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questions about cross contamination
Started by Carrie
Posted: September 19, 2009 at 05:50
I moved in with my roommate about a month before he had surgery. I knew at that time that I had staph. Unfortunately, I didn't realize this was MRSA, for over all these years of chronic infections, MRSA was never mentioned, nor did I tap into the right resources to find this out myself or at least the possibility. Anyway, moving on.

3 days after returning home his incision became infected and he was hospitalized for another week, on Vancomycin IVs, then sent home to continue this for another 3 weeks...

I visited him in the hospital a couple of times during both stays. The first time I visited him on the second hospitalization I stopped by the nurse's station and asked permission to enter his room, specifically I asked if it was appropriate for me to just go in. The nurse said sure, go ahead and thanks for asking. There were no gloves, gown, mask at that time. The next time I went, they had the door posted with instructions to use these precautions.

When the home health care people came to "teach and train" for the IV treatment, they wanted me to do it. I told them I could not, as I had a problem with staph infections. I never touched his incision. We are not physically close, just friends, not touchy, and don't sleep together.

It was after he came home that I went to a walk in clinic to have a cyst lanced and drained. I (once again) talked of these chronic staph infections. This is the first time I heard MRSA.

So here I am, facing the treatment for myself, hope I can get the Vanco, may be issues. He has just finished the last IV. I have been diligent about disinfecting. I keep all my personal things like toothbrush, toothpaste, towels, etc. in my bedroom. When I use the toilet I clean the seat and all surrounding surfaces with a bleach cleanser. Constantly wiping surfaces in the kitchen. When I prep food I wear gloves. When I wash dishes, I add a little bleach to the water.

I am so upset because this man was so kind to take me in as a roommate, I really needed a place to stay. And now I have to wonder if I am responsible for his infection. And also wondering if I need to go somewhere else so I can't re-infect him. He had an angioplasty with stents at the inguinal arteries. His wounds have been covered so far, there's a sort of vacuum pump there, but it will be coming off soon.

Any advice would be appreciated, I feel so terrible about this. His doctors say the infection came from the hospital and kind of shrug me off when I inquire about cross contamination. They just say be hygenic.


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Re: questions about cross contamination
Reply #1 by Taunia
Posted: September 20, 2009 at 13:11
I totally know how you feel. I own a cleaning business and am in alot of homes. I have been battling mrsa since feb. Anyhow one of my clients had surgery and when she got home she got mrsa in her incision as well as an abcess. Could that be from me? I think that mrsa is getting so bad that it is everywhere. I dont think you can blame your self hun. But it would be nice if dr's actually researched a little more. I have three kids and I am deathly afraid of giving it to them. It sounds like you are doing everything you can possibly do so dont feel guilty!
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Re: questions about cross contamination
Reply #2 by ladyk
Posted: September 20, 2009 at 16:27
Carrie –

I understand your concerns. Most of us struggle with knowing we have the ability to cross contaminate others. This was a constant concern at our house too, having husband and college student coming and going. We took extended precautionary measures, and did not share bathrooms. If it helps ease your mind a bit, over three years later… neither has ever tested positive carrier status, nor became MRSA infected.

After I&D… was your lesion/purulent drainage cultured at walk in clinic?

Since we co-exist with staph aureus/mutations in our environment, there are so many variables it is difficult to say at what point, via what source… we become infected. Especially when cultures are not utilized directly.

If your strain and his strain are different (HA-MRSA vs CA-MRSA) you would know conclusively as to whether contamination came from you or not.

The only difference between you and another as far as cross contamination goes... is that you know you've had staph aureus complications in the past, and are aware of just how necessary precautions are to avoid cross contamination.

Keep up with impeccable precautions, at the end of the day he is being exposed to your MRSA strain, and you are being exposed to his. Precautions help to protect both of you and others.

Hope this helps you Carrie.

Best Wishes
ladyk
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Re: questions about cross contamination
Reply #3 by carrie
Posted: September 21, 2009 at 04:41
ladyk, thank you for your response. In answer to your question: The cyst has also been a problem over the years, it has been lanced 4 times now. It is not full of pus but sebum and has not been cultured.

I talked to the ARPN about chronic abcesses, showed her my scars, and a new baby abcess that had developed. I also let her know that a dermatologist had done a culture about 8 months previous and said it was staph, with a sensitivity to Omnicef.

Since 2 rounds of Omnicef didn't clear up the infection(s) and also because of the length of time I have had these infections, it was through deduction that she determined MRSA.

So because the dermatologist just said staph, not MRSA, should I believe that it is just regular staph? I don't think it is because of the many general health problems I have.

Anyway, just wanted to make this clear.

I am struggling with trying to find a way to live alone. I don't really think this is a good situation for either of us. Until and unless I can do that I will continue to do the best I can with this.

Perhaps I should get the records of this culture to determine what strain it is? Would this give me the answer? Why would my dermatologist say staph if it shows MRSA or do they look the same? I'm confused over this.

Answers are coming, I know I just have to ask the right questions.






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Re: questions about cross contamination
Reply #4 by ladyk
Posted: September 21, 2009 at 14:36
Carrie –

A couple of things come to mind when reading your post.

It has been the experience of many on these forums where often physicians neglect to divulge diagnosis of MRSA, rather they are inclined to say ‘staph’ infection. MRSA bacteria’s parent - if you will is… Staph aureus. MRSA is staph aureus which has mutated to more virulent strains which are resistant to Methicillin /penicillin class of antibiotics. MRSA is tougher to treat than most strains of staphylococcus aureus (or staph) because it's resistant to some commonly used antibiotics.

BRAND NAME: Omnicef
GENERIC NAME: cefdinir

DRUG CLASS AND MECHANISM: Cefdinir is a semi-synthetic (partially man-made) oral antibiotic in the cephalosporin family of antibiotics. The cephalosporin family includes cephalexin (Keflex), cefaclor (Ceclor), cefuroxime (Zinacef), cefpodoxime (Vantin), cefixime (Suprax), cefprozil (Cefzil) as well as many injectable antibiotics. Like other cephalosporins, cefdinir stops bacteria from multiplying by preventing bacteria from forming the walls that surround them. The walls are necessary to protect bacteria from their environment and to keep the contents of the bacterial cell together. Cefdinir is active against a very wide spectrum of bacteria, including Staphylococcus aureus; Streptococcus pneumoniae; Streptococcus pyogenes (the cause of strep throat); Hemophilus influenzae; Moraxella catarrhalis; E. coli; Klebsiella; and Proteus mirabilis. It is not active against Pseudomonas. Therapeutic uses of cefdinir include otitis media (infections of the middle ear), infections of soft tissues, and respiratory tract infections.

Omnicef is in the *cephalosporin class/family of antibiotics.

*MRSA is resistant to all penicillins and *cephalosporins.

You wrote:
[“I also let her know that a dermatologist had done a culture about 8 months previous and said it was staph, with a sensitivity to Omnicef.”]

Since you are being treated with Omnicef… if your affliction is indeed MRSA, it would be rendered useless due to resistant factor.

This is why it is important to be recultured. A culture that is eight months old (valued for history alone) would be as useless in diagnosing current issue, as being treated with ineffective meds.

I would strongly suggest a reculture, so without speculation you know what you are up against. It is quite plausible you started with sebaceous cyst, which became infected with staph aureus eight months back. Since it is possible for cyst to become infected with staph aureus (which co-exists on our skin), it is as possible for MRSA to capitalize on open wound. With any openings in skin surface we run the risk of contracting MRSA. So if these ‘cysts’ lead to openings at skin surface, you are at risk.

Obtaining previous culture report would be to your advantage in determining whether staph aureus vs MRSA was your affliction nearly a year ago. Location of cyst?

ladyk
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Re: questions about cross contamination
Reply #5 by carrie
Posted: September 23, 2009 at 16:00
ladyk thank you for the info. The cyst is on my left outer thigh. It hasn't caused as much problem for me as the boils in the armpit and groin, but was the impetus for this particular doctor's visit which led to MRSA diagnosis after she reviewed my history re the boils, and antibiotic history. I am currently working on getting all records to her, starting with the past cultures. Again, thank you.


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Re: questions about cross contamination
Reply #6 by carrie
Posted: September 25, 2009 at 01:23
ladyk. - Wow. Thanks for all this info. I'll try to answer a few of your questions here.

You wrote:[Are you immune compromised with pre-existing medical maladies, for example diabetes?]

I have genital herpes. I haven't had an outbreak since the first one, that was in 1988 or 89. Is that unusual? Nothing else that I know of other than prolapsed mitral valve, they say it's minor and the murmur can barely be detected.

My ARPN got the lab results from above mentioned dermatologist, who told me the culture was positive (8 months ago). The copy we got says negative. I called and asked about it and she said definitely negative. She had prescribed Omnicef twice based on a sensitivity test and she claims there is no record of such labs being done. Very strange. I am trying to get on medicaid, that's why all the concern over history. Also, the blood test recently taken at the hospital ER says negative for staph. Incubated for 72 hours, the ARPN thinks maybe not long enough? CBC shows no infection but very low lymph. Is this a low lymphocyte count? So in all, now I wonder if I even have MRSA at all!

I plan on getting another abcess cultured tomorrow morning. I have been on Bactrim and Doxycycline for almost 3 weeks now, so would this not skew the results? I will bring this up before the culture is done and check for your response before I go. Maybe I should get off the antibiotics (for how long) and then get a culture. I am sure of 2 things: The sun will rise, and I will get another abcess. They've been coming fast and furious for the last year.

It has occurred to me, in light of these developments that I my immunity is so low that a normal amount of bacteria is causing all these problems.

I am extremely fatigued and have been for at least 8 years, to this degree. My BP is quite low. My heart does a littly skippy jump for no apparent reason (heart murmur?) from time to time, and beats way too hard with minimal exertion. I have migraines with no aura, and plenty of vomiting.

But no diagnosis except major depression, lol.

Also, I was in a relationship for the most of this "really bad spell" of the last 8 years that was abusive. This really took me down physically. Not beaten physically, just emotionally and mentally. I'm out of that now. I know that the stress factor has made me a lot worse.

You asked about meds. Just the Doxy and Bactrim. Mupricin in the nose daily. I have been using Hibiclens for hand washing (2-3 times a day) and showers daily or every other d

The dermatologist did not do a scraping of the spots on my feet and legs. She prescribed a cream of some sort and said if it didn't work, which it didn't, she would culture it. What's the point? She'll just deny it, lol. But I will have this done.

All this is coming straight out of pocket and these pockets are very shallow...I need medicaid but seem to have no basis. I will do all I can but want to spend wisely when it comes to tests. Suggestions?










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Re: questions about cross contamination
Reply #7 by ladyk
Posted: September 25, 2009 at 06:11
Carrie –

You wrote
[“I plan on getting another abcess cultured tomorrow morning. I have been on Bactrim and Doxycycline for almost 3 weeks now, so would this not skew the results?”]

In my opinion… yes. In saying this it would be reasonable to believe if you are ingesting Bactrim and Doxycycline these are reducing bacteria. But if you are presenting with an ‘active’ lesion, it is worthy of culture and especially sensitivity providing list of current correct susceptible antibiotics for what ever culture grows. Be sure lesion is cleaned properly before (needle stick?) culture. Gloves worn. Site covered before leaving office.

Tests I would request
-ESR = (Erythrocyte sedimentation rate)
Elevated ESRs are not specific but generally do indicate inflammation. High neutrophil count (neutrophilia) can lead to leukocytosis which is associated with bacterial infection and leukemia. Low lymphocytes (lymphocytopenia) is associated with mononucleosis and malignancy. High blood platelets (thrombocytosis) is associated with, among other things, leukemia (CML), Hodgkin's, and other lymphomas.
Note: Keep in mind everyone is different and values do not conclusively apply to every one, every time.
-A1c (The A1C test shows average blood sugar level commonly over the past three months.)
-Culture & sensitivity/susceptibility of active lesion
-Scrape culture & sensitivity/susceptibility of lower extremities skin anomaly

You wrote
[“My ARPN got the lab results from above mentioned dermatologist, who told me the culture was positive (8 months ago). The copy we got says negative. I called and asked about it and she said definitely negative. She had prescribed Omnicef twice based on a sensitivity test and she claims there is no record of such labs being done. Very strange.”]

What?

I’ll respond to this and your other issues ASAP.

ladyk
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Re: questions about cross contamination
Reply #8 by carrie
Posted: September 25, 2009 at 11:53
ladyk, thanks for the quick response.

The foot and leg spots look like capillaritis.
The sores on soles of feet, looks like diabetic sores.
I believe, however that I have been tested for diabetes.

I will present these test suggestions to my ARPN today.

Bless you, you are doing good work here.

Carrie
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