You’ve probably heard a lot about MRSA in the news lately. The press, both print and electronic, seems to be covering this infection out of all proportion to the infection’s true frequency and lethality. Unfortunately, this only seems to have served to frighten people.

MRSA is something that we in Public Health and in hospital medicine have been dealing with for a long time, at least for 20 years. Most cases of Methicillin-Resistant Staphylococcus Aureus are hospital-based (approximately 85%), but there has recently been a slowly growing number of cases in the community. One of the higher profile locations for MRSA infection was the locker room of the USC football team. When a couple of team members had skin infections caused by this brand of Staph Aureus two years ago, it resulted in a widespread change in the hygiene practices within the locker room, and there has been a lot of discussion about it since. The reaction was a bit excessive, and it spawned some unnecessary recommendations involving schools and health clubs.

Staphylococcus Aureus is a germ that has been infecting human beings for centuries and probably longer. It’s quite possible that the germ has been associated with us humans for as long as humans have been on the planet. It’s been the most common cause of abscesses and boils. These are skin infections that begin as pimples and then progress to red, swollen lesions containing pus. The yellow pus with which we are familiar is that color because of all the white blood cells that are there fighting the infection. But of course, the pus contains a lot of Staph germs too and is contagious.

Most Staph Aureus is not Methicillin resistant. Regular Staph Aureus, which can be killed by Methicillin, and Methicillin Resistant Staph Aureus both behave in the same way. The difference between them is which antibiotics must be used to kill the germ. Until the 1960’s, penicillin was adequate to kill Staph Aureus, but then the germ became resistant to that. Pharmaceutical companies invented Methicillin, a synthetic form of penicillin, and that antibiotic was sufficient for Staphylococcus Aureus until about 15 to 20 years ago, when the first strains of Methicillin Resistant Staphylococcus Aureus emerged. Over the years the percentage of Staph Aureus that is Methicillin resistant has increased because of the use of Methicillin. So naturally we’re finding a bit more of it recently than we did in years past. Just because it is resistant to Methicillin does not mean that MRSA is not able to be killed by some other antibiotic. It’s merely a question of which antibiotics must be chosen. It is exceedingly rare for Staph Aureus to be resistant to every antibiotic that we have on the planet.

The reason that Staph is everywhere, and the reason that we will never eradicate it is because many people, (including hundreds reading this article) are at this moment, carrying the germ in their noses. We refer to this as your body having been "colonized" with Staph Aureus. Somewhere between 70 and 90 percent of all people are colonized at some time in their life with Staph Aureus, and 20 to 30 percent are colonized permanently, meaning that the Staph infection cannot be eradicated from those carriers.

People who are colonized are not ill and not aware that they are carrying the germ. But once in awhile, people will become infected with the disease of Staph Aureus which will cause, as we said above, abscesses in the skin. Occasionally the germs can burrow deeper, particularly if the skin infections aren’t treated, and then the disease can become very serious and even fatal. It can infect the blood, the lungs or the brain.

The reason that Methicillin resistant strains have emerged is frankly due to irresponsible behavior on the parts of both physicians and patients. We use too much antibiotic in this country and have for years. Doctors often give antibiotics when they aren’t necessary (for instance, in cases of colds or flu), and patients often insist on antibiotics, feeling that they been "gypped" if they go to see the doctor, get an examination and aren’t given a prescription. The result is that the Staph germ, often simply colonized in someone’s nose and not causing any illness, has seen a lot of Methicillin over the years and has learned how to become resistant to it.

As it stands now, the major risk factors for acquiring MRSA are as follows:

It’s time for a story. In the mid-1800’s, an obstetrician in Vienna named Semmelweis was in charge of the medical students at a "lying in hospital". That means a hospital where women go to have their babies. There were two wards in the hospital, one run by doctors, one run by midwives. In those days it was not unheard of for women to die in childbirth, that is, go into the hospital in labor to have a baby (usually a happy event) and the mother leaves the hospital in a casket. Semmelweis noted, however, that there was a difference in mortality rates between the two wards. Most years, the maternal mortality rate in the midwives’ ward was two to three percent (a rate that would be absolutely unacceptable in this day and age). However, on the physician-run side, the maternal mortality rate usually ranged between eight and 12 percent.

Through simple observation, Simmelweis theorized that the common practice at the time among doctors of smearing blood on their gowns to show how much experience they had and therefore how good a doctor they are, and never washing their hands, may have played a role. He used all of his influence (and almost got fired for it) to insist that all physicians and medical students wash their hands before doing examinations on pregnant women. It was quite difficult to force this change in common medical practice but he did, and the results were dramatic. Maternal mortality rates dropped in the physician’s ward down to levels found commonly on the midwive’s ward.

So, how do we prevent the spread of MRSA? There are five important activities that will accomplish this:

Trembling in fear over MRSA, variously reported in the press as a "Super Bug", or the killer germ or a horrendous infection is of no help whatsoever. The truth, the facts, and washing your hands are.