In the U.S., methicillin-resistant Staphylococcus aureus, commonly known as MRSA, currently accounts for more deaths each year than AIDS, and incidence is increasing at alarming rates.1Studies at Parker College of Chiropractic concluded that all teaching clinics and private chiropractic offices should adopt infection-control practices, including routine table disinfecting and hand sanitizing. They noted that vinyl tables need to be cleaned regularly to remove both pathogens and allergens. All cloth tables need to be replaced.2-3
Fundamentals of MRSA Infection
MRSA is a type of staph infection resistant to antibiotics.4 Staph infections occur most frequently in health care facilities.5 While S. aureus is commonly found in the nasal cavity, most are skin infections.6 These may appear as pustules or boils which often are red, swollen, painful or have pus or other drainage. These skin infections commonly occur at sites of visible skin trauma such as cuts and abrasions, as well as areas of the body covered by hair, such as the back of neck, groin, buttock, armpit and the bearded area of men.
MRSA is usually transmitted by direct skin-to-skin contact, or contact with shared items or surfaces that have come into contact with someone else's infection. Five factors make it easier for MRSA to be transmitted: crowding, frequent skin-to-skin contact, cuts (or abrasions), contaminated items and surfaces, and lack of cleanliness.
The need for vigilant personal hygiene by chiropractors is very important.7 Unfortunately, most antibiotic soaps have the potential of creating more antibiotic-resistant bacteria. Alcohol's effect does not last long and dries out the skin with frequent use. For those health professionals who desire a natural product for frequent daily hand washing and nail cleaning, there is a special type of honey from New Zealand called manuka honey. It is available in multiple forms for both personal protection and medical treatment via dermal application.
Unlike antibiotics, manuka honey destroys bacteria by drawing water out of the microorganisms by osmosis.8 Bacteria have the ability to mutate and become resistant to elements that can destroy them. However, no bacteria can survive without water. That should prevent future manuka-resistant strains from developing. Furthermore, all honeys produce an anti-microbial peroxide reaction upon application.9,10 Manuka honey contains high levels of the natural anti-microbial chemical methylglyoxal.11 Gels, foams, creams, sprays and bandages for personal protection and/or for wound healing are all currently available.12 For those doing deep-tissue work that utilizes oils, both manuka oil and tea tree oil (melaleuca) at less than 5 percent dilution have shown utility against MRSA.13-15
Although manuka honey may be considered for hand washing and treatment of cuts and abrasions, we must also consider our tables and therapeutic devices that come into skin contact with our patients.16 While there are many sanitizing products that are chemical-based, there is a growing body of products that are not only effective, but also nonsticky, nontoxic and even all-natural and "green." Products that have a long-lasting effect are also desirable, as that will make actual daily compliance much easier. Just as desirable are products that will not adversely affect the materials upon which they are applied. A most natural approach is to use products based on environmentally friendly, nontoxic ingredients like silver ions and citric acid.17
Of all the modalities we must consider in our hygienic efforts, the chiropractic table presents perhaps the greatest, and certainly the most common and obvious challenge.18 Although face paper should be used, it is woefully inadequate in itself. Application of an EPA-approved, hard-surface anti-microbial spray should be used on the table itself between patients to kill germs on surfaces including the hand holds and face-cradle. Considering the rising potential of worldwide pandemics (SARS, avian flu, norovirus), H1N1 and antibiotic-resistant superbugs like MRSA, it is all the more incumbent on all chiropractors to review their clinic and personal hygiene in light of these increasing threats.
Supporting a Healthy Immune System
Of course, we also emphasize the import of a healthy immune system through neuroaxial balance, proper rest, recreation, hydration and nutrition. In regard to the latter, the minerals zinc and selenium, and vitamins A, C and D are perhaps the best appreciated. One might also consider nutraceuticals like mushroom and thymus extracts or colostrum. The American Society for Microbiology meeting in Atlanta in June 2005 included a presentation on a natural garlic extract, allicin, for treating MRSA.19
Healthy intestinal flora and fauna is also part of a robust immune system. According to the May 8, 2006 online edition of Medical News Today: "Current interest in probiotics is motivated ... by the increasing antibiotic resistance of pathogenic bacteria ... and the rise of consumers' demand for natural substitutes of drugs."20
Spigelman has a novel idea concerning probiotics and MRSA prevention: "Any student who has grown bacteria in a lab will know that they (bacteria) generally do not grow on top of one another. So when we wash our hands, we could actually be killing off harmless commensals to the extent that we leave space for other bacteria, such as MRSA strains, to settle. ... Perhaps we should be thinking about using probiotics and even dipping our hands after thorough washing into a solution which contains harmless bacteria, which could then colonize our skin and prevent pathogenic bacteria from settling on it."21 Unfortunately, I am not aware of any such probiotic hand treatment on the market as of yet.
As a closing thought, for those doctors who provide wellness care, consider the following quote from the American Academy of Anti-Aging Medicine: "Chronic infection is a vastly underestimated cause of disease and disability. The public needs to be mindful that low-grade infections are estimated to potentially reduce the healthy human lifespan by up to 20 years, robbing them of a lifetime of bountiful energy, productivity, and happiness. Bacteria, fungi, viruses, and parasites may well be the single most important yet undiscovered cause of premature aging and the chronic degenerative disorders of aging that now plague Americans."22
- MRSA: Methicillin-Resistant Staphylococcus Aureus in Healthcare Settings. CDC Features, Center For Disease Control.
- Evans MW, Campbell A, Husbands C, et al. Cloth-covered chiropractic treatment tables as a source of allergens and pathogenic microbes. J Chiropr Med, 2008;7(1).
- Evans MW, Campbell A, Husbands C, et al. Assessment and risk reduction of infectious pathogens on chiropractic treatment tables. Chiropr Osteopat, 2007;15:8.
- Aston JL, Dortch MJ, Dossett LA, et al. Risk factors for treatment failure in patients receiving vancomycin for hospital-acquired methicillin-resistant Staphylococcus aureus pneumonia. Surg Infect (Larchmt), 2009 Aug 18.
- Miller M, Cook HA, Furuya EY, et al. Staphylococcus aureus in the community: colonization versus infection. PLoS One 2009, Aug 20;4(8):e6708.
- Yang ES, Tan J, Eells S, et al. Body site colonization in patients with community-associated methicillin-resistant Staphylococcus aureus and other types of S. aureus skin infections. Clin Microbiol Infect, 2009 Aug 18.
- Lankford MG, Zembower TR, Trick WE, et al. Influence of role models and hospital design on hand hygiene of health care workers. Emerg Infect Dis, 2003;9:217-23.
- Dustmann JH. Antibacterial effect of honey. Apiacta, 1979;14:7-11.
- Weston RJ. The contribution of catalase and other natural products to the antibacterial activity of honey: a review. Food Chem, 2000;71:235-9.
- Dustmann JH, Op Cit.
- Mavric E, Wittmann S, Barth G, Henle T. Identification and quantification of methylglyoxal as the dominant antibacterial constituent of Manuka (Leptospermum scoparium) honeys from New Zealand. Mol Nutr Food Res, 2008;52.
- Molan PC, Cooper RA. Honey and sugar as a dressing for wounds and ulcers. Tropical Doctors, 2000;30:249-50.
- Thompson G, Blackwood B, McMullan R, et al. A randomized controlled trial of tea tree oil (5%) body wash versus standard body wash to prevent colonization with methicillin-resistant Staphylococcus aureus (MRSA) in critically ill adults: research protocol. BMC Infect Dis, 2008 Nov 28;8:161.
- Carr A. Tea Trees and Their Therapeutic Properties. The Linus Pauling Institute, Oregon State University.
- Settineri RA, Krassner SM, Vermilye A. Antimicrobial effects of plant-derived essential oil formulations on pathogenic bacteria. J Am Nutraceut Assoc, 2003;6(3)
- Koehler J. Fighting MRSA, staph and the flu in chiropractic wellness centers. Artipot.
- "Pure Biosciences Receives EPA Registration of Expanded Efficacy Claims for Its SDC-Based Disinfectant." www.puregreen24.com/PURE_Expanded_EPA_Claims.pdf
- Evans MW, Op Cit (reference 2).
- "New Natural Extract for Treating MRSA." Medical News Today.
- "Probiotics Show Promise In Treating Gastrointestinal Diseases." Medical News Today.
- Spigelman M. MRSA: Why treat the symptoms and not the disease? Ann Royal Coll Surg, 2005;87(5):452-3.
- "No Tricks This Halloween: The American Academy of Anti-Aging Medicine (A4M) Issues MRSA and Superbugs Alert."
Click here for previous articles by John Maher, DC, DCBCN, BCIM.