10/10/2005

Flesh-Eating Bacteria: Another Good Reason to Observe Universal Precautions!

By Barbara K. Garrison, M.S., CHMM, CET, Safex

If you are an embalmer or assist in the handling of remains and you need another good reason why you should observe universal precautions, I have two words that should make you reach for your gloves, gowns, goggles and face protection: necrotizing fasciitis (NF). NF is a bacterial infection caused commonly by group A streptococcus (GAS). It is popularly referred to as "flesh-eating bacteria" because it destroys muscles, fat and skin tissue. In 2002, there were approximately 540 reports of necrotizing fasciitis in the U.S. About 25% of patients with necrotizing fasciitis die. While this may not seem like a significant number of fatalities compared with other diseases such as hepatitis B, it is a largely preventable disease if you observe a few basic precautions when handling remains.

GAS is a bacterium often found in the throat and on the skin. While most GAS infections result in no illness or mild illnesses like strep throat, NF can occur when bacteria get into parts of the body where bacteria usually are not found, such as the blood, muscle, or the lungs. GAS bacteria are spread through direct contact with mucus from the nose or throat of persons who are infected or through contact with infected wounds or sores on the skin. Most often the bacteria enter the body through an opening in the skin, quite often a very minor opening, even as small as a paper cut, a staple puncture, or a pin prick. It can also enter through weakened skin, like a bruise, blister, or abrasion. It can also happen following a major trauma or surgery, and in some cases there appears to be no identifiable point of entry.

Early signs and symptoms (usually within 24 hours) of necrotizing fasciitis include:

Some pain in the general area of the injury. Not necessarily at the site of the injury but in the same region or limb of the body.

The pain is usually disproportionate to the injury and may start as something akin to a muscle pull, but becomes more and more painful.

Flu like symptoms begin to occur, such as diarrhea, nausea, fever, confusion, dizziness, weakness, and general malaise.

Intense thirst occurs as the body becomes dehydrated.

Advanced symptoms (usually within 3-4 days) include:

The limb, or area of body experiencing pain begins to swell, and may show a purplish rash.

The limb may begin to have large, dark marks that will become blisters filled with blackish fluid.

The wound may actually begin to appear necrotic with a bluish, white, or dark, mottled, flaky appearance.

NF infections can be treated with many different antibiotics, but early detection is
crucial and surgery is often needed to remove damaged tissue.

The spread of all types of GAS infection can be reduced by good hand washing and observing universal precautions: Treating all body fluids as if they are infectious and protecting those parts of your body that might come into contact with the body fluids.
If you have a cut or wound, make sure you keep it clean and watch for possible signs of infection such as redness, swelling, drainage, and pain at the wound site. A person with signs of an infected wound, especially if fever occurs, should seek medical care.
If you would like more information about NF, visit the National Necrotizing Fasciitis Foundation's website at www.NNFF.com or follow this link to the Center for Disease Control's website: