Don't forget to wash your hands

Resistant bacterial organisms, such as methicillin-resistant Staphylococcus aureus (MRSA), are a major problem for our hospital-based colleagues and their patients. And the problem is getting worse. Because ophthalmology is an outpatient specialty, with many procedures performed either in office or at ambulatory surgery centers, ophthalmologists may have considered themselves relatively unaffected by that trend. Overwhelmingly, however, the data pour in to tell us that MRSA is no longer a hospital problem, but a community problem.

Key Points

"We are well on the way towards getting rid of the harmful bacteria and viruses causing disease, and it is probable that most of those we suffer from will be merely historical curiosities in the next century."

-James Harpole, "Leaves from a Surgeon's Case-Book" F.A. Stokes Co., 1937, page 202

Because ophthalmology is an outpatient specialty, with many of our procedures performed either in office or at ambulatory surgery centers, we ophthalmologists may have considered ourselves relatively unaffected by that trend. Overwhelmingly, however, the data pour in to tell us that MRSA is no longer a hospital problem, but a community problem.

According to the CDC study, "Despite the increase in MRSA prevalence, there was also a decrease in MRSA that was resistant to multiple drugs. The researchers hypothesize that the influx of MRSA strains from the community might have replaced those multidrug-resistant strains associated with the hospital. 'Unlike traditional MRSA the community strain is very fit-it causes infection in healthy people,' said CDC epidemiologist R. Monina Klevens, DDS, MPH. 'When it is introduced into a hospital, where ill patients are more vulnerable to infection, it has the potential to cause significant morbidity and mortality.' Due to community MRSA's ability to infect the young and healthy, traditional risk factors for identifying hospital-associated MRSA colonization, such as dialysis and prior hospitalization, are not effective predictors of whether a person is carrying the community strain."

Researchers at the Monroe Carell Jr. Children's Hospital at Vanderbilt University, Nashville, TN, swabbed the noses of 500 healthy children who were at their pediatricians' office for routine immunizations.2 In 2002, 1% of children had the bacteria in their noses. In a follow-up study 2 years later, 9.2% had the bacteria.

"What we see now is a germ that is firmly entrenched in the community," said Buddy Creech, MD, MPH. "Children really don't have to have any risk factors for having these bacteria. They don't have to be sick, and they don't have to have had antibiotics recently."

More than half of the Staphylococcus skin infections seen in the university's emergency room are caused by MRSA. The figure puts Nashville in line with cities such as Chicago and Houston that have a higher-than-average frequency of the bacteria, he said. According to a 2005 CDC study, about 2 million people carry MRSA in their noses.3

In 2003, 10% of a Connecticut college's football team contracted MRSA infections. Two players had to be hospitalized.

Athletes who practiced body shaving had a 43% risk of MRSA infection, and players who sustained turf burns on the artificial turf field were seven times more like to come down with an MRSA infection.4 More than half of all athletic trainers have treated athletes for skin infections caused by MRSA.5