Managing community-acquired MRSA lesions: What works?

In sports environments. Athletes who have a CA-MRSA infection should not compete unless the wound can be completely covered with a dry dressing. Recommend to those in charge of school and commercial facilities that, in a confirmed case of MRSA infection, they routinely clean locker rooms and sports equipment with either a 10% bleach solution or commercial disinfectant. There is no evidence, however, that more widespread or vigorous cleaning—such as dismantling a training room and all its cardio-fitness equipment for disinfecting—prevents the spread of MRSA.

Encourage athletes to wash their hands properly. Communal towels should be washed in hot water (>140°F) with bleach before reuse. Personal equipment should be cleaned according to the manufacturer’s instructions. Athletes should use a clean towel to provide a barrier between their skin and the surfaces of weight-room and cardio-fitness equipment. They should also clean equipment before and after use with an appropriate cleanser, such as a disinfectant hand wipe.

Avoid unproductive actions

Screening household contacts for MRSA isn’t useful; attempts to eradicate colonization are generally ineffective. In a large study of military personnel, intranasal mupirocin failed to decrease nasal carriage of MRSA and the incidence of MRSA infections.¹¹ The MRSA nasal colonization rate was 3.9%; 121 persons colonized with MRSA needed to be treated with nasal mupirocin to prevent one MRSA infection in the total study population.

More complex antibiotic regimens are sometimes used in an attempt to eradicate MRSA carriage, but they also have limited effectiveness and carry the general risks of antibiotic use (e.g., gastrointestinal disturbance, allergic reaction). If your office is considering an eradication attempt, consult first with an infectious disease clinician.

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