Food Protection Connection: Superbug Calls for “Super” Hygiene

(reprinted from Dietary Manager, May 2008)

Heightened concerns about methicillin-resistant Staphylococcus aureus (MRSA) have dietary managers asking new questions about sanitation and infection control. Outbreaks of virulent Staph infections from this particular strain of the bacterium have hit healthcare organizations hard over recent months. However, the impact is not limited to hospitals and nursing homes. Day care centers, schools, and universities have experienced high-profile infections, too, afflicting young people who would otherwise have been considered healthy.

Deaths from MRSA have been on the rise, and not only the aging or ailing are losing their lives to this infection. According to the CDC, MRSA was responsible for an estimated 94,000 life-threatening infections and 18,650 deaths in 2005. More people died from MRSA infections than from AIDS that year. Here are more facts:

• Two-thirds of MRSA can be traced back to a hospital stay or exposure in a healthcare setting.
• People over age 65 are at heightened risk, being four times more likely to get a MRSA infection (compared with the general population).
• Staph bacteria can live on the skin of healthy people. (Colonization means bacteria are present but are not causing illness.)
• One in four individuals is colonized with Staph bacteria.
• 1 percent are colonized with MRSA.

Staph in Healthcare Settings

Problems with Staph bacteria in hospitals and related settings are not new. Because Staph bacteria colonization is so common, the bacteria are easily spread in a healthcare environment. For example, a nurse caring for a patient with an open wound can inadvertently infect the wound, resulting in a Staph infection for the patient. This is one of the reasons handwashing is considered critical in all healthcare environments.

What’s changed is that today, some of these infections are much more difficult to treat. In the past, a physician could prescribe an antibiotic such as methicillin to kill the bacteria and cure the infection. As bacteria emerge and adapt to today’s environment, some have genetically altered themselves to resist methicillin and other commonly used antibiotics. MRSA infections can lead to invasive infections such as necrotizing pneumonia, sepsis (an infection of the bloodstream), and other life-threatening conditions.

Many scientists attribute the rise in antibiotic-resistant bacteria to the intensive use of antibiotics throughout the world, in both farming and medicine. New research reported in Science magazine (April 4, 2008) suggests that bacteria living in soil not only resist many of today’s antibiotics, they can actually eat the antibiotics, and thrive! This underscores the ability of bacteria to adapt more quickly than researchers can invent new drugs for treatment.

The MRSA “Family”

MRSA falls into a broader category the CDC labels as multidrug-resistant organisms (MDROs). Other bugs in the family include vanomycin-resistant enterococci (VRE ), penicillinresistant Streptococcus pneumoniae (PRSP), and others. According to the CDC, MRSA and VRE are the most common drug-resistant pathogens in non-hospital healthcare facilities, such as nursing homes. PRSP is common in outpatient care settings. A CDC report on MDROs in health care states, “The prevention and control of MDROs is a national priority—one that requires all healthcare facilities and agencies to assume responsibility.” (CDC. Management of MDROs in healthcare settings, 2006)

Advancing age is one of the risk factors for both colonization and infection with MDROs, says the CDC. Additional risk factors include invasive procedures (e.g., dialysis or urinary catheterization), underlying disease conditions (e.g., chronic renal disease, insulin-dependent diabetes, peripheral vascular disease, or skin lesions), previous exposure to antimicrobial agents, and repeated contact with the healthcare system.

MRSA in Meat

A study released in the United Kingdom (UK) in 2007 reveals that MRSA is directly contaminating the food chain. In the Netherlands, 20 percent of pork, 21 percent of chicken, and 3 percent of beef recently tested positive for MRSA, according to the UK Soil Association. The Association also notes that half of pig farmers in the Netherlands carry the resistant bug themselves. This suggests the germ is transferring to people directly from farm animals. Like the US, the UK is experiencing troubling outbreaks of MRSA illnesses.

Staph bacteria can directly cause foodborne illness. One vehicle for transmission is human hands. This is why basic hygiene procedures stipulate that an employee with an infected wound cannot handle food. There could be Staph bacteria in the wound, and these can enter food. Staph-related foodborne illness is both an infection and an intoxication (the bacteria produce a toxin). At the same time, it is important to know that Staph bacteria can cause a variety of infections through a variety of mechanisms. The highly publicized MRSA illnesses are NOT foodborne illness but can be spread by foodservice workers.

Back to Basics

Foodservice managers everywhere are asking how to play a part in prevention. The CDC’s answer is that standard precautions should be used for all patient care. Above all, this means handwashing and exclusion of workers who have Staph infections.

A foodservice worker can spread the germ by handling food or food contact surfaces, if MRSA bacteria are present on the skin or in a skin lesion. A foodservice worker can also spread the germ by handling dirty dishes from an infected patient or resident— and not washing hands before contacting food. Isolation procedures for an infected individual vary, but many healthcare organizations are using a private room plus gloves for all workers contacting the patient.

Every single person working in a healthcare environment can help prevent the spread of MRSA by practicing impeccable hygiene—wearing clean clothes to work, and washing hands after touching soiled dishes, using the bathroom, handling trash, and before preparing or serving food. Many foodservice managers have stepped up employee education and monitoring to ensure diligent handwashing. Many are also monitoring employee health more carefully than ever, with attention to restriction and exclusion policies. The CDC reports that standard infection control practices do indeed help control the spread of MRSA.

In many healthcare institutions, infection control officials ask all employees having contact with an infected patient to wear disposable gloves. This can apply to a foodservice worker handling a soiled meal tray. However, policies and procedures vary, so check with the infection control specialist in your own organization to fine-tune your foodservice hygiene procedures.

Sue Grossbauer, RD, author of several books, and a regular contributor to DIETARY MANAGER magazine.