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Staph Infections in the News

Methicillin-resistant Staphylococcus aureus (MRSA) has been in the news recently, including an article in The Wall Street Journal. The Associated Press reports that MRSA bacteria were blamed for the deaths of a 17-year-old Virginia high school senior and a 12-year-old New York City middle school student this month. MRSA is a type of Staph that is a serious human threat because it is resistant to nearly all common antibiotics. Although the Staph bacteria are an uncommon cause of recreational water illness (RWI) and MRSA has not been positively linked to any outbreak in pools or spas, there is strong evidence that Staph is found in spas. Outbreaks of Staph have not been documented in properly sanitized and maintained pools or hot tubs.

MRSA is divided into two groups: hospital-acquired MRSA (ha-MRSA) and community-acquired MRSA (ca-MRSA). Ca-MRSA is a rapidly expanding public health issue in the general U.S. population.

According to the U.S. Centers for Disease Control, Staph infections, including MRSA, occur most frequently among people in hospitals and health care facilities (such as nursing homes and dialysis centers) who have weakened immune systems. The CDC reports that factors that have been associated with the spread of MRSA skin infections include close skin-to-skin contact; openings in the skin, such as cuts or abrasions; contaminated items and surfaces; crowded living conditions; and poor hygiene.

The CDC recommends the following good hygiene practices to prevent MRSA skin infections:

• Keep your hands clean by washing thoroughly with soap and water or using an alcohol-based hand sanitizer.
• Keep cuts and scrapes clean and covered with a bandage until healed.
• Avoid contact with other people’s wounds or bandages.
• Avoid sharing personal items, such as towels or razors.

Athletic activities and facilities may contribute to the spread of ca-MRSA. For example, Staph can be spread by sharing contaminated towels and bars of soap. Health clubs with spas need to be especially diligent in preventive measures. However, the greatest microbial risk in spas from rashes is still Pseudomonas aeruginosa, not Staph. The vast majority of Pseudomonas infections heal within two weeks without medical treatment. Dermal Staph infections cause more serious boils and carbuncles. The much more potent strains of MRSA can lead to toxic shock, organ failure, and death in some cases. Unlike Psuedomonas aeruginosa, which can attack normal intact skin, Staph attacks are associated with cuts and abraded skin.

The following preventive measures should be followed to minimize the risk of infection in spas.

• Maintain the sanitizer level in the pool or spa at all times.
• Test frequently, especially when large groups are using a public facility.
• Discourage individuals with broken skin from using a public pool or spa.

Note: Be sure to advise your patrons to report any rash promptly to the facility management and seek medical advice from their health care provider if the rash does not show rapid improvement. Bathers should be certain to discuss with their health care provider recent swimming pool and/or spa use.

For more information, including fact sheets on Staph, visit the CDC website at www.cdc.gov.