Lance Cpl. Richard Blumenstein Proper hygiene is essential to preventing infection. USNA photo by MCSN Michael Croft.

MRSA is not new. What’s new is the recent media attention it’s been getting. According to CDC, nearly 90 million people in the U.S. carry naturally occurring bacteria ''staph'' on their skin and nose, out of which over 2 million of these carriers have MRSA, the mutated form of staph that is resistant to many antibiotics. Serious MRSA infections occur in approximately 94,000 persons each year and are associated with approximately 19,000 deaths. Of these infections, about 86% are healthcare-associated (HA-MRSA) and 14% are community-associated (CA-MRSA).

The media has reported concerned parents calling for drastic measures to protect their children including the use of preventative mass antibiotics and the complete closure and sterilization of schools. Unfortunately, staph bacteria have outsmarted most antibiotics and the few that remain successful have become a last resort. Also, as soon as a decontaminated school reopens, the possibility for recontamination remains with the return of students.

Despite these attempts, deadly MRSA infections are preventable. The solution is with personal protective measures. These work with common diseases too, including the flu. This is where you come in. What would you do if you saw smoke coming from the main engine room? You would report it! What would you do if critical watertight integrity was lost? You would secure it! This same attitude taken towards combating disease will ensure your safety as well as that of your shipmates.

CA-MRSA is found in settings where the five C’s (crowding, frequent skin-to-skin contact, cuts or abrasions, contaminated items and surfaces, lack of cleanliness) increase the risk of spread. These settings include schools, military units, and athletic venues. CA-MRSA is most often spread through direct contact with contaminated skin, shared clothing, towels, personal hygiene items or training equipment. Prolonged person-to-person contact and lapses in personal hygiene can create ideal conditions for CA-MRSA transmission.

The following are personal protective measures for you and your shipmates in the battle against MRSA:

- If you see a skin infection, such as abscesses, boils, and other pus-filled lesions on yourself or your shipmate, report it to medical personnel.

- If you have a skin infection keep it covered with a clean dressing and avoid swimming, contact sports, and other close contact activities.

- Thoroughly wash your hands with soap and water a minimum of 5 times per day, including before meals and after toileting. An alcohol-based hand sanitizer serves as a great alternative when soap and water is not readily available.

- Take adequate showers daily or more frequently as necessary.

- Do not share personal items such as towels, razors, soap, or other toiletries.

- Do not reuse soiled clothes or towels. These items should be laundered daily with detergent and hot water.

- Disinfect athletic areas and sports equipment at least weekly using a commercial disinfectant (look for EPA-approved, hospital-grade germicide on the product label) or a fresh (daily mix) solution of 1 part bleach to 100 parts water (1 tablespoon bleach in 1 quart of water). Bleach solution must be left on surfaces for at least 5 minutes to achieve maximum disinfection.

- For cleaning of sports equipment (i.e. weight bench or helmet) prior to use, wipe surface with a clean dry towel. If sanitary wipes are available in the gym facility, use the wipes to clean the equipment before use.

- Use a towel or clothing as a barrier between the skin and shared equipment.

- Disinfect commonly touched or soiled surfaces in your living quarters on a regular basis using an EPA-registered product effective against Staph: http:⁄⁄www.epa.gov⁄ . Follow label instructions for use.

These easy and practical personal protective measures were put to the test over the course of Plebe Summer 2007. In a collaborative effort between Naval Health Clinic Annapolis and Naval Academy leadership, these measures, as well as other education and infection prevention initiatives, were implemented to improve hygiene and control the incidence of CA-MRSA infections among plebe Midshipmen. MRSA prevention education sessions were provided to plebes, training cadre, and the medical staff. Handwashing was emphasized, and hand sanitizer was made readily available in the mess hall and as issue in medical welcome aboard packages for plebes. In addition, showering times were increased to 3-5 minutes in length, weekly antiseptic showers were encouraged, and weekly environmental cleaning of plebe personal spaces and gear was recommended. These efforts contributed to an 83% drop in the incidence of MRSA wound infections as well as a 71% reduction in lost physical training time among Plebes. These observations support the premise that education and enhanced hygiene are reasonable strategies to help control the incidence of skin infections that are easily spread through close contact with individuals and⁄or contaminated objects. Monitoring of MRSA cases and considerations for continued improvement are ongoing at Naval Health Clinic Annapolis.