This Too Shall Pass: Healthcare

Methicillin-Resistant-Staphylococcus Aureus

MRSA cluser - image from website: www.cdc.gov

Methicillin-resistant-Staphylococcus aureus also know as MRSA is Satan's gift to modern medicine and our "reward" for the overuse and misuse of antibiotics in the 70's and 80's!!!!! This is not the whole truth but as the mother of a child who has fought these blasted things for many years it is my truth!!!

If you are not familiar with MRSA count your lucky stars!!! I will provide what limited knowledge I have on the topic in this post. MRSA is Methicillin-resistant-Staphylococcus aureus. This means that this bacterium is resistant to Methicillin based antibiotics. MRSA is also called the 'Superbug'. As a result of the over use of antibiotics this bacteria has evolved and developed an immunity to standard antibiotics. Humans have staph bacteria on our bodies naturally. It is part of the natural flora of our skin. When a person has repeated exposures to MRSA or has repeated infections they can become colonized by the methicillin resistant staph. In essence the bad staph moves in and takes over the place of the normal staph. You can be tested to see if you have become colonized with MRSA by having your doctor perform a nasal MRSA swab test.

At one time MRSA was predominately hospital acquired. This means that if a person developed a MRSA infection it was typically via exposure to the bacteria in a hospital setting when the individual's immune system was low and they had suture sites, openings in the skin or injuries which allowed the bacteria an access point into the body. Now MRSA is becoming not only hospital acquired but publicly acquired. This means that it is more prevalent in the general population and in public ares than in previous years. Please understand that MRSA has been around for a very long time but the occurrence of it has been increasing for decades. I have been recently informed that publicly acquired MRSA has been linked to Osteomyelitis. From the Mayo clinic website: http://www.mayoclinic.com/health/osteomyelitis/DS00759 Osteomyelitis is defined as “the medical term for an infection in a bone. Infections can reach a bone by traveling through the bloodstream or spreading from nearby tissue. Osteomyelitis can also begin in the bone itself if an injury exposes the bone to germs.”

This is what a MRSA infection looks like in the early stages:

MRSA infections have very distinctive characteristics:

Extremely rapid onset.
Red circular appearance with a dark raised center. It looks very similar to a spider bite.
Localized swelling
There will be a hard central circular inner core.
If there is drainage it will have a greenish/brown color.
Extremely painful.
It may feel hot to the touch. (Please use gloves!!)
General symptoms:

I have noticed with my son that he will start to feel weak and agitated. He will not sleep well and simply feel sick. He will have no other symptoms before the spot appears and I am often trying to figure out what may be wrong so I start paying very close attention to his skin. I am always on guard and watching for these things so we have been fortunate and have caught them early so far. There has been a couple of the times they have started developing for a few hours to a day before I caught them. When I said they have rapid onset.... I am referring to hours not days!

I have researched this topic for many years now. Although I am not an expert I have dealt with several infections my son has had. During my research and experiences I have found many many articles on the internet that recommend this or recommend that. I have tried many but I have found no 'cure-all'. We can get him to a point where he is infection free for approximately six months but it seems that six months is the limit. I was once told that if one can keep it from recurring for six months then it may be possible to eradicate it from the body. The reasoning for this is that the MRSA staph will die off and be replaced by the naturally occurring staph. I haven't seen it happen yet. However, I do believe we have suppressed the outbreaks to an extent.

The following are instructions that are based upon recommendations from the infectious disease doctors with Children's Medical Center in Dallas for treatment of active infections:

First and foremost:

Go see your doctor or go to the emergency room now!!
Please do not delay as early treatment is key to recovery. These infections are extremely fast moving and can become life threatening in a very minimal amount of time! Remember they can and will be fatal if not treated quickly and appropriately. You should not attempt to treat this on your own. Get the advice of your doctor!!

Start oral antibiotics ASAP. If your infection is severe they may suggest IV antibiotics... If they do offer DO IT!! Through IV the antibiotic will get into your system much faster and will begin battling the MRSA quicker than oral antibiotics.
If you suspect your infection may be MRSA insist that your healthcare provider perform a swab culture on the fluid inside the wound to determine if it is MRSA or not. The culture will tell the doctors exactly what you are dealing with and which antibiotics will have the most impact. Please remember that it is crucial you insist upon a culture! There are still antibiotics that will work although the choices are limited. After receiving the results of the culture your doctor will know which antibiotics to use to treat the MRSA strain you have. They will start treating you with a general antibiotic known to be effective for treating MRSA but if the culture indicates the need for a more specific or a different antibiotic they will contact you and change your treatment plan.
Always perform good hand hygiene. Wash your hands with warm water and a disinfectant soap after treating the patient. I use Hibiclens® when he has an infection. If your child uses diapers use gloves when you change the diaper. The MRSA staph will be in the urine too! Once there is an infection it can travel throughout the body and will be in the body fluids.
Bathe the patient three times a day with antibacterial soap. Soak the wound in the warm water. This will help it to drain. Again, I use Hibiclens.® I have heard that you can also use bleach in the bathwater but I have never done so. I feel that adding bleach to the water when there is a break in the skin is not a good idea. That is just my opinion and preference.
After each bath use gloves to encourage the pus to come out by gently but firming pushing from the sides towards the center. The goal is to remove the core and keep the wound draining. You want to get as much of the junk inside the spot to come out. As Alan's doctor has said … “it either comes out or goes futher in” you do NOT want it to go further in and spread throughout the tissues under the surface!!! To be graphic and kinda gross I will describe it this way.... you want to try and pop it like it is a big zit. Sorry... gross I know but it is the truth! I can't stress this enough... you as a caregiver MUST WEAR GLOVES !!!! while treating your child or anyone who has one of these infections to lessen the possibility of contracting MRSA yourself!!!

Please realize this step is extremely painful for the patient but it must be done. What I have begun doing is when I start squeezing I have someone slowly count to ten. At ten I stop and let him recover. Depending on how the wound looks and how much stuff is coming out I may repeat that step. Again … have someone count to ten so your patient knows there is a momentary end coming. If the wound appears to be getting worse but isn't draining go to the emergency room immediately as they will need to lance it so it will drain. Keep this in mind … “it either comes out or it goes further in”. You do not want this stuff going deeper into the tissues.

After squeezing the wound you will need to apply a topical antibiotic. Be sure to ask your doctor for a prescription for Bactroban® ointment or an equivalent. Apply liberally over the wound. Loosely apply a clean dry bandage. I usually place a non-stick bandage on the wound and then apply a gauze bandage over the top. I secure it in place with paper tape. I have used the silk tape but because of how many times you have to remove and replace the bandage and the tape it tends to irritate the skin. Paper tape works best for him. Learn from my experience: when paper tape gets wet it is extremely hard to remove from the skin. Be sure to remove the bandages and tape before bathing. Always use a clean bandage! You want to be sure to cover the wound with a loose bandage. You want it to drain but you don't want the clothing or anything else to come into contact with the fluid draining from the wound. Also, anything rubbing on the wound such as clothing with actually be very painful. Since the bandage is there to catch the drainage and protect the wound it does not need to be a pressure bandage so applying it loosely is fine.
Please consider giving ibuprofen or acetaminophen per directions for pain while there is an active infection. This isn't a requirement but I do it because of how extremely painful these infections are for my son.
Clean anything in your household that can be cleaned with bleach. I clean the bathtub with bleach after each bath to try and sanitize the tub so that whoever takes a bath next isn't stepping into MRSA soup! Clean your counters with bleach. I wash his clothing and his bedding and in hot water with bleach added. I clean door knobs, light switches (carefully), his wheelchair, his car-seat... anything I can I disinfectant. If it can't be washed or soaked in bleach then I spray it with Lysol® disinfectant spray. I can't quantify the effectiveness of these actions but I feel I am fighting back on some small level.
Be sure to follow your doctors instructions exactly and return to see him/her if your symptoms are worsening or just not getting better. I suggest going back to see your doctor within three to four days of starting the antibiotics. You want to be sure your doctor knows exactly how you are responding to the treatments.
ALWAYS TAKE ALL OF THE ANTIBIOTICS EVEN IF YOU SEE A MARKED IMPROVEMENT!!!! ALWAYS ALWAYS FINISH THE TREATMENTS. This is in part how MRSA has become so virulent. Patients would take their antibiotics until they felt better or their symptoms were gone and then stop. Just because you seem better does not mean the bacteria has been killed. It is still in your system and if you stop the antibiotics before the time instructed and before the bacteria has been killed then you will actually be helping it to develop a resistance to the antibiotic you were using. If the MRSA becomes resistant to our final defenses as a result of the misuse of the antibiotics.... Heaven help us all!!

Those were my suggestions for an active infection. Now for the routine care and prevention when there is no infection.

After an infection bathe daily using the Hibiclens® soap.
After each bath take a cotton swab and place a small amount of Bactron® on the tip and insert into the nostril. Don't go deep into the nostril. You want to get just inside the nose and swirl the tip of the swab so that the antibiotic ointment is applied all around the inside of each nostril. Be sure to use the tip in only one nostril. After you apply it in one nostril rotate the swab and use the other end in the other nostril. MRSA lives in the nostril so you are trying to get it where it lives and kill it.
Once you have treated the nose then apply the ointment underneath the tips of the fingernails.

After the first week this treatment can be performed once a week for a month. After the first month perform the intense daily treatments of the antibiotic soap and the antibiotic in the nose and under the nails once a week for one week of the month. Do this indefinitely. During the weeks that you are not performing the intense treatments I suggest using Safeguard® soap . Be sure to change bedding at least once a week and add bleach to the wash. If you have a cut or broken skin apply the antibiotic to the site until it has healed.

Be ever vigilant and watch for any sign of the beginnings of a MRSA infection. Remember that early treatment is the key to recovery!!!

And one final thought ...

THE BATTLE IS ON AND IT IS US AGAINST THEM!!!

For more information on MRSA try the links below:

Center for Disease Control and Prevention - http://www.cdc.gov/mrsa/
WebMD - http://www.webmd.com/search/search_results/default.aspx?query=MRSA
PubMed Health - http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004520/
Mayo Clinic - http://www.mayoclinic.com/health/mrsa/DS00735
Medicine Net - http://www.medicinenet.com/mrsa_infection/article.htm
Texas Department of Health - http://www.dshs.state.tx.us/idcu/health/antibiotic_resistance/mrsa/
Medicine News Today - http://www.medicalnewstoday.com/articles/10634.php
The New England Journal of Medicine - https://cdf.nejm.org/register/reg_onestep.aspx?promo=ONFKG61B&prc=ONFKG61B&cpc=FMDAALLP0612A&query=PPC
The American Journal of Medicine - http://www.sciencedirect.com/science?_ob=ArticleListURL&_method=list&_ArticleListID=2103997179&_sort=r&_st=13&view=c&_acct=C000062335&_version=1&_urlVersion=0&_userid=4143358&md5=25456579d1f953962e4b81d59bb0fc8a&searchtype=a

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