Risk of transmission of MRSA

Question

Hello,

we are a bit worried after we got the information, that the grandfather of our daughter (1.5 years, CF) now has MRSA after a long-lasting inflammation of the elbow.

As we did not know, what he had exactly, he paid very much attention to hygiene in dealing with our daughter, that means few direct contact and every time disinfection of his hands before.

How high do you estimate the possibility of transmission of the germ to our daughter? As MRSA is a problematic germ for CF patients we are of course a bit worried.

Our CF-doctor estimates the risk under the above mentioned measures to be small, particularly as we saw the grandfather with this inflammtion only for a few days and he only wants to do a thoat swab in the middle of April as it is planned routinely.

Furthermore, we consider as parents to have a swab done ourselves. Would you recommend this to us?
And how do we deal with our grandfather from today on? How do we act correctly, especially with regard to our daughter? What should he or we avoid to do as long as he has the germ?

Many thanks for your advice.

Answer

Hello,

you report that MRSA has been detected at a therapy-resistant wound in the area of the elbow of the grandfather of your daughter (1.5 years old, CF patient). You report that you visited the grandfather only for a few days in the time since the inflammation occured. You ask how high the risk of an infection of your child is, in spite of the fact that the grandfather disinfected his hands always throughly and only few direct body contact took place. To the ways of transmission of MRSA it has to be said that this takes place via direct body contact and via contaminated things in the household. Staphylococcus aureus and therefore also MRSA are very modest germs, which survive also in dry environment for many weeks, so that contaminated things can represent a germ-reservoir for many weeks. Theoretically it is therefore possible to get an infection without any body conctact to the infected person. Small children have here probably a higher risk, as they put their fingers in the mouth and touch uncontrolled everything, what is near them.

In your special case it has also to be clarified, if the grandfather lies at home or lives in an old-people's home. It is known, that many inhabitants of old people's homes - very often unknown - are colonized with MRSA. A visit to an old people's home should therefore be done by a CF-patient only under strict hygienic rules of behaviour.

In case the grandfather lives at home, one has to assume that tables and surfaces of furniture as well as door handles are probably contaminated with MRSA. As you are understandably very concerned about the question of a possible infection of your child, you should ask your CF doctor, to take a swab of the nasal mucosa and the throat of your child at a special date. You as parents should have a swab of the nasal mucosa done at your general practitioner to be on the safe side.

As long as the infection of the grandfather goes on, visits of your daughter should be reduced to a minimum and a meeting should take place better outdoors. Direct body contact has to be avoided.
In general it has to be said, that an infection with MRSA for healthy people - under which you count as parents - does not represent a danger. In case of a healthy infected person the immune system of the body kills the germs very fast. In case of CF patients however, it comes not uncommonly to a chronic colonization of the airways.

For a CF patient that means, that at every visit of the CF center or stay in the hospital he can only be taken care of under the strictest hygienic measures. Therefore, a colonization with MRSA has to be avoided at any price.
Unfortunately, we cannot give you more soothing information. We wish that the results of the investigation come out positively.

Yours sincerely,
Dr. H.-G. Posselt

09.06.2011