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Infection Control

CA-MRSA: Is your team protected?

September 19, 2010
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Our nation, our athletes, and our bodies are under siege by an onslaught of antibiotic-resistant pathogens, in spite of impressive advances in the creation of new drugs.

Causes include: Improper hygiene; incomplete surface disinfection; indiscriminate use of antibiotics; and patients failing to complete their prescribed dosage as conditions improve.

Infectious bacteria remain un-eradicated and can mutate to antibiotic resistant forms.

The increase in immune-compromised patients broadens the spawning ground for such pathogens.

Expanded global travel and greater interchange among world markets and athletes opens a potential to new, unidentified and undiscovered infections.

What is CA-MRSA?
Potentially, the most dangerous is that of community-acquired (associated) methicillin-resistant Staphylococcus aureus (CA-MRSA).

The deadly strains within this classification of staph starts as a simple lesion on the skin of an athlete, child, client, or employee and becomes red, sore, and eventually is treated with beta-lactams — the very class of antibiotics to which CA-MRSA has evolved a tenacious resistance — as a typical skin infection.

The lesion grows in size and pain until finally the flesh begins to degrade (if left untreated) as if it were being consumed, resulting in possible amputations, sepsis, or even death.

Contaminated environmental surfaces, such as locker rooms and playground equipment, become the catalyst for broad community-acquired outbreaks.

Reports demonstrate that CA-MRSA can spread by direct person-to-person contact or via transient carriage on hands and body parts of athletes and children.

The indiscriminant pathogen has affected dozens of professional athletes and crippled franchises, while literally killing children unable to fight off the infection.

Previously, MRSA had only attacked the immune-compromised.

USA 300 and 400 strains
The USA 300 and 400 strains of CA-MRSA have evolved to community-acquired levels that attack healthy children and professional athletes by way of the skin rather than the traditional MRSA mucosal routes, which makes it different from the more common strain of MRSA that affects the immune-compromised.

USA 300 and 400 are most commonly associated with the injuries, sickness, amputation, and death of athletes ravaged by CA-MRSA.

Dogs, cats, rabbits, and ferrets have been found carrying the USA 300 strain.

As in people, it can cause serious skin infections and other illnesses.

What you can do
It is clear that the importance of an antibiotic-resistant disinfection program with proven efficacy against CA-MRSA is paramount.

Understanding the risk level of your facility is the first step in protecting your team.

Assessing the size, congestion, traffic load, and nature of activities within your organization begins to reveal zones of exposure and liability.

The Centers for Disease Control and Prevention (CDC) suggests that facilities in these exposure categories utilize proper personal hygiene, not share personal items, such as towels, razors, and water bottles, and incorporate the use of an appropriate disinfectant.

For more about the CDC’s FAQs, educational handout materials, and clinical links, visit
Choosing the appropriate disinfectant becomes a critical strategy when defending against this formidable foe, as well as the legal battlefield.

There is a temptation to assume that a pesticide with proven ability to kill Staph or even MRSA (ATCC 33592), can also kill other strains of Staph, such as CA-MRSA and USA 300 and 400.

The assumption would seem to make good sense to anyone except the athlete, the doctors, or trainers called to a deposition.

“Making good sense” and proven evidence-based health practices are two different paradigms.

Rather than guessing at what makes good sense, choose to follow the direction of thought-leaders and risk managers, while basing your practices upon what it is we do know.

Factual information
We do know that no studies exist proving that all pesticides killing Staph or even MRSA kill all strains of MRSA.

History illustrates the gold standard for health care providers (HCPs) making disinfectant decisions is to evaluate the alternatives through close review of the EPA-registered stamped label copy incorporating proven AOAC protocol and third-party laboratory efficacy.

HCPs evaluate disinfectants by their ability to provide proven AOAC laboratory efficacy against individual specific pathogens of consequence on specific hard inanimate surfaces and not broad, generic classifications, such as “Staph.”

The medical and clinical community view CA-MRSA, USA 300 and 400 as distinct strains, requiring specific awareness, cross-contamination, and educational programs.

We also know that the CDC has classified CA-MRSA and its strains as individual pathogens of consequence to the point that it has provided a separate FAQ website.

Risk management case history has forced the chemical manufacturing industry to invest heavily in research to provide products with label claims versus specific pathogens in order to gain acceptance by Internal Review Boards (IRBs) and Infection Control Committees for use within Long Term Care (LTC) and Acute Care facilities.

Moreover, if health care workers and institutions were not concerned with a product having documented confirmation of its ability to kill specific pathogens of consequence, products used today would be much less expensive and less powerful, as they would not have been required to meet such stringent performance levels to achieve efficacy against such pathogens as HBV, HCV, and HAV.

We would simply have one disinfectant that kills Staph, Pseudomonas, and Salmonella.

Everything else would be covered by the “assumption” of, “if it kills A, it must kill B.”

The U.S. government requires a product to provide proven efficacy of HIV and HBV, or TB in order for it to be blood-borne pathogen compliant.

While we know that HIV is very readily killed by low-level quats, we would be less than responsible, reckless, and even criminal to state that any quat with any level of efficacy can kill HIV and therefore complies with the Blood-borne Pathogen Standard if we did not have proof that it did so according to AOAC methodologies.

Several state health agencies and the health care community in general have identified CA-MRSA USA 300 and 400 as being different and of consequence, as evidenced by their special position statements, awareness programs, and website offerings.

The real risk mitigation requires certainty versus a specific pathogen of consequence, not a guess.

There is hope
An effective formula does exist.

The product kills USA 300 and 400 as well as MRSA (ATCC 33592).

We know that this product is a quaternary ammonium compound.

We also know that in speaking with a quat manufacturer, we learned of an interesting event in their third-party lab.

The manufacturer had a client that desired to kill a specific bacterial strain of Pseudomonas with a formula incorporating a 2,000 PPM quat blend.

The manufacturer said “no problem” as they knew that the same formula at 1,000 PPM quat killed the same strain in third-party studies with 100 percent efficacy (disinfection).

The client, with great confidence, commissioned the expensive third-party tests at 2,000 PPM of the same quat blend, in the same formula, against the same strain and failed.

Why? How could this be? Was the sample batch made wrong?

No, it was tested to be within acceptable specifications.

Were the efficacy tests run incorrectly?

No, this was confirmed and re-evaluated to be a “clean” test.

An investigation was sponsored by the quat manufacturer in an attempt to discover what had happened.

The final analysis proved that the strain of Pseudomonas tested, in the presence of 2,000 PPM quat, initiated a self-defense process called a “pellicle.”

The pellicle forms a protective barrier around the bacteria and shields it from the quat’s deadly activity.

Why do I share this story?

To demonstrate that it is a very dangerous practice to assume that because a strain can be killed by one concentration of quat, doesn’t mean that a concentration twice that will be effective.

It is then even more reckless, as a result of these findings, to assume that if one can kill MRSA with a variety of low-level quat formulations that one can also kill a very different strain of CA-MRSA that attacks and kills otherwise healthy adults and children.

Bacteria survive because they adapt to the environment.

Don’t assume
We endanger ourselves if we ever assume that we have out-smarted them.

This myth must be busted before someone makes the mistake of assuming a MRSA (ATCC 33592) claim is all they need to fight CA-MRSA USA 300 and 400 (NRS 384 and 123) strains.

Bleach, a CDC default, can de-color, corrode, or de-activate in the presence of a soil load or light.

When products de-color, de-activate, corrode, form dangerous gases when combined with other materials, have abbreviated shelf life, and are rendered useless in the presence of soil, they are less dependable.

This lack of confidence compromises the assurance of efficacy itself and may contribute additional risk.

We also know that having an environmental surface CA-MRSA, USA 300 and 400 disinfection program covers only part of your liability in the fight — education is key in ensuring success.

Your employees, coaches, administrators, and athletes must understand the voracity of CA-MRSA USA 300 and 400.

Your cleaning staff must be knowledgeable in contemporary best practices when disinfecting critical potential ports of cross-contamination, such as athletic mats and outdoor play equipment.

One must also understand that every strong prevention program begins with proper hygiene to include proper hand-washing, handling of personal hygiene items, and personal health awareness.

Awareness, education, proper procedures, disinfectant electives, discipline, and commitment are crucial.

Have you mitigated risk to a comfortable level?

Rather than accepting what “makes good sense,” have you chosen to follow the direction of thought-leaders and risk managers basing your practices upon what it is you do know?

Are you guessing?

Do you know that your team is protected?

Jeffrey C. Gayer is director of marketing and innovation at Canberra Corporation, a manufacturer of cleaning, dispensing, and disinfection technology in Toledo, OH. Canberra was the first industry leader to market disinfectants with CA-MRSA USA 300 and 400 efficacy. To learn more about CA-MRSA USA 300 and 400, go to
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