nose ring-MRSA

[angelstrings]

Hello,

Avoiding conversation as to the professionalism of nose rings, I have a health question about MRSA.

Say you'd been in the hospital as a CNA for a long time, and assumed you were already colonized (betcha I am). Would getting a nose ring gaurentee infection with MRSA? The bugs are already there inside the nose, then the skin is broken, in go the bugs, then...

Am I thinking of this correctly? So there is really no way a healthcare worker can get a nose ring without getting MRSA infection, right?

angelstrings

[TheSquire, DNP, APRN, NP]

Go ask this in the Infectious Disease specialty forum, they might have a clue.

[angelstrings]

Will do. Thanks Squire!!!

[slacktime]

Sorry, but your theory is not completely correct. I am sure having a nose piercing increases the risk of infection, partly because of the skin integrity is compromised, but mostly because the hardware is a transcutaneous foreign body, but it does not guarantee infection. One compromises intranasal skin integrity regularly, every time one sneezes, blows their nose, picks their nose, etc, etc, the skin is compromised, often microscopically, but compromised. The immune system kicks in from several different sources to eliminate MRSA that are there. Health care workers are MRSA colonized sometimes, but so is the general public. In our community, MRSA colonization is more prevalent among high school teachers than hospital nurses, nose piercing infections are much less common than MRSA colonization. Thousands of transcutaneous medical implants (IV catheters, external orthopedic fixators, etc) are implanted every day in MRSA colonized individuals, MRSA infections is still rare among these patients. when these infections do occur, they are often a minor problem, only requiring implant removal (pull the IV, remove the external fixator) to cure the infection. Probably more than you want to know, sorry if I have been verbose.

[angelstrings]

Thank you for going into detail, actually. I come into contact with patients who have MRSA all the time, so before I get a nose ring, I just wanted to understand my chances of getting sick.

Let me ask another question. Lets say my nose is colonized. Lets also say I keep the piercing clean, never touch my face, and as usual, always wash my hands. That still doesn't gaurentee MRSA infection right, because the difference between colonization and infection is number of bacteria present? Am I right?

[slacktime]

Sorry, I wish life was so simple. Generally infected tissue contains more bacteria than colonized tissue but not always. If your nose is colonized with MRSA, the risk of foreign body associated soft tissue infection increases, probably to the point where it outweighs the benefits of enhanced esthetics of a nose piercing. You make that desicion.

Keeping the piercing clean and hand hygiene will reduce the risk of infection but probably not to the point of no piercing. If the piercing is colonized, plan on it staying colonized until it is autoclaved, it is unlikely that keeping it clean will de-colonize the thing, every time one enters a pt room with a colonized nose piercing, they are bringing with them a dose of MRSA loaded into aerosoliztion device (nose), every sneeze or little cough dispenses a dose.

The crux of the problem that the piercing is a foreign body and MRSA is an adherent, biofilm forming bacteria. They secrete a sticky exopolysaccharide matrix on the foreign body and then live and divide in this matrix. Biofilm bacterial cells have a metabolism different than free floating bacteria, they communicate with each other and do not divide like free floating cells. Cells that are not actively dividing are not killed by antibiotics, disinfectants or the immune system. Generally, MRSA biofilms are at least 1000 times less susceptible to antibiotics or disinfectants and are in fact, resistant. Pts with MRSA foreign body infections often require extensive surgical debridement, aggresive antimicrobial therapy, and almost alwys, foreign body removal. If it is an infected nose ring, take it out and throw it away, an IV catheter, pull it and use the other hand, prosthetic knee, surgically remove it (after it was cemented in to last a lifetime), fill the surgical defect with bone cement beads loaded with vancomycin, give the pt IV vancomycin for at least 6 wks, wait a month and then surgically remove the beads and replace the prosthetic joint. If it is a prosthetic heart valve, give high dose of vancomycin and gentamicin for as long as you dare (couple of days) and surgically replace the valve but plan on an extensive debridement and a high risk of relapse.

more questions, send me an email and I will be in touch.

[angelstrings]

That was awesome. Thank you!!!

[Alvindudley]

MRSA-SHCMRSA, having a nose ring or visible tattoo is in my opinion, not professional. I know that it is mainstream these days, I'm just sayin

[Blindsided]

Hey, can we get CEUs for reading this?? Great info. By the way, I worked in a clinic close to a tatoo joint. I saw more than a few infections from tats and pierceings.