March 3, 2009
DALLAS - The Dallas County Jail is the site of one of the most comprehensive studies ever undertaken of a dangerous, drug-resistant bacterial infection that has alarmed health officials across the nation.
Last month, the Parkland Memorial Hospital staff began handing out medicated cleansing cloths to hundreds of participating inmates to see whether the cloths will stop the spread of the infectious, flesh-eating bacteria methicillin-resistant Staphylococcus aureus, or MRSA.
It's part of a three-year University of Chicago study of the spread of staph infections in the jail that began last year. The medical research team selected Dallas County's jails over the Los Angeles County jail system - the nation's largest.
"We were excited to do it because it's the only study of its type to be done in a jail," said Sharon Phillips, Parkland's vice president in charge of jail health. "It's a great study and hopefully in the next couple of years, we'll know more about MRSA."
The Chicago research team hopes to publish its results next year.
If successful, the study could offer guidance to improve prevention in jails and prisons and other public facilities, including schools and recreation centers. It also could help stop inmates from spreading MRSA to the general population after their release.
Like other large jail systems, the Dallas County jails had a major staph infection outbreak several years ago. But the number of cases has fallen steadily since 2006 because of better medical care from Parkland and improved hygiene and cleaning routines in the jails.
Today, jail guards and medical workers are no longer being infected along with inmates, Phillips said.
The Chicago research team is led by Dr. Robert Daum, professor of pediatrics at the University of Chicago and a MRSA specialist. Daum had wanted access to the Cook County Jail in Chicago but had to look elsewhere after getting resistance from the jail's clinic.
Dallas was convenient and the research team had a relationship with a doctor at UT Southwestern Medical Center, which is participating in the jail study, said Dr. Michael David, who is Daum's colleague.
There are two main strains of the MRSA bacterium, one of which is found in hospitals and is highly resistant to multiple drugs. The other is a community-based strain found in places like day-care centers, school locker rooms and jails.
Daum wants to know how the community-based strain is spread from person to person at the Dallas County Jail and if it can be slowed by using medicated washcloths.
On Jan. 5, Parkland jail staff began distributing two sets of disposable washcloths to inmates to use in cleaning their skin.
One set of cloths is treated with a chemical antiseptic called chlorhexidine, which is found in skin cleansers. Another group of inmates receives cloths soaked in water. Parkland staff, who don't know which is which, will distribute them for about seven months.
A third group receives no cloths.
"We send information to Chicago every day," Phillips said.
Daum wants about 1,500 inmates to participate in the study. So far about 1,200 have volunteered and signed consent forms, Phillips said. The inmates don't receive anything for their participation, she said.
Jail medical staff members also are collecting bacteria from inmates with bacterial skin infections for 18 months to determine how often they are caused by MRSA, as opposed to other bacteria.
David said his team also wants to know if the bacteria, which can live for weeks on objects such as railings and phones, can infect someone who touches them.
MRSA is a skin infection marked by inflamed reddish sores and pus-filled boils that is spread quickly and easily, especially in confined areas like jails and hospitals. New strains are becoming more resistant to antibiotics.
In some cases, the bacterium can get into the bloodstream and infect bone, spinal fluid and vital organs. It can be deadly without proper draining and treatment.
"These new strains cause new kinds of infections that are fatal in healthy people occasionally," David said.
The bacteria have flourished in jails and prisons because of crowded conditions and a lack of hygiene and overall cleanliness. Such facilities also house people with a greater risk of carrying the bacterium, such as drug users and the homeless who don't have access to health care.
The infection can spread when inmates share towels, soap and mattresses.
David said that MRSA is spreading quickly through healthy communities and that it has become an epidemic in some areas of the nation. However, the Dallas County health department said it has no statistics on infection rates in the community because MRSA is not a reportable disease.
Staph infections in the jail are rarer today, said Parkland's Phillips.
In November 2004 and 2005, about 250 cases were reported - a higher rate than that of the larger Los Angeles jail system at the time. However, by 2007, a total of 135 cases were detected for the entire year, Phillips said. In 2008, 229 cases were found, she said.
ABOUT THE STUDY
What is the purpose of the study? Medical researchers from the University of Chicago are conducting a three-year study of MRSA infections in the Dallas County Jail, which has struggled with outbreaks in recent years. The research team hopes to control the spread of the bacteria using medicated washcloths.
What is MRSA? Methicillin-resistant Staphylococcus aureus, known as MRSA, is a "staph" bacteria that is resistant to antibiotics.
Who gets it? One strain of the bacteria is often found in hospitals and nursing homes. A second, called community-associated MRSA, can cause skin infections in otherwise healthy people in jails and prisons, as well as other facilities.
What does an MRSA infection look like? MRSA bacteria can cause skin infections that may resemble a pimple or boil. They can be red, swollen, painful and have pus. More serious infections can cause pneumonia and get into the bloodstream and surgical wounds.
Who is at risk? The bacteria can be spread through skin-to-skin contact, cuts and wounds, and by touching contaminated items and surfaces in crowded living conditions with poor sanitation and hygiene.
How are skin infections prevented? Wash hands thoroughly with soap and water; keep cuts and scrapes clean and bandaged until healed; avoid contact with other people's wounds or bandages; and avoid sharing personal items such as towels and razors.
SOURCE: Centers for Disease Control and Prevention