2. I. THE EVOLUTION OF BACTERIA © I.Methicillian- Resistant Staphylococcus Aureus THE EVOLUTION OF BACTERIA ©

3. Drug-resistant staph lurks in many places By Anita Manning, USA TODAY Drug-resistant staph lurks in many places By Anita Manning, USA TODAY

4. Antibiotic-Resistant Staph More Common Antibiotic-Resistant Staph More Common June 25, 2007; Page B5

5. Increase In Community- Associated Staph Infections Involving Antibiotic-Resistant Bacteria 02 Jun 2007

6. 'Superbugs' Could 'Dwarf' AIDS, Flu CHICAGO and NEW YORK, June 22, 2006 (CBS) Public health officials are becoming increasingly alarmed by the growing number of illnesses caused by antibiotic-resistant staph bacteria.

7. Drug Resistant Staph Bacteria a Global Problem Wednesday, June 21, 2006

8. Sunday, Jun 18, 2006 Surviving the New Killer Bug A nasty, drug-resistant staph infection--the kind usually seen in hospitals--is racing across the U.S. By CHRISTINE GORMAN

9. MSNBC.com Drug-resistant germs on the rise, doctors warn Study: More Americans acquiring hard-to treat staph infections The Associated Press Updated: 1:59 p.m. ET April 8, 2005

10. 'Superbugs' spread fear far and wide Drug-resistant staph infections no longer threaten just hospital patients, for reasons unknown, they're striking even healthy children and adults

11. Staph infections spreading across the United States as key antibiotic loses punch Posted: Wednesday, Jun 21, 2006 - 03:04:36 pm CDT

12. ASM: Resistant Staph Bacteria Survive on Bed Linen for Days, Keyboards for Weeks By Katrina Woznicki, MedPage Today Staff Writer Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco Source News Article: CNN, MSNBC, Yahoo! NewsRobert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco

13. HICPAC/SHEA Guidelines Debate New Research Estimates MRSA Infections Cost U.S. Hospitals $3.2 Billion to $4.2 Billion Annually Posted on: 05/16/2005

14. National Prevalence Study of Methicillin- Resistant Staphylococcus aureus (MRSA) in U.S. Healthcare Facilities June 25, 2007, 12:01 am EDT EXECUTIVE SUMMARY In October and November 2006, the Association for Professionals in Infection and Epidemiology (APIC) conducted a national MRSA prevalence study. … Data show that 46 out of every 1,000 patients in the study were either infected or colonized with MRSA. This rate is between 8 and 11 times greater than previous MRSA estimates. Source: Association for Professionals in Infection and Epidemiology (APIC)

15. II. MRSA ENTERS THE COMMUNITY

16. STAPH MRSA CA-MRSA (Staphylococcus aureus) In existence for as long as we know, very common and normally harmless. Approx. 35% of population are carriers (Methicillian-Resistant Staphylococcus aureus) Also called Hospital Acquired (HA-MRSA). Traditionally confined to healthcare settings, first identified in the 1960’s. Requires use of “last resort” antibiotics. (Community Acquired - Methicillian-Resistant Staphylococcus Aureus) Identified in late 1990’s. No healthcare exposure necessary. Infects normally healthy people. Penetrates skin through open wounds and abrasions. Evolving rapidly. Produces deadly toxin (panton-Valentine leukocidin) in bones, joints, bloodstream and major organs. Current est. up to 52 million carriers - today.

17. Often the symptoms are initially described as “spider bites”. Red bumps on the skin or red, dry, chapped skin.

18. Left untreated, these infections soon become far more severe, invading the body’s organs and bloodstream. At this point, these infections are life threatening. Following photos are very graphic

19. CA-MRSA can develop into pneumonia, “flesh eating” bacteria, cause blood toxicity, septic shock and eventually organ failure.

20. MRSA has developed a resistance to the most common antibiotics, such as; Penicillin Penicillin Keflex Keflex Cephalexin Cephalexin

21. Late 1990’s, MRSA infections were identified in non-healthcare environments, such as: Schools Correctional facilities Athletic teams Health and fitness clubs Military housing Other areas of close quartering

22. APIC estimates that currently up to 5% of the population carries MRSA in their noses – POSSIBLY AS MANY AS 52 MILLION PEOPLE WORDWIDE Source: APIC (Association for Professionals in Infection and Epidemiology)

23. MRSA spreads in the community through: Skin-to-skin contact Skin-to-skin contact Cuts and open wounds Cuts and open wounds Abraded or chaffed skin Abraded or chaffed skin

24. Exacerbated by: Poor hygiene Overcrowded living conditions Overcrowded living conditions Communal or shared items Communal or shared items

25. Main risk factors: Age Age Living Conditions Living Conditions Weakened Immune System Weakened Immune System Activities (ie. contact sports, frequent skin abrasions, exposure to bodily fluids, …) Activities (ie. contact sports, frequent skin abrasions, exposure to bodily fluids, …) Sharing personal items (ie. Towels, uniforms, clothing, athletic gear, razors, …) Sharing personal items (ie. Towels, uniforms, clothing, athletic gear, razors, …) Contact with healthcare workers Contact with healthcare workers Recent hospitalization Recent hospitalization Use of certain antibiotics Use of certain antibiotics

26. III. WHAT IS NEXT?

27. Avian (bird) flu Avian (bird) flu SARS SARS Clostridium difficile (C. Diff.) Clostridium difficile (C. Diff.) E. Coli E. Coli Hepatitis A & B Hepatitis A & B HIV HIV Herpes Herpes Salmonella Salmonella Parvo virus Parvo virus The next pandemic?

28. IV. PROACTIVE APPROACH “Best offense is a good defense”

29. Where do you need protection? Wherever MRSA thrives! H ANDS & S KIN B ED L INENS, COMFORTERS, BLANKETS & PADDING S HOWERS, L OCKER R OOMS, EXERCISE & T HERAPY E QUIPMENT U NIFORMS & T OWELS C AFETERIA, COMPUTER ROOM, CLASSROOM …

30. How do we stop cross-contamination and infection from bacteria, viruses, spores, fungus …? CLEAN SANITIZE Hands and skin with residual sanitizer Hands and skin with residual sanitizer Hard surfaces treated with active anti-microbial Hard surfaces treated with active anti-microbial Washable textiles with residual, self-sanitizing finish Washable textiles with residual, self-sanitizing finish Wash hands Wash hands Wash environmental contact surfaces Wash environmental contact surfaces Wash clothing, linens, towels, uniforms, equipment… Wash clothing, linens, towels, uniforms, equipment… e prevent the spread! At the source - we prevent the spread!

31. HANDS & SKIN  FDA Approved  Alcohol-free  Non- flammable  No water or towels required  Non-sticky and won’t dry out skin  Does not remove protective body oils  Greaseless, no-drip FOAM  Residual anti-microbial activity  Efficacy increases with use

32. Benzalkonium Chloride-based products exhibit increased efficacy with use. Ethyl Alcohol-based products decline in performance! Ethyl Alcohol-based products fall below FDA Minimum Standards within 3 - 4 uses!

34. SURFACES SureClean ™ Hard Surface Disinfectant and Sanitizer EPA Registered  EPA Registered  Disinfectant, Sanitizer, Mildewstat, Fungicide  Kills 99.9%, or more of infectious bacteria  Broad spectrum (HIV, VRE, MRSA, HBV, HCV, Herpes (Type 1 & 2), Strep, Avian Influenza A)  No rinsing required  Convenient, Ready-to-use spray  Non-acid formulation contains no bleach, phenolics or phosphates  Effective in hard water (up to 400 ppm)

35. CLOTHING, BED LINENS, UNIFORMS, TOWELS, … BacStop ™ Fabric Sanitizer & Bacteriostat  EPA Registered  Liquid fabric sanitizer and mildewcide  Self-sanitizing finish (continually kills minimum of 99.9% of newly acquired bacteria)  Continues working after textiles are laundered (creates a Zone of Inhibition)  Eliminates odors due to bacterial growth  Easy to use, final rinse treatment

36. Infectious Bacteria Zone of Inhibition Treated Fabric Textiles treated with BacStop™ retain a self-sanitizing condition, creating a Zone of Inhibition around the surface area of the textile. Bacteria do not replicate on the surface – and therefore die.

37. Program for Infection Control Foaming Hand & Skin Sanitizer Pro-Tex™ Foaming Hand & Skin Sanitizer Hard Surface Disinfectant and Sanitizer SureClean™ Hard Surface Disinfectant and Sanitizer Fabric Sanitizer & Bacteriostat BacStop™ Fabric Sanitizer & Bacteriostat Concentrated odor neutralizer DeScent™ Concentrated odor neutralizer

39. An once of prevention