22/09/2017
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MRSA

MRSA

Staphylococcus aureus, or S. aureus, is a common human bacterium that is probably living on your skin right now. A break in your skin can lead to a type of infection called a staph infection. Common staph infections result in boils (abscesses), often on the buttocks or legs, or styes on the eyelids. Staph infections can be deadly when they occur in the lungs, bloodstream or at a surgical wound site.

Sailors, Swimmers and other ocean recreationalists are subject to staph infections, particularly if wounds are not promptly and properly treated. Staph infections are becoming more common, particularly amongst deck crew who are handling ground lines. It appears to be more common in the waters of Eastern Europe.

A new, more resistant S. aureus strain has recently emerged, called Methicillin Resistant Staphylococcus aureus, or MRSA. Unlike the more treatable S. aureus, MRSA is resistant to many of the more common antibiotics, and is more successfully treated with only specialized antibiotics that are potentially toxic. In addition, MRSA can be more invasive, which means that it is more painful, destroys tissues faster and is more likely to cause large abscesses. Severe infection may require surgery including amputations. Fatalities have occurred.

MRSA began infecting patients in hospitals decades ago, and the number of hospital-acquired MRSA infections has steadily grown with time. MRSA infections have also become problematic in facilities such as nursing homes, sports team locker rooms and similar facilities. This variety of MRSA is known as Community Associated MRSA or CA-MRSA. The rise in MRSA cases may have been made worse by physicians who over-prescribe and patients who demand antibiotics when they are not indicated.

Although it’s not clear if sailors are getting staph (including MRSA) infections from exposure to contaminated water (also seehere and here) or whether open wounds from yachting simply allow staph acquired elsewhere to have an entry point into the body, these infections are a serious concern. The commonality of these infections to sailors and other ocean users is becoming alarming. MRSA has been cultured from the near shore waters and has been reported in storm and sewer waters as well. Thus the risk to sailors is storm water-related, like the other disease risks from yachting and handljng lines in brown waters.

Studies are also beginning to indicate that wet beach sand harbors many potential pathogens and staph may also reside there.

A new development in the past several years has been the rise is a certain potentially serious staph. MRSA, for methicillin-resistant Staphylococcus aureus, is on the rise in the community, and possibly in the surf. When recognized and treated early, it’s not serious.

The problem is that it is resistant to most antibiotics, with a couple of oral (pill) exceptions (sulfa-trimethoprim and sometimes rifampin and/or clindamycin). It can require IV treatment by potentially toxic antibiotics including vancomycin and some other newer, more experimental drugs. It can spread to other organ systems and lead to septic (infectious) shock, stroke and loss of cardiac, kidney and other functions.

Perhaps some of you are familiar with the case of Timmy Turner, which was in Surfer magazine. His story and some video of him are on the Web. He was treated at Hoag. It’s still unclear, and there’s little firm data on it, but it looks like soft tissue wounds and fresh tattoos in ocean waters can be a source of entry for getting the infection.

My own thought is that some sailors have acquired it, and due to good general health either don’t have much or are carriers with no symptoms.

A word of caution to yachties– for soft tissue lesions that enlarge, become red and sore like boils, it could be MRSA. Get them checked and cultured. Play it safe and stay out of the surf if you have any sores, cuts, lesions, fresh tattoos or recent surgical incisions.

The appearance of a MRSA infection may initially resemble that of a spider bite, in that there may be evidence of tissue destruction. The best prevention is good hygiene, including washing skin on a regular basis, using clean clothing and linens, and washing all cuts and scrapes thoroughly with soap and disinfected water. Using an antiseptic ointment, such as bacitracin or Triple Antibiotic ointment on open wounds may not prevent a MRSA infection, but will certainly help prevent other Staphylococcus infections and Streptococcus (“strep”) skin infections.

More Detailed Information on Preventative Measures.

How can I prevent staph or MRSA infections?

Most skin infections can be prevented with good hygiene. Wash your hands well and often with soap and water, or use a hand sanitizer, especially after changing bandages or touching a wound. Keep cuts and scrapes clean and covered with a bandage until healed. Avoid recreational water exposure (especially sea water) until wounds are healed, as constant moisture can delay healing and increase the risk of infection. In areas with rocky or reef bottoms, a laceration should be cleaned as soon as possible with isopropyl alcohol or vinegar. This will kill the coral animals, protozoa and other critters that lodge in your skin and will reduce the chances that staph on your skin will infect the area. Keep your skin healthy, and avoid getting dry, cracked skin, especially during the winter. Healthy skin helps to keep the staph on the surface of your skin from causing an infection underneath your skin. Avoid contact with other people’s wounds .Don’t share personal items such as towels washcloths, razors, or clothing that may have had contact with an infected wound .Clean sheets, towels, and soiled clothing with hot water and laundry detergent. Drying clothing in a hot dryer, rather than air-drying, will help kill bacteria in linens and clothing. If you are an athlete, or someone who has frequent skin to skin contact with others, be extra careful with your personal hygiene. Be sure to shower well after games and practices and disinfect surfaces such as mats daily. Contact your doctor if you have a skin infection that does not improve .Oh, and you might want to consider increasing your caffeine intake.

More Details on Sanitizing/Handwashing/DecolonizationSurface sanitizing

Isopropyl alcohol and dilute Betadine (povidone iodine) solution have been proven to be effective skin surface sanitizers against MRSA. However, as the alcohol evaporates it becomes less effective and is unable to actively protect surfaces from future contamination. Constant alcohol use can also dry the skin and decrease its natural resistance. Polysan (with TEFLEX) is a disinfectant that is also effective as a surface sanitizer against MRSA.

Hand washing

At the end of August 2004, after a successful pilot scheme to tackle MRSA, the UK National Health Service announced its Clean Your Hands campaign. Wards were required to ensure that alcohol-based hand rubs were placed near all beds so that staff could hand wash more regularly. Although alcohol-based rubs are somewhat effective, a more effective strategy is to wash hands with an anti-microbial cleanser with persistent killing action, such as Polysan or Chlorhexidine(Hibiclens).

Decolonization

After the drainage of boils or other treatment for MRSA, patients can shower at home usingchlorhexidine (Hibiclens) or hexachlorophene(Phisohex) antiseptic soap from head to toe, and apply mupirocin (Bactroban) 2% ointment inside each nostril twice daily for 7 days, using a cotton-tipped swab. Doctors may also prescribe strong antibiotics such asclindamycin or levofloxacin. Household members are recommended to follow the same decolonization protocol. NOTE: posterior body openings can also be the sites of staph colonization, especially in younger people.

Conclusion

Staph infections (especially MRSA) are a potentially serious, growing problem. Sailors, Swimmers & wayer lovers can minimize their chances of developing such an infection by staying out of polluted waters, practicing good hygiene, and properly treating wounds. If you do develop a skin infection that does not improve, it’s important that you promptly contact a doctor and report the case to your county or state health department. In some locations the MRSA problem has remained somewhat of a “shadow” illness due to under-reporting. In many states, MRSA is not even considered a “reportable illness.”
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