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| Ubiquitous but manageable |
| By Jim Montalto, News Editor |
| Published: 04/09/2007 |
Dr. Joseph Bick, chief medical officer for the California Department of Corrections, provides a comprehensive review in March's Infectious Diseases in Corrections Report, of how methicillin-resistant Staphylococcus aureus (MRSA) creates havoc in correctional settings. He cites crowded conditions, close living environments and barriers to prompt access to health care as just some of the many elements that increase the chances of transmitting microorganisms and diseases to those working and living in facilities. Not only is it difficult to control many of these challenges, but other factors like mental illness, inmate distrust of administrators and health care workers, and, in some cases, a reluctance by facilities to ask for assistance when dealing with outbreaks has also complicated managing contagious diseases in corrections. Bick then discusses how �over the past several years, infections due to MRSA have been increasingly recognized as a major problem in many jails and prisons.� Those unfamiliar with MRSA will appreciate the epidemiology Bick provides about the bacteria as well as S. aureus (SA) infections. Historic particulars like the fact that SA was almost universally susceptible to penicillin in just a few years after the first clinical use of the drug in the 1940s, and how SA resistant semi-synthetic penicillins became known as MRSA, helps those understand both bacteria�s defiant legacy. Recommended diagnosis and treatments, education and prevention measures are also discussed in the necessary medical detail. �The first step in adequately treating infections due to MRSA is to ensure rapid access to health care for all inmates who have [skin and soft tissue infections] SSTIs. Access to medical care can be improved by eliminating co-payment requirement for contagious conditions, employing an adequate number of clinical staff, and maintaining a 24/7 clinical operation for urgent medical conditions,� Bick recommends. �When evaluating SSTIs and other infections in which SA is common, clinicians must maintain a high degree of suspicion for MRSA. When possible, all significant SSTIs should be cultured. Cultures are especially valuable for establishing the local epidemiology and resistance pattern for SSTI. Once MRSA is identified within a facility as an endemic organism causing SSTI, empiric antibiotic selection should include an agent that has activity against this organism,� he continues. He details other preventive and infection control strategies and also provides tips on educating inmates. He then debates the feasibility of completely eradicating MRSA; Bick isn�t optimistic nor does he recommend taking the time to completely destroy the bacterium. Instead he urges facilities to implement a variety of measures, which include ensuring that inmates avoid sharing personal items, that they maintain good hygiene, and that all employees and offenders wash hands regularly, to improve the early diagnosis, prevention and treatment of diseases caused by MRSA. For the full March report go to www.idcronline.org Related Resources: Centers for Disease Control, Overview of Healthcare-associated MRSA Legal diseases, 11/1/06 Attacking from the inside out, 11/8/06 |
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