Oral Health Topics
Methicillin-Resistant Staphylococcus Aureus / MRSA
To find information about the topic listed on this page, please visit the MouthHealthy.org page about MRSA.
Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staph bacteria that is resistant to certain antibiotics, including methicillin, penicillin, and amoxicillin. For decades, MRSA primarily has affected people who are immunocompromised, such as patients in hospitals and long-term care facilities. Recently, however, it has been detected in otherwise healthy people. These infections typically show up as skin infections, like abscesses or boils.1 Less often, these infections can be more severe, causing pneumonia, sepsis or other potentially life-threatening infections.1
- Who is at risk for MRSA?
- How is MRSA transmitted?
- What can I do in my dental office to prevent the spread of MRSA infections?
- Should staff members infected or colonized with MRSA be restricted from working with patients?
- Is it safe to treat a patient who has been infected or colonized with MRSA?
Anyone can be colonized with MRSA or can develop a MRSA infection. People who have the MRSA bacteria on their skin or in the anterior nares (nostrils), for example, but are not sick, are said to be colonized or carriers. Carriers can spread the bacteria, but rarely get sick themselves.2,3
Infection with MRSA occurs when the bacteria enter the body though a cut or scrape and cause signs of disease. Typically, these signs are localized around the initial wound and include swelling, redness and drainage. Rarely, the bacteria may spread to other parts of the body—the lungs, bloodstream or bones, for example—causing more serious, potentially life-threatening, infections. Groups of people who have close contact with one another are at higher risk than others of contracting MRSA. For example:
- Children in daycare;
- Inmates in correctional facilities; or
- Patients in long-term care facilities, like nursing homes.1
MRSA is transmitted through skin-to-skin contact or through the sharing of personal items, like towels or razors that may have come into contact with a MRSA-infected wound.
Follow standard infection control procedures to prevent the spread of any infectious disease.4 Good hand hygiene is especially important in preventing transmission of MRSA. Good hand hygiene includes washing your hands with soap and water or an alcohol gel between patients, after contact with body fluids and after handling contaminated items—whether or not gloves are worn.1 Also, gowns and eye protection should be worn whenever you conduct procedures likely to generate body fluid sprays or splashes.
As always, any barrier protection on equipment or surfaces should be removed and discarded between patients. In addition, surfaces should be disinfected between patients with an EPA-registered hospital disinfectant that has an HIV, HBV claim or a tuberculocidal claim. Gloves should be worn when disinfecting the operatory between patients. Used patient-care instruments, including single-use devices, should be handled as described in the CDC’s infection control guidelines for dentistry.4 Critical items (those that penetrate soft tissue or bone) should be heat sterilized. Semi-critical instruments (those that touch mucous membranes or non-intact skin) should be heat sterilized if possible; if the instrument is heat sensitive, you can use a high-level disinfectant during processing. Non-critical patient care items are those that only come in contact with intact skin. Multi-use items can be cleaned or if visibly soiled, cleaned and disinfected with an EPA-registered disinfectant that has a tuberculocidal claim. Barriers also may be used for non-critical patient care items.
The CDC also recommends that all staff get a flu vaccine in addition to routine vaccinations (i.e. hepatitis B).5
According to the CDC,4 health-care personnel with active, draining skin lesions should be restricted from contact with patients and patient’s environment. Health-care personnel that are carriers of MRSA should not be restricted from work unless he/she is epidemiologically linked to transmission of the organism.6
According to the CDC, standard infection control precautions should be used in ambulatory care settings to reduce the risk of disease transmission, including transmission from patients infected or colonized with MRSA.7 Patients also can minimize transmission by keeping cuts and abrasions covered with a clean, dry bandage until healed, in addition to practicing good hand hygiene and not sharing personal items that come in contact with bare skin, like towels or razors.8
- Gorwitz RJ, Jernigan DB, Powers JH, Jernigan JA and participants in the CDC-convened experts’ meeting on management of MRSA in the community. Strategies for clinical management of MRSA in the community: summary of an experts’ meeting convened by the Centers for Disease Control and Prevention. 2006. Available at www.cdc.gov/ncidod/dhqp/pdf/ar/CAMRSA_ExpMtgStrategies.pdf. Accessed Nov. 27, 2007.
- Maryland Department of Health and Mental Hygiene, Epidemiology and Disease Control Program. Guideline for control of Methicillin-Resistant Staphylococcus aureus (MRSA) in long-term care facilities. Available at edcp.org/guidelines/mrsa.html. Accessed November 29, 2007.
- Boyce J. Methicillin-resistant Staphylococcus aureus in hospitals and long-term care facilities: microbiology, epidemiology and preventive measures. Infection Control and Hospital Epidemiology 1992;13:7725-37.
- Centers for Disease Control and Prevention. Guidelines for Infection Control in Dental Health-Care Settings – 2003. MMWR 2003;52(No. RR-17):9.
- Pearson ML, Bridges CB, Harper SA. Influenza vaccination of health-care personnel: Recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP). MMWR 55(RR02):1-16.
- Bolyard EA, Tablan OC, Williams WW, et al. Guideline for infection control in health care personnel, 1998. Available at www.cdc.gov/ncidod/dhqp/pdf/guidelines/InfectControl98.pdf. Accessed Dec. 3, 2007.
- Siegel JD, Rhinehart E, Jackson M, Chiarello L, Healthcare Infection Control practices Advisory Committee. 2007 Guidelines for isolation precautions: preventing transmission of infectious agents in healthcare settings. June 2007. Available at www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf. Accessed Dec. 3, 2007.
- Centers for Disease Control and Prevention. Community-associated MRSA information for the public. Available at www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_public.html. Accessed Dec. 4, 2007.