This Issue's Rounds Question -
"An 18-month-old child is in a Hip Spica for a fractured femur. Prior to his/her discharge from the hospital, you have been asked to petal the child’s cast.

(responses to be published in next issue)

In the last issue of Body Cast, Rounds asked: “What is Staphylococcus aureus (MRSA)?”

The following responses were received:

From Tom Broughton:
Methicillin Resistant Staphylococcus Aureus is a common bacteria that can be found in most people. It lives in the warm moist areas in and on the body. If it gets into the body, it can cause infections such as skin boils or possible lung pneumonia.

MRSA (Methicillin Resistant) is an organism that is resistant to some commonly used antibiotics. Some people can become carriers by coming in contact with the organism from physical contact with someone who is ill (colds, flu, hospitals, open wounds, Foley catheters or draining tubes).

The most common way to spread MRSA is from person-to-person contact, usually with hands or contact with dirty surfaces such as hand railings, drinking faucets or handles.

The best way to prevent contact spread are good hand washing with bacterial soaps, avoid sharing personal articles such as cups, towels or toothbrushes, clean and protect all skin wounds right away, cover your mouth when sneezing or coughing, and always use an antibacterial soap before touching different surfaces with your hands, or use clean gloves during your normal daily activities.

From Irene Mills:
MRSA is a type of staph bacteria resistant to many antibiotics. Staph bacteria normally live on your skin or in your nose, without problems until they cause infection. For people whose health is compromised, these infections are serious. MRSA cannot be treated with antibiotics like methicillin, therefore it becomes harder to rid the patient of the infection. When antibiotics are used too often, or used incorrectly, bacteria can, over time, “out smart” antibiotics so that they no longer work well, causing “super bugs”.

MRSA is spread in many ways, i.e., hand-to-hand, or by touching objects the person with MRSA has handled. For a person in hospital, infection occurs in wounds, or skin, burns, IV, or other tube sites.

MRSA is becoming common in healthy people, not just chronically ill patients. Any wound or cut on a person with close contact to others, such as sport teams, can become infected.

From Earl Oborowsky:
Staphylococci are gram-positive spherical bacteria that occur in clusters resembling grapes. MRSA is a strain of staphylococcus aureus resistant to methicillin. This drug-resistant organism is spread by direct contact including patient to patient, patient to health care worker or vice versa, patient to visitor, and health care worker to visitor. MRSA causes a variety of pus-forming infections in humans. It causes superficial skin lesions such as boils, more serious infections such as pneumonia or phlebitis, and deep-seated infections such as osteomyelitis. It is a major cause of hospital-acquired infection of surgical wounds and infections associated with indwelling medical devices.

Aseptic technique and proper hand washing between patient care, proper handling of linen, environmental surface and patient care equipment can avoid the transmission of microorganisms onto health care worker clothing, skin and mucous membranes, decreasing the spread of drug-resistant organisms. If we all work together, then MRSA will no longer be an increasing problem.

From Mary Perkins:
I asked Dr. Jubin Payandeh, Orthopaedic Resident of the year to help me with this response. Staphylococcus aureus (staph) is a bacterium that is a leading cause of soft tissue infections and illness in humans. Humans, animals and food are the primary reservoirs. Healthy people frequently have staph living on the skin or in the nose, presenting in common illnesses such as pimples, boils, cellulites and abscesses. Health care workers with this common staph often pass it along to their patients resulting in pneumonia, endocarditis, meningitis and septicaemia. It then becomes a life-threatening concern. Staphylococcus aureus MRSA is a methicillin (antibiotic) resistant strain, which is commonly called a super bug and is resistant to most antibiotics. Vancomycin is often the antibiotic of choice. Basic hand washing and food preparation/storage can reduce the risk of transmission.

Responses were also received from Ruben Aceron, Lynn Arseneau, Livain Arseneau, Tony Bellon, Hansani brown, Lhea Burk, James Carragher, Eric Christiansen, Edward Clancey, Adrain Crossman, Norm Ellsworth, Mark Florian, Derek Gauthier, Melvin Gillingham, Richard Grenier, Suzanne Groulx, John Humeniuk, Mary Anne Lash, Brian Lavallee, Cam Longphee, Lori MacDonald, Gary Marshall, Leroy Martin, Blair Matheson, Joe Maulucci, Javad Movasseli, James Punwassie, Bill Rawlings, Cheryl Rivers, Vital Robichaud, Bert Sheppard, Vall Stockdale, Angela Wentzell, Joen Wilson, Heather Wong, Neuville Yao, Tom Yorke and Mary Young.