Healthcare-Acquired Antibiotic-Resistant Staph Infection (HA-MRSA)

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KEY POINTS

• Methicillin-resistant staphylococcus, or MRSA, is a type of staph infection that is hard to treat with most antibiotics. The infection sometimes occurs after you have received some type of healthcare.
• Treatment depends on your symptoms. You may need to be in the hospital to get IV fluids and antibiotic medicine to treat the infection.
• Ask your healthcare provider how long it will take to recover, when you can return to your normal activities, and how to take care of yourself at home.

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What is antibiotic-resistant staph infection?

Staphylococcus aureus, also called “staph,” is a common cause of skin infections. Most of the skin infections are minor, such as pimples and boils, and heal on their own without antibiotics. However, sometimes the bacteria infect the blood, urinary tract, lungs, or surgical wounds and cause very serious illness. The widespread use of antibiotics has caused some of these bacteria to change and become resistant to antibiotics. Methicillin-resistant staphylococcus, or MRSA, is a type of staph that is very hard to treat with most antibiotics.

Serious MRSA infections are often healthcare-acquired, which means that you get infected after:

• At least 72 hours in the hospital or after recent or frequent stays at the hospital
• Treatment in a dialysis center
• Staying in a nursing home
• Use of medical equipment such as an IV catheter

You may be at higher risk for an MRSA infection if you had surgery or you have a condition such as cancer or diabetes that lowers your ability to fight infections.

MRSA infections that are acquired in the community and not in a healthcare setting are less likely to cause serious blood infections.

What is the cause?

MRSA may spread in a healthcare setting from:

• The hands of healthcare workers
• Contact with things that have staph on them, such as bedrails, bed linens, and medical equipment
• Contact with visitors who carry staph on their body, even if they don't have an infection

Taking antibiotics when you don’t need them can cause problems for you and others. Bacteria can change and become resistant to antibiotics. This means that some types of antibiotics may no longer be able to kill the bacteria. This can make it hard to treat serious infections.

What are the symptoms?

When staph infects the skin, it may look like a pimple or boil. The skin may be red, swollen, or painful. You may have pus or other drainage. The infection may look like a rash, with redness and oozing or crusting.

When the infection gets inside the body, especially if it gets into the bloodstream, the symptoms can be more serious. Symptoms may include:

• High fever or chills
• Pain
• Trouble breathing
• Confusion
• Very low blood pressure
• Loss of consciousness

If MRSA is not treated or cannot be treated because the bacteria are resistant to all antibiotics, it can cause death.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Tests to look for the bacteria causing infection may include:

• Blood tests
• Tests of fluid from a wound
• Tests of sample of sputum (fluid coughed up from the lungs)
• Urine tests
• Checking medical equipment, such as vein catheters (IVs) for infection

If bacteria are found, they are tested to see what antibiotics can kill them.

How is it treated?

Treatment depends on your symptoms. If you are very ill, you need to be in the hospital. Treatment will include IV fluids and antibiotic medicine to treat the infection. You may also need to take antibiotics when you go home from the hospital.

While you are hospitalized with MRSA:

• You may stay in a private room or share a room with another patient who has MRSA.
• All healthcare providers, hospital workers, and visitors will use an alcohol-based hand cleaner and wear gloves and gowns to protect their clothing when they are in your room.
• You may be required to stay in your room.
• If you are allowed to leave your room, you may be asked to stay out of common areas, such as gift shops, cafeterias, and restrooms.

How can I take care of myself at home?

Follow the full course of treatment prescribed by your healthcare provider. In addition:

• If you are taking an antibiotic, take the medicine for as long as your healthcare provider prescribes, even if you feel better. If you stop taking the medicine too soon, you may not kill all of the bacteria and you may get sick again. Not finishing your antibiotic may cause more resistant bacteria to develop. Do not share antibiotic medicines with other people or save them for another time.
• Wash your hands well with soap and water after caring for any wounds, even when you have used gloves.
• Put gloves, tissues, or other waste items soiled with blood or other body fluids in a separate bag from your regular trash. The bag should be sealed and leak-proof. For example, use 2 bags, putting one inside the other. Follow your local health department's instructions for disposing of waste products.
• Wash all linens or clothing soiled with blood or other body fluids separately from other laundry. Use detergent and germicide. Follow your local health department's instructions for safe washing and disposal of the water.
• Bleach baths have been shown to help in treatment. Talk to your provider about how much bleach to use in the bath water. Be careful so that you do not splash water containing bleach onto your face or in your eyes. If you are doing soaks, for example in the bathtub, the tub should be cleaned right after your soak.

Ask your provider:

• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent HA-MRSA?

You or your family members should speak up about any concerns about your care when you are in the hospital. You may need to remind the hospital staff to wash their hands, clean their stethoscope, and not use anything that has fallen on the floor. Let your providers know that you are aware of the risks of MRSA and you want to work with them to avoid getting infected while you are in the hospital. You can also remind visitors to help you prevent infection.

Here are some other general guidelines for preventing MRSA infections:

• Do not overuse antibiotics. Take them only when needed and take them exactly as instructed. Don’t share antibiotics with other people, and don’t save them for another time. If you are having problems with an antibiotic, tell your healthcare provider and ask what your options are.
• Wash your hands often and especially after using the restroom, coughing, sneezing, or blowing your nose. Also wash your hands before eating or touching your mouth, nose, or eyes.
• Don’t visit people at the hospital if you have a rash, any infection, or an open wound.

You can get more information from:

• Centers for Disease Control (CDC)
  http://www.cdc.gov/mrsa/