Control 'Superbugs' in the Workplace

If antibiotic-resistant “superbugs” were present only in health care settings, then only health care employers would need to take precautions. But cases of Methicillin-resistant Staphylococcus aureus infections, known as MRSA, can be found in all types of workplaces.

“Every single one of our corporate clients has had at least one significant incident, if not several,” of employees developing antibiotic-resistant staph infections, said Roslyn Stone, COO of Corporate Wellness, a national provider of occupational health services based in Mount Kisco, N.Y.

Staph bacteria, including MRSA, can cause skin infections that might look like a pimple or boil and can be red, swollen or painful or have pus or other drainage. “An employer will not know if someone has MRSA or regular Staph. aureus or some other bacteria. There is no way to know unless someone has a culture done,” according to Karen M. Anderson, infection preventionist for the California Pacific Medical Center and chair of the Association for Professionals in Infection Control and Epidemiology’s education committee.

Unlike other bacteria, MRSA is not killed by many commonly used antibiotic drugs. It can cause deep skin abscesses that require surgical draining. Sometimes the bacteria burrow deep into the body, causing potentially life-threatening infections in joints, bones, bloodstream, heart valves and lungs.

How easily it spreads “depends upon how much MRSA is present at the source of the infection,” Anderson said. “For example, an open draining wound would be more likely to contaminate the environment than something like cellulitis,” a more superficial skin infection. “Also, does the [patient] have an open wound or cut that may be an opening for any kind of infection if not cared for?

“We probably contract MRSA just like we contract other bacteria and viruses all the time. But most of us don't get sick,” she added.

Factors that make it easier for MRSA to be transmitted are referred to by the National Institute for Occupational Safety and Health (NIOSH) as “the 5 C's:”

• Crowding.
• Frequent skin-to-skin contact.
• Compromised skin (i.e., cuts or abrasions).
• Contaminated items and surfaces.
• Lack of cleanliness.

So far, the risk of contracting MRSA appears to be slight in most workplaces, according to Stone. But people often have heard just enough about “superbugs” to react with alarm.

Stone recalled receiving a call from a senior executive who had just learned that his administrative assistant had a MRSA infection. “At 10 o’clock on Friday night my pager went off. He was in a panic—that’s typical.”

Fear of contagion runs especially high in places where people share work stations, such as call centers, she added.

Health care workers, prison guards, police officers, firefighters, veterinarians and farm workers seem to be at high risk of contracting these infections. But Stone has seen cases of employees bringing MRSA infections into banking, telecommunications, trucking and service industry workplaces, too.

“If you have a workforce of more than 100 people and you don’t think you’ve had a MRSA [case], you’re wrong,” Stone said.“It’s across industries.”

While nearly 100 client companies have reported cases of employees with MRSA, Corporate Wellness determined that in only one case did the infection spread from one employee to another at the workplace. But that case was significant.

The workplace transmission “went on for months. Employees were re-infecting themselves and each other,” she said. “We think employees were leaning against a steam table and there may have been some skin-to-skin contact.”

Dealing with a Workplace Infection

The antidote to fear is good information and proper treatment. “Know the signs and symptoms. Sanitize with soap and water. Don’t let employees [with infections] come back to work until they are cleared by their physician and the wound can be properly covered,” Stone said.

NIOSH offers a web resource that elaborates on Stone’s dictum and recommends:

• Adequate facilities and supplies at work to promote hand-washing and other good hygiene practices.
• Appropriate cleaning of equipment and surfaces in the event of contamination.
• For individuals who have a MRSA infection or an infected wound:
• Cover and take care of a wound as directed by a health care provider.
• Clean your hands.
• Avoid sharing personal items.
• Ask your health care provider before returning to work.

Cleaning services should focus on surfaces that touch people’s bare skin each day and any surfaces that could come into contact with uncovered infections. There is no evidence that spraying or fogging rooms or surfaces with disinfectants will prevent MRSA infections more effectively than the targeted approach of cleaning frequently touched surfaces and any surfaces that have been exposed to infections.

According to the NIOSH web site, “unless directed by a health care provider, workers with MRSA infections should not be routinely excluded from going to work. Exclusion from work should be reserved for those with wound drainage (‘pus’) that cannot be covered and contained with a clean, dry bandage and for those who cannot maintain good hygiene practices.”

Until their infections are healed, workers with active infections should be excluded from activities where skin-to-skin contact with the affected skin area is likely to occur.

MRSA can enter the workplace through employees who were infected in the hospital or in the community, according to Jeanine Thomas, founder of the MRSA Survivors Network in Hinsdale, Ill. Thomas was ill for several years with recurring infections after she had ankle surgery. “It could be from a day care center or from playing contact sports,” she said. MRSA “spreads through a family, and it’s difficult to eradicate. It’s like a scourge.”

Companies should have policies about keeping the workplace clean, not just because of MRSA infections but also because of the danger of all types of contagious diseases, she added.

“This is just the world we live in, the new reality that we have in our home and work environment,” Thomas said. “MRSA will continue if we don’t control this.”

Balancing Act

Protecting an infected employee’s privacy while protecting the health and safety of other workers is a delicate balancing act involving the interplay of the Americans with Disabilities Act(ADA), the Family and Medical Leave Act (FMLA), the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and state privacy statutes, according to attorney Philip Gordon. Gordon is chairman of Littler Mendelson’s Privacy and Data Protection Practice Group in Denver.

He advised:

• First, investigate. Learn the facts. Do not rely on rumors.
• Notify colleagues of an infected employee and advise them to undergo testing, but maintain privacy as much as possible. “There’s no reason to identify the [infected] person by name.”
• Interview the infected employee or, if the person is too ill, talk with a family member. An employee’s doctor will not be able to disclose information without the employee’s authorization.

If the employee does not want to cooperate with the investigation, “explain your concern; tell the person that you will make efforts to protect their privacy but that the employee should keep in mind that co-workers could be affected. Put it to the employee: ‘You [would be] helping the people you are coming into contact with.’ ”

Under the ADA, Gordon said, “you can tell supervisors the amount of time that the employee is going to need leave. … Tell them what they need to know.”

Taking the right steps to protect employee safety and privacy is “a tough juggling act,” agreed Stone, but doing it right can help prevent not only illness but also lawsuits.

“If you give good information, address the rumors and help [infected employees] get good care, it will help avoid liability issues.”

Freelance contributor Stephenie Overman is the author of Next-Generation Wellness at Work (Praeger, 2009).