I knew it was only a matter of time before the worry and fear of drug resistant infections jumped from the world of human medicine to our utopia of veterinary medicine. Veterinary Medicine: where we don’t HAVE to wear gloves with every patient, we will remove a needle cap with our teeth, and where getting blood on our hands is just another daily occurrence. With the prevalence of MRSA talk happening and the increase of MRSA/MRSI diagnosed cases that we are seeing at DoveLewis, is it time for the utopia to end? Before we all don our Level 5 biohazard suits I want to give everyone some practical knowledge about MRSA and hope to keep the panic at bay.
MRSA stands for methicillin resistant Staphylococcus aureus. Typically dogs more commonly have MRSI (methicillin resistant Staphylcoccus intermedius) but the implications are the same. What makes these little bugs special is that they are resistant to all of the β-lactam antibiotics (like ampicillins and cephalosporins – usually our popular picks). These bugs can also transfer resistance to other classes of antibiotics rendering them useless in treating these infections. We have precious few antibiotics left that are successful in killing MRSA/MRSI.
MRSA bacteria live naturally on many of us, the skin and mucosal surfaces are their popular dwelling places. The important thing to remember about these bacteria is that they are opportunistic – preying on the immune comprised, pregnant, and the very old and the very young. Coming in contact with a patient with a MRSA infection is not the end of the world, chances are many of us have already done so and come out unscathed. People can act as carriers for MRSA and pass it along to our coworkers and patients. It can pass back and forth between animals and people. Overall, those of us working in the veterinary profession have a higher prevalence of MRSA. It’s unclear the significance of that fact, just that we know it’s out there and we need to do what we can to protect ourselves and our patients.
Now, when I say that we are seeing more cases of MRSA/MRSI at DoveLewis it means we are seeing it diagnosed, period. More veterinarians are culturing wounds and urine so we know what we are dealing with. As we continue to move forward with advances in veterinary medicine we are treating sicker patients for longer periods of time; seeing these resistant infections will more than likely continue to increase. The most common sites of infection in veterinary patients are surgical sites and wounds, skin infections, ear infections, urinary tract infections, and pneumonia. These are diseases many of us are seeing daily so we need to increase our awareness for the bacteria these wounds and diseases may be harboring.
What can you do to keep yourself and your other patients safe? First of all – clearly label any patient that has MRSA or that you even suspect may have MRSA. Make sure that all staff are aware and those at higher risks do not handle these patients or their laundry. These patients should be kept away from other patients with open wounds, compromised immune systems, etc. Wear gloves and protective clothing (we use isolation gowns, gloves and shoe covers). Use caution when restraining these animals – especially try not to let them touch your face. Have treatment items dedicated to just that patient (like tape, thermometer, stethoscope, bedding, etc). Wash all laundry items for that patient separately, wash them twice using bleach (look into IsoWash®bags – they are awesome!). Cages should be cleaned daily, floors cleaned as often as you can. Wash yourself well after touching the patient. Once the patient leaves the hospital make sure to disinfect everything that came in contact with that patient (fluid pumps, kennels, food dishes, hospital floor) with an approved cleaner that will kills MRSA. Often times these patients will be in your hospital while the culture is still growing but treat them the same if your suspicion for MRSA/MRSI is high.
Don’t forget to take care of yourself – practice good nutrition, keep your stress levels low, and protect your immune system! Use caution with cracks and scratches on your hands - they are open pathways to further infection. Cover scratches or wear gloves during any patient contact. Clean your stethoscope between patients (sick or otherwise) and be sure to always wash your hands between patients. Look in to getting some hand sanitizer in your hospital-these are popular in human medical settings and they will clean your hands (and often moisturize as well) without the drying properties of soap and water. Organic debris like blood and urine will still need soap, water and scrubbing, but a quick pump of hand sanitizer between patients will keep everyone clean and happy.
MRSA/MRSI aren’t the only concerns in the world of super bugs, there are also bacteria resistant to vancomycin and fluoroquinolones that can cause headaches when choosing antibiotic therapy. Keep this in mind when treating really nasty infections, remember to culture if your first choice of treatment doesn’t work like you thought it should, and make sure to take care of yourself and your patients. With some simple cleaning rules in your hospital you can prevent the panic.