FACT SHEET: Methicillin Resistant Staphylococcus Aureus Carriage/Infection (also known as “MRSA”; includes “community-associated MRSA” [CA-MRSA] and “healthcare-associated MRSA” [HA-MRSA])
Date of Publication: March 11, 2013
Is the initiation of non-invasive dental hygiene procedures* contra-indicated?
Is medical consult advised?
Is the initiation of invasive dental hygiene procedures contra-indicated?**
- No, as long as there is no active infection in the oral cavity.
Is medical consult advised?
- Only if active infection in the oral cavity is suspected.
Is medical clearance required?
Is antibiotic prophylaxis required?
Is postponing treatment advised?
- Possibly, depending on result of the medical/dental consult if oral infection is suspected.
Oral management implications
- Mode of transmission is via skin-to-skin contact, contact with infected bodily fluids (e.g., pus), or objects which have become contaminated with infected bodily fluids (e.g., contaminated medical equipment). While about 33% of people are colonized in the nose with Staph, only 2% are colonized with MRSA. [Colonized: When a person carries the organism but shows no clinical signs or symptoms of infection. For Staph aureus the most common colonized body site is the nose.] MRSA involves resistance to the antibiotic methicillin and other more common beta-lactam antibiotics such as penicillin, amoxicillin, and oxacillin. Persons with weakened immune systems and chronic illnesses are more susceptible to MRSA infections, and spread in hospitals and long-term care facilities is frequent. Most MRSA infections in the community setting — and therefore most likely to be encountered by dental hygienists — are skin infections.
- If a person picks up MRSA on the hands, that person can spread it to others if the hands are not cleaned properly. A person can also infect one’s self through an open wound on one’s own body.
- In healthcare settings, MRSA is typically spread from patient/client to patient/client on unclean hands of healthcare personnel or through the improper use or reuse of equipment. To prevent the spread of MRSA, ensure appropriate hand hygiene (i.e., washing with soap and water or using an alcohol-based hand sanitizer) along with other appropriate infection prevention and control practices.
- Disinfectants effective against “ordinary” Staphylococcus aureus are likely also effective against MRSA. Most disinfectant manufacturers provide a list of microbes on their product’s label that their product can destroy.
- No specific oral lesions are associated with MRSA. The mouth is not typically a site of MRSA concern. However, in a known MRSA carrier, a higher index of suspicion is warranted in the presence of unusual oral lesions.
Related signs and symptoms
- In the community setting, most MRSA infections are skin infections and can be successfully treated (e.g., via incision and drainage and/or certain antibiotics). These skin infections may manifest as pustules or boils, which are often red, swollen, and painful, and/or have pus or other drainage. These lesions commonly occur where skin trauma occurs (e.g., cuts and abrasions), and areas of the body covered by hair (e.g., back of neck, groin, buttock, armpit, and beard area of men). Fewer may be present.
- More rarely, MRSA infections — particularly in institutional settings amongst patients/clients with immunosuppression or chronic diseases — can result in serious and potentially life-threatening complications such as septicemia (i.e., infection of the bloodstream), osteomyelitis (i.e., infection of the bones), and pneumonia (i.e., infection of the lungs).
- Risk factors for community-associated MRSA include participating in contact sports, living in crowded or unsanitary conditions, men having sex with men, and using intravenous drugs.
- Risk factors for healthcare-associated MRSA include being hospitalized, having an invasive medical device (e.g., intravenous line or urinary catheter), and residing in a long-term care facility.
References and sources of more detailed information
- College of Dental Hygienists of Ontario
- Royal College of Dental Surgeons of Ontario
- Public Health Ontario
- Provincial Infectious Diseases Advisory Committee https://www.publichealthontario.ca/en/eRepository/PIDAC-IPC_Annex_A_Screening_Testing_Surveillance_AROs_2013.pdf
- Government of Canada
- The Centers for Disease Control and Prevention (USA) offers specific advice for preventing MRSA in a variety of settings, including healthcare settings. http://www.cdc.gov/mrsa/
- Mayo Clinic
Date: December 16, 2012
Revised: August 31, 2015; April 1, 2020