Why is it Important to Prevent MRSA in Texas Jails?

MRSA (methicillinresistant Staphylococcus aureus) is a type of staph bacteria that is potentially dangerous, and it is usually spread within a community by contact with infected people or things that are carrying the bacteria. Jail is a place where MRSA has been known to spread, and the inmates and correctional staff are at risk.

What is MRSA?

MRSA is a “gram-positive coccus clustered bacteria,” and it can infect the host and cause soft tissue infections or skin infections. The infections present as a form of broken skin, such as a boil or rash.

The spread of MRSA usually happens with direct contact with infected skin. Touching materials or surfaces that had contact with the infection or the drainage (pus) are other ways MRSA can spread. When MRSA lesions develop, they are often mistaken for minor skin problems, such as pimples or spider bites. The lesions may start out as bumps that are red, painful, swollen, full of pus, accompanied by a fever, or warm to the touch.

Why is it Important to Prevent MRSA in Jails?

MRSA infections are resistant to treatment with certain antibiotics. It usually starts out as a mild skin lesion, but MRSA can become serious or even fatal. Outbreaks have occurred at several jail systems in the U.S. The two factors that contribute to the spread of MRSA are:

Crowded living conditions and
The higher prevalence of MRSA among detainees compared to the general public.

When detainees develop skin sores or any of the features that may be indicative of MRSA, a healthcare provider should promptly examine the sores on the skin so that a diagnosis can be made and treatment can begin.

MRSA and Correctional Staff

When MRSA (methicillin-resistant Staphylococcus aureus) spreads in jails and prisons, members of the staff are as vulnerable as the detainees. Jails should provide their employees with training in health and safety procedures, and they should also require them to practice those procedures. To foster a safety culture, methods of prevention of the spread of MRSA should be discussed periodically in health and safety bulletins and in staff meetings. Communication can also be achieved through videos, websites, and posters.

Training to Prevent the Spread of MRSA

Be sure the jail staff is educated to assume that any detainee may be contagious. Precautions should be taken when there has been direct contact with mucous membranes, non-intact skin, or body fluids.

Personal Cleanliness

One of the reasons MRSA is so dangerous is that it is difficult to treat because of resistance to some antibiotics. If there is evidence of MRSA (methicillin-resistant Staphylococcus aureus) in a jail, the protocols begin by protecting the correctional staff against the staph infection.

Diligence in teaching staff and detainees certain protocols about personal cleanliness can help to stop the spread of staph/MRSA as well as flu.

The basic first step is for staff and detainees to wash their hands frequently.
Liquid soap dispensers should be placed at all communal sinks used by staff or detainees. It is important that hands are dried with either a paper towel or an individual-use cloth towel.
When handwashing is not feasible, an alcohol-based sanitizer should be used by employees. However, hand sanitizer should be kept in secure locations away from detainees. Because of its high alcohol content, hand sanitizer is considered contraband. This was a complicated issue during the COVID-19 outbreak.
Provide large-bottle dispensers or wall-mounted hand sanitizer dispensers in secure locations. Another alternative is to have employees carry personal-size bottles of sanitizer with them if they are able to do so safely.
Advise users that hand sanitizers should not be used if the hands are visibly dirty because it would not be effective. Prior to using an alcohol-based sanitizer, the hands should be thoroughly washed with soap and water.
Permit staff to change their clothing if they have significant contamination with body fluids. Allow staff to shower and change as soon as possible after contamination.

Instructions to Detainees on Personal Cleanliness to Avoid MRSA

It’s not always an easy thing to control MRSA (methicillin-resistant Staphylococcus aureus) when there is an outbreak in the jail. Instruct detainees as follows to improve the chances of avoiding the spread of the infection:

Encourage detainees to shower daily and wash their hands frequently.
Never share soap or towels.
Change into clean clothes frequently, preferably once daily.
Shower after heavy sweating or vigorous exercise.
Never pop sores.
Avoid tattooing because it can spread MRSA.

Laundry Duty

When handling dirty laundry or when stationed near the handling of laundry, require staff and detainees to use gloves.
Handle soiled or wet laundry as seldom as possible and place the garments in a leak-proof bag.
Consider washing laundry that is contaminated with MRSA separately.
Ensure that laundry is machine-washed with detergent and machine-dried thoroughly using high heat.
Use the warmest water recommended on detergent and clothing labels.
Avoid over-filling the washing machine because the items may not get clean and MRSA may not be removed.

No Sharing of Personal Items

Make sure detainees and staff know that it’s important not to share personal items such as clothing, towels, and razors. Sharing personal items can spread MRSA.

History of MRSA in Jails

In 2011, Methicillin-resistant Staphylococcus aureus (MRSA) was recognized as an emerging threat to public health, particularly in correctional settings. In the years previous to 2011, Texas, California, Mississippi, and George saw outbreaks of MRSA in jails and prisons. The increase in the spread of MRSA infection in jails was greater than what occurred in the general population. A study was done to examine the lessons learned about MRSA in jails and an article produced out of that study pondered what can yet be learned about MRSA in jails.

Health professionals began to see a pattern in which MRSA infections occurred in the community among people who had contact with someone who had a healthcare-related risk factor or who had a recent medical procedure. Until the 1990s, MRSA was confined to hospital settings.

A New Strain of MRSA

In the 1990s, community-associated (CA)-MRSA infections began emerging in community members with no hospital risk factors. CA-MRSA are distinctly different from hospital-associated (HA)-MRSA strains as regards the type of strain, type of location of the infection, location of outbreaks, and susceptibility to antibiotics. Most significantly, CA-MRSA strains are more contagious and are associated with greater morbidity and mortality than HA-MRSA strains, including increased skin and soft tissue infections (SSTIs).

Outbreaks of community-associated (CA)-MRSA have manifested in a variety of groups unassociated with healthcare settings. Those groups include detainees in jails, children in daycare centers, homeless populations, intravenous drug users, men engaging in sex with men, and military recruits.

Correctional populations could be a source for the transmission of MRSA. In December 2021, approximately 5, 444,900 individuals were in the custody of adult correctional systems in the U.S. The rate at which persons were in jail or prison at that time was 680 per 100,000. With so many people living in close quarters, the correctional system may be an important source of MRSA colonization and infection in the community.

At the time of the study, MRSA outbreaks had occurred in jails in Texas, California, Georgia, Mississippi, and Missouri. Studies conducted on those outbreaks suggested a high prevalence of MRSA infection and/or colonization in those populations but a noted increase in MRSA infection/colonization within the previous decade.

Studies show that MRSA varies considerably in incarcerated populations. The prevalence of MRSA infections in Texas county jails and New York state prisons was similar to the general population. However, Cook County jail was more than three times the prevalence in the general population. In the booking facility of the Baltimore jail, the prevalence of MRSA infections was nearly 33% greater than in the general population. The Chicago jails had MRSA prevalence more than 50 times the national rate. Only in Texas was MRSA prevalence in the prison system lower than the national prevalence.

Study of an Outbreak of MRSA in Jail

The dynamics of the transmission of CA-MRSA (community-associated) (methicillin-resistant Staphylococcus aureus) was studied following a 2002 outbreak that persisted at Los Angeles County Jail (LACJ) from January through September. The CA-MRSA outbreak involved 628 clinical infections from skin lesions (565 male detainees and 63 female detainees).

The total number of cases of CA-MRSA at LACJ between 2002 and 2005 was 8,448. The researchers scrutinized the spatial dynamics of MRSA outbreaks in the jail to establish whether the cause of the outbreak was the result of high CA-MRSA transmission in the community or was caused by within-jail transmission.

One thousand of the scenarios at the LACJ were studied, and it was found that within-jail transmission had been low. The community had experienced a high incidence of CA-MRSA. Hence, that may have contributed more to the prolonged outbreak in the Los Angeles jail than transmissions within the jail.

During the prevalence of CA-MRSA, within-jail transmissions were not sufficient to sustain the outbreak. The primary reason for the lengthy outbreak of CA-MRSA despite low transmission within the jail was because of the sustained inflow of infected and colonized detainees from the community. The outbreak would not abate until the infection rate in the community subsided.

Another factor that may have contributed to low instances of within-jail transmissions of CA-MRSA (community-associated) (methicillin-resistant Staphylococcus aureus) is that the average length of incarceration in the jail was relatively short, being 47 days for males and 33 days for females.

For within-jail transmissions to have sustained the outbreak, the average length of stay in jail for males would have had to increase to 83 days. The average stay for women would have had to increase to 60 days. These hypothetical increases in the length of incarceration would have caused a 40% increase in the infections at the jail. That would have resulted in thousands of infected and colonized detainees being released into the community.

More Studies of MRSA Outbreaks

MRSA colonization was an issue brought to light in another study, and Texas jails and prisons were among the correctional institutions that were included. To understand why it is important to prevent MRSA in Texas jails, it helps to understand the terminology. MRSA colonization has to do with how contagious an individual might be. A person may be either simply colonized or have an active infection.

Youth may also be a risk factor for MRSA infection. One study found that older detainees have a significantly decreased risk of MRSA infection. At the same time, detainees aged 30 to 49 years were significantly more likely to have MRSA colonization than detainees between 20 to 29 years old and the >50-year-old age groups.

It’s possible that younger detainees may be more susceptible to MRSA infection because they are new to the environment, or they may have more risk factors than older detainees.

In the study of a Mississippi outbreak of MRSA, significantly more females were colonized with MRSA compared to the males (5.9% vs. 2.5%). Similarly, female inmates incarcerated in Texas had a slightly higher prevalence of MRSA infection than males and also had an incidence of MRSA infection that was twice that of males.

What Does it Mean to be Colonized?

A frequently asked question about MRSA methicillin-resistant staphylococcus aureus has to do with contagion. If you are colonized with MRSA, it means that you carry it in your nose or on your skin, but you are not ill with an MRSA infection. When you are colonized, the risk is much less than when there is an active infection or drainage present on the skin. There is a small risk of transmitting MRSA to close contacts such as your spouse when you are colonized. In jails, where there are close quarters, colonization poses more of a risk than in less crowded conditions.

If you have an abscess, boil, swelling, or pain—which are signs and symptoms of an MRSA infection—then you are much more likely to spread MRSA. That’s because the infected area contains many MRSA germs. Therefore, it is essential to keep the area of the wound covered and to wash your hands after touching the wound.

Risk Factors for MRSA Infection in County and Municipal Jails

The risk factors for methicillin-resistant staphylococcus aureus (MRSA) in U.S. jails include outdoor work assignments, prolonged incarceration, self-draining of boils, washing clothes by hand, previous antibiotic use, history of antimicrobial use, close contact with persons known to have MRSA, and other factors associated with inadequate hygiene and crowding. Comorbidities are another risk factor, a comorbidity being the simultaneous presence of two or more diseases or medical conditions in a patient.

Incarcerated individuals also have higher prevalences of other risk factors for MRSA, such as:

Intravenous drug use and
Associated infections (HIV, hepatitis B and C, and tuberculosis).

All comorbidities except skin conditions led to a moderate risk of MRSA infection among Texas county jail detainees compared to detainees with no comorbidities.

How Can You Tell if You Have MRSA?

MRSA infections and other staph infections may appear as abscesses or boils with drainage or pus present. They are often mistaken for spider bites. There may be swelling, pain, redness, or warmth at the site of the infection, and you may also have a fever. If the wound is not getting better or is rapidly getting larger, contact your health provider.

If you were in jail or had a loved one who died in a jail related to MRSA and believe that it happened due to the jail’s negligence, please reach out to us whether you’re in Texas or elsewhere in the United States and we’ll do our best to see if we can help.

One of this website’s purposes is to provide helpful resources to benefit Texas county and municipal jail detainees and their families. Implying that an individual or entity has engaged in wrongdoing is never intended.

–Guest Contributor

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