MRSA in the firehouse: How to avoid getting sick
MRSA is now killing more people than HIV, and it loves to live in and around firefighters
By Robert Avsec
When a mark on a Tucson, Ariz. firefighter's foot turned out not to be a spider bite, but rather an aggressive bacteria known as MRSA, it prompted equally aggressive action by the department to find systemic solutions.
Kelly Reynolds, a University of Arizona researcher and public health educator, and her team initially collected 500 samples at nine Tucson Fire Department facilities. The MRSA bacteria were most frequently found on couches, class desks and commonly touched office surfaces such as desktops, computer keyboards and telephone handsets.
Once the study results were in hand, the Tucson Fire Department took actions that included reupholstering furniture to remove material where the bacteria were found. Couches and chairs are now covered with material containing an antimicrobial layer. The department also replaced facility carpeting with hard-surfaced flooring that is more easily cleaned and disinfected.
In addition to the structural changes, the department revised its infection control protocols to address daily disinfection of all commonly used surfaces like television remote controls and computer keyboards.
Because of the communal lifestyle in fire stations, and their frequent contacts with high-risk populations (including hospital, nursing home, indigent and prison populations), firefighters are at a high risk of exposure to infectious microbes, especially MRSA, that they then bring back to the station.
NFPA 1581: Standard for Fire Department Infection Control Program (Chapter 5) and OSHA 1910.130, Blood Borne Pathogens set the requirements for fire departments to have standard operating protocols to protect firefighters in the workplace that cover infection control, training, personal protective equipment, cleaning protective gear and equipment, and post-exposure actions. Cleaning protocols in the living quarters, however, are less standardized and can vary by department.
Want to keep your people safe from bad bugs like MRSA? Start by developing, maintaining and following a set of written standard operating procedures that emphasize the daily cleanliness of the living quarters. Pay particular attention to these targets areas where MRSA — and other nasty characters like influenza and hepatitis — can be found:
- Bathroom counters and sink handles
- Door handles
- Fitness equipment
- TV remotes, armchair rests
- Kitchen table and appliances
- Desks and computer keyboards
- Beds and carpeting
According to the Centers for Disease Control and Prevention, there is no evidence that spraying or fogging entire rooms or surfaces with disinfectants will more effectively prevent MRSA infections than the targeted approach of daily cleaning of frequently touched surfaces and any surfaces that have been exposed to contaminated items.
Here are some sanitation steps most fire departments can implement.
- Hand washing is the most important practice to prevent disease transmission. Wash hands before entering the living quarters. Provide hand sanitizer solutions in all areas of the living quarters.
- Clean and disinfect targeted surfaces and areas on a daily basis.
- Place multi-level scraper walk-off mats with rubber backing at entrances of the fire station and the living quarters; the mats should span the entryway and be 15 to 20 feet long. Vacuum walk-off mats daily.
- Clean dirt and debris off work boots. Leave all boots outside the living quarters.
- Launder work clothes at the fire station or have it done by a professional cleaning service to reduce the risk of carrying MRSA home.
- Wash sheets, blankets and bed covers in hot water with a detergent at the fire station. Do not share sheets, blankets or bed covers.
- Provide cleanable covers for electronics such as TV remote, keyboards, and radios. These may be difficult to clean or disinfect or could be damaged if they become wet. Check to see if the manufacturer has specific instructions for cleaning.
Where it thrives
A recent study from Children's Hospital Los Angeles suggests MRSA can survive on some nonporous surfaces up to eight weeks following contamination — and skin transmission takes only three seconds. In addition, the presence of organic matter generally increases the survival of pathogenic bacteria fomites.
Visibly soiled surfaces provide the perfect medium for the possibility of increased exposure to surviving pathogens, causing a higher probability of exposure to MRSA than a cleaned surface. Making changes in your fire station can greatly improve the ability of your staff to routinely clean and disinfect living areas.
Replace carpeted areas with hard surface flooring, such as quarry tile or laminated tile. Also, replace upholstered furniture fabric with non-porous material that can be cleaned easily. Get rid of old wooden or damaged kitchen counters and tables in favor of surfaces are easily cleaned, with no surface joints or seams.
Candice Wong is the manager of civic and public safety studio at RRM Design Group and has done extensive work with fire station design.
"For countertops, we use several different products to provide a hard and easy to clean surface," Wong said. "They are manufactured products like Corian, Trespai, i.e. high-end custom grade laminate product — produced under very high pressure, and Quartz stone. My personal favorite is stainless steel; cost is comparable and maintenance is easy."
Ensure living quarters are maintained at relative positive air pressure as compared with the apparatus bay. The air should flow from living quarters to the apparatus bay.
CDC reports that deaths from MRSA now exceed those caused by the human immunodeficiency virus (HIV) in the United States. The International Association of Fire Fighters has stated that it considers MRSA to be a serious threat to emergency healthcare responders.
A University of Washington School of Public Health study led by Marilyn C. Roberts, sought to determine potential areas within the fire stations that were contaminated with MRSA and characterize the isolates to determine if they were related to hospital-acquired and/or CA-MRSA strains.
The research team assessed nine different areas in two fire stations that included medic trucks, fire trucks and fire engines, outer fire gear, garages, kitchens, bathrooms, bedrooms, gyms and other areas.
The results were published in the June 2011 issue of the American Journal of Infection Control. Investigators found that because the fire personnel had interaction with both hospital and community population as part of their job, they had the potential for exposure to MRSA from both sources.
The results also showed that both HA-MRSA and CA-MRSA can contaminate fire station surfaces. Dr. Roberts and her team found the same strains in the fire apparatus and apparatus bay areas; the strains were also found in the station living quarters suggesting that the transmission of MRSA was occurring between those two areas — personnel were bringing the germs into their living areas following responses.
If your Mom was anything like mine, you probably heard this phrase from her more than once growing up: Cleanliness is next to Godliness. To that I’d add: In your fire station, cleanliness is next to healthiness.