now the media thinks it is this super dangerous bug. The specialist also mentioned that MRSA is prevelent in the health care setting....nursing homes and hospitals. In the last few years, it has move out in to the general population. I went to the hospital just a few weeks ago to donate some movies on VHS that we no longer watch to the childrens ward. While there, one of the doctors who remembered us said that she was dealing with two cases on the floor at that moment, and that the elbow seemed to be a common area to get it.

Edited November 18, 2007 by grumpyff

[grumpyff 1,159]

so in laymans terms what is MRSA??????????? people run around school saying it, its like the new thing in school, soposibly if u get a cut u have it????

MRSA basically is a staph infection of the skin that is resistant to most, but not all antibiotics. Penicillin, and most other common antibiotics have no effect of MRSA. My daughter was treated with IV antibiotics. Here is a link to learn more about MRSA: http://www.medicinenet.com/mrsa_infection/article.htm

Edited November 18, 2007 by grumpyff

[ckroll 101]

Interesting and amusing. How many health care workers have run into MRSA? All of us. On a regular news cycle, the press trots out disease of the month. Hep C in firehouses, E. coli in in hamburgers, samonella in chicken, parasites in fish, Norwalk virus on cruise ships, Lyme/babesiosis/ehrlichiosis. For special occasions they run the plague/ebola panic ..... [if its a slow flu season] and the oldie but goodie, mad cow disease. [The next big thing will be CWD in New York deer... you heard it here first.]

First, the world is a filthy place and second, a lot of this stuff, like staph, is part of the natural biological make-up of our epidermis. There are a thousand reasons to be careful about anything you touch. As for precautions, for MRSA, nothing more than the usual BSI... pair of gloves changed regularly and removed before I touch anything else and handwashing.

Things that REALLY terrify me.....

1. The thought of being trapped on a cruise ship with 1000 drunk strangers looking to swap spit.

2. Salad bars...like a sneeze guard ever stopped anything,

3. Door knobs in restrooms. ... door knobs anywhere.

4. Touching money.... credit cards can save your life.

5. 'Air' in airplanes.... just try opening a window up there.

Do you have ANY idea where the produce in the grocery store has been before you buy it.... in three countries, on four trucks, a boat and handled by at least 8 people who have not recently washed their hands. Ever seen a fish market? Before that $20 a lb Chilean sea bass was lying in a display case, it was lying in a really old box drawing flies on a dock. Do you have any idea what that lobster was eating before you ate it? Commercial hamburgers are called fast food for a reason.... leave it on a table and it can crawl away on its own.

About the only safe stuff out there is a good ripe cheese, because it is so encrusted with fungus that nothing else can grow on it. So yes, MRSA is worth paying attention to, but its got a LOT of company.

[Guest alsfirefighter]

CKroll you are right on target with me and what I wanted to say...smart minds think alike!

MRSA is everywhere already gang. It becomes a problem when your immune system is weak, lack of hygiene etc.

BSI covers it and wash you hands and do so properly. I have seen a few of you on here who do not, or even forget or skip it. YUCK! Wash your hands...find a gingle that is about a minute long and sing it, make sure you get all of your hands, I got good at it when I worked in the OR and learned to scrub. You'd be shocked how much of your hands actually gets missed, particularly your thumbs and fingertips.

Also...the dirtiest thing you can touch...is what you did to post your message. Keyboards and mouses were rated to be the most germ ridden devices in your home and office. Public bathroom cultures had less bacteria. And yes...MRSA is pretty much everywhere...so I hope you lunch tasted good after surfing the web. Think about it...at work...the phone, steering wheel...if you share a stethoscope on the ambulance...how often do you clean those? Although it should be after every patient. That was also found to be a huge bacteria spreader amongst doctors in hospitals. Ambulances are bacteria factories!

[Guest paramedico987]

If you've EVER been inside an ambulance, hospital, or nursing home within the last 10 years you have been exposed to it... unless of course you were wearing a level A suit.

[NJMedic 96]

Courtesy of EMSResponder.com

MRSA: Recommendations and Resources

In light of increasing national concern and media coverage over the spread of MRSA (methicillin-resistant Staphylococcus aureus), EMSResponder.com has compiled a list of online resources, the latest news coverage and the following advice for EMS personnel:

As MRSA continues to spread across the country, EMS personnel are encouraged to pay close attention to patients with open sores or wounds. Victims often include patients of health care facilities, high school athletes, rescue personnel and elementary school students.

Some health officials are calling this spread of MRSA (methicillin-resistant Staphylococcus aureus) an epidemic, but careful hygiene may contain it. The public is advised to simply wash hands frequently with soap or an alcohol-based sanitizer, keep cuts and scrapes covered with a bandage and avoid sharing towels or other items.

Health care providers should be especially diligent about wearing gloves and washing their hands after patient contact, and continue to use universal precautions, says Dr. Robert Bass, executive director of the Maryland Institute for Emergency Medical Systems (MIEMSS).

"Other than the use of gloves and masks, there's really nothing else we can suggest," he said. Bass added that particular attention should be taken if EMS personnel observe sores, boils or other injuries on their patients. Wounds should be covered.

EMS agencies may also be able to improve their procedures and compliance for disinfecting vehicles and equipment, as outlined in this month's EMS Magazine cover article, Bug Patrol.

MRSA and the Workplace: http://www.cdc.gov/niosh/topics/mrsa/

MRSA and Health Care Settings: http://www.cdc.gov/ncidod/dhqp/ar_mrsa.html

MRSA and non-hospital health care settings: http://www.cdc.gov/ncidod/dhqp/ar_multidrugFAQ.html

MRSA in the Ambulance: http://emergency-medicine.jwatch.org/cgi/c...07/608/1?q=etoc

and in one of my local newspapers today.....

"Superbug" myth gets squashed, Experts: MRSA risk real but overblown

Home News Tribune Online 11/19/07

By CLEM FIORENTINO

STAFF WRITER

Part tragedy, part hype and part hysteria, the "Saga of the Superbug" appears to be history. It's still out there and warrants our attention, but the infection known as methicillin-resistant Staphylococcus aureus (MRSA) that reared its ugly head earlier this autumn, including in several Central Jersey schools, seems to be under control.

In fact, health-care professionals insist that it was never out of control.The story of the mutating infection, long associated with health-care facilities (Healthcare-Associated MRSA) where it attacks people with reduced immune systems, earlier this autumn took on a life of its own.

This time, it told of an insidious, egregiously aggressive, nigh-invincible strain of Community-Associated MRSA — soon dubbed "The Superbug" — and parents, children, school officials and journalists were told to quake in its wake.

But how and why did the story get so dramatic?

"Most of us in the field are still scratching our heads about that," said Dr. Melvin Weinstein, chief of the division of infectious diseases at Robert Wood Johnson University Hospital in New Brunswick. "This has been a problem that we have been dealing with for years. But this year, the cases were given more publicity."

It all started with a featured article in the Journal of the American Medical Association, based on data from the Centers of Disease Control data for 2005 that estimated the total number of cases from Community-Associated MRSA in the United States.

Soon thereafter two schoolchildren — from Virginia and Brooklyn, N.Y. — died.

"It got very badly out of hand," said Kathy Horn, director of Infection-Control Services at Hunterdon Medical Center in Raritan Township. "It was the way the press presented it. First, there was the journal article, and then there was a child who died."

A perception takes hold

Then came the perception that we were dealing with an all-powerful invasive strain of the bacteria that could not be controlled with any regimen of antibiotics or, as reported on last Sunday's "60 Minutes' on CBS, that the bacteria had mutated to the point where one — and only one — antibiotic had any effect whatsoever.

"That's not true at all," Weinstein said. "There are at least two and often four oral antibiotics that will be effective, and there are several antibiotics that could be given intravenously. Patients who became seriously ill were in the minority and were relatively easily treated."

Dr. Robert W. Tolan Jr., chief of the division of Allergy, Immunology and Infectious Diseases at The Children's Hospital at Saint Peter's University Hospital in New Brunswick, agreed.

"For years I've been seeing patients with MRSA," he said. "Typically, it is breaks in the skin that give the infection a toehold. When it gets into a family, we don't know if it will bounce around the house or if it's a one-time deal."

He, too, reassures everyone that there are plenty of options.

"There are lots of choices for treatment," he said. "What it requires and what ER docs have come to understand is that you need to treat these patients differently than had been the case in the past," Weinstein said. "Sometimes, if you simply do an incision and drainage, and you use topical cleansing agents, patients do just as well without antibiotic."

Hand-washing is most important, Horn added.

"Use normal good hygiene," she said. "Don't share towels. Clean pieces of equipment that people get sweaty and perhaps get cuts from. Shower before going into pools and whirlpools. Wash your hands, because it is spread by touching. And be sure to keep open wounds clean and dry."

"Smart little suckers'

Conventional hygiene is, in most cases, enough to prevent these infections, Weinstein said.

"I would not encourage the general public to be washing themselves down with antibacterial soaps three or four times a week." Weinstein warned. "We're all colonized by bacteria, all over our skin. They're smart little suckers. In a matter of a few years, the bugs become resistant" to the soap.

School officials throughout the area are still on guard, but many are breathing a sigh of relief.

"I haven't heard of any new cases. It was a one-time-only," said Eva Nagy, president of the board of education in Franklin, where one case was reported. "We live in a tense society. This virus is not uncommon, but the fact that it has happened in some of the schools means everyone is paying attention."

Contracted outside school

In Piscataway, administrators believe that the two reported cases in their school district were contracted outside of school. District officials sent a notice home to parents to educate them about staph infections and preventative guidelines.

And in Westfield, the Board of Education on Tuesday will review a summary of the district's health curriculum, including steps the district has taken to inform students and parents about recent concerns regarding MRSA.

Statewide, too, officials are downplaying the incidents.

"Lots of reports were staph infections, but not MRSA," said Tom Slater, a spokesman for the state Department of Health. "To qualify as an outbreak, two or more cases must be reported in one facility (where people don't live together) over a two-week period."

That will trigger an investigation, Slater said, "but not every investigation results in an outbreak."

[WAS967 97]

Enjoy the Wisdom of George Carlin:

I think, to be fair, the planet sees us as a mild threat. Something to be dealt with. And the planet can defend itself in an organized, collective way, the way a beehive or an ant colony can. A collective defense mechanism. The planet will think of something. What would you do if you were the planet? How would you defend yourself against this troublesome, pesky species? Let's see... Viruses. Viruses might be good. They seem vulnerable to viruses. And, uh...viruses are tricky, always mutating and forming new strains whenever a vaccine is developed. Perhaps, this first virus could be one that compromises the immune system of these creatures. Perhaps a human immunodeficiency virus, making them vulnerable to all sorts of other diseases and infections that might come along. And maybe it could be spread sexually, making them a little reluctant to engage in the act of reproduction.

[Guest]

Staphylococcus aureus (staph) is the bug behind all of these infections. The media has picked MRSA as the bug of the month but there are different strains resistant to different antibiotics. PRSA is a Staphylococcus aureus strain resistant to penicillin. The letter in front of the RSA describes the antibiotic it is resistant to.

Staph is carried around by about 30% of the population and your precautions should be your normal BBP PPE. Handwashing is by far the best way of preventing its spread and keeping yourself from becoming infected through an open wound.

[ckroll 101]

Staphylococcus aureus (staph) is the bug behind all of these infections. The media has picked MRSA as the bug of the month but there are different strains resistant to different antibiotics. PRSA is a Staphylococcus aureus strain resistant to penicillin. The letter in front of the RSA describes the antibiotic it is resistant to.

One of the most wide spread and least understood is the OSHA. It can be found in every firehouse and ambulance corps in the country and there appears to be no way to get rid of it. When there is an outbreak, cover the infected area with paperwork and then wash your hands.

[DOC22 1]

One of the most wide spread and least understood is the OSHA. It can be found in every firehouse and ambulance corps in the country and there appears to be no way to get rid of it. When there is an outbreak, cover the infected area with paperwork and then wash your hands.

HAHA!!!!! Very good, ckroll!!! I like it!!!

[mfkap 0]

Staphylococcus aureus (staph) is the bug behind all of these infections. The media has picked MRSA as the bug of the month but there are different strains resistant to different antibiotics. PRSA is a Staphylococcus aureus strain resistant to penicillin. The letter in front of the RSA describes the antibiotic it is resistant to.

Staph is carried around by about 30% of the population and your precautions should be your normal BBP PPE. Handwashing is by far the best way of preventing its spread and keeping yourself from becoming infected through an open wound.

Just because someone that is healthy does not become very sick from MRSA does not mean it is not a problem. The already sick patients are at the greatest risk for MRSA infection. We transport a lot of patients that are immunocompromised, and MRSA is a greater risk to them. When you don't decon the ambulance after the first MRSA patient, the second patient who didn't have it could die from it. An infected skin wound with MRSA isn't terrible, but a line infection with it is.

In the hospital setting, it is a big deal. Usually in hospitals all staff have to wear a gown + gloves + handwashing (contact isolation) when interacting with these patients, who are usually isolated in a single room. It isn't only for the staff, but when you go from room to room, the bugs can catch a ride on your scrubs. Because it is partially resistant, you have to use stronger antibiotics, which can have a lot of side effects, such as C. diff infection, red man syndrome (from vanco), etc. There are other resistant organisms out there as well, such as VRSA and VRE.

By downplaying MRSA as just something that you can fix with golves, it is a disservice to all. It is much better for you and your patients to decon + use correct PPE than to assume you won't get sick, so it doesn't matter. There is a reason that MRSA is all over nursing homes these days. There is a reason people die from MRSA sepsis or complications from its treatment. And it isn't because everyone is doing the right thing.

[Bunkers 0]

About a month ago, my room mate was playing in a rugby match on the turf field at school. he was tackled, got turf burn and a week later, his knee was the size of a volleyball. A few kids at my school have gotten it and everyone has been fine. Just as a precaution, they made me move from my room to entirely different floor and they also called in a company to "decon" my old floor. As Als told me, just wash your hands- a lot..

[ckroll 101]

By downplaying MRSA as just something that you can fix with golves, it is a disservice to all. It is much better for you and your patients to decon + use correct PPE than to assume you won't get sick, so it doesn't matter. There is a reason that MRSA is all over nursing homes these days. There is a reason people die from MRSA sepsis or complications from its treatment. And it isn't because everyone is doing the right thing.

Fair enough. I hope the effort was intended to downplay hysteria, not hygiene. No one here has suggested abandoning good BSI practices. Patients do not come with their exposure risks stamped on their foreheads. Any patient can have anything and we should be taking adequate precautions all the time, not just when the aide tells you that this particular patient carries a pathogen.

I do think you can fix the largest and most critical part of the problem with gloves. Use them, change them properly and frequently. Any time a patient is handled, gloves need to be changed before touching anything else. ...cots steering wheels, doors, BP cuffs, opening equipment; it's an endless list. A problem inherent in multiple back-ups is the sense of security if one level fails, that another level will pick it up. That leads people not to treat each level seriously. Half hearted gloving, half hearted suiting up, and half hearted decon, which I see happen a lot, doesn't stop transmission either. If we put enthusiasm into enclosing the patient, and glove technique, then maybe wouldn't be spraying pathogens all over the rigs.

In practice, EMS is under huge time and financial constraints. Full body PPE and thorough decon on every call where there is potential pathogen exposure, while a great idea, is asking more than the system can tolerate. Putting priority on initial contact conditions will, I think, give us and our follow on patients the greatest level of protection and be best use of resources.

It is important to recognize that protection from pathogens is probably more important to our patients than it is for those of us who are healthy. If we are gloving once and touching surfaces with the intent to keep ourselves clean, then we are doing a disservice. If we glove and re-glove as necessary to limit spread, then we serve ourselves and our patients.

[PVFD233 68]

How many Responders have come in contact with possible MRSA patients

Unfor. a couple. Its kind of hard not to anymore. Another thing is this has been around for a loooong time. Now everyone is making a big deal about it?