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Vital Signs: Staph infections can kill

October 2, 2019


>>Hi, everyone and welcome to our
special event here today at CDC. We are very glad to have you
joining us here for a Facebook live. We are going to be talking about
staphylococcus aureus, or staph. It’s one of the leading causes
of infections in the US. Now you’ve probably heard
of one type of staph before. A lot of people call it M-R-S-A
or MRSA, but today we’re going to be talking about all kinds of staph. I’m joined here by two CDC experts who are
going to talk us through some of the latest data from CDC on staph infection
rates and deaths from staph, as well as ways that you can protect
yourself and your family from staph as you go on living your every day lives. Before we get started, I do want to mention that
we’re going to be asking some questions today that we received in advance of the event. But, if we don’t get to your question or we
run out of time, please put your questions in the comment section and we’ll
do our best to answer them. So with all of that said,
let me introduce myself. I am Katy Capers. I’m the communications lead for antibiotic
resistance at CDC and I’m joined here today by doctors Alex Kallen and Athena
Kourtis who are going to talk to us more about staph and how to protect ourselves. So Alex, do you mind starting
us off with an introduction, what you do at CDC and outside of CDC.>>Sure, thanks Katy it’s a pleasure to be here. My name is Alex Kallen and I’m a practicing
infectious diseases physician and I also serve as the chief of prevention and
response branch in the division of healthcare quality promotion at CDC. My branch is charged with
developing and implementing programs to prevent healthcare associated infections,
to reduce the spread of antibiotics resistance and to make sure that people
use antibiotics correctly. We also are the branch that helps facilities when there’s outbreaks of
things like staph aureus.>>Great. Athena, will you tell
everyone about yourself a little bit?>>Sure, hi everyone. I’m doctor Athena Kourtis. I’m a medical officer at the division for
healthcare quality and I’m a pediatrician and infectious diseases specialist. My team at CDC helps monitor trends of
infections that happen in healthcare. And if we see that there are rising
trends or there are any new threats, we sound the alarm to protect patients.>>Great, thanks you guys both for being here. So we’re here to talk about staph. Athena, will you just make sure we’re all on
the same footing and let us know what staph is?>>Yes, so staph is type of
bacteria that is very common. It’s found on many of us in our skin,
in our nose and mucous membranes. And, the fact that is so common in us
does not mean that it always causes harm. A lot of the time it just there colonizes us. But, it can cause infections and the infections
can range from mild infections of the skin and soft tissues, to severe infections of
the internal organs and can even spread through bloodstream and cause
life-threatening infections or even sepsis, which is the body’s extreme
reaction to infection. So staph is one of leading causes of infections
in healthcare, that means in hospitals, nursing homes and other healthcare settings.>>How common is staph? Does everyone have it?>>Well, about a third of us
carry it on our skin all the time. And another proportion, about a third
carry it on and off on our skin, so it’s very commonly found on our bodies and of
course on objects we touch and we contaminate. But, infections do not happen so commonly. They can happen particularly if you have some
particular risk factors or if you are about out of surgery, for example, or have a
medical device inside in your body. But, we just released a report that shows the
trend and the number of infections and deaths from this bacteria and we found that there
are almost 20,000 deaths in the United States in 2017 that were associated
with staph infection. So it’s an important problem and
something that we take very seriously.>>Yeah, I know a couple of years ago, I felt
like staph was all over the news all the time. So I think what you are saying
is it’s something we still need to be very vigilant about and worried about.>>That’s right. We need to be very vigilant. Let me say also that we have seen
a remarkable progress in our, in staph infections in the hospitals. When we look at the trends of these infections,
we saw that there was a marked decrease in the number of these infections
from 2005 to 2012. And since then we’re seeing a plateau. Now, the rates are still much lower
than what they were ten years ago. But, we still need to be very
vigilant because we are not making as much progress as we would like. And we want to prevent these infections. These infections are preventable and
we want to bring them down to zero.>>Great. Alex, will you tell us
what puts us at risk for staph? Especially the serious staph infections
that Athena was talking about.>>Right, so as Athena mentioned, there’s
lots of different types of staph infections which can range from relatively simple skin
infections, things like redness or swelling and pains, that doctors call cellulitis,
to boils, to much more severe infections. And generally these can be things like bloodstream infections
and, infections of the brain. Meningitis. Things like that. Most people aren’t at risk
for these types of infections. These are fairly rare, fortunately. And, really what it requires
is for two things to happen. First, you have to have the
bacteria on your skin. So Athena mentioned that you
get the bacteria on your skin. About 30% of the time, 30% of
people can carry it intermittently. That’s called being colonized. So what that means is the bacteria lives on
your skin and it’s not really causing disease. It kind of is just sitting there. So that’s the first step. The second step is, there has
to be some breach or break in the hosts, in the person’s normal defenses. And historically, that’s things like
catheters, like IV catheters that you might get in the hospital, etc. or invasive procedures. Things like dialysis procedures or, or surgical
site infections when you undergo surgery, or surgical sites when you undergo surgery. When you get the commonness of those things,
you have the bacteria, then you have a portal of entry into the body, you can
get these serious infections. But like I said, it’s more often going to be
seen in people who are exposed to healthcare or have under lying medical problems.>>So it sounds like we know that
being in healthcare might put you at higher risk for staph infections. What are healthcare providers doing to
protect their patients from these infections?>>Yeah, so there’s a lot of
things that healthcare providers and facilities are doing
now to help protect folks against from serious staph aureus infections. And it kind of boils down to
three big categories of things. The first is preventing the
infections in the first place. So I’m sure many people know there’s lots of
bundles or sets of interventions that people use or facilities use now to
prevent the most serious forms of healthcare associated infections. Things like central line or catheter
associated bloodstream infections, and ventilator associated pneumonias
and surgical site infections. So that’s the first step. Let’s prevent the infection in the
first place, whatever the cause is. The second big category is, and this is
mainly seen at the resistant bacteria that Athena was mentioning, so things like MRSA
so this is the resistant form of staph aureus. It’s resistant, it’s not for
which many antibiotics don’t work. So the idea here is to prevent
transmission of those things which often occurs in healthcare settings. So, if admitted to the hospital, with carrying
MRSA, colonized or with MRSA infection, people may go into special
precautions called contact precautions, where they will put the person in
their own room, not with a roommate. And the providers may wear gowns like over the
tops of their clothes and gloves on their hands and the idea here is to prevent the staph
from getting on their body or on their clothes so that they can’t spread it to another person. And of course, washing your hands
is critical for that as well. And then the third set of interventions
are kind of old interventions that are gaining popularity again. And these are called strategies
for decolonization or some people call it source control. And the idea here is to bathe with
a type of antiseptic on your skin and sometimes antibiotics or antiseptics in your
nose cause staph tends to live in your nose. The idea is if you do that, you can actually
reduce the amount of bacteria on your skin. And that does two things. The first is it prevents
that makes it less likely for that person to get an actual infection. But it also reduces the number. So when the healthcare workers are coming in
contact with those people, they are less likely to get it on their skin or clothes
and pass it on to the next person.>>Gotcha. I know decolonization is something that
we talk a lot about in our division. Is it something that I need
to do when I’m at home?>>No, I think you know again,
there is downsides to decolonization and lots of things we don’t understand. So it generally, decolonization or source
control strategies are reserved for people at the highest risk of infection. So where the, if there are any potential
downsides, clearly outweighed by the benefits. And again, those are things like people in
the intensive care unit in the hospital, people who are in the hospital
with but with invasive devices and sometimes people undergoing surgery.>>Great. So let me say back
what I think you just said. So we’re going to stop spread,
prevent the infection with all of the recommendations that CDC has. And stop spread from specific sources.>>Yeah, so the decolonization
strategy is preventing spread and preventing the infections
in the first place.>>Great, thanks. One question we did receive is
healthcare providers are doing a lot of work to protect their patients. So Alex, I’ve got another question for you. What can patients do to protect
themselves from staph?>>Right. So there’s lots of
things that patients can do. Sometimes, some are not quite
as intuitive as you might think. And I know people always think
CDC always says wash your hands. But we do that for reason,
cause it really does work. And the first thing is keeping your hands clean. So staph can live on your body. And as I said, that’s kind of the
first step to developing infection. So people can inadvertently touch their nose
or other places where the staph can live, usually warm, moist areas like
armpits and noses and things like that and then inadvertently touch other
places where the infection can get set up like a catheter or surgical incision a wound. So keeping your hands clean
helps decrease the risk of that. The second thing that I think Athena has done a
lot of work on recently, with her recent report in the Vital Signs is the high
risk that people who use inject, inject drugs are at for developing
these types of infection. So it’s really important if you are one of those
people, to make sure that you are mentioning that to your doctor or your provider. Because they can help link you to care and help provide helpful suggestions
to help decrease that risk. And then the third thing which I think
makes a lot of people uncomfortable is, making sure your healthcare
provider is washing their hands. So a lot of patients feel very uncomfortable about reminding the healthcare
worker to wash their hands. And I’m sure Athena can weigh, jump in
as well, but as a practicing provider, I like people to remind me
to wash my hands if I forget. Because I think you know, we are busy, we
forget and it’s, and I don’t think most people, most providers will take it offense
if you remind a healthcare provider to wash their hands before they care
for you, they miss an opportunity. So, remember, that that’s really important.>>Right.>>That’s right. And I would also add that
if you have an open sore, it’s important to keep it clean and covered. So that you protect yourself but
also protect others if it’s infected. And also avoid sharing items
like towels, razors, needles, things that come in touch with your body. Makeup, and then of course if you
think you may have an infection, it’s important to seek medical
care early so it doesn’t progress. The infection doesn’t progress, if you think
you might be infected, ask your doctor.>>Great.>>All great points.>>Yes, thank you for that advice. So doctor Kallen just talked to us about,
the risk in healthcare, but I know talking to you guys every day that staph
isn’t just in healthcare facilities. So Athena, will you tell us a little
about what our risk is in the community?>>Sure, so as we’ve mentioned,
staph is everywhere. A lot of us carry on our skin, so we
touch objects, we contaminate them. So it’s very frequently found
in the environment. Now, you are not particularly at risk for a
serious staph infection unless you have one of the risk factors that Alex mentioned, or
if you have some ongoing conditions like, for example, diabetes or
a chronic skin condition. You may be at risk for skin infections or if
you are in chemotherapy for cancer, for example. Something that may bring your defenses down. But even otherwise, healthy
people can get infections. And the factors that Alex mentioned
earlier, close contact with skin of others. Such as it may happen in crowded settings
or high contact sports for example. Places where people are, have close
contact to each other, may have sweating, may have less than perfect hygiene. Also they may be sharing
items, equipment and so on. We’ve seen several outbreaks in sports teams. And also child care centers, military
barracks, jails, places like that places where there is a lot of people
and a lot of skin contact.>>Great. So one thing I just wanted
to mention that I hear a lot outside of CDC is this question about laundry. If I maybe, I’m on a team that there has
been an outbreak of staph, or maybe I’ve been in a healthcare facility and worried about
staph, do you guys, what are the recommendations from CDC about laundering my clothes?>>So CDC has lots of recommendations
that you can get on the web. But what it really boils down to is regular
laundering of clothes is more than adequate to get rid of staph and make
dirty laundry safe for folks. So you know, a lot of times, when
there’s outbreaks on sports teams or sometimes we see them in
schools, there’s this temptation to do these very aggressive
interventions to try and stop it. But really, what it boils down to is good
hygiene and making sure that you know, that as Athena mentioned, you know, your
cleaning surfaces that can be contaminated with sweat, etc. between folks, you know. The outbreaks that she mentioned on sports
teams, you know we frequently see very, very dirty whirlpools, and trainer tables
etc. that just aren’t being cleaned well and big buckets of the ointment
that people put on their skins that people are dipping their hands in. So it’s really very basic, simple things like
that that help stop transmission and outbreaks. Especially in schools and sports settings.>>Great.>>And it’s a good idea to wash your clothes
after you come from the gym or a place where you have used the equipment
that others have used. It’s also important to do the dryer cycle. The warm drying.>>Gotcha, great. That’s really helpful advice. Thanks guys. It sounds like CDC is doing a lot of work. You guys are very well informed on this topic. Athena, can you tell us a little about what
CDC is doing to prevent staph infections?>>Sure. CDC is doing several things because preventing staph
infections is a priority for CDC. As I mentioned, we monitor the
rates of infections very closely because we need these data for action. If we see that there is not the data
show that the rates of infections are not where they should be, we will let the
hospitals know and the health departments know. So that they, so they know where they are, and
if they are where they need to be, that’s great, but if the rates are higher than what they
should be, then there are additional steps, prevention steps that they can take. And doctor Kallen’s team recently published
a prevention framework for staph infections that lists all the prevention
steps that hospitals can take. And you know, it’s not a one size fits all. There are situations where hospitals
might need to take additional steps, and those approaches are highlighted
in this prevention framework as well as when is the appropriate time to use them. So we work with healthcare facilities,
we are forming learning collaborative. So hospitals that struggle with high rates
of infection can learn from each other, can implement a prevention framework
together and sort of evaluate it, so we can continually improve the
prevention steps that we take. And of course last but not least, CDC works
with researchers and academic partners to evaluate new and better innovative ways
of prevention for staph and other infections.>>Great. Thanks for your work. Okay so we told everyone where they
are at risk for health staph infections in the community and in healthcare. But, what do staph infections look like? Athena, do you mind answering that one?>>Sure, so an area of infection may be
red, swollen, tender, warm to the touch. But there’s nothing really
path pneumonic or you know, that will make it look like a staph infection. For example, it could look like a bump
or like a spider bite some people think. So it’s not always easy to know
that you have a staph infection. That’s why it’s important to ask your doctor
when you suspect you may have an infection. Now if you have symptoms like fever or chills, then that’s an indication the
infection may be spreading and it’s even more important
to seek medical care. A lot of times staph infections may also
cause puss collections, puss can be yellow or green discharge from the wound,
so that’s another sign that you need to look out for, and seek medical care.>>Great.>>And the other thing that is
classically described too is a spider bite. So there are certain types of staph
that are found in the community, especially resistant strains, the
MRSA strains, that can cause lesions that have been confused with spider bites. So, you know, keep your eye out for that. That sometimes include that you
have MRSA infection as well.>>Especially if you don’t see a spider.>>Especially if you don’t see a spider.>>Right.>>That’s right>>Okay, great. So, what if I think I have a staph
infection, I have the red, itchy, might have a fever, what do I need to do? Alex.>>So, as Athena said, the most important
thing is you should get it checked out. It’s really important when these
infections are early to catch them and get them treatment, whatever’s required. Either some type of drainage or
antibiotics to make sure they don’t progress into these more severe infections. So the other things that
you should do, is again, like we talked about before,
keep those hands clean. That helps protect other sites,
if you have other places, other wounds from getting infected, or if you
have devices, if you happen to have a catheter, or something like that from
those getting infected. As Athena said also, so keep it covered. That helps prevent spread to other people. And that’s important. So if, and especially if you have a lesion
that can’t be covered or it’s draining and you can’t keep that drainage collected,
it’s probably best to take a few days off from football practice or whatever sport
you are playing or going to the gym etc. until the drainage can kind of slow down. Avoid kind of picking and popping the
lesions and those sorts of things. Those are probably the most important
things but again, just to reiterate. It’s important to catch these things early. This is a bacteria that can really spread
rapidly and cause severe infection. So if you think you have an infection,
you know, get it checked out so that somebody can make sure that you
are on the appropriate treatment.>>And it sounds like being alert for
these things protects you and other people. Maybe people you live with at your house,
or in your community or at your gym, so it’s very beneficial to the community.>>Yes, that’s correct.>>Great. One question we got back that was really interesting Alex
was, can you get staph from your pet?>>Wow, that’s a great question. So the short answer is yes, you can. And it’s, it’s kind of interesting. You know, years ago when MRSA was first
emerging, there was lots of work to try figure out how much household pets were
involved in the transmission of MRSA. And what it what it kind of boils down to, is that they can be colonized usually they
get colonized, or they get the staph aureus on their bodies from their owners or from
someone in the family who’s colonized. And there’s lots of great examples
over the over the years of outbreaks where there’d be a household with lots of people
with lots of ongoing staph aureus infections that were basically just
transmitting it back and forth between the pets and the household members. So the long and short, the long answer is yes,
they tend to be more colonized with it then to develop true infections and they tend
to be able to spread it back and forth. So the person, the human could
become decolonized and then play with pet again and get it colonized. So again, I will reiterate, when
you’re playing with your pet, clean up your hands and face
or wherever afterwards.>>Afterwards, gotcha. But keep your pet.>>Keep your pet.>>Good to know. All right, so we are getting
close here to the end. I did want to ask one more question
Athena, about if I have a staph infection, I just want to be really clear to folks at home. If I have a staph infection,
how will I be treated? Am I, should I be afraid? Should I be worried? What will happen?>>So there are several antibiotics
that work against staph infections. And you mentioned MRSA that tends to be
resistant to many commonly used antibiotics, but there are options even for those infections. Sometimes some of the infections may need to
be drained, if there’s a big puss collection, your physician will determine that. Sometimes combination of the two. But most infections can be
treated if they’re caught early.>>Thank you. Last question. I want to ask both of you. Is there anything that we haven’t shared
today that you really want to drive home. Alex, anything for patients?>>Yeah, I think I would just
reiterate the things that you should do to help prevent yourself from
getting the staph aureus infection. So again, keeping those hands clean, making
sure your healthcare providers are keeping their hands clean. You know, not sharing personal items like towels
and razors and things like that is a good way to prevent the transmission of staph aureus,
and being vigilant for these infections when they’re early so that you can catch them
early and prevent them from getting worse.>>Great. Anything for healthcare
providers, Athena?>>Yes, so for healthcare providers in the
audience, I would like to just reiterate that we’re seeing this rise
in community infections that we think may be linked
to the opioid crisis. So think of this when you see people who come
back, keep coming back with staph infections or other skin infections, think of an under
lying injection drug use and link these patients to care for their under lying disorder.>>Great, and I will do a quick
plug for some new resources that we have available on CDC’s website. We have some injection infection resources for
healthcare providers, but also for patients. Ways to reduce those infections if you
are going to continue to inject drugs.>>Thank you, yes, thank
you for bringing that up. Yeah, materials for safer injection practices.>>Yeah, well thank you both
for being here today. I really appreciate your time. And thanks everyone for joining us. We really appreciate you joining us today. Two quick reminders. If you have any questions, please put
them in the comment section below. And we’ll get back to you, and
we have additional resources as we mentioned today on CDC’s website. It’s CDC.gov/vitalsigns/staph. S-T-A-P-H. Thanks for joining us.

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