Germ Probes

By Bequi Livingston

Recently confirmed cases of MRSA really shook things up in the wildland fire community. One Arizona Hot Shot crew saw an outbreak during the recent wildland-fire complexes in Northern California. It started with a single exposure, which then led to other crew members becoming infected, from simply handling the equipment of the originally affected individual. And over the course of the fire season, cases of MRSA from previous years came to light.

Methicillin-resistant staphylococcus aureus is resistant to certain antibiotics, making it harder to treat. Sometimes a simple Staph infection that starts as a skin infection may worsen or be diagnosed as MRSA. Staph is a bacteria that can cause skin infections that look like pimples, boils or insect bites and can easily enter existing skin openings such as cuts, scrapes and lesions. Staph can be treated easily if diagnosed early; however, Staph can cause more serious conditions such as infections of the bloodstream, surgical sites or pheumonia or may be diagnosed as MRSA.

Anyone can contract a Staph infection or MRSA, but chances are higher if a person has:

• Skin-to-skin contact with someone who is infected;
• Contact with items and/or surfaces that have the bacteria on them;
• Any open wounds on the skin such as cuts, scrapes, insect bites, and poison oak or other lesions;
• Crowded living conditions;
• Poor hygiene; or
• Weakened immune system.

MRSA, which used to be more prevalent in hospitals and other facilities hosting individuals with weakened immune systems, is becoming more common in healthy people. These infections are extremely contagious and can occur among people who are likely to have open wounds and close contact with one another, such as members of the wildland fire community. This type of MRSA is known as community-based MRSA, or CA-MRSA. MRSA is not to be taken lightly, especially if contracted during a fire assignment. In this case, it's critical that infected individuals take immediate action and seek medical attention with the support of the incident medical unit. It's equally critical that the incident management team is advised to take immediate steps to prevent the spread of the infection and/or recognize additional exposures.

The wildland-fire environment provides the perfect host for a Staph infection to thrive due to limited personal hygiene practices, close living conditions, weakened immune systems and potential contaminants.

All employees that continue supporting wildland fire and/or all-risk incidents need to be proactive and take preventative measures prior, during and after assignments. Crew members should:

• Take a small supply kit in their fire gear that has alcohol-based hand sanitizer.
• Be compulsive about hand-washing and hand sanitizing during assignments. Hands should be washed often, preferably with hot water and soap.
• Not touch other people's open wounds or bandages without proper protection (latex gloves or equivalent).
• Not share personal items such as towels, combs and razors.
• Pay close attention to any open wound (cut, scrape, insect bites, poison oak) and treat them as a perfect MRSA or Staph entry site. If a firefighter notices any redness, swelling, pus, or joint pain, he or sher should seek immediate medical attention.
• Keep all open wounds clean and covered with a clean bandage.

Team leaders should discuss preventative measures at all safety briefings, and crews should pay close attention to the incident action plan components in case you encounter a medical emergency. All employees on an incident need to read and understand the medical plan every day (shift).

If there is a suspected or confirmed exposure, take immediate measures to ensure proper disinfectant of all clothing, equipment and personal items.

Compounding the MRSA concerns was the continued rash of poison oak-related issues and incidence of “camp crud.” One complex in Northern California alone reported close to 900 poison-oak cases. Some individuals received immediate treatment from the medical unit, while others required additional medical attention by a hospital or other medical facility.

In further discussions with a variety of medical specialists, safety officers and firefighters, it became quite apparent that the common denominator related to MRSA, poison oak and “camp crud” was related to personal hygiene.

After several Safenet reports were submitted regarding the poison-oak concerns, it became evident that a culture still exists where personal hygiene just isn't the cool thing to do. Crews were coming back to fire camp after three to five days in spike camp, unshowered and still wearing the same clothing, and standing in the chow line with germs on the sleeves of their nomex shirts. This behavior is the exception and not the rule; however, it does still exist and compounds the concerns related to MRSA and poison oak.

Simple, proactive measure related to personal hygiene include:

• Changing clothes as often as possible.
• Removing Nomex shirts (at minimal) before entering the chow line. This is especially important for poison-oak exposure. The urushiol sticks to the material and can be easily transferred to another person's skin.
• Leaving dirty Nomex and boots outside the sleeping area as not to transfer contaminants.
• Taking showers when units are available.
• Obtaining “Bath-In-A-Bag” components in the absence of a shower unit.
• Sanitizing hands and skin often either with a hand sanitizer or hot water and soap.
• Trading dirty Nomex for clean Nomex through the supply unit.

Bequi Livingston is the regional fire operations health and safety specialist for the U.S. Forest Service, Southwestern Regional Office. She also is a certified personal fitness trainer, fitness specialist and fitness instructor. Livingston currently is completing her college education in exercise science and athletic training. She owns a fitness consulting business and developed Fireline Fitness in 1984 to provide a balanced fitness program for wildland firefighters. Livingston, along with a team of other interagency fire experts, recently developed the national FireFit program endorsed by the Federal Fire and Aviation Safety Team.

Tod Schimelpfenig, National Outdoor Leadership School, contributed to this article.

Centers for Disease Control and Prevention www.cdc.gov

WebMD (*search for MRSA or Staph infection) www.webmd.com

Environmental Protection Agency (information on recommended disinfectants) http://epa.gov.oppad001/list_h_mrsa_vre.pdf