5 MRSA 'Hot Spots'

MRSA Loves Gyms, Barracks, Prisons, Schools -- and Your Nose

By Daniel J. DeNoon
WebMD Feature

Reviewed By Louise Chang, MD

Where in your community can you find the drug-resistant staph germs known as MRSA? The surprising answer: They're closer than you may think.

With all the buzz about MRSA (methicillin-resistant Staphylococcus aureus), it's easy to forget there really are two MRSA epidemics going on at the same time.

By far the largest epidemic is going on inside hospitals and other health care facilities. The staph bug causing these infections resists treatment with a broad range of antibiotics. Because it attacks so many people with weakened immune systems, hospital-acquired MRSA accounts for the vast majority of fatal MRSA infections.

But another, unrelated strain of MRSA is circulating in communities across the U.S. This strain is resistant to first-line antibiotics.

News that MRSA is now killing at least 19,000 Americans each year has focused public attention on community-acquired MRSA. Where does it lurk? WebMD asked epidemiologist Jeff Hageman, one of the scientists tracking MRSA at the CDC.

"We see outbreaks in settings where there is crowding, a lot of skin contact, and, often, a lack of good hygiene," Hageman tells WebMD.

Hot spots for these outbreaks have been:

• Athletic settings
• Military barracks
• Prisons
• Schools

Interestingly, Hageman says day care centers have not been hot spots for MSRA outbreaks.

"It is kind of surprising to us that we have not received many reports of MRSA in day care," he says. "We hear lots of reports of MRSA in children, but not associated with day care. One reason is that day care centers already have policies in place to handle a wide variety of diseases. Those same policies would prevent MRSA infections."

Hageman says outbreaks happen when a person with an MRSA infection comes into direct skin-to-skin contact with another person -- or after a person uses a towel or other object that's been contaminated by an infected person.

But you can't avoid MRSA by avoiding so-called hot spots.

"Staph is found anywhere. One in three people carry staph on their skin. They can spread infections anywhere in the community," Hageman says.

Why do so many people carry staph germs? Because the human body is the staph bacterium's natural habitat, says Gordon Dickinson, MD, chief of infectious diseases at the University of Miami and the Miami VA Medical Center.

"We are the ecology," Dickinson tells WebMD. "Humans are the ecological niche for Staphylococcus aureus. MRSA is just a variant."

This means the No. 1 hot spot for MRSA is: your nose.

"It can live in moist areas of the skin -- like under the arms, in the groin -- but you find it mainly inside the front of the nose," Dickinson says.

Whose nose? There's a very good chance it's your own.

"Our current understanding is that 20% of healthy people never seem to carry staph, while up to 60% carry it sometimes," Dickinson says. "And 20% of healthy people carry staph day in and day out, usually in their noses."

Most of these people carry the normal kind of staph. But an increasing number carry MRSA. Why doesn't it hurt them?

"We don't understand why staph causes mischief. Most of the time it does not," Dickinson says. "But presumably, little breaks in the skin allow it to get past our barriers. Then it can multiply -- and staph comes with a bundle of proteins and toxins and enzymes that allow it to do a lot of damage."

So how can you stop staph from getting from the front of your nose to your skin?

"Theoretically, one thing people can do is quit picking their noses. But that won't help -- studies show people can't keep their hands away from their noses," Dickinson says.

Fortunately, there are a number of ways to prevent infection with both normal staph and MRSA.

MRSA may be the latest scary germ to grab headlines, but good old-fashioned hygiene is the key to protection.

Here's how to keep MRSA at bay:

• Wash your hands. Your hands are the part of your body most likely to pick up a germ and transfer it to an itchy sore, your eyes, your mouth, or your nose. So keep them clean. Use soap and warm water -- the rule of thumb is to scrub gently and thoroughly as long as it takes to sing the alphabet song.
• Got a cut or scrape? Clean it -- and cover it with a bandage until it heals.
• Avoid contact with other people's wounds or bandages.
• Do not share towels, razors, or other personal items.
• Shower right away after exercise, especially at the gym. Don't toss your wet towel in your gym bag. Clean and disinfect any gym bag that's come into contact with dirty athletic gear.
• Wash all athletic clothing daily. Regularly wash athletic gear such as elbow pads and kneepads.
• Bathe every day. MRSA can live on the skin, but it can be washed away. Staph can enter the body through hair follicles, so be particularly careful to clean your groin, underarms, arms, and legs.
• Be on the lookout for infections. Early on, a staph infection looks like a spider bite (a red, irritated bump). Don't wait -- have a nurse or doctor look at it.
• If you have an infection, don't try to squeeze out the pus. This only spreads germs on your skin. Have ALL infections treated by a health professional.
• Practice careful hygiene when visiting crowded facilities such as prisons, military bases, shelters, hospitals, and schools.

SOURCES: CDC web site. Mayo Clinic web site. WebMD Medical News: "MRSA: Experts Answer Your Questions." Gordon Dickinson, MD, chief of infectious diseases, University of Miami and the Miami VA Medical Center. Jeff Hageman, epidemiologist, CDC.

Reviewed on November 02, 2007




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