It`s Not Sexy, But This Is Important

As you are reading this, the surrounding pages are filled with columns about firefighters who had close calls and about fighting fires in unusual structures as well as articles recapping how fire departments handled major events. This column is not sexy, but the information here could save your life.

The problem is the overuse of antibiotics and drug-resistant strains of staph that are impacting people outside the hospital setting. Recent media coverage of a "super-bug" and MRSA (methicillin-resistant Staphylococcus aureus) was probably little but a passing headline for most fire and EMS personnel, but if you dig into stories behind the headlines, you will see that there is a lot more that you need to concern yourself with.

Most staph infections result from hospital stays, but the cases that have caught recent headlines, including the deaths of some children, are known as CA-MRSA infections. CA stands for community-associated or community-acquired. Even though most of the headlines are associated with children becoming infected in schools, the truth is that CA-MRSA is possible wherever people of any age are in close contact. This is especially true where people are involved in athletic activities, share lockers - or live together in a fire station.

Staphylococcus aureus, referred to simply as "staph," are bacteria commonly carried on the skin or in the nose of a healthy person. When there is no infection, the person is said to be colonized with staph. Staph is so common that the Centers for Disease Control and Prevention (CDC) estimates up to 30% of the population is colonized (bacteria are present, but not causing infection). However, staph may create skin infections that most commonly look like infected pimples or boils and can worsen to include redness, warmth, swelling, pain and discharge.

The infection currently in the press and of concern comes from MRSA. Unlike regular staph organisms, MRSA organisms are usually resistant to common classes of antibiotics. Infections typically occur in people with open wounds and/or weakened immune systems as are often found in nursing homes, hospitals and ambulances.

Of particular concern to EMS personnel is that MRSA is present in ambulances. A study published in April 2007 in Prehospital Emergency Care examined 21 ambulances for MRSA. Five areas of each ambulance were swabbed and cultures were allowed to grow in petri dishes. What is alarming is that 47.6% of ambulances tested were found to have MRSA, and more commonly in areas where the crews work than where patients may have been found.

In England, a national watchdog group alleges that ambulances in Yorkshire were responsible for spreading MRSA. Union leaders contend that ambulance-cleaning policies are to blame. The union officials would like to see dedicated teams who clean ambulances while emergency medical crews check patients into hospitals; now, emergency medical crews must stop their cleaning process and respond to an emergency if they are dispatched. An official for Yorkshire Ambulance said the agency is about to launch a "deep-cleaning" program to tackle the problem. This will involve teams of specialists responsible for scheduled deep-cleaning of all ambulances. If an emergency medical crew reports that a vehicle is in need of cleaning, a "Make Ready Team" will be sent to deep-clean it. Yorkshire Ambulance also recently purchased 40 new ambulances with walls that are impregnated with an infection-control solution.

What can you do to prevent MRSA infections? Firefighters and EMS personnel can continue their normal routines at work and at home while taking appropriate steps to protect themselves and families by following good-hygiene practices:

• Wash hands thoroughly and frequently with soap and water or use an alcohol-based hand sanitizer
• Keep cuts and scrapes clean and covered with bandages until healed
• Avoid contact with other people's wounds and bandages
• Avoid sharing personal items such as towels or razors
• Wipe surfaces of exercise equipment with a sanitizer before and after use
• Disinfect blood pressure cuffs, splints and backboards after each patient use
• Every piece of fire apparatus should have a plentiful and readily accessible supply of alcohol-based hand gel (commercial wipes suitable for disinfecting equipment should also be available wherever patient-care equipment is used so it can be immediately cleaned and disinfected before being placed in service for the next patient)

Early treatment of suspected MRSA is important. If you are concerned about a wound or sore, consult your health-care provider. Again, this information isn't sexy, but it's important.