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Friday, December 19, 2014

Question

I work at a 1500 bed correctional institution. The health care department is all worried about MRSA. They came in with bleach and "Comet". I believe that our Quat cleaner is enough. Please let me know the best way to deal with MRSA in an institutional situation.


Answer

A quat or bleach, used daily on commonly touched surfaces, will aid in the prevention of cross contamination. Abrasive cleansers can damage surfaces, making their cleaning and disinfection more difficult. I would avoid their use.
Again, we should stress that simple hand washing and proper personal hygiene are the best defenses against any infectious agent, including MRSA.
In a correction facility, which affords opportunity for lots of personal contact in crowded areas, you surely have a valid concern about MRSA, but to use an old expression, “Let’s not panic!” Staph is very common in the healthy community. It has been around for a long, long time and is carried by many people (25 -30% of the population have it in their nostrils with only 1% of these having MRSA). Attempting to wipe it out totally or even reduce the over all amount in the general population will be as successful as attempting to remove every fallen leaf from the Idaho forests every fall. An impossible task and highly unnecessary to boot!
Take 5 minutes and listen to the CDC podcast at: http://www2a.cdc.gov/podcasts/player.asp?f=6936 where you will have it confirmed that,
1) MRSA is treatable with several antibiotics. Methicillin-resistant does not mean all-antibiotic resistant.
2) The greatest danger outside of the hospital setting is in acquiring a skin infection, not a bloodstream or internal organ problem. Outside of healthcare, the staph is labeled CA for community-associated MRSA.
3) The common skin infections (pimples or boils) of CA-MRSA can be treated successfully even without antibiotics.
4) Transmission is by skin-to-skin contact with one who is infected. Uncovered cuts and skin abrasions are risky, as are homosexual practices and poor hygiene. Touching infected items such as gym equipment, shared toweling, or razors can lead to cross-infection. Keep them clean and disinfected with properly concentrated bleach or quat solutions.
5) Avoiding the risky things listed in 4) will aid in prevention of the spread of MRSA and staph infections in general.
For reference, you may wish to wade thru the CDC document, at:
http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Disinfection_Nov_2008.pdf This will give you some research-based guidance about what to use for disinfection. It contains such gems as: “After reviewing environmental fate and ecologic data, EPA has determined the currently registered uses of hypochlorites will not result in unreasonable adverse effects to the environment., and “One study showed a significant decline (~40%–50% lower at 1 hour) in the concentration of quaternaries released when cotton rags or cellulose-based wipers were used in the open-bucket system, compared with the nonwoven spunlace wipers in the closed-bucket system. , and “Quaternary ammonium compounds…effectively (>95%) remove and/or inactivate contaminants (i.e., multidrug-resistant S. aureus, vancomycin-resistant Entercoccus, P. aeruginosa) from computer keyboards with a 5-second application time. No functional damage or cosmetic changes occurred to the computer keyboards after 300 applications of the disinfectants. , and “Surfaces are considered noncritical items because they contact intact skin. Use of noncritical items or contact with noncritical surfaces carries little risk of causing an infection in patients or staff. Thus, the routine use of germicidal chemicals to disinfect hospital floors and other noncritical items is controversial.
It stands to reason that if the greatest danger of infection is from skin-to-skin contact, then all the people in your charge must be wiped down each day with a bleach solution and an abrasive cleanser to do any good. Better to apply the CDC recommendations and treat any infections promptly and properly while encouraging good hygiene and careful cleaning of shared equipment.
Lynn E. Krafft, ICAN/ATEX Associate Editor
lekrafft@juno.com