Super bugs: Coming to a department near you

     It began innocently enough. A few Fresno, California, firefighters reported a strange rash that appeared to be from spider bites. Fresno officials quickly hired an exterminator to eradicate the pests. However, as the number of afflicted firefighters grew and the condition of others worsened, administrators feared something more ominous was at work.

     Health department authorities inspected the city's three fire stations and quickly confirmed their suspicions. All but one of the facilities tested positive for MRSA (methicillin-resistant staphylococcus aureus), and, the one station that didn't, already had two infected firefighters.

     "In one case, a firefighter spread it to his kids," says Jacky Parks, Fresno police officer and president of the Fresno Police Officers Association.

     The Fresno Fire Association enlisted Parks to help investigate whether public safety officials encountered the bacteria on the job. The resulting inquiry revealed several Fresno police officers also had been infected, and that yes, it was likely a job-related hazard.

     "Our officers were being exposed to this on the street due to an increasing transient population in the downtown area," Parks notes. "As the transient population grows, the issue becomes more common and more serious."

     Fresno's situation is hardly an anomaly. Antibiotic-resistant super bugs, such as MRSA, SARS (severe acute respiratory syndrome), Avian Flu and others, are plaguing departments across the country.

     Police work is a high-risk occupation that often involves physical contact to subdue violent suspects or prisoners. But today's criminals bring more than a potential for violence to the streets, some also carry the silent and less obvious risk of unknown infection. Likewise, once officers restrain a subject, the danger is far from over. The infectious material these individuals transmit may continue to contaminate booking stations, holding cells or incarceration facilities for some time to come.

     The most common of the super bugs is MRSA. The Centers for Disease Control and Prevention (CDC) estimates this bug alone infects around 94,000 people annually and causes approximately 19,000 deaths. While the CDC reports 86 percent of these infections are hospital acquired (HA-MRSA), 14 percent and growing are of the community-acquired (CA-MRSA) variety, which law enforcement officials come across daily.

     Public safety officials are particularly vulnerable to serious infection, agrees Charles Tiffin, Ph.D., who currently chairs the public safety program at Capella University and is the author of www.publicsafetysignals.com. "On any given day, a law enforcement officer might encounter 100 different people in a variety of circumstances," he notes. "This puts them at great risk. MRSA is a bug that moves very easily from person to surface and from surface to person, and it's very robust."

     Couple this with the fact that the Journal of the American Medical Association reports drug-resistance forms of staph are becoming more commonplace. So much so, that James Dunford, an emergency room doctor at the University of California — San Diego Medical Center, jokes that if he doesn't see one to two cases of MRSA a day, he's somehow disappointed. But all kidding aside, he calls MRSA a very prevalent skin infection with the potential for dire, and possibly fatal, consequences.

     Common-variety staph infections, such as impetigo, cause sores on the body, which spread easily and do not heal well on their own. But these contagions rarely make affected individuals sick. However, Dunford says MRSA, which penetrates the skin more effectively and spreads more rapidly, bears the potential to make victims very, very ill. "Infected individuals get a lot sicker and sometimes even get bloodstream infections," he explains.

     But even with these concerns, Dunford describes media accounts designed to shock and scare the public about this threat as "gross exaggerations of what really occurs."

     "If you get in early, and I mean within a couple of days of thinking you have a 'spider bite,' things go just fine," he explains. "You start on antibiotics and everything goes well. But, all you have to do is add a health impairment that compromises your immune system or neglect the wound, and some pretty lousy stuff can happen."

     Because of the risks for severe infection and law enforcement's frequent contact with the bug, Tiffen says he believes authorities must consider implementing more stringent controls, using resistant and easily decontaminated materials, and establishing comprehensive training and education programs.

     This is a far cry from what the retired police major recalls from his own days on the street. When Tiffen entered policing three decades ago, he says law enforcement officials didn't pay any mind to contaminants or blood-borne pathogens; awareness began to build in the final years of his career as concerns over AIDS and Hepatitis mounted. Departments at that time began placing more emphasis on gloving up and decontaminating patrol vehicles. But in today's environment he says this is no longer enough.

     Effective standard operating procedures (SOPs), universal precautions (infection control techniques recommended following the AIDS outbreaks in the 1980s), and other protocols are quickly rendered ineffective when officers lack proper training and education, stresses Sgt. Eric Wilson of the Harrison County Sheriff's Office, located in Cadiz, Ohio. "For the protection of our officers, their families and the community, we need to educate our ranks to protect themselves and to fully understand how these diseases are transmitted," he states.

     Wilson's rural county agency recently hosted a MRSA informational session for officers and the public. The hour-long program, presented by Bob Brems, an epidemiologist with MPH Zanesville/Muskingum County Health Department, defined MRSA, showed images of infections, and covered the bacteria's transmission and treatment. The discussion also centered on specific risks police officers face and the precautions they must take.

     Effective educational campaigns include the entire community, emphasizes Parks, who notes Fresno public safety officials first developed comprehensive MRSA training to convince Fresno city officials that MRSA infections ought to be covered by worker's compensation. "We needed to explain that public safety officials must respond immediately, and that we can't dictate the emergency, the emergency dictates our actions," he says. "There isn't always time to 'glove up,' and we may not have all the information about whether the situation is safe or unsafe in advance."

     Since then the associations' educational efforts have expanded. The associations' train board members to provide MRSA education to all city employees and the community at large. "We teach officers that whenever they are in contact with a subject or victim, they should wash their hands and inspect their skin for unusual bumps afterward," Parks says. "If city workers notice any unusual skin conditions, we start the protocol and get them tested for MRSA."

     The city's protocal follows steps designed to eliminate concerns over reporting infections. "It's a tough thing to talk about. People don't say in general conversation that they have a bump or a rash," Parks explains. "They fear if they report it to their department, they'll be in violation of a 'fit for duty' requirement and lose their jobs."

     Fresno assuaged this apprehension by developing a confidential reporting system that all city employees are well versed in. In the past, officers hesitated to have a rash inspected — especially if they needed to burn a sick day to do so. Now, Fresno public safety workers can see a doctor for such concerns on the city's time and dime.

     Under the current protocol, an officer first expresses MRSA concerns to risk management officials within the police association. These administrators gather information on how the worker believes he was infected, how long he's been sick, and the symptoms he's had. Doctors culture the employee's wound and send the affected person home until the results are known. If it's not identified as MRSA, the employee returns to work immediately. If it is, doctors treat the individual with antibiotics and worker's compensation covers the patient's medical care and pay.

     Culturing suspicious wounds keeps MRSA outbreaks at bay, underscores Nancy Booth, an employee with the Medical Division of the San Diego (California) Sheriff's Department. "Culturing a wound better identifies the organism you're dealing with and the antibiotics to treat it with," she explains.

     In San Diego's seven jails, housing more than 5,000 inmates on any given day, MRSA was a recurring affliction until the organization began questioning inmates about sores they had, where and when they felt they might have gotten them, and any other symptoms they had upon arrival to the facility. Doctors now perform wound cultures upon admission and administer antibiotics if necessary, and the facility segregates affected inmates from the rest of the jail population until they heal. Since implementing these steps, Booth reports San Diego jails have seen MRSA cases drop more than 20 percent.

     In discussions about MRSA it appears your mother was right when she told you to wash your hands. Hand washing ranks as the top protection against MRSA and other super bugs. It's so important that: Booth developed a hand washing protocol for San Diego deputies and placed waterless soap dispensers throughout every facility; San Diego equipped ambulances and fire trucks with similar dispensers; and many patrol officers have begun carrying hand sanitizers within their squads and using them after every contact with the public.

     Your mother was also right when she scoured your skinned knee with hydrogen peroxide, as you sat there and screamed, then applied antibiotic ointment and covered it with a bandage. "You have to be more vigilant than you used to be when you nick yourself," Dunford clarifies. "Some people think if you cut yourself, kind of suck it clean, and cover it with a Band-Aid, you're protected. But MRSA seeks out breaks in the skin and has a ready ability to invade."

     Your mother was also right when she told you not to pick your nose, adds Dunford, who points out that staph lives in a person's anterior nostrils, which provide a safe haven for bacteria to live and colonize.

     Universal precautions dictate that public safety officials and health care workers treat every individual as if they are infected and take precautions to minimize risk. These safety measures not only include the hygiene habits your mother taught you, they also comprise the use of gloves and other barriers, such as protective clothing, goggles and aseptic techniques. Dunford adds that these guidelines should be followed whenever possible. "Don't assume someone doesn't have MRSA," he warns. "Put your gloves on."

     Surfaces also require attention after every subject contact and should be thoroughly cleaned with disinfectants designed to kill MRSA, Avian Flu and other super bugs. Officers often share lockers, gear, exercise equipment and squad cars. In the course of 24 hours, four officers and countless arrestees may occupy a single vehicle. "If that vehicle hasn't been decontaminated properly, the number of exposures quickly adds up," Tiffen says, noting he recommends agencies also disinfect other shared equipment such as spotlights, radar guns and even clipboards.

     Until now, Dunford says super bug infections have been taken about as seriously as advice to not overeat. But as Fresno and other communities have learned, it's time to listen up. "You really need to pay attention to this," he says. "This is the real McCoy."

     A downloadable PDF of the MRSA educational program presented by Bob Brems, an epidemiologist with MPH Zanesville/Muskingum County Health Department for the Harrison County (Ohio) Sheriff's Office is available on Officer.com at: www.officer.com/magazines/let/msra_harrison_sherrif.pdf