ChiroACCESS: Methicillin-Resistant Staphylococcus aureus (MRSA) and Chiropractic: What you need to know

Methicillin-Resistant Staphylococcus aureus (MRSA) and Chiropractic: What you need to know

This information is provided to you for use in conjunction with your clinical judgment and the specific needs of the patient.

Will Evans, DC, PhD, CHES Michael Ramcharan, DC

Published on September 14, 2009

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INTRODUCTION

Methicillin-Resistant Staphylococcus aureus (MRSA) is a type of Staph bacteria that resists an entire family of antibiotic therapies. ¹ Infection with MRSA is becoming more and more prevalent and is also surfacing more outside of a health care or hospital environments. Two categories are noted with one being community-associated MRSA (CA-MRSA) and the other hospital-associated MRSA (HA-MRSA). ² MRSA can be isolated from the surfaces of various treatment equipment and instruments including stethoscopes and otoscopes ³, clothing or gowns ⁴, gym training surfaces ⁵, and recently, chiropractic treatment tables. ⁶

According to the American Medical Association, by 2005 there were almost 100,000 cases of MRSA infections in the United States and at least five studies on prevalence and surveillance in chiropractic teaching clinics have been conducted that demonstrated the presence of MRSA and other pathogens on treatment table surfaces. ^6,7,8,9,10 As a matter of patient and doctor/staff safety, protocols should be adopted to reduce this threat and one such recommendation has been published in the United States and one in Australia. ^{11, 12}

RISK FACTORS

Various risk factors exist for the two types of MRSA. Among them, recent hospitalization or previous infections with MRSA are significant for HA-MRSA as is residing in a long-term care facility or long-term antibiotic use. CA-MRSA is more common in younger people, immuno-compromised, contact sports participants, prisoners, and those living in crowded or unsanitary conditions. ²

In general, misuse of antibiotics, antibiotic use in food production, and bacterial evolution has caused this increasing epidemic of MRSA. There are several items that are outlined in a protocol paper by Evans and colleagues on what should be done in the chiropractic setting¹¹ and it can be accessed free from the Journal of Chiropractic Medicine at: http://download.journals.elsevierhealth.com/pdfs/journals/1556-3707/PIIS1556370708001314.pdf

PREVENTION STEPS

Among the most important prevention techniques in the chiropractic practice are;

washing hands or sanitizing hands with an alcohol rub between each patient
having sanitizer accessible as a wall dispenser or pocket bottles that the practitioner can carry and use in between patients
sanitizing the chiropractic table between each patient with an appropriate CDC and OSHA compliant sanitizing wipe and having staff do the same
identifying patients who are at risk for the infection and taking appropriate steps to prevent spread in the office and;
sanitizing other surfaces in the office regularly such as instruments, machines and surfaces touched by patients and staff

Proper hand hygiene is recognized as the leading measure and the single most effective means to prevent, control and reduce the incidence of healthcare related infections. The importance of hand hygiene and sanitizing the surface of the table cannot be over- emphasized. However, each of the steps involved are generally very simple to perform and are a bargain for the risk reduction they provide.

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References

1. US Centers for Disease Control and Prevention. Management of Multi-drug Resistant Organisms in Health Care Settings, 2006. The Health Care Infection Control Practice Advisory Committee. [ Full-Text Link ]

2. Zeller, JL, Burke AE, Glass RM. MRSA Infections. JAMA, 2007;298(15): 1826.

3. Stethoscopes and otoscopes: a potential vector of infection? Fam Practice. 1997;14(6):446-449.

4. Graham, M, Snyder, MD, Kerri, A, et al. Detection of Methicillin-resistant Staphylococcus aureus and Vancomycin-resistant Enterococci by healthcare workers on infection control gown and gloves. Infect Control Hosp Epidemiol. 2008;29(7):583-589.

5. US Centers for Disease Control and Prevention. About Methicillin-Resistant Staphylococcus aureus (MRSA) Among Athletes. November 2008. [ Full-Text Link ]

6. Bifero, AE, Prakash, J, Bergin, J. The role of chiropractic adjusting tables as reservoirs for microbial diseases. Am J Infect Control 2006;34:155-157.

7. Pokras RS, Iler LL. Bacterial load on the chiropractic adjusting table. J Aust Chiropractors’ Assoc 1990;20:85-90.

8. Evans MW, Breshears J, Campbell A, Husbands C, Rupert R. Assessment and risk reduction of infectious pathogens on chiropractic treatment tables. Chiropr and Osteopathy 2007;15:8 doi:10.1186/1746-1340-15-8.

9. Evans MW, Campbell A, Husbands C, Breshears J, Ndetan H, Rupert R. Cloth-covered chiropractic tables as a source of allergens and pathogenic microbes. J Chiropr Med 2008;7:34-38.

10. Burnham K, Peterson D. Impact of microbial surveys on disinfection protocols in the chiropractic college environment [Abstract]. In: Proceedings and Abstracts of the Association of Chiropractic Colleges Research Agenda Conference. Tyson’s Corner, VA. J Chiropr Ed 2008;22:51.

11. Evans, M, Ramcharan, M, Floyd, R. et al. A proposed protocol for hand and table sanitizing in chiropractic clinics and education institutions. J Chiropr Med. 2009;8:38-47. [ Full-Text Link ]

12. Crawford B, Cameron M. Risk prevention strategies and infection control for chiropractors and osteopaths-part II. General prevention of infectious disease. In: Chiropractic and Osteopathic College of Australasia: Risk Management Program II Edited by: French S. Victoria, Australia: Chiropractic and Osteopathic College of Australasia. 2003: 33-6.