Super Bug - Emergency responders prepare for deadly germBy Mary Vandeviere
Published: Wednesday, February 18, 2009 9:43 AM CST
Arizona law recently was changed to provide workers' compensation coverage for firefighters, paramedics and other first responders infected on the job by what is being called a “superbug.”
Methicillin-resistant Staphylococcus aureus, or MRSA, is a germ that is resistant to common antibiotics. If not detected and treated quickly, MRSA infections can develop rapidly into serious illnesses.
According to 2005 estimates from the Centers for Disease Control and Prevention, 18,650 people died with MRSA infections while hospitalized, and an estimated 94,000 people developed invasive, or serious, MRSA infections.
The threat from MRSA has grown in recent years - accounting for 63 percent of all staph infections in hospitals and healthcare facilities in 2004, up from 22 percent in 1995 and just 2 percent in 1974, according to the CDC.
“Given the nature of our job we're always going to be exposed to it,” said Northwest Fire Battalion Chief Brad Bradley, Emergency Medical Services. Northwest Fire/Rescue District is in Marana. “We all carry it with us every single day, but limiting transmission of it is what our goal is.”
MRSA infections appear on the skin as red and swollen areas. They are warm to the touch and filled with pus or other fluid. A MRSA infection usually moves very quickly and is extremely painful, said Clarence Tucker, infection control officer at Phoenix Fire Department.
“MRSA tends to be more aggressive than other staph and produces proteins that destroy tissue very visibly. It starts drilling holes in your tissue,” Tucker said. By the eighth day of infection, one infected firefighter had to have surgery to cut out damaged tissue.
In the past two to three years, 22 firefighters in the Phoenix department came down with MRSA. Suspected MRSA cases are immediately treated with the antibiotic Bactrim. More advanced cases are treated in a hospital with intravenous injections of Vancomysin.
“That's the strongest antibiotic around - it's the last bastion,” Tucker said. “When that doesn't work, usually you're in deep trouble.”
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The fire department's health center used to test bacteria cultures before treatment. Tucker says after the spate of MRSA cases, the health center changed procedures for immediate treatment.
“The cultures take five days to get back. You can't wait five days,” he added.
Firefighters, as first responders for emergency medical services, can come down with MRSA because of the contact they have with people who have open wounds, are recovering from recent surgeries or were recently hospitalized, said Tim Hill, president of Professional Firefighters of Arizona.
A firefighter may handle a patient who has MRSA, which then gets on the emergency worker's skin. If the firefighter later has an injury or an open wound, the MRSA germ will seek out the weakest point, and he or she will become infected.
Tucker trains emergency responders to assume patients are carrying MRSA if they are on antibiotics, have open wounds, live on the street, are diabetic, in prison or just out of a hospital.
“The responders have to wash anything they touched after touching the patient - the drug box, the trauma kit, handles on the truck,” Tucker said. And after cleaning, they must wash their hands.
“It is the most important thing in infection control,” he added.
Tania Hare, infection preventionist at Banner Good Samaritan Medical Center, agreed. “Good hand hygiene is the most important thing we can do,” she said.
Using alcohol-based hand gel and hand washing for 15 to 20 seconds are effective in keeping hands healthy, Hare added.
Overall, most serious cases of disease from MRSA are tied to healthcare risks such as prior hospital stays and surgical procedures or nursing home residency, according to the CDC. These MRSA cases are grouped by medical professionals as healthcare-associated. The CDC reports that about 85 percent of all serious MRSA infections in a 2005 study were healthcare-associated.
People who have not been hospitalized within the past year or undergone procedures such as dialysis, surgery or catheter insertion develop what is known as community-associated MRSA infections.
Mesa-based DC MedPrep trains emergency medical technicians and paramedics to appreciate the value of “body substance protection,” including protective garments such as gloves and masks, said Mike Beilfuss, program director.
Gloves should always be used in handling all patients, Beilfuss said, and he recommended that paramedics wear a mask and have the patient wear one as well.
“It may go as far as a full face shield and gown,” Beilfuss added First-responders should change out of their uniforms before leaving work, put the uniform in a plastic bag and wash it separately from other laundry, he advised. “As soon as you walk through the door, your wife or husband or kid hugs you. If you're in your uniform, you certainly don't want to bring a germ home and pass it along,” Beilfuss said.
Northwest Fire/Rescue District adopted a policy last year and made changes to improve protection against MRSA. Employees are prohibited from wearing firefighting equipment or clothing in the work stations, and the district is using new cleaning supplies and techniques that are effective against MRSA. Chairs and couches in the stations are being replaced because the upholstery material was porous, and it absorbed and housed MRSA. Northwest's Bradley said that amid the changes, it's important to remember basic principles of protection: frequent hand washing and use of protective clothing.
“Some of the easiest ways of protecting us are also the most effective ways,” Bradley said.
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