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Strange bedfellows
By Ann Coppola, News Reporter
Published: 11/17/2008

Hiv mrsa The medical community will be the first to say that when it comes to the correctional population, “MRSA is here to stay.” Methicillin-resistant staph aureus (MRSA) infections are easily transmitted in crowded, confined spaces, making prisons and jails ground-zero for the bug. Fortunately, there is a growing body of research on treatment best practices. There also is an emerging theory that points to an entirely new risk factor for the antibiotic-resistant skin infections.

At a recent Albany Medical College educational satellite videoconference, experts in correctional medicine presented evidence linking the human immunodeficiency virus (HIV) to MRSA. MRSA is currently identified in a variety of populations, including prison and jail inmates, athletic teams, day care centers, intravenous drug users, and indigenous populations. The at-risk population of increasing interest to health care providers is those with HIV/AIDS.

“HIV has been shown to be an independent risk factor for MRSA,” Jason Farley said during the presentation. Farley, an assistant professor at the Johns Hopkins University School of Nursing, is a nurse practitioner who treats HIV patients.

Recent studies at HIV clinics in Boston, Dallas, San Francisco and Baltimore all support the MRSA/HIV connection. A Dallas study found that an individual who has HIV or is at risk for HIV is five times more likely to contract MRSA than someone who does not have HIV. The two major risk factors for HIV are drug injection and unprotected male homosexual sex. In the San Francisco study, men who engaged in homosexual sex were shown to be at a very significant risk for MRSA.

"Studies have shown in HIV patients, MRSA is a significant problem," said Daniel Skiest, a Tufts School of Medicine professor and HIV program director at the Baystate Medical Center in Massachusetts. “We now may be thinking about community associated MRSA as a sexually transmitted disease.”

MRSA is normally transmitted by skin-to-skin contact or by touching an object or surface contaminated with the bacteria. The exact cause for the high number of MRSA infections in persons with HIV has yet to be determined. However, evidence suggests that the skin-to-skin contact occurring during sex transmits the infection.

"The bad news is there is more MRSA in inmates than ever," said Lester Wright, chief medical officer for the New York State Department of Correctional Services. "The good news is we have more cultures available and a greater ability to diagnose and correctly treat MRSA."

According to Wright, MRSA cannot be diagnosed by simply looking at the skin. Instead, a culture of the wound or area must be taken.

"I still see too many cases where patients are being treated for MRSA without a culture ever being taken,” Wright said, “and the patient is given ineffective antibiotics because we’re not using a culture to diagnose. It takes a culture to know."

MRSA is commonly treated with wound care and antibiotics. Wright pointed out that there is no current data concerning the total number of MRSA infections in the correctional population. He recently submitted a proposal to the National Institutes of Health to conduct a study in prisons that will determine the prevalence of the infections.

The presentation also reviewed a common mistake made in health services concerning MRSA and spider bites. According to the panel, MRSA infections are sometimes misdiagnosed as spider bites in emergency rooms and correctional settings.

"When you see a patient with what looks like a spider bite and no spider is identified as being present, you should be thinking it could be community associated MRSA," Farley said. "This is an important point to make to corrections professionals. Don’t think about spider bites, think about MRSA."

Public awareness campaigns within facilities are one way to combat the spider bite mistakes. The panel suggested hanging posters that address the misconception in areas where staff will see them. In addition, patients need to be educated as well.

"Educate the patient to avoid taking leftover antibiotics," Farley said. "I have had patients tell me they felt they didn’t need the antibiotics so they gave them to a family member. We also should educate patients that recurrence is common and that there are potential mechanisms to reduce recurrence, however it should be noted, data on this is unclear."

Farley suggested that facilities have an infection control plan with a variety of preventative measures in place.

“I can’t stress enough the importance of making available alcohol-based hand sanitizers in waiting areas and even hand sanitizing soap in cells," Farley said. "We’ve all heard the arguments against alcohol-based sanitizers, but we need to learn to remember to update staff on when it is appropriate to use hand hygiene and develop a responsible culture of hand hygiene practices in every facility.”

During the viewer call-in question and answer portion of the videoconference, a correctional employer from Florida asked what protocol to follow when staff contract MRSA.

“I would say this is a very delicate issue," Farley responded. "What is ideal may not be what is most practical. We are in a staffing shortage throughout the country, and we need to develop a pragmatic approach. This approach should include taking the employee off work, appropriate treatment of the wound to remove the active infection as much as possible, place the individual on antimicrobial therapy for 24 or 48 hours, and cover the wound. The likelihood the employee can return to work after this process with a covered wound is high.”

Another area of concern was how MRSA could spread throughout facilities. “The transmission of MRSA from using work out and exercise machines is an added risk in corrections," Wright added. "It seems that’s something we could focus on.”

The videoconference attracted more than 400 viewers from 35 states and Canada. The program is part of an ongoing satellite videoconference series addressing clinical issues in the management of HIV-infected patients. Since 1997, 11,000 people have viewed the presentations.

Related Resources:< br />
National MRSA Education Initiative

HIV/AIDS Information



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