Since the first news stories broke about methicillin-resistant Staphylococcus aureus (MRSA) showing up in community settings as opposed to just healthcare facilities where it has remained for decades, America has been disinfecting with fervor, intimidated by the idea of a "superbug" that scoffs in the face of commonly prescribed antibiotics.

While some say awareness generated through others' plights with the stubborn bacteria is positive -- lending support to campaigns that urge hand washing and not sharing personal items -- others say the attention may be overblown and misunderstood, causing undue alarm for otherwise healthy people who can indeed overcome the bug.

Whatever the case, MRSA is here to stay. Healthcare providers share insight into dealing with the bugs.

As reality of MRSA grows, health providers work to educate in effort to contain

MRSA, or methicillin-resistant Staphylococcus aureus, is nothing new to hospitals and healthcare facilities, whose already immune-compromised patients are susceptible to invasive infections primarily via their surgical wounds, catheters and ventilators.

The germ is resistant to many commonly used antibiotics, except for a couple that are given intravenously.

Concern has mounted in recent years as the bacteria also started showing up in locker rooms, schools and other community settings, transferred via skin-to-skin contact among healthy people without ties to healthcare settings.

Dr. L. Silvia Munoz-Price, an infectious disease specialist with Medical Specialists, says many people don't have the concepts of the healthcare-acquired (HA-MRSA) and community-acquired (CA-MRSA) versions very clear.

"They think they are both the same thing," she says of the two types, which actually are different genetic variations of the same organism. "They don't understand that they behave significantly differently."

She says HA-MRSA occurs mainly in older, sicker patients who may have been in and out of hospitals or long-term care facilities or have had surgeries. The infection may occur as pneumonia, bloodstream infections or urinary tract infections. The mortality among people in this group is high, she says, not necessarily because of MRSA, but because of their other medical problems.

HA-MRSA is a bug, she says, that will generally cause problems only for those who are already very sick.

Cases of CA-MRSA, on the other hand, occur in otherwise healthy younger people who aren't typically in a healthcare environment. The most typical presentation, Munoz-Price says, is a boil, but not just any pimple. These are large, deep-seeded boils that are tender, red, warm and continue to enlarge, usually to more than a centimeter in size. The infections are usually localized in the skin and are indeed susceptible to oral antibiotics unlike the healthcare-acquired version.

In many cases, Munoz-Price says, CA-MRSA can be managed simply by incision and drainage of the boil on an outpatient basis, possibly even without oral antibiotics, though most physicians will prescribe them.

This is where Munoz-Price says the recent media attention has been overblown.

"The deaths we have seen in the media are not the norm," she says. "We see a significant amount of patients on a regular basis every day with CA-MRSA that do just fine, do not die, that live normal lives otherwise."

Still, whatever the bug and wherever the origin, the public has demanded action be taken.

Some methods are more effective than others. School janitors wiping down desks nightly, for example, is overzealous and fruitless, Munoz-Price says, because the germ is spread primarily by skin-to-skin contact.

In the healthcare environment, tighter measures aim not only to vanquish the spread of both types, but also keep the bacteria from gaining momentum.

Five area hospitals -- St. Margaret Mercy Healthcare Centers' north and south campuses, St. Anthony Medical Center in Crown Point, St. Anthony Memorial Hospital in Michigan City and Franciscan Physicians Hospital in Munster -- are working together to institute procedures aimed at containing the bug.

Currently, everyone who enters one of these facilities is questioned to determine his or her susceptibility to MRSA, and higher risk individuals are tested with a swab to the nose. Those who are carriers of the bug, whether symptomatic or not, are isolated from other patients.

At the same time, the infection control coordinators at each hospital say the urgency of basic hygiene practices can't be overstated.

"It's just stressing the importance of hand hygiene and just total body hygiene and being conscious of your environment and washing hands frequently," says Sally Bola, infection control coordinator at St. Margaret Mercy Healthcare Center in Hammond.

The coordinators hope their message of hand washing, using hand sanitizers, showering after participating in sporting events and cleaning gym equipment filter down into community settings as well.

Chris Shakula, infection control coordinator at St. Anthony Medical Center in Crown Point, says the MRSA project is also a safeguard to prepare for MRSA challenges ahead.

"A patient can come in with a community-acquired strain and spread that strain into the facility and it becomes a blurred line of, is it now community-acquired or healthcare acquired?" Shakula says.

Mary Tipton, infection control coordinator at St. Margaret Mercy Hospital in Dyer, said not only will there be both types of MRSA in the healthcare setting then, but it could contribute to HA-MRSA gaining a higher level of virulence.

"We want to find these people as soon as they come into the hospital and make sure we take appropriate precautions when we care for them to prevent further spread in the hospital," Tipton says.

But outside the healthcare setting, isolating individuals is pointless, says Munoz-Price, as both symptomatic individuals and carriers without symptoms can transmit the bacteria just as easily.

Instead, she says efforts in the community should focus on decolonization of those known to carry the germ. More widespread use of the chlorhexidine antiseptic used in hospitals by previously diagnosed individuals and their close contacts could be one solution for longer term containment and one that needs more study, Munoz-Price says.

"There are so many people that are carriers and they don't know it. We can't isolate half the population. ... The point is that we are going to have to learn how to live with this and start thinking in a different way of decreasing the bacteria burden of everybody."