Study Leads to New MRSA Training Course
By Rebecca Ruiz-McGill

(University Communications)

A mark that looked like a spider bite on a Tucson firefighter's foot has turned into a nationwide public health call to action.

The mark and a series of other rashes on local firefighters were identified as Methicillin-resistantStaphylococcus aureus, commonly known as MRSA – a potentially deadly infection caused by a strain of staph bacteria that can become resistant to antibiotics.

A University of Arizona study found high levels of MRSA bacteria on couches, class desks and commonly touched surfaces in Tucson Fire Department offices. Prompted by these results, firefighters now are taking strict prevention measures, and UA researchers have developed an online training program to help firefighters across the country recognize and prevent MRSA infections.

"The UA has done a tremendous service for fire departments everywhere," said Ed Nied, a deputy chief with the Tucson Fire Department. "We'd like more people to know about the study and the training because they contain life-saving information that any first responder can use."

UA Mel and Enid Zuckerman College of Public Health researchers began the first study of its kind to assess the occurrence and frequency of MRSA bacteria on surfaces in Tucson fire stations, training sites and offices of emergency medical responders.

Kelly Reynolds, a UA researcher and public health educator, and her team initially collected 500 samples at nine fire-related facilities in Tucson. They found the highest prevalence of MRSA bacteria on the couches, class desks and commonly touched office surfaces.

In 2007, the year the study began, 15 cases of MRSA were reported among Tucson fire station employees. Nationally, the number of reported cases is growing; in one case, a Texas firefighter died from a MRSA infection.

"The findings let us know that the initial cases of MRSA were not isolated – the potential for contamination was evident. Once we certified the presence of MRSA contamination, we knew there was a need to help prevent its spread within this vulnerable community," Reynolds said.

The research, published in the June issue of the American Journal of Infection Control, to date is the only published study on MRSA contamination of fire stations in scientific literature.

The International Association of Firefighters considers MRSA a serious threat to emergency healthcare responders, as they are at higher risk of exposure because of communal lifestyles in fire stations and frequent contact with high-risk populations in hospitals, nursing homes and prisons.

S. aureus is an opportunistic pathogen able to cause conditions ranging from minor skin infections to life-threatening pneumonia, septicemia and death.

Some strains of S. aureus have developed resistance to many commonly administered beta-lactam antibiotics. Staphylococcus strains that exhibit this resistance are known as methicillin-resistant Staphylococcus aureus, or MRSA.

Each year, an estimated 126,000 hospitalizations are attributed to MRSA, with 94,000 being invasive, leading to approximately 19,000 deaths. Since the late 1990s, there has been a significant increase in MRSA infections – a 500 percent increase since 2003 alone.

It's estimated that 14 percent of all deaths in the U.S. yearly are attributed to MRSA – this includes people with no recent exposure to hospitals and patients in long-term care facilities.

The UA study was divided into three phases. The first phase was an exploratory survey with 500 samples from nine fire-related occupational and training facilities. The second phase was a repeat monitoring involving 160 samples. The third phase was a mitigation effort using EPA approved MRSA agents. All sites were sampled every five days or so for a total of 10 times over a period of two months.

Reynolds' team included Jonathan Sexton, who oversaw the MRSA testing aspect of the study, and community health master's student Kelly Hager. Hager, as part of an internship requirement at the College of Public Health, developed the MRSA 101 training course to help firefighters recognize the risk of exposure and contamination as well as provide them with knowledge on how to prevent its spread.

The training is available courtesy of the UA's Global Health Institute, part of the Mel and Enid College of Public Health, through an educational website that provides certification as well as community health and wellness training.

Firefighters and emergency medical responders across the nation are now enrolling to earn MRSA 101 certification through the training developed by Hager, which is available for free to anyone interested in the topic. Hager said the site, which has been up and running since February, typically certifies five new firefighters or paramedics a day.

"As a result of the study, we have made dramatic changes to our environment," Nied said. Changes included reupholstering furniture to remove material where the bacteria was found.

"Couches are now covered with a material that is wear resistant with an antimicrobial layer, and we removed carpets," he said. "We made specific changes to any area where the infection-causing bacteria can harbor."

Nied has become an MRSA educator and travels internationally teaching other fire department personnel about the study and changes that have been implemented that have led to no new cases of MRSA in the Tucson Fire Department.

Entrances now are installed with hand sanitizer, and its use is now required upon entering buildings. Routine infection control protocols include daily disinfecting of all commonly used surfaces such as television remote controls and computer keyboards.

Other guidelines implemented include designating "clean" and "dirty" areas. The clean areas include anything not in the apparatus bay such as living areas, dorms, bathroom, livingroom and kitchen, are treated with increased caution – tools, clothing and boots are not allowed.

Precautionary procedures for responding to emergency calls have also been implemented, reducing the transfer of MRSA bacteria from field to the station. Infection-control guideline levels are now in place for specific types of calls, particularly those thought to be high-risk for infectious disease transmission.