A recent study by the University of Washington School of Public Health has shed light on the dangers potentially lurking within our firehouses. Researches took samples of surface materials from many locations with fire stations within the study locations. In particular, samples were analyzed for methicillin resistant staphylococcus aureus (MRSA).
Alarmingly, 4.3% of the samples taken tested positive for MRSA. The highest incidence was found—not surprisingly—in medical transport units, followed closely by kitchen surfaces and computer keyboards and desks. After personnel education and hand-sanitizer installation, a second sampling was conducted at the same stations with a 3.9% incidence of MRSA being found on all nine tested surfaces in the fire station.
Additionally, researchers collected nasal cultures from 40 reportedly healthy firefighters in 13 fire stations; 30% of the cultures tested positive for MRSA. The same 30% showed genetic linkage to the MRSA particles from firehouse surfaces, suggesting transition from surface to fire and emergency service personnel.
This isn’t surprising, since fire and emergency service professionals are exposed to both hospital personnel and the community at large where strains of MRSA are encountered. However, MRSA has been attributed to some 19,000 deaths in the United States. Community outbreaks in otherwise healthy populations have been on the rise and reported in communal settings, such as schools, day care facilities, sports teams, jails and the military.
MRSA is spread by contact; it can be transmitted by touching others who have it on their skin. Further routes of transmission include touching objects that have MRSA bacteria on them, particularly if an open wound exists. MRSA is carried, or colonized, by approximately 1% of the U.S. population, although most carriers aren’t infected.
MRSA infections are most commonly identified among people who have weak immune systems and are in hospitals, nursing homes and other health-care centers or communal care facilities. Infections can appear around surgical wounds or invasive devices, like catheters or implanted feeding tubes.
Rates of infection in hospitals, especially intensive care units, are rising throughout the world. In U.S. hospitals, MRSA causes more than 60% of staph infections. This is particular important to the fire and emergency service, as interaction occurs within community care facilities.
However, MRSA is also showing up in healthy people who haven’t been living in a hospital. This type of MRSA is called community-associated MRSA (CA-MRSA). The CDC reports that in 2007, 14% of people with MRSA infections had CA-MRSA. Recent studies have shown that rates of CA-MRSA infection are on an upward trend at a significant rate. One study of children in southern Texas found that cases of CA-MRSA had a 14-fold increase between 1999 and 2001.
CA-MRSA skin infections have been identified among certain populations that share close quarters or experience more skin-to-skin contact, such as team athletics, military recruits and prison inmates. For fire service professionals, this may be characterized by interaction with patients during EMS encounters. However, more and more CA-MRSA infections are being seen in the general community as well, especially in certain geographic regions.
While the University of Washington Schools of Public Health study authors were careful to call for further study and analysis about the impact on fire stations and fire service personnel, strict prevention activities are essential in preventing the spread of this highly infectious disease process.
Careful attention to personal hygiene is key to avoiding MRSA infections:
- Wash your hands frequently, especially if visiting someone in a hospital or long-term care facility.
- Don’t share personal items such as towels or razors with another person; MRSA can be transmitted through contaminated items.
- Cover all wounds with a clean bandage and avoid contact with other people’s soiled bandages.
- If you share equipment, clean it first with antiseptic solution.
- Make sure that shared bathing facilities are clean.
In August 2004, after a successful pilot program to tackle MRSA, the U.K. National Health Service announced its Clean Your Hands campaign. Hospital wards are required to ensure that alcohol-based hand rubs are placed near all beds so staff can hand-wash more regularly. It’s thought that even if this cuts infection rates by no more than 1%, the plan will pay for itself many times over.
As with other bacteria, MRSA is acquiring more resistance to some disinfectants and antiseptics. Although alcohol-based rubs remain somewhat effective, a more effective strategy is to wash hands with running water and an anti-microbial cleanser with persistent killing action, such as Chlorhexidine.
A June 2008 report, centered on a survey by the Association for Professionals in Infection Control and Epidemiology, concluded that poor hygiene habits remain the principal barrier to significant reductions in the spread of MRSA. These lessons learned from the health-care sector certainly have value and application within our fire and emergency service facilities and for all our personnel.
This study and its findings should make all members of the fire and emergency service more sensitive to the risks associated with the environments we operate in. This requires heightened attention to ensure we’re protected through adequate preventative measures.
Todd J. LeDuc, MS, CFO, CEM, MIFireE- is Assistant Fire Chief for Broward Sheriff Fire Rescue in Broward County, FL., a career CAAS accredited Metro Department in the nations’ 18th most populous County. Chief LeDuc is Director at Large for the SHS Section.