EMS Corner

Staph infections threaten work

Volume 23. No 4
By BILL KERNEY/College of Southern Nevada

We all worry about contracting many of the infectious diseases that are present in the workplace. We are cognizant of the risk that these infections pose and try to protect ourselves with appropriate Universal Precautions (PPE) and cleanliness of the work environment. We are aware of the risks of HIV (blood to blood and semen to blood), Hepatitis ‘B’ (secretions, blood to blood and surfaces, very virulent), Hepatitis ‘C’ (blood to blood) and other infectious diseases that may present (including TB, airborne) in treating patients.

You have been preached to about infection control, including by me in my column here at IFW (see IFW, EMS Corner, Jan./Feb. 2008 © Industrial Fire World). Now we are seeing a new menace in this arena, MRSA. While MRSA (pronounced ‘MER-sa’) or ‘staph’ infections are really NOT a new threat, a great deal of attention is being paid to this one as it has recently claimed some lives and the infection case numbers grow. MRSA, or methicillin-resistant Staphylococcus aureus is the latest member of an ever-growing list of infectious disease. MRSA is transmitted most frequently by skin-to-skin contact, contact with shared items and contact with surfaces that have come into contact with someone else’s infection.

The issues with MRSA appear to hold real significance for pre-hospital providers as two-thirds of the infections are ‘out-of-hospital’ manifestations. Yes, this of course means that one-third do occur in-hospital and shows what a problem this is for institutions! Endemic infections kill thousands every year who go in for, sometimes routine, hospital procedures.¹ The biggest problem associated with MRSA is that the infection is resistant to many of the antibiotics used to treat regular staph infections. The presence of “Staph” involves two mechanisms; one called ‘colonization’ where the bacteria is present in or on the body but does not cause illness, and two, ‘infection’ where the bacteria is present and causing illness.

There are several risk factors for both colonization and infection:

• severity of illness
• previous exposure to antimicrobial agents
• underlying diseases or conditions, particularly:
• chronic renal disease
• insulin-dependent diabetes mellitus
• peripheral vascular disease
• dermatitis or skin lesions
• invasive procedures, such as:
• dialysis
• presence of invasive devices
• urinary catheterization
• repeated contact with the health care system
• previous colonization of a multidrug-resistant organism
• advanced age²

As you can see, many of these patients are exactly the types of calls and situations that are responded to in the pre-hospital arena. Thusly, this is an issue that we MUST pay attention to, recognize the infected patient when presented, and take all possible precautions necessary to prevent our exposure.

Six months ago, a 33 year-old Garland, TX, firefighter died after contracting MRSA. Over a period of 10 days and multiple doctor visits, he was finally was admitted to the hospital, but it was too late and he expired two days later. He was dead within two weeks of becoming symptomatic. His untimely death was so sudden that family members did not know what to do or how to deal with it. It was a tragic end to a firefighter’s career.

What special precautions do we need to take to protect ourselves (and in reality, our patients as well — remember, they are already sick!) from the scourge of MRSA? Ok, maybe scourge is a little dramatic, but the reality is that you should already be doing the necessary disinfectant procedures to protect yourself and crewmates from MRSA. There really is nothing to add to the currently practiced (and if you are NOT doing these, here is one more good reason to get with it!) infection control procedures. So to reiterate:

• Keep your hands clean by washing thoroughly with soap and water or using an alcohol-based hand sanitizer. Use at least WARM water (yes, you may have to wait till it warms up, but do it!) and scrub thoroughly after all patient contacts. Do this frequently and make sure you use hand protecting lotion copiously as well.
• Use soap dispensers and disposable towel dispensers that are “hands-free” operations. (A case study from the University of Arizona shows that manual dispensers with a seal or a refillable solution application spread bacteria and fecal matter.) Also, do not forget to open the door with the paper towel so as not to touch the handle and re-contaminate.
• Keep cuts and scrapes clean and covered with a bandage until healed.
• Avoid contact with other people’s wounds or bandages.
• Avoid sharing personal items such as uniforms and personal protective equipment.
• Sanitize (thoroughly) all surface areas with a minimum of a 1-10 solution of sodium-hypochlorite solution (household bleach cut with water) or a good, commercially available surface disinfectant appropriate to the task.
• Lastly, “if it’s wet and it’s not yours, don’t touch it!”

The issues of infection control and prevention are not going away, and carelessness on the job is foolish in the least and dangerous in the worst. Do everything you are supposed to do regarding cleaning and disinfecting the rig (and your personal workspace for your office personnel, keyboards, phones, etc.) and equipment and you will minimize your chances for exposure.

1. Journal of the American Medical Association 2007;298(15):1763-1771.
2. www.cdc.gov/ncidod/dhqp/ar_multidrugFAQ.html

William R. Kerney, MA, EMTP-A, is a professor of emergency medicine at the College of Southern Nevada. E-mail your comments to bill.kerney@csn.edu.