Methicillin-resistant Staphylococcus aureus (MRSA) is a variant of S. aureus which is considered to be resistant to all beta-lactam antibiotics (including penicillins, cephalosporins, and cephamicins).

It may also be resistant to one or more other classes of antibiotics.

MRSA strains have been identified as a major source of health care acquired infections and outbreaks in the U.S. and Florida. For over four decades, MRSA has presented a challenge for hospitals attempting to control this organism.

Disease Reporting Requirement

All practitioners, health care facilities, and laboratories in Florida are required to notify the Florida Department of Health of diseases or conditions of public health significance under section 381.0031, Florida Statutes, and Chapter 64D-3, Florida Administrative Code.

More recently, MRSA has also been increasing in the community in individuals without health care-associated risk factors. Organisms that cause community-associated MRSA (CA-MRSA) infections are genetically distinct from the typical health care-associated MRSA (HA-MRSA) commonly encountered in health care settings.

Transmission

MRSA spreads in the community through contact with infected people, wounds, or things that have touched infected skin and are carrying the bacteria. Some people who carry MRSA can go on to get a MRSA infection.

Health Care-Associated MRSA (HA-MRSA)

Infection and colonization with HA-MRSA are typically seen in older individuals with one or more of the following risks: long hospital stay; multiple hospitalizations; more than 65 years old; multiple invasive procedures; wounds; severe underlying disease; receiving broad-spectrum antibiotics; undergoing hemodialysis; and intravenous drug use.  Resistance to multiple classes of antimicrobial agents is common.

Community-Associated MRAA (CA-MRSA)

Community-Associated MRSA is frequently seen in younger persons and involve skin and soft tissue infections.  Risk factors for infection are referred to as the 5 C’s:

  1. Crowding
  2. Frequent skin-to-skin Contact
  3. Cuts or abrasions
  4. Contaminated items and surfaces
  5. Lack of Cleanliness

Frequently, community-associated cases have initially been misdiagnosed as spider bites. This misdiagnosis prevents timely treatment and may increase the chance of transmission to others.

Outbreaks of these infections have been described in numerous groups including people found in correctional facilities (jails and prisons), sport teams, men who have sex with men, and commercial fishermen. Resistance to multiple classes of antimicrobials is uncommon.

Many of the CA-MRSA infections may be effectively treated with good wound care with or without oral antibiotics, while more resistant strains may require intravenous vancomycin.

Symptoms

The symptoms of an S. aureus infection, including MRSA, depend on the part of the body that is infected. Broken skin, such as scrapes or cuts, is often the site of a MRSA infection. Most S. aureus skin infections, including MRSA, appear as a bump or infected area on the skin that might be:

  • Red
  • Swollen
  • Painful
  • Warm to the touch
  • Full of pus or other drainage
  • Accompanied by a fever

You cannot tell by looking at the skin if it’s a MRSA infection. People sometimes confuse some MRSA skin infections with a spider bite. However, unless you actually see the spider, the irritation is likely not a spider bite.

Treatment

Your health care provider will determine which treatments are best for you.

Antibiotics – Health care providers often prescribe antibiotics to treat MRSA infections. While MRSA can be resistant to several antibiotics, meaning these drugs cannot cure the infections, there are antibiotics available to treat MRSA infections.

Surgery – Some types of S. aureus infections need surgery to drain infected areas.

Complications

MRSA infections can cause serious problems in and outside of health care settings, including: pneumonia (lung infections), bloodstream infections, surgical site infections, sepsis, and death.

MRSA in Special Populations

Schools and Daycares

Although CA-MRSA has been reported in school settings, school age children are not a high-risk population and classrooms are not a high-risk environment for the spread of CAMRSA. In Florida schools, reported CA-MRSA infections generally occur in settings where the 5 C’s are present. Precautionary recommendations for schools include:

  • Education of students and staff in the transmission (person-to-person contact) of CA-MRSA and individual precautions emphasizing hand hygiene to reduce the likelihood of transmission.
  • Do not exclude colonized individuals from routine activities. Many people are asymptomatic carriers of CA-MRSA. Focusing on carriers will not decrease transmission.
  • Teachers, coaches, and staff are encouraged to look for signs and symptoms of infection and refer the individuals to their health care providers and report outbreaks to the local county health department.
  • Regular housekeeping and cleaning regimens should be applied. Locker rooms and sports equipment should be cleaned and disinfected frequently with an EPA-approved disinfectant, used as directed.
  • Laundry (uniforms, towels, etc.) should be routinely washed. Bleaching is not necessary. Items should be thoroughly dried on high heat (>160° F) and not allowed to air dry.
  • Individuals with active infection should keep wounds covered with clean, dry bandages and contain any wound drainage. Infected individuals need not be isolated or excluded from school activities, unless wound drainage or other contaminated body fluids cannot be contained.
  • Infected individuals may be excluded from activities that increase the chance for spreading the infection (e.g., physical education, sports activities) until lesions have resolved or can be adequately covered and contained.
  • County health departments are available as resources for education and infection control plans.
  • The Florida Department of Health does not recommend closing schools for cleaning. 

Athletic Settings

CA-MRSA infection has been reported in athletes and participants in contact sports at all levels. Preventive measures to reduce infection and transmission of CA-MRSA in athletes and sports facilities should include:

  • Encouraging personal hygiene among patrons and staff.
  • Not allowing infected individuals with lesions that cannot be adequately covered to participate.
  • Making products available (alcohol hand-sanitizers, disinfectant spray bottles, and paper towels) that allow hand hygiene and disinfection of equipment to be performed in activity areas.
  • Encouraging showering at the end of activities.
  • Thorough cleaning of facilities on a scheduled basis. Shared equipment and facilities, such as exercise machines and saunas, should be cleaned and disinfected daily with an EPA-registered disinfectant, used as directed.
  • If laundry services are provided, washing linens, towels, and clothing and drying thoroughly at high heat (>160° F) before use. Items should not be air dried

Correctional Facilities

CA-MRSA infections and outbreaks have been observed in correctional facilities around the country, including Florida. Facilities that house inmates in closely-confined quarters provide suitable conditions for the spread of infections, including MRSA.

Basic prevention and control measures for correctional facilities should include:

  • Encouraging personal hygiene, with an emphasis on hand washing and regular showering.
  • Educating staff and inmates on methods of transmission, prevention, treatment, and containment of MRSA in the facility.
  • Encouraging inmates to seek medical assistance for skin conditions indicative of infection or that may lead to infection.
  • Housing individuals who have poor hygiene or draining lesions that cannot be contained separately from other inmates, if possible, until infection has resolved or is contained.
  • Maintaining scheduled cleaning of residential quarters and medical facilities, including disinfection of shared equipment and facilities. This includes medical equipment, exercise equipment, sinks, showers, and toilets. Areas should be cleaned and disinfected using an EPA-registered disinfectant, used as directed.
  • Developing and following a facility-wide infection control plan.

Information for Health Care Providers

General Health Care-Associated Infection Resources

According to a recent federal survey, one in 25 hospital patients have a health care-associated infection (HAI).

The Agency for Healthcare Research and Quality has shown that the implementation of recommendations from the Healthcare Infection Control Practices Advisory Committee can reduce HAI by 70% overall and virtually eliminate some specific types of infections.

Strategic Plan: Prevent HAI and Antimicrobial Resistance

Developed by the Florida Department of Health’s Health Care-Associated Infection Prevention Program.

View Strategic Plan
Multi-Drug Resistance Organisms (MDRO)

Patients can also take action to help protect themselves from these types of infections:

  • Speak up when receiving care and ask health care workers to wash their hands before touching you.
  • If you are having surgery ask your doctor what you can do before surgery to help prevent infection or if you have a catheter, ask each day if it is still needed.  
  • Only take antibiotics when you need them, finish the course of treatment (do not stop taking your medicine when you begin to feel better), and remember that antibiotics typically are not effective against the common cold.
Isolation and Hygiene Signage
Prevention Resources
Florida Health Care-Associated Infection Program Information

Broad implementation of the guidelines saves lives, reduces suffering, and decreases health care costs. Through partnerships and the commitment of stakeholders, the Florida Department of Health’s Health Care-Associated Infection Prevention Program supports health care facilities implementing best practices for preventing the spread of HAIs.

Health care facilities are asked to conduct surveillance or track HAI infections, ensure health care workers perform hand hygiene before and after patient contact and when they come in contact with body fluids, use personal protective equipment such as gowns and gloves, minimize use of devices (e.g. catheters), and ensure the patient care environment has been cleaned including the proper cleaning of shared medical equipment, such as blood pressure cuffs and glucometers.

In addition, antibiotics need to be used wisely. Antibiotics do help fight infection, however overuse of antibiotics leads to the development and spread of multi-drug resistant organisms. Health care providers are asked to order cultures and review the results to ensure the most narrow spectrum antibiotic is used to treat infections.

Infection Control Training

The Health Care-Associated Infections Prevention Program of the Florida Department of Health has five separate web-based training modules on infection control, specifically created for facility nursing staff members in acute care hospitals, ambulatory care, and nursing homes. These trainings are available on-demand and at no charge. Each will satisfy one hour of continuing education units.

The training modules are available on the TRAIN Florida. If you do not have an account, you can create an account. You will be directed to a page that will ask for your professional license. You will need to choose your license and enter your license number to receive continuing education credit.

You can find the courses by searching for “FDOH Infection Control” and filtering the affiliate with “Florida.”  You may select the class you want to take separately, or in a series by selecting the infection control series. With the series, you will take a brief Introduction course that will explain the course directions, the class “An Overview of Infection Control,” and select one course from the remaining classes dependent on your position and type of facility.

To register for the module

  • Select the Registration tab, and then select Launch. Once completed, you will mark the course as completed. You will see a message stating Course was marked as “Completed.”
  • You will need to take a 10-question quiz and post review.
  • You need to score 70% on the quiz to pass the course, and you will need to post a review to receive credit for the class.

Blended Learning Series (Compilation)

Introduction and Overview (both classes are required)

Elective Modules (only one course from this section is required)

Each of these courses can be taken separately