COMMUNICABLE DISEASES

Prevalence of MRSA on UNH Campus

Emily Hazelton, Jasmine Brousseau, Ariana Lodise, Katelyn OConnor,

Colleen Martell, Molly Gardineer

Preceptor: Judy Stevens

NURS 704P: Public Health Project

Raelene Shippee-Rice, Ph.D

University of New Hampshire

Abstract

The prevalence of Methicillin-Resistant Staphylococcus aureus (MRSA) on the University of New Hampshire campus was examined. MRSA can be transmitted through skin to skin contact and it is also found on items that people might share such as towels, razors, keyboards, athletic equipment, and showers. Many students use Dimond Library, Hamel Recreation Fenter gym, and the athletic Field House weight room on the UNH campus. Six samples from each location were cultured and examined for the growth of MRSA. Computer keyboards, mice, and printing stations were swabbed at the library and gym equipment such as weights, benches, and yoga balls were sampled from the Hamel Recreation gym and the athletic Field House. MRSA was found at all three places. MRSA can be contained with proper cleaning of equipment and hand hygiene. Interventions included teaching and education packets to the administrators of the three locations as well as signs reminding students and faculty to clean their hands and the equipment before and after using them. Further research should be done to evaluate the effectiveness of the interventions presented.

Preplanning

Staphylococcus aureus is a gram-positive bacteria found in the normal flora of the nares and skin of most people. Studies show that about one in three people carry staph in their nose, usually without any illness (Centers for Disease Control, 2014). People can be carriers of Staph aureus and never have an active infection. Staph aureus infection commonly causes skin infections such as boils and impetigo. Staph aureus can also cause food poisoning if food is prepared improperly. When antibiotics were created, Penicillin was often used to treat Staph aureus infections. Antibiotics were sometimes misused or overused which led to drug resistant microbes. S. aureus developed resistance to Penicillin. Methicillin, a form of Penicillin, was introduced to counter the increasing problem of Penicillin-resistant S. aureus. Methicillin was one of most common types of antibiotics used to treat S. aureus infections; but, in 1961, British scientists identified the first strains of S. aureus bacteria that resisted methicillin. This was the so-called birth of MRSA (National Institute of Allergy and Infectious Diseases, 2008). MRSA used to be more common in healthcare settings but now has become a public health concern. Methicillin-Resistant Staphylococcus aureus is a type of Staph aureus bacteria found in hospitals and the community. In the general community, MRSA can cause skin and other infections. In a healthcare setting, such as a hospital or nursing home, MRSA can cause severe problems such as bloodstream infections, pneumonia, and surgical site infections (Centers for Disease Control, 2014). MRSA, like Staph aureus can be found on many items in the community and it is important to maintain personal hygiene and avoid unnecessary sharing of equipment and items. Anyone can get MRSA through direct contact with an infected wound or by sharing personal items, such as towels or razors, that have touched infected skin. MRSA infection risk can be increased when a person is in certain activities or places that involve crowding, skin-to-skin contact, and shared equipment or supplies. This might include athletes, daycare, and school students, military personnel in barracks, and people who recently received inpatient medical care (Centers for Disease Control, 2014). Without the proper cleaning of sporting equipment, gym equipment, public computers, bathroom stalls, etc., people may be exposed to MRSA. The University of New Hampshire contains 12,500 undergraduate students and 2,200 graduate students all whom share library computers, tables, gym equipment, dorm room showers, and many of the other amenities that the campus has to offer which means MRSA may be highly prevalent on the UNH campus.

The University of New Hampshire has a Health Services building that is located on campus in Durham, NH and provide medical healthcare and wellness education to students, faculty, and staff. The Health Services mission is as follows:

The University of New Hampshire Health Services promotes, maintains and improves the health and well-being of the University community in support of the institutions academic mission. This is accomplished by providing primary health care services, by teaching health care consumerism, illness prevention and health promotion, by providing co-curricular learning opportunities for students, and through its public health role. Services are accessible, cost effective, and provided in a caring and professional manner. University employees have convenient access to certain clinical and educational services, as well. Health Services continuously improves the quality of its care and services.

UNH Health Services uses a holistic approach to promote wellness and illness prevention physically, socially, emotionally, spiritually, environmentally, intellectually, occupationally, and economically. The Universitys Health Services team professionally treats all students with dignity and respect by maintaining confidentiality and providing the most up to date evidence based care.

Working with Judy Stevens, the public health nurse at the University of New Hampshire Health Services, we decided to inquire about Methicillin-Resistant Staphylococcus aureus on campus. Judy Stevens is notified when a person is diagnosed with MRSA at Health Services or if three or more persons in a confined area (sports team, dorm room hall, etc.) are diagnosed. According to Judy Stevens, MRSA has been identified among students at the University of New Hampshire campus several times within recent years. Judy Stevens reports, This year I have had 3 positive MRSA cases reported to me thus far. They have been community acquired. It is important to note that many people are diagnosed at home and not reported so this is an underestimate of actual cases. To my knowledge no sports teams have been involved for the past year, 9/13 -9/14. In recent years we have seen outbreaks on the football team and crew and mens hockey (Stevens, 2014). Although only three outbreaks have been identified this year, it is only the beginning of the year and many students go to their primary care doctors instead of Health Services. It should also be kept in mind that MRSA is not a reportable disease, and students are not required to notify UNH Health Services of any MRSA infections that were diagnosed at other facilities. From discussion with Judy Stevens and our student experience with MRSA in hospital settings, we decided to pursue the investigation of this communicable health issue to determine if MRSA is truly a public health concern on the UNH campus that is worthy of an intervention.

Before intervening and educating students, faculty, and those from the public that use the facilities about MRSA on campus, we decided to investigate and see if MRSA was actually present on campus. MRSA was identified in three people this year, and in the past years, but we wanted to be sure of its significance. In order to investigate the prevalence of MRSA around campus, we decided to swab the areas we thought were likely to have MRSA spread among students: the Field House athletic weight room, the Hamel Recreation Fitness Center, and the public computer area in Dimond Library. The experiment we have created along with the research conducted, will help us determine if MRSA is prevalent on the University of New Hampshire campus and help us create an intervention based on the results.

Assessment and Analysis

Research is necessary in order to validate our experiment. Using the database CINAHL, articles were chosen based on their relevance to MRSA infection among college campuses, including outbreaks on athletic teams. It was found that research had been conducted across the country on this issue. In many cases it was determined that the spread of MRSA was not hospital-based, rather it was found to be community-acquired. One study concluded that for more than 40 years, resistant S. aureus presented a formidable problem to hospitalized patients; in the past decade, however, it has begun to appear outside the clinical settingoften in young people without significant medical conditions. (Weiner, 2008). The same revelation was found in a study by Sanders, stating that MRSA could usually be linked to a health care setting acquisition. In the late 1990s, a different type of MRSA emerged within the community setting. This new type could not be linked with a prior history of health care exposure (Sanders, 2009). Another study examined the carriage rate of MRSA in the nares of athletes and found that of the 203 participants who were screened, 60 (29.6%) carried S. aureus. (Rhode, 2009) These carriers have the ability to spread the bacteria despite no signs of infection. Our experience shows that the athletes are consistently exposed to MRSA from the community and that cross-transmission occurs among team members (Romano, 2006), thus proving that MRSA is increasing in numbers in the community and is no longer just a hospital-acquired infection. We also looked to the literature to identify practices to reduce the amount of MRSA in high traffic areas. It was found that common-sense approaches to prevention, along with intelligent use of the laboratory and available antimicrobials, can protect patients from this new threat (Weiner, 2008). Because not everyone in the population of interest is aware of the ramifications of MRSA, an education program may be a beneficial interven