In 1996, a pair of Chicago doctors noticed an unusual disease that was causing serious illness, even death, among the city’s school-age children, athletes, and normally healthy people.
Apparently, increasing numbers of people were contending with a stubborn staph infection that normally only afflicts small numbers of people in hospitals, medical centers, and nursing homes.
A closer look found that the cause of the illness was methicillin-resistant Staphylococcus aureus, or MRSA.
As the number of cases increased, two alarmed University of Chicago pediatric specialists, Dr. Robert Daum and Dr. Betsy Herold, called an impromptu meeting with city and community leaders.
What they reported was sobering: “There has been a dramatic increase in young patients showing up at the hospital with MRSA infections. Dozens of children (have been) sickened by the resistant bacteria … and it appears to be an unprecedented outbreak.”
The doctors said the city was witnessing a “pivotal episode” of a disease formerly found in hospitals and nursing homes, now in the general community, causing 94,000 severe infections each year with 19,000 deaths, according to a recent federal estimate.
As the disease spread outside of medical facilities and nursing homes to the general community, it came to be known as community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA).
They also reported that the disease had transformed itself since it was first discovered nearly 50 years ago, becoming more menacing and lethal.
As potentially serious as the problem is, Daum and Herold did indicate that treatments for MRSA are available if doctors know how to recognize the disease early and begin an effective treatment regimen immediately.
However, it is becoming increasingly clear that the best way to deal with MRSA is not to treat it, but to prevent it.
And, some strategies are actually rather simple.
Fighting the disease
Since athletes have been its victims in many parts of the United States, England, and Australia, doctors recommend taking a shower after playing sports or working out.
Additionally, hand hygiene is a critical component in preventing this and scores of other germs and bacteria from being transferred from one person to another.
This is especially true in medical facilities, nursing homes, and assisted care centers where hand hygiene, by staff and patients, has inched up to one of the most important ways to prevent the spread of infection.
However, a much more specific MRSA-stopping strategy falls to the JanSan industry: Finding ways to make a scientific risk assessment that the germs and bacteria which cause the disease may exist, then implementing effective ways to remove them.
Although scientists identified the bacterium Staphylococcus as far back as the 19th century, many medical experts say the first cases of the disease caused by Staphylococcus, or something resembling MRSA, were identified in the early 1950s.
Most of these cases were in British medical facilities.
However, there was little concern at the time because the infection was easily treated with penicillin, then still considered the wonder drug of the century.
However, within a few years, the bacterium causing the disease had stopped responding to penicillin, and doctors began to recognize that Staphylococcus had an uncanny ability to rapidly change itself in order to become resistant to drug treatment.
Hope was rekindled in 1959 when a new antibiotic, methicillin, was developed.
But once again, this drug became ineffective as well.
After this happened, doctors began calling the disease methicillin-resistant Staphylococcus aureus.
“We can always expect antibiotic resistance to follow antibiotic use, as surely as night follows day,” says Dr. John Jernigan, a medical epidemiologist with the Centers for Disease Control and Prevention (CDC).
But, treating MRSA with antibiotics was proving to be an ever-growing challenge.
The first American cases of MRSA were reported in Boston in 1968.
Incidents of MRSA occurred throughout the 1970s into the 1990s, but attracted little attention because of the relatively few cases and because, if caught early, it could be effectively treated with newly developed, more powerful antibiotics.
However, according to a February 2006 study by the Annals of Clinical Microbiology and Antimicrobials, MRSA rates have steadily increased in the U.S. since 1998, and the rate appears to still be on the rise.
Also, the bacterium causing MRSA has become ever more tolerant to drugs.
Newer and even more potent antibiotics, such as vancomycin, along with combinations of antibiotics, have been used to treat patients.
This proves effective only if the disease is caught early.
“Therefore, the key approach is prevention of the infection,” says Judene Bartley, vice president of Epidemiology Consulting Services, Beverly Hills, MI, “such as strict attention to keeping the indoor environment, especially frequently touched surfaces, clean and disinfected.”
MRSA game plan with technology
Before an effective cleaning and disinfecting game plan can be put into action, cleaning professionals need to perform a risk assessment to know if and where they may be vulnerable to hosting contamination that could promote the growth of illness-causing germs and bacteria, according to Steve Nason, director of sales for Hygiena, which manufactures rapid hygiene-monitoring systems as well as other devices used to detect contamination.
Nason says this will help improve worker productivity by ensuring crews spend more time cleaning areas that need special attention.
It will also help prevent the wasteful use of chemicals and disinfectants on areas where they are not needed.
Since the 1970s, systems have been available that help perform a risk assessment by detecting the presence of adenosine triphosphate (ATP).
ATP is the primary energy conductor within all living cells and a vital component of germs and bacteria, including those that cause MRSA, norovirus, and other illnesses.
If detected on a floor, counter, toilet or other surface, it should be viewed as a red flag to professional cleaners that harmful bacteria may be present, according to Nason.
Early ATP monitoring systems, just like early computers, were large machines that were expensive and slow by today’s standards.
Fortunately, these devices have become much smaller (handheld), are relatively inexpensive, and provide results in a matter of seconds.
To test a surface before or after a cleaning with one of these devices, cleaning workers use a specialized ATP test device containing an enzyme compound to retrieve samples from a test area.
The swab must not touch any other surface or the test may prove inaccurate or inconclusive.
The swab is then placed in the handheld ATP detector.
If ATP is detected, the amount will be noted on the device’s screen.
Thresholds can be set up depending on the surface to give the user a pass, caution, or fail result.
According to Nason, if ATP is present, depending on your predetermined threshold limits, the area must be cleaned and disinfected and then retested again after cleaning.
If no ATP is found on the second test, this provides “proof of service” that the area is now clean and disinfected.
Additionally, he says, many facilities monitor surfaces on a daily basis and log the data.
This not only provides a record and helps ensure that areas stay hygienic and contamination-free, but also provides a “trend analysis” so that facility managers can determine if, when, and why some surface areas are more susceptible to accumulating and harboring contamination that has ATP.
Although MRSA is becoming resistant to a range of antibiotics, the bacterium that causes MRSA is not becoming resistant to the EPA-registered disinfectants designed to kill the bacterium causing MRSA.
These disinfectants are used to clean surfaces, such as floors, walls, and restroom fixtures, as well as high-touch areas, such as doorknobs, light switches, and countertops, according to Robert Robinson Sr., president of Kaivac and a former ISSA Board of Directors member.
And, in MRSA-target facilities — medical facilities, nursing homes, and schools — it is these high-touch areas, especially countertops, where some of the greatest concern lies.
Robinson agrees with Nason that cleaning professionals, especially those working in these “target” facilities, should check regularly for ATP on various surfaces.
These areas must be cleaned daily and, especially if ATP is present, disinfected using an approved disinfectant.
In recent years, Robinson says, some manufacturers have introduced one-step disinfectant cleaners, which are effective against a broad spectrum of bacteria.
Also, new flat surface cleaning systems (FSCs) have been developed that minimize the use of cleaning cloths, which have been scientifically proven to quickly lose their effectiveness at removing contaminants and can actually spread germs and bacteria as they are used.
The road ahead
We probably have not seen the worst of MRSA yet.
Scientists have now found PVL, a toxin associated with MRSA that can remain latent and relatively harmless in the body for years.
But, some studies suggest MRSA with PVL can cause more serious forms of disease, including a severe form of pneumonia.
Although there have been some successful attempts at developing a vaccine for MRSA, it is too early to tell if these will be effective.
Worse, if new strains of MRSA evolve, these vaccines may prove ineffective almost as soon as they are developed.
As a result, the way to stop MRSA now and in the future continues to emphasize detection and effective cleaning.
Fortunately, the cleaning industry is better equipped now than ever before to meet this challenge.
Susan Moore is a writer for the professional cleaning and building industries. She may be reached at firstname.lastname@example.org.