How Can I Protect Against MRSA?
MRSA is all over the news lately. What is it? What does it do? How does it spread? How do I know I have it? How can I prevent it? These are questions that my patients regularly ask me. Here are some answers I give them.
What is MRSA? What does it do?
"Methicillin resistant staphylococcus aureus" is the long name for this bacteria. We all have staph bacteria on our skin. The staph genus is one of the main critters that make up our "skin flora", or the population of microorganisms living on our skin. Like all skin flora, staph can cause infection given the right circumstances. You can often use antibacterial soaps such as Hibiclens to protect yourself and your family from recurrent infections.
Pimples are one example of a skin bacteria causing a localized infection. When the body mounts an immune response to this infection, we see the typical finding of a raised, red lump with pus in it. In most cases these small infections go away on their own. Occasionally they grow larger, causing a cellulitis -- a flat, red, painful area of skin in which bacteria and our immune system do battle -- or an abscess, or boil, which is a raised, pus-filled sore that the body has walled off to protect the surrounding skin and muscle from further infection. Lots of people mistake staph abscesses for spider bites.
The pus inside a boil is made up of your body's immune cells that have come to fight the infection, as well as the bacteria and a buildup of fluid. Sometimes a skin infection can show signs of both an abscess and a cellulitis at once. The treatment for cellulitis is antibiotics. The treatment for an abscess is drainage. Most small abscesses will drain on their own, but larger ones will need to be drained by a doctor.
Bacteria in culture
What makes MRSA different from other staph species is that it's resistant to a lot of our first-line antibiotics, and in many cases it's much more "virulent" -- that is, aggressive and prone to cause widespread disease -- than other skin flora. The sad stories we hear about in the news are cases in which a small infection took root in someone's skin, then spread internally, affecting their lungs, brain, or bloodstream. So if MRSA is a "superbug" (I hate that term, but it's used commonly now), then it has two super powers: It is more virulent than normal bacteria, and it is immune to our attacks with many antibiotics. A third troubling fact is that most of the time it's silent. You can have it and not even know it until you develop a boil. In some studies, up to 30% of the population has been shown to be colonized with MRSA.
How does MRSA spread?
MRSA spreads by contact. Recent literature suggests that those most at risk for contracting MRSA are household members of someone who has it; people sharing bathrooms, locker rooms, and personal items such as towels; people who work in hospitals and clinics; the homeless; and people who use illegal drugs. Sharing someone's razor or nail clipper at the gym is probably not a good idea. There are reports of MRSA contamination of computer keyboards and mice. Basically, anything that anyone touches regularly is fair game.
How do I know if I have MRSA, and how do I get rid of it?
MRSA is a sneaky bacteria. You can have it and not know it. But there are some hints that you might have it. Pay attention for recurrent boils/abscesses of the insides of your nose, groin, buttocks, backs of the legs and knees, or armpits. These are the places where MRSA likes to hide. If you have recurrent boils, it's worth treating them as though they were MRSA even if you don't have a diagnosis.
As I mentioned above, large abscesses that don't drain on their own need to be drained by a doctor. If you have recurrent abscesses that drain on their own, the first step is to be very particular about your personal hygiene. Bathe every day. A few times a week, use an antibacterial soap such as Hibiclens, which you can buy at a pharmacy. Use a sponge and clean every inch of your body when you bathe. When you get out of the shower, use a clean towel. Wash your towel after every use so that you don't recolonize yourself with the bacteria you're trying to wash away. Wash your clothes frequently. I tell my patients with recurrent boils not to wear the same clothes more than once between washings. Make sure your family members do the same, because chances are they're carrying the bacteria as well.
Frequently wash your bed linens, towels, wash cloths, clothes, and anything else you regularly wear or touch. Wipe the surfaces of your home, bathroom, kitchen, and office with an alcohol-based cleaner to kill any bacteria that you or someone else might pick up by touching. Telephones, keyboards and mice, and doorknobs come to mind.
Though there is conflicting data on the use of tea tree oil to get rid of MRSA, there's no good reason not to try it as long as you're not allergic to it. Since MRSA loves to live in the nose, take a cotton swab with a few drops of tea tree oil on it and swab the inside of your nose. Note that this may sting a little, and your nose may run for a few minutes afterward. Do this twice a day for a week, then every other day for a week, then once a week for a couple of weeks.
If these methods don't work, see your doctor about trying an MRSA decolonization protocol. This involves a several week course of oral and intranasal antibiotics. The results of this protocol are mixed. The best thing to do, of course, is to prevent yourself and your family from being colonized.
How can I prevent MRSA?
Unless you live on a deserted island, you're going to come into contact with people who have MRSA. Remember that 30% of your friends and family are probably colonized. The best thing we can do is have good personal hygiene. Don't share towels or razors. Clean public computer equipment and telephones before you use them. Wash your clothes, bed sheets and towels frequently. Finally, if you're truly concerned about MRSA, go see your doctor. She or he can give you the statistics for MRSA prevalence in your area and advice about how best to protect yourself and your family.
*I generally discourage the use of "normal" antibacterial soaps such as those made by Dial or other brands. These contain antibiotics to which bacteria can become resistant. I like Hibiclens in particular because it is not an antibiotic per se, but rather a strong soap that happens to kill bacteria quite well. It has the same ingredients as the soap that surgeons use when they scrub in for surgeries.