Preventing recurrence of MRSA infection in a community space

January 8, 2006 8:36 PM

HygeineFilter: How to prevent the recurrence of MRSA infection in a community center?

I'm on the board of directors for an organization that runs a community center. We serve a diverse population, including homeless and immuno-suppressed people.

Recently, a worker cut her hand while renovating the kitchen, resulting in an MRSA (methicillin-resistant staphlococcus aureus) infection that took three days in the hospital to clear up.

My question is, what specific steps do we need to take to minimize the risk of a recurrence -- and what do we not need to do?

We are planning to close our facility for a month and clean it from top to bottom (which it needs anyway). My sense is that the first priority is to deep-clean the bathrooms and kitchen and wash bedding and towels, using bleach as a disinfectant.

How thoroughly do we need to clean the "dry" areas of the house (not bathrooms or kitchen) -- do those need the bleach treatment too? Should we steam-clean the furniture and rugs? Or throw everything out and start over, as some in the community are suggesting?

Suggestions and information resources greatly welcome. Thanks for your help!

posted by ottereroticist to health & fitness (10 comments total)

I think you should contact your local health board or maybe the CDC or someone more qualified than Meta Talk. I know of a vet clinic that had to replace all their walls due to an antibiotic resistant bacterial outbreak- which could apparently live in concrete.
posted by fshgrl at 8:58 PM on January 8, 2006

lots of hand washing and disposable gloves.
posted by brandz at 9:12 PM on January 8, 2006

CDC page

DermNet NZ

Guidelines for the control of MRSA
posted by dhartung at 9:49 PM on January 8, 2006

The thing with MRSA is you just don't know who may have it, and who is a carrier. That's the problem with it. Three days is a relatively short time to be "cured" of MRSA, BTW. She must have been on antibiotics for longer than that.

I would contact the CDC. Your local health department might also be able to guide you, maybe you could arrange to speak with a Infectious Disease specialist to help you with this task and to answer your questions.

Good luck.
posted by 6:1 at 10:00 PM on January 8, 2006

How to prevent MRSA from entering your facility: culture nasal swabs from every person entering (especially those who've spent time at a hospital, of which you must serve many), and bar anyone who tests positive as a carrier from coming inside. The thorough cleaning of your facility is awesome (and also removes other pathogen reservoirs), but once you reopen the doors to people, you're letting the mrsa buggies back in. Other people, not surfaces, are the main MRSA colonization source.

How convenient is it for someone to wash his hands in your facility? Do you have an adequate number of sinks? And obviously, make sure you keep the soap dispensers filled. Putting up those stupid "yay wash your hands plz!!!!" posters or stickers might help nudge people into proper handwashing hygiene.
posted by neda at 10:33 PM on January 8, 2006

After the big cleanup, place a alcohol-based gel dispenser at every door. Nobody goes anywhere without a little spritz.
posted by frogan at 11:07 PM on January 8, 2006

I'm surprised the local health department hasn't already come knocking. MRSA infections typically are reported & followed up on (as are infections of E. coli O157).

For what it's worth, bleach at 10% dilution is the standard cleanup solution in micro labs.
posted by Brian James at 11:30 PM on January 8, 2006

I'm not sure what goes on in your community center, but you have beds so maybe it's a little like a hospital? Staff and clients in physical contact? If so, you need make sure all staff who touch clients have and use alcohol-based wipes all the time.

If it's anything like a hospital, remember that doctors might not be very careful after examining dozens of people, but patients, if reminded that the doctors have just touched a lot of other people, may be careful to look after themselves. In such a situation, give each bed or examining station a box of wipes and remind the clients to make sure all staff wipe their hands before touching them. Tell them that it's part of empowering patients, of getting them to share responsibility for their proper care.

Make sure doors and sinks and toilets can be operated without people having to touch handles, which are always great places for picking up infections. If some doors have handles that must be grasped, maybe someone (I don't know who you have) making rounds could be encouraged to pick up the habit of giving these handles (and vending machines and so on) a quick wipe every time they go through.

And you asked about carpets and furniture: if you don't need soft, absorbant surfaces, get rid of them. Where possible, reduce things to smooth white surfaces that can be easily wiped, sprayed, or mopped with bleach, and then of course make sure they are wiped, sprayed, or mopped all the time. I'd rather have a hard chair than a persistent infection.

And know your sources of infection: get staff and clients tested.
posted by pracowity at 3:12 AM on January 9, 2006

When you wash bedding and towels, use hot water and hot dryer in addition to bleach. Make sure the ventilation system is clean, especially filters, not for this infection, but because it's good practice. Your local hospital will likely have an Infection Control Specialist. They'd might be willing to do a presentation on infection control for your agency. Your city and/or state Health Department can advise you as well.

Hand washing is critical. The importance of proper handwashing cannot be overestimated, so make sure handwashing is easy and encouraged. Alcohol wipes and disinfectant juice are a poor substitute, and people seem to use them instead of handwashing, when they should be used in addition to handwashing. Hand disinfectant pumps for visitors/clients are a nice idea, in addition to easy access to soap and water. If staff have contact with immuno-suppressed and ill people, you should get gloves for staff.

Do the homeless people who use your center have a place to get clean? That might be something you could provide, that they would really appreciate, and would contribute greatly to their health and self-esteem.
posted by theora55 at 8:10 AM on January 9, 2006

Call the local health department and notify the CDC. Absolutely. Community-acquired MRSA (as opposed to that acquired in a hospital) is a very serious issue and it's on the rise. But without accurate reporting, health officials won't know just how dire the situation is. My boyfriend acquired MRSA at a workout facility a year ago and it took a life-threatening four days for doctors to even figure out that it was MRSA. He was sent home from the hospital twice with wrong diagnoses and useless antibiotics. (He eventually recovered but his recovery was slow and painful.) If reporting is more accurate, health officials won't wait so long to consider MRSA as a culprit behind infections.

You might check out http://www.hospitalinfection.org/. It's aimed primarily at hospital patients but might have some useful prevention info for you.
posted by lilybeane at 10:53 AM on January 9, 2006