Staphylococcus aureus is a common type of bacteria (germ) that is often found in the nose, but can also grow in wounds and other sites of the body, where the infection may cause great harm. Methicillin is an antibiotic or medication that is used to treat these infections. In the early days of antibiotic therapy, Penicillin was used to treat staph infections, but gradually the organism became resistant to most antibiotics except for methicillin. Over time, the bacteria have become resistant to methicillin as well, so this antibiotic is no longer able to kill the germ. If a person has an infection with this germ that cannot be treated with methicillin, the person is said to have Methicillin-resistant Staphylococcus aureus, or MRSA, and must be treated with other antibiotics.

Enterococci are bacteria that are normally found in the bowel and vagina of humans. When they get outside these areas, these bacteria can cause infections of the urinary tract, wounds, or bloodstream. Vancomycin is an antibiotic that usually works to treat these infections. Infections caused by Enterococci that are resistant to Vancomycin are called Vancomycin-resistant Enterococci, or VRE, and are very difficult to treat.

What conditions increase the risk of acquiring these organisms?

People may be carriers or infected with these germs. Carriers means that the germ is present in or on the body but is not causing illness. Infection means that the germ is present and is causing illness. Signs of illness can include fever, elevated white blood cell count, pus, pneumonia, and inflammation (warmth, redness, swelling).

In general, healthy people are at low risk of getting sick with MRSA or VRE. Risk factors for infection include history of using antibiotics; underlying diseases or conditions such as chronic renal (kidney) disease, insulin-dependent diabetes mellitus, peripheral vascular disease, and dermatitis or skin lesions; invasive procedures such as dialysis; presence of invasive devices such as urinary catheters; past hospitalization and long hospital stays; history of having a drug-resistant bacterium; and older age.

How are these germs spread from one person to another?

MRSA is transmitted primarily by contact with a person who has an infection or is a carrier of the bacteria. The germ can be spread by direct contact with the person or by the hands of someone caring for the person touching others before washing hands. MRSA can survive for an hour or more on environmental surfaces such as floors, sinks, blood pressure cuffs, etc. but these are NOT the most likely source of spread.

VRE can be spread person-to-person by the hands of personnel or indirectly on contaminated environmental surfaces and patient care equipment. Studies have found that VRE can live for a long time on hands, gloves and environmental surfaces. For example, the germ has been found after 5-7 days on countertops, 24 hours on bedrails, and 60 minutes on telephone handpieces.

What can be done to prevent the spread, especially in home care settings?

Patients who are carriers or infected with drug-resistant organisms who are discharged to their homes require no special control measures beyond regularly cleaning all surfaces contaminated by secretions or touched by hands. They should be allowed to socialize and participate in normal activities as long as draining wounds are covered, bodily fluids are contained, and good hygiene is practiced. Patients should tell anyone caring for them that they are carriers or infected with a drug-resistant germ.

• Handwashing is the most important way to prevent the spread. The risk of spreading the germ depends on the site of the infection in the patient and the type of contact each person has with the patient. Therefore, each person should take the appropriate precautions for the type of contact. For example, those with casual contact may simply wash their hands after the visit, while persons who expect to have contact with body fluids should wear disposable gloves. Hands should be washed after removing the gloves.

• Family members and visitors should wash their hands after direct contact with the patient or with items the patient has touched and before leaving the home. Hands should be washed with soap and water for a minimum of 10 seconds. Everyone should wash hands after using the toilet, before preparing food and before eating.

• Healthcare providers and workers that are providing care in the home of an infected person should follow the recommended practices and precautions. They should focus on preventing spread to others via the clinical bag, clothing, and medical or other equipment that is carried to and from the home by healthcare personnel. Reusable equipment must be cleaned either in the patient's home or bagged prior to leaving the person's home. Hands should be thoroughly washed before leaving.

• Those living with HIV/AIDS are at greater risk. Good hand-washing techniques and the use of gloves (barrier precautions) are keys to prevention and control. Hands should be washed before and after every contact with the infected person

• Cleaning: Linens should be changed and washed on a routine basis and any time they are soiled. Towels used for drying hands after contact should be used only once. Dishes should be washed in hot water and dried. The patient's environment should be cleaned on a routine basis and any time it is soiled with body fluids.