Is the increasing incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections related to the rise in body modifications, such as piercing and tattooing? Besides wearing masks, gloves, etc., what can I do to protect myself and my staff? What can I say to patients who are concerned about transmission after sitting between infected patients in the waiting room and seeing my staff in masks and gloves?
—Wayne Tamberelli, PA-C, Tarboro, N.C.

CA-MRSA, as reviewed on the CDC Web site ( Accessed October 17, 2007), has become a significant problem for community clinicians. The infection has affected diverse populations, including infants, athletes, and men who have sex with men. Contact precautions are recommended if there is to be any sort of visit with a patient having an open wound known to be draining MRSA. Continued contact isolation in the outpatient setting has not been routinely recommended. Patient rooms should be cleaned using a bleach solution (one tablespoon of bleach in one quart of water). Attention to hand hygiene between patient visits is effective and should be encouraged for all those working in your clinic. CA-MRSA is transmitted through close physical contact: It is not a respiratory pathogen. Professional football players, wrestlers, exotic dancers, and individuals who engage in high-risk sexual activities are those at greatest risk. Person-to-person transmission in the outpatient setting has not been described.
—Cedric W. Spak, MD, MPH (109-7)

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