Methicillin resistant Staphylococcus aureus(MRSA)in the community:Information for the public

Community acquired MRSA (CaMRSA) can cause skin and other more serious infections. It can spread from person to person via direct contact, hands, towels and personal grooming items. Avoid sharing items and wash hands thoroughly, especially after touching skin infections.

Last updated: 16 December 2008

What is Methicillin Resistant Staphylococcus Aureus?

Staphylococcus aureus (commonly known as staph) are common bacteria. Staph are usually harmless and many healthy people carry these bacteria on their skin or in their nose. However, sometimes they can cause infection and serious illness. Some strains of staph are resistant to the antibiotic called methicillin, and to other antibiotics. These staph are known as methicillin resistant Staphylococcus aureus (MRSA). Some people call MRSA infection "golden staph".

What is community-acquired MRSA?

MRSA infections occur frequently among people in hospitals and other healthcare facilities. However, some MRSA strains spread readily between people in the community, and these are known as community acquired MRSA (CaMRSA) infections. CaMRSA strains are often quite different to MRSA strains associated with hospitals and may cause infections in people who are otherwise healthy.

What are the symptoms?

Just like ordinary staph, CaMRSA infections can cause:

• infections of the surface of the skin such as boils and impetigo (school sores)
• infections under the skin that can be tender and increase in size (abscesses and cellulitis)
• infections of the bone, blood, lungs and other parts of the body

How is it spread?

CaMRSA can get into the body through broken skin or sores, resulting in redness, pimples, swelling, tenderness or boils. Infections can become serious leading to blood infections or pneumonia. CaMRSA can be spread by:

• touching or squeezing an infected body area, such as a boil or open wound
• using towels, clothes or bed sheets that have been used by a person with a MRSA infection
• using grooming items that have been used by a person with a MRSA infection
• not washing your hands carefully

Who is at risk?

CaMRSA skin infections can affect anyone. Crowding and frequent skin to skin contact can increase the risk of infection, so outbreaks tend to happen in schools, dormitories, military barracks, households, jails, and childcare centres. Cuts or abrasions, contact with contaminated items and surfaces, and infrequent washing increase the risk of infection. People who have health problems such as diabetes or a poor immune system or who have broken skin due to wounds, or dermatitis are also more likely to get an infection.

How is it prevented?

1. Hand washing is important to prevent the spread of CaMRSA. You should thoroughly wash all parts of your hands with soap and running water for 10-15 seconds
   • before & after touching/dressing an infected area
   • after going to the toilet
   • after blowing your nose
   • before handling or eating food
   • after touching or handling unwashed clothing or linen
   
   
2. Cover boils or other skin infections with a waterproof dressing. People who handle food must make sure that they don't contaminate any food and keep any sores or skin infections completely covered with a waterproof dressing
3. Don't share personal items such as clothes, towels, or bed sheets (if you share a bed with someone, keep sores or wounds covered overnight) or grooming items such as nail scissors, tweezers, razors and toothbrushes.

MRSA in childcare and schools
In addition to general hygiene, specific measures to prevent spread in schools and childcare include:

• teachers, children and families should understand the importance of hand washing, covering coughs and staying home if sick
• hand washing products (soap dispensers, running water and paper towel) should be available and accessible
• activities should allow time for hand washing (before eating and after going to the toilet)
• if open skin wounds cannot be kept covered, temporary exclusion from child care or school may be considered until the wound is healed or drainage of pus from the wounds can be contained using an sealed bandage
• surfaces such as counters, desks and toys that come in contact with uncovered or poorly covered infections, should be cleaned daily with detergent, and whenever visibly contaminated

MRSA in sporting groups
In addition to general hygiene, measures to prevent MRSA spread in sporting groups should include:

• People who have skin infections or open wounds that cannot be kept covered should not participate in contact sports until the wound has healed or drainage can be contained
• People who have skin infections or open wounds should be excluded from common spas or saunas
• People who have uncovered skin wounds should not share towels or sports equipment that is in contact with the skin

How is is diagnosed?

Staph infections are usually diagnosed on the basis of their appearance and the presence of any related symptoms (eg fever). To diagnose an infection of MRSA, your doctor will need to take a swab or sample from the boil, wound, or other site of infection, for laboratory testing.

How is it treated?

Your doctor will advise on the best treatment for your infection. Many CaMRSA skin infections can be treated by draining the abscess or boil. Letting the pus drain out safely is often the only treatment that is needed and the person often feels better once this has happened. Drainage of skin boils or abscesses should only be performed by a doctor or trained nurse or health worker under sterile conditions. It is important to keep the wound well protected with a waterproof bandage so that you don't spread the infection to others.

In some circumstances CaMRSA is treated with special antibiotics. If you are given an antibiotic, take all of the doses as instructed by the doctor or pharmacist, even if the infection is getting better, (unless your doctor tells you to stop taking it). It is possible for a CaMRSA skin infection to come back after it appears cured.

What is the public health response?

Public health units can advise on the control of outbreaks. CaMRSA is not a notifiable condition in NSW.

Updates and other links

• Staphylococcus aureus in the community - Information for clinicians  /factsheets/infectious/staph_aureus.html