"Superbug" — what you need to know about MRSA

By Carol M. Ostrom
Seattle Times health reporter

The head of the federal Centers for Disease Control and Prevention calls MRSA the "cockroach of bacteria." It's omnipresent, tough and adaptable.

This fall, methicillin-resistant Staphylococcus aureus suddenly went from a festering public-health issue to the top of the national news on word that it's worse than previously thought.

Many people — and many media outlets — started seeing it as a much bigger menace than a simple roach.

It became "the superbug," and the tales of its incredible power have featured people fighting for their lives after getting what they thought was a simple little "spider bite."

But what is MRSA, anyway? How afraid should you really be?

Last month, a report in the Journal of the American Medical Association estimated that in 2005, some 94,000 people were infected by the most serious form of MRSA infections, and one in five died.

Since then, public-health officials have been singing out of both sides of their mouths.

On one hand, they want to reassure people: Like many germs, MRSA is common. Many of us carry it around on our skin and in our noses, and it lives on surfaces from athletic gear to fabric. Outside the hospital, it's not hard to avoid, but if you get it, you'll likely just get a treatable skin infection.

On the other hand, the public-health gurus want to sound an alarm. They warn that MRSA is a symptom of a larger danger: the great number of germs worldwide becoming increasingly resistant to antibiotics.

"The prospect that effective antibiotics may not be available to treat seriously ill patients in the near future is real," says Dr. Jeff Duchin, communicable-diseases chief for Public Health — Seattle & King County.

So what do you really need to know and do?

Q: What is MRSA?

A: Germs, also known as bacteria, have been around forever. Staphylococcus aureus, also called "staph," was first identified in 1880 by a Scottish surgeon poking around in pus oozing from hospital patients. After antibiotics were discovered in 1928, staph was largely beaten back. But S. aureus evolved to survive the oldest type of antibiotics, called the penicillin-methicillin class. Methicillin-resistant Staphylococcus aureus (MRSA) was first identified in 1968.

Q: Why is it such a big deal all of a sudden?

A: Actually, the problem isn't new. Although most people don't get serious infections, staph has always been a "bad bug," says Duchin.

MRSA is even badder. Researchers are discovering that MRSA is surprisingly widespread and becoming tougher. It's a classic lesson in Darwinian evolution: As the weaker germs are killed by antibiotics, the strongest, most resistant ones survive and multiply, particularly when antibiotics are used improperly.

In 2000, a new strain of MRSA "took off like wildfire," according to Dr. Yuan-Po Tu, a MRSA tracker at the Everett Clinic. Before, most MRSA infections were caused by a strain mostly contracted in hospitals. This new, "community acquired" strain can be even more virulent, potentially causing severe illnesses even in healthy people.

Q: What does MRSA do?

A: Most of the time, community-acquired MRSA (sometimes shortened to CA-MRSA) causes skin and soft-tissue infections that can be treated with other readily available antibiotics. But if not properly treated, the bug can work its way into the body and is tough to get out.

The vast majority of serious, "invasive" MRSA infections and deaths occur in hospitalized patients who are suffering from other serious diseases, have lowered immunity or have recently undergone surgery.

Q: How is it spread?

A: MRSA likes to travel. Not by air, but by hand, towel, clothes, bedding and gym equipment.

Unlike the flu virus, MRSA isn't caught by breathing it in — there has to be actual skin-to-germ contact. The CDC says high-risk groups include children, athletes, military recruits, prisoners and other population groups who live in crowded or impoverished living conditions.

Q: So MRSA is inevitable?

A: No, because there are easy ways of avoiding it. Alcohol-based hand cleaner works. So does good, old-fashioned hand-washing.

And so does a bit of courage.

According to Duchin, not all health-care providers are religious about washing their hands according to guidelines. In the hospital, that means before and after seeing you. So you need to ask them: "Did you wash your hands?"

Don't be afraid of insulting them. "There are only two acceptable answers: 'Thank you for reminding me,' and 'I just did it, but thank you for asking,' " says Marcia Patrick, infection-control director for MultiCare Health System in King and Pierce counties.

Q: What else can I do?

A: Besides frequent hand-cleaning, the best defenses are avoiding skin-to-skin contact with other people's skin infections and learning how to care for wounds, Duchin says. And get a flu shot, he says, because MRSA-caused pneumonia can follow the flu.

The CDC also recommends:

• Showering immediately after exercise.

• Avoiding sharing items such as towels and razors.

• Using a barrier such as a towel or clothing between your skin and shared exercise equipment.

• Ensuring that surfaces are cleaned regularly at the public places you often go.

Any surfaces known to be contaminated by any type of staph, including MRSA, should be disinfected, but generally "extraordinary disinfection measures" or closures of schools or workplaces aren't necessary, Duchin says.

Q: Should I worry about cuts and scrapes?

A: Not any more than you already should: Keep them clean and covered. Watch for what Duchin calls the cardinal signs of infection: redness, warmth, swelling and pain, or a fever. If you have a bump or boil, surrounded by a lot of redness, don't assume it's a "spider bite." It probably isn't. Think MRSA, and make sure your doctor does, too.

Q: What about my kids?

A: "All kids are getting scratches and scrapes all the time, and the vast majority aren't getting infected" when kept clean and covered, Duchin says. "The world is full of bugs; that's why we have immune systems and vaccines."

But consider asking your day-care center, school or gym to install alcohol-gel dispensers and posters on what they are for, suggests medical writer Naida Grunden, who has written about a Pennsylvania hospital's successful efforts to reduce MRSA.

Q: If I'm going into the hospital, should I get a MRSA test?

A: There are different views on whether this simple test — a nose swab, basically — is worthwhile. Grunden says yes. "Could save your life," she says. But neither Duchin nor the CDC recommends that step because the germs are so common and it's not clear why some people get sick and others don't.

Q: OK, I'm careful. Can I quit worrying?

A: "It's important to understand the real threat posed by antibiotic-resistant bacteria, but it's not necessary to panic," says Duchin.

Even so, don't be lulled into a false sense of security, he warns, or MRSA and other germs could soon outstrip our ability to kill them.

New Technlogy to Prevent Disease Transmission in Dental Water

Genesis Dental Technologies, LLC Launches New Web Site Featuring the AquaSept(TM) Independent Water Delivery System to Prevent Disease Transmission in Dental Water

NEWS RELEASE
ELMWOOD, Wis., June 25 /PRNewswire/ -- Researchers, microbiologists, dental professionals and organizations have known for decades about potential risks and concerns of disease transmission caused by dental water containing high levels of bacteria and biofilm. As health professionals became more aware of diseases such as HIV/AIDS, tuberculosis/respiratory infections, hepatitis, bacterial endocarditis, legionnaires disease and pseudomonas-related diseases in immune-compromised patients, more CDC recommendations were issued and are now referred to as standard precautions. Still with all these precautions and the ability to measure the bacterial levels, lethal drug-resistant strains continue to spread around the country and are frequently reported in national news. A few months ago a hepatitis B transmission between two patients in one dental office was reported (The Journal of Infectious Diseases 2007; 195:1311- 1314). The route of transmission is still under investigation.

In order to reduce patient risk of disease transmission due to shared dental water, the CDC issued guidelines in December 2003 (see http://www.aquasept.com/, go to The Library, Links and Downloads page and review pages 28, 29, 30, and 46 of the PDF version of the CDC Guidelines). These guidelines specify the use of sterile irrigation fluids during any invasive procedure where tissue penetration is likely to occur. To comply with CDC Guideline, the dental professional can install an AquaSept(TM) Independent Water Delivery System. This system provides for the sterile delivery of irrigation fluids through a sterilized container, sterilized fluid delivery line and the sterilized dental handpiece. This allows the dental professional to provide each patient with separate, sterile dental water and practice the best possible dental water infection control standards for the benefit of the patient and all associates in the dental office.

There is a potential time bomb lurking in current dental office water systems. The current design of all built-in water systems is the bi-directional flow of fluid. While the largest portion of fluid is expelled out the end of the handpiece, friction causes a "passive retraction" of microscopic particles from the patient's mouth, through the dental instrument, up the water line and into the water reservoir. (See the "Biofilm" section of http://www.aquasept.com/). The continued use of the same water line and water reservoir among a group of patients results in cross contamination of the dental water among patients. The AquaSept(TM) Independent Water Delivery System prevents and protects patients from such cross contamination.

To quote a prominent dental professional with years of private practice and dental university experience: "In the 21st Century, the danger of infectious disease is heightened because of 1) the emergence of more dangerous microbes that defy medical treatment and can lead to a fatality, 2) a rise in patients who are immuno-compromised due to other conditions, and are therefore much more susceptible to disease with fatal consequences and 3) a rise in antibiotic-resistant strains." Robert Hasel, D.D.S.

Genesis Dental Technologies, LLC is a division of Genesis Industries, Inc. founded in June 1985 and is located in Elmwood, WI, about an hour east of the St. Paul/Minneapolis metro area.

For information on the AquaSept(TM) Independent Water Delivery System, please contact Genesis Dental Technologies, LLC at 715-639-2042, 1-800-523-8185 or email info@aquasept.com. For additional information visit http://www.aquasept.com/. Genesis Dental Technologies, LLC

CONTACT: John Dykstra, Sales and Marketing of Genesis Dental
Technologies, +1-715-639-2042, fax, +1-715-639-9205, johnd@aquasept.com

Web site: http://www.aquasept.com/

New Approach Could Lower Antibiotic Requirements By 50 Times

Antibiotic doses could be reduced by up to 50 times using a new approach based on bacteriophages.
Steven Hagens, previously at the University of Vienna, told Chemistry & Industry, the magazine of the SCI, that certain bacteriophages, a type of virus that infects bacteria, can boost the effectiveness of antibiotics gentamicin, gramacidin or tetracycline.
It is the phages' ability to channel through bacterial cell membranes that boosts antibiotic effectiveness. 'Pseudomonas bacteria for example are particularly multi-resistant to antibiotics because they have efflux pump mechanisms that enable them to throw out antibiotics. A pore in the cell wall would obviously cancel the efflux effect,' Hagens explains.
Pseudomonas bacteria cause pneumonia and are a common cause of hospital-acquired infections.
Experiments in mice revealed that 75% of those infected with a lethal dose of Pseudomonas survived if the antibiotic gentamicin was administered in the presence of bacteriophages. None survived without the phages (Microb. Drug Resist., 2006, 12 (3), 164).
The bacteriophage approach would also be particularly useful for treating cases of food poisoning, because the lower doses of antibiotic needed would not disrupt the friendly bacteria in the gut - a big problem with conventional antibiotic treatments.
'The prospect of using such treatments to prolong the life of existing agents and delay the onset of widespread resistance is to be welcomed,' said Jim Spencer a lecturer in microbial pathogenesis at the University of Bristol.
The overuse of antibiotics since the 1940s had slowly created a host of infections that are resistant to antibiotics. MRSA (Methicillin-resistant Staphylococcus aureus) for example is rapidly spreading through hospitals, affecting more than 8,000 people in the UK every year. MRSA infection can lead to septic shock and death.
Note: This story has been adapted from a news release issued by Society of Chemical Industry.

WHAT OTHERS ARE SAYING;-Star Tribune of Minneapolis, on the use of antibiotics in animals:

Wisconsin dairy farmer John Vrieze wants FDA permission to give his cows a powerful antibiotic, cefquinome, that is now the drug of choice and last resort for several difficult-to-treat human conditions. He shouldn’t get that permission.
By all accounts, Vrieze is a very good dairy farmer who embraces advanced techniques for keeping his cows happy, healthy and producing. So when one of his cows comes down with bovine respiratory disease, he’d like to treat the animal with a powerful drug, cefquinome. The manufacturer of cefquinome has petitioned the Food and Drug Administration for permission to begin selling the drug for use in animal husbandry.
That has set up a tug of war between those opposed to wider use of antibiotics in animals and those who favor it. In this battle, the opponents are the good guys; they include the American Medical Association, other health groups and the FDA’s own advisory panel.
The problem is that the disease-causing microbes which antibiotics attack constantly mutate. The wider the use of an antibiotic, the sooner one of those mutations will defeat the drug.
Widespread use of antibiotics in animals accelerates this process tremendously, leaving humans more vulnerable to diseases once controllable. ...
Enter cefquinome. ... Worried that using cefquinome in animals puts the efficacy of cefepime at risk, the advisory board at the FDA’s Center for Veterinary Medicine recommended against approving animal use.

Sanitary Surfaces Create Healthier Kitchens

First, people were warned to steer clear of spinach, then it was scallions and later, romaine lettuce. The food recalls of recent memory proved one thing to us: Sanitary measures can be a matter of life or death.
A cursory look around the Internet will show that we’re still in the infancy of truly innovative sanitary surface design. Most of the attention on that subject has been focused on commercial manufacture for the hospitality industry or in spaces where germs are an especially significant threat, such as hospitals and nursing homes.
But specifying or suggesting to a health-conscious client the inclusion of products that promote an environment hostile to germs and other bacteria is not just another potential profit center, it’s good sense. The consumer can’t always control what comes into the kitchen, but making sanitary surfaces part of the design can provide the user with a healthier kitchen experience.
Countertops are not the only surfaces to consider; any place a client’s next meal or exposed skin might possibly touch should be as easy to keep clean as possible, which means making sure to include low-Volatile Organic Compound (VOC) emitting products, sinks that are resistant to water absorption and specialty appliances that aid the client in maintaining a germ-hostile environment.
Careful Countertops
Anyone who has ever had to scrub a tile shower can testify that tiles, while offering almost unlimited design potential, can become unsanitary over time, and this common wisdom applies to tile in the kitchen as well. The grout that holds countertop or backsplash tiles in place is nook-and-cranny central, and there will always be places a client’s scrubber sponge won’t be able to reach. This is the perfect breeding ground for mildew growth, which can activate allergies and aggravate asthma.
But what if your client loves tile and nothing else will do? A simple solution is to include a waterproofing acrylic finish in the tile application process: After installation, coat the grout with the colorless finish to cut the risk of mold, mildew and other bacterial growth.
Another option is to select tiles that have antibacterial treatments added in during the mixing process. Rutland, VT-based Questech’s Q-Seal tiles are natural stone tiles featuring permanent waterproofing and the inclusion of Ultra-Fresh, the firm’s signature antimicrobial protection.
Microban, an antimicrobial that works at the cellular level to disrupt key cell functions within bacterial microbes, is included in Laticrete’s SpectraLock grouts, which are available in 40 colors, and are resistant to stain-causing mold and mildew.
Additionally, SpectraLock is Greenguard certified for low-VOC emissions and does not require any additional sealants.Microban is also a component of Cosentino’s Silestone natural quartz surfaces. Quartz has long been lauded for its sanitary properties and ease of maintenance since, unlike “natural” stones like granite, quartz is non-porous and requires no chemical sealing to make it stain resistant. With Silestone, Cosentino sees the built-in antimicrobial protection as adding yet another layer of protection.
Soapstone, too, is non-porous, requires no chemical sealing and does not absorb stains or liquids. It is also resistant to acids and alkalis. If the client is concerned about maintaining the luster of a soapstone countertop but does not want to use chemicals, advise the person that soapstone can be maintained organically by applying mineral oil to bring out its natural patina.
Non-Porous, No Problem
When it comes to keeping surfaces sanitary, non-porosity is key. Using porous materials that can absorb water and subsequently hold onto it increases the chances of cross-contamination from growing bacteria. By contrast, materials that have withstood long-term firing under intense heat, such as vitreous china, fire clay, glass and porcelain, have extremely low rates of water absorption. Most residential tiles specified for use in the kitchen – be it on a backsplash or on a high-traffic floor – have between 0.5-3% rate of absorption, making them virtually waterproof, according to Tile of Spain.
Glass is another natural option. “Glass countertops don’t require any long-term maintenance such as sealants, polishing, stain removal or burn repair,” says Doris Rocklin of Boisbriand, Quebec, Canada-based ThinkGlass. “Maintenance is as simple as wiping the surface with any common glass cleaning product,” she adds.
Finally, stainless steel has long been a popular choice for appliances, and in recent years, has increasingly been on countertops. It is relatively easy to clean and has been touted by health professionals for its antibacterial properties. But for the client who wants the sanitary benefits of stainless steel yet desires a warmer look, copper offers a more traditional aesthetic. Products like Frigo Design’s copper countertops and line of “fingerprintless” stainless steel for countertop applications can address this need.
While stainless steel is known for its germ-repellent/germ-killing properties, a recent study by Dr. Bill Keevil, director of environmental healthcare at Southampton University in England, showed e. coli lived an average of four hours on a copper surface, compared with a stainless steel top, where 10% of the bacteria was still alive after 34 days. Copper is currently being tested to see what effect it has on superviruses such as clostridium difficile and antibiotic-resistant staphylococcus infections, both which can be present in food sources and transmitted through touch.
Avoiding Cross-Contamination
Since no one lives in a vacuum, it’s to be expected that clients often share their homes with children and pets. Likewise, they will likely be handling raw food items in their kitchen. Having a germ-hostile countertop is a good start, but is not the only sanitary measure worth considering.
For clients with special needs, such as immune deficiency disorders, including specialty sanitary appliances can be key. Kitchen-sized autoclaves are one option; Korea-based Nawooel makes a countertop kitchen sterilizer/sanitizer that uses ultraviolet radiation to sterilize items such as implements used to cut, tenderize or that in any way touch raw meats, or utensils and plates used by especially vulnerable groups such as infants, the elderly and those with compromised immune systems. Placing the sterilizer in the work triangle nearest to where the food preparation takes place cuts down on the need to transfer dirty utensils to the sink, cutting down on the risk of cross-contamination.
If the concept of a personal autoclave is not a preferred solution, including a second prep sink in the design has the same effect by confining utensils used in raw food prep to a space away from where dishes and utensils are washed and stored.
Hands-Off Helping
Hands-free is the last line of defense – if they don’t touch it, it won’t get dirty. Many companies now offer hands-free faucets, which have the added eco-bonus of aiding in water conservation by shutting off when the sensor does not detect an object in front of it.
The battery-powered iTouchless hands-free trashcan uses an infrared sensor to detect when something is within 6" of its lid; the lid then opens and closes after the user has deposited trash.
With other hands-free items on the market such as soap dispensers and light switches, it’s easier than ever to prevent the spread of germs and design a truly healthy kitchen.
For more about green design, also read FusionDesign-Themed Showhouse Features ‘Green’ Focus, Breathing Easy, Firm Infuses New Life into Vintage Showhouse, Sleek and Green Define Kitchen and Bath Design, Green Countertops are Wide Ranging, High-Style Appliances Promote Safety and Energy Efficiency, It’s Easier Than Ever Being Green, Taking Steps Toward ‘Greener’ Kitchen Design, ‘Living Home’ Embraces Environmental Elements and Residential Project Featuring 3,000 Sq. Ft. of Italian Tile Honored for Sustainability and Style
For more green design resources, check out the Green Design section of the Helpful Links section.