Recent news reports detail super-drug-resistant staph infections in schools across the country and school closings for the cleaning of shared surfaces, particularly with respect to shower areas and shared sports equipment.1 The threat of the spread of these infections is particularly relevant to the gaming industry due to the significant amount of contact between employees and the general public. Additionally, the number of shared common spaces, such as table games and slot machines, leads to potential concerns. Furthermore, because many casinos are part of larger resorts that include gyms and spas, the gaming industry needs to consider these issues, too, when assessing the potential risks. Gaming employers should prepare for anticipated questions from employees about rumors of super-staph infections among coworkers, contamination risks in the workplace, and precautions that the employer is implementing to maintain a safe work environment.
What is an MRSA Staph Infection?
Staphylococcus aureus (staph) is a bacteria commonly found on the skin or in the nose of a healthy person. Approximately 25 to 30 percent of the population is “colonized” (i.e., bacteria are present without causing infection) in the nose with staph bacteria. Although staph is one of the most common causes of skin infections (such as pimples and boils) in the United States, staph bacteria can also cause serious infections, including surgical wound infections, bloodstream infections and pneumonia.2
Some staph infections are resistant to many antibiotics. MRSA (methicillin-resistant Staphylococcus aureus) is resistant to beta-lactam antibiotics, including the commonly-prescribed oxacillin, penicillin and amoxicillin. While 25 to 30 percent of the population may be colonized with staph bacteria, only about 1 percent are colonized with MRSA.
An article in the Oct. 17, 2007, issue of the Journal of the American Medical Association3 adopted a different method of counting cases and reported a significantly higher number of deaths (94,360) in 2005 due to MRSA infection. According to the article, approximately 18,650 people died during a hospital stay related to serious MRSA infections. Serious MRSA infections are still predominantly related to exposures in the healthcare industry. About 85 percent of all invasive MRSA infections were associated with healthcare. Of them, two-thirds occurred outside of a hospital setting, in nursing homes or extended-care facilities. Only about 14 percent of all cases occurred in people without an obvious exposure to healthcare services.
How is it Spread?
The Centers for Disease Control and Prevention (CDC) has investigated clusters of CA-MRSA skin infections among athletes, military recruits, children, Pacific Islanders, Alaskan Natives, Native Americans, prisoners, and men who have sex with other men. Factors associated with the spread of MRSA skin infections include: close skin-to-skin contact; openings in the skin, like cuts or abrasions; contaminated items and surfaces; crowded living conditions; and poor hygiene.
Prevention
Prevention of staph or MRSA skin infections includes good hygiene practices:
1. Clean hands regularly with soap and water or by using an alcohol-based hand sanitizer.
2. Keep cuts and scrapes clean and covered with dry bandages.
3. Avoid contact with other people’s bandages or wounds.
4. Avoid sharing personal items like razors or towels.
People with weakened immune systems, including those with HIV, may be at risk for a more severe illness if they get infected, but at this point, the CDC recommends only that such persons exercise the good hygiene practices listed above.4
Employers need to consider how to educate employees and visitors on such “good hygiene” practices and whether “health monitors” or disciplinary actions might be appropriate as part of the program. Additional steps might include: increased cleaning of commonly shared work spaces; ensuring the availability of soap and alcohol wipes; proper disposal of wipes, towels and bandages; personal protective equipment for first-aid providers; sickbay precautions and protocols; and communication plans to inform employees of possible infections and precautions without raising privacy issues or promoting unnecessary panic or concern.
Treatment
Staph infections and MRSA infections are treatable. For many staph infections, treatment may not even include antibiotics; instead, a healthcare provider may drain the abscess or boil and dress the wound with a dry bandage. MRSA infections are treatable with some antibiotics. Patients should take all of the prescribed doses and not share or save unfinished antibiotics for use at another time.
Employer Responses
At this stage of OSHA public information5 and CDC guidelines, employers would be well advised to be aware of the general duty clause of the OSH Act,6 which imposes on employers a duty to avoid certain recognized hazards in the workplace and other potentially relevant OSHA requirements, like an employer’s bloodborne pathogens program.7
An employer faced with an employee who self-discloses that he or she has an MRSA infection needs to be mindful of several potential legal pitfalls. The employee may be entitled to the protections of the Americans with Disabilities Act, including reasonable accommodation and protection from retaliation, which might entail providing time and a location to change bandages or leave from work to obtain on-going treatment. Employees may be entitled to FMLA leave or other company-provided leave to care for themselves or an infected family member. Furthermore, such shared confidential medical information also raises privacy concerns and potential HIPAA obligations, particularly as an employer takes steps to disinfect and clean the workplace, or other precautions.
MRSA infections also raise a relatively new problem for employers, similar to the challenges of preparing for avian flu, SARS, drug-resistant tuberculosis and other pandemic illnesses. Each of these highly-contagious health threats creates new demands on employers to prepare emergency health plans involving all facets of their operations. Such emergency planning might include: examining how normal operations and the worksite could be changed to minimize face-to-face interactions of employees and promote social distancing (greater than three feet) in times of a flu pandemic; securing and training employees on the use and disposal of personal protective equipment, including masks and gloves; monitoring employees’ use of good hygiene practices in the workplace, such as skin-to-skin contact and cough etiquette; arranging for the proper disposal of tissues and bandages; increased cleaning of shared work spaces and gathering locations, helping employees not infect each other or the public; maintaining IT and financial data processing during employee absences; and shifting operations to non-infected areas. Employment concerns raised by these highly contagious illnesses call for a level of sophistication about health issues, proactive planning and employee communication protocols that extend far beyond the issues raised by how to respond to a single sick employee.
Footnotes
1 See “Staph infections reported at schools across the country,” The New York Times, Oct. 17, 2007, available at http://nytimes.com/2007/10/17/us/17school-cnd.html; Guest Column: “Finding the facts on student infections,” Frances B. Phillips, Maryland Gazette, Oct. 17, 2007 (commenting on two weeks of reports about skin infections primarily affecting county high school students).
2 “Community-Associated MRSA Information for the Public” at http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_public.html.
3 Journal of the American Medical Association, 2007; 298(15):1763-1771.
4 CDC recommendations for patient care related to prevention and management of the transmission of MRSA in hospitals may be found at Management of Multidrug Resistant Organisms In Healthcare Settings, 2006, available at CDC “Infection Control Guidelines” at http://www.cdc.gov/ncidod/dhqp/guidelines.html.
5 OSHA at this stage has merely issued public information on its website that paraphrases the CDC information and recommendations. “Hospital eTool-HealthCare Wide Hazards Module: MRO-Multi-Resistant organisms,” at http://www.osha.gov/SLTC/etools/hospital/hazards/mro/mro.html.
6 Each employer “shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious harm to his employees.” 29 U.S.C. § 654.
7 The Bloodborne Pathogens Standard requires precautions when dealing with blood and other potentially infectious materials. 29 CFR §§1910.1030, et seq.
Patrick H. Hicks is Founding Shareholder of Littler Mendelson’s Las Vegas and Reno offices. He can be reached at phicks[at]littler.com.
Sandra Ketner is an Associate at Littler Mendelson in Reno. She can be reached at sketner@[at]ittler.com.
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