- KEEPING THINGS CLEAN: At War Memorial Fitness Center.
A look at methicillin-resistant Staphylococcus Aureus bacteria under high magnification is enough to make you want to go wash your hands: clusters of egg-shaped yellow globs, dog-tick plump and more than a little on the gelatinous side. Ironically, the impulse to scrub up might be the first step toward controlling what could be a looming health crisis.
In its natural state, the staph bacteria is mostly harmless; one of the hundreds of microscopic “flora” that people carry around on their skin. According to the Centers for Disease Control and Prevention, staph resides happily in the nostrils of up to 30 percent of Americans. It only becomes a problem if it finds its way through the skin, where it can cause everything from pimples to weeping lesions to — in rare cases — toxic shock and death. The bacteria can be passed from person to person via the fluid expelled from lesions and sores. While it can be dangerous for those with diabetes or compromised immune systems, in otherwise healthy people, most cases of CA-MRSA — community-acquired methicillin-resistant staphylococcus Aureus — are mild, and can be treated with antibiotics.
It was the use of antibiotics that helped create CA-MRSA in the first place. Soon after the development of penicillin in the 1940s, Staphylococcus Aureus began developing immunity to the drug. In 1968, eight years after the introduction of the antibiotic methicillin, the CDC logged the first case of methicillin-resistant Staphylococcus Aureus (MRSA), a “super bug” which resisted all forms of penicillin.
The early outbreaks of MRSA were confined to hospitalized patients and health-care providers. In the last few years, however, the CDC has come to recognize CA-MRSA, a new form of the disease. Passed among those with no apparent links to hospital environments or the health care industry, CA-MRSA is mostly characterized by painful skin lesions in soft tissue, and often affects those forced in close quarters to one another: prison inmates, students, and athletes involved in contact sports.
Dr. James Phillips is medical director of the infectious diseases branch of the Arkansas Department of Health. The ADH has sent out several health alerts about MRSA in recent months. Phillips said that while the problem of antibiotic-resistant staph goes back 30 or 40 years, the community-acquired form of the disease has only become a real problem in the past decade.
Phillips said that early cases of CA-MRSA were thought to be hospital-acquired MRSA that had gotten out into the general population. Since then, however, Phillips said that community-acquired staph has been proven to be genetically different from its hospital-bred cousin. If you’re looking for a silver lining, these differences include a better success rate for treatment — including the use of more potent antibiotics and the simple incision and drainage of lesions without the use of antibiotics.
While Phillips said that comparing illness severity and fatality rates between the hospital-acquired and community-acquired staph is “not comparing apples to apples and oranges to oranges” due to the fact that most hospital patients are already ill when they contract the disease, he said that with the overuse of anti-bacterial soaps and the over-prescription of antibiotics, there is a good chance that CA-MRSA will become more resistant to treatment in coming years
Fina Bartlett is the assistant director of the War Memorial Park fitness center in Little Rock. A personal trainer who has been in the “fitness business” for 15 years, Bartlett said that MRSA has been pushed to the forefront of the industry in the past two years. Nearly every issue of the fitness trade magazines she subscribes to relates another warning about staph.
“Bicycle seats are a really big culprit,” she said. “Any kind of equipment that has a handle on it that people touch repeatedly. Bathrooms, floors where people are tracking through with wet feet.”
Bartlett said there has never been a case of staph reported at the War Memorial center. They aim to keep it that way. “Every hour on the hour, out staff goes through and wipes the equipment down,” Bartlett said. “The handles, the knobs, anything that gets touched repeatedly by the clientele.” Twice a week, the staff washes every machine thoroughly with hot water and soap. In addition, there are bottles of sanitizer and rolls of paper towels that patrons are encouraged to use before and after their workout.
Staph is a growing problem for public schools as well. In October, Westside Middle School in Jonesboro was closed for a day by a staph outbreak, with cleaning staff and officials spending a long weekend sanitizing the school. While such outbreaks like that are still rare, things as simple as hand-washing and personal hygiene are crucial in slowing the spread of MRSA, said Margo Bushmiaer, coordinator of health services for the Little Rock School District. Bushmiaer oversees the district’s 41 school nurses, and makes sure they all keep an eye out for staph. So far, Bushmiaer said, the district has seen few instances of the disease, and nothing that could be called an outbreak, though three athletes at J.A. Fair High School came down with seemingly unrelated cases of staph.
Bushmiaer said there are no collected figures on just how many student staph cases have appeared this year, but added that when she sent an e-mail out to the district’s school nurses, inquiring if they had seen any, “I got many back — one case here, one case there.”
The problem doesn’t stop at the high school door, either. Lyn Edington, nurse manager at the University of Arkansas’s Pat Walker Health Center, said that while the UA campus has so far seen only a handful of MRSA cases, it is a concern.
“Knock wood, but our campus has only seen a bit of it,” she said. “We know it’s there so we’re suspicious when anybody comes in with a skin lesion, but it’s not anything we’ve had to raise alarms over.”
Edington said that in addition to things like not regularly washing their hands, students are warned that the disease can spread through a more high tech vehicle. “Everybody, especially these kids, share cell phones,” she said. “You put it up to your face, and if you don’t have it on your skin, somebody else may… we caution our kids about cleaning their cell phones and not sharing them.”
Edington said that these days, everyone in the student health community has CA-MRSA “on their radar,” which can be a powerful weapon in hindering outbreaks.