MRSA in SchoolsMRSA in Schools

Dept. of Infectious DiseasesDept. of Infectious Diseases

Kaiser Modesto Medical CenterKaiser Modesto Medical Center

Dec. 12, 2007Dec. 12, 2007

Learning ObjectivesLearning Objectives

What is Staphylococcus aureus?What is Staphylococcus aureus?

What is MRSA?What is MRSA?

What are the risk factors for MRSA?What are the risk factors for MRSA?

What increases the risk of MRSA infection?What increases the risk of MRSA infection?

How is MRSA spread?How is MRSA spread?

How can we reduce the spread of MRSA in How can we reduce the spread of MRSA in schools?schools?

What is Staphylococcus What is Staphylococcus aureus?aureus?

Staphylococcus aureus, often referred to as Staphylococcus aureus, often referred to as “staph,” are bacteria commonly carried on “staph,” are bacteria commonly carried on the skin or in the nose of healthy people. the skin or in the nose of healthy people.

About 25-30% of the U.S. population carries About 25-30% of the U.S. population carries “staph” on their bodies and yet the bacteria “staph” on their bodies and yet the bacteria do not always cause illness or infection.do not always cause illness or infection.

What is MRSA?What is MRSA?((Methicillin-resistant Methicillin-resistant Staphylococcus aureusStaphylococcus aureus))

MRSA is a kind of MRSA is a kind of Staphylococcus aureusStaphylococcus aureus (“staph”) bacteria(“staph”) bacteria

Often causes skin infectionsOften causes skin infections

““Super Bug” - resistant to (not killed by) Super Bug” - resistant to (not killed by) penicillins and many other antibioticspenicillins and many other antibiotics

Treatable with appropriate antibioticsTreatable with appropriate antibiotics

Is MRSA different from other Is MRSA different from other “staph”?“staph”?

MRSA is a kind of “staph”. It can be carried on the skin or in the MRSA is a kind of “staph”. It can be carried on the skin or in the nose of healthy people, and may never cause an infection or nose of healthy people, and may never cause an infection or make them sick (MRSA carriers). make them sick (MRSA carriers).

It can cause minor skin infections that go away without any It can cause minor skin infections that go away without any special medical treatment.special medical treatment.

MRSA can cause skin infections that look just like infections MRSA can cause skin infections that look just like infections caused by other “staph”. caused by other “staph”. MRSA is also spread the same way MRSA is also spread the same way as other “staph”.as other “staph”.

More serious infections, such as pneumonia, bloodstream More serious infections, such as pneumonia, bloodstream infections, or bone infections, are very rare in healthy people infections, or bone infections, are very rare in healthy people who get MRSA skin infections.who get MRSA skin infections.

Does MRSA cause more serious Does MRSA cause more serious infections than other “staph”? infections than other “staph”?

MRSA usually does not cause more MRSA usually does not cause more serious problems than other “staph”. serious problems than other “staph”.

Many MRSA skin infections are mild and Many MRSA skin infections are mild and heal by themselves when kept clean and heal by themselves when kept clean and dry. dry.

Some MRSA, just like some “staph”, may Some MRSA, just like some “staph”, may produce substances that cause more produce substances that cause more severe infections severe infections

What do MRSA skin infections What do MRSA skin infections look like?look like?

Spider or bug bite (looks & feels like)Spider or bug bite (looks & feels like)

Infected skin/wound Infected skin/wound

ImpetigoImpetigo

Boil/abscessBoil/abscess

Who Gets MRSA?Who Gets MRSA?

Anyone can get MRSA!

Risk factors associated with Risk factors associated with MRSA infectionMRSA infection

The 5 C’s of MRSAThe 5 C’s of MRSA: :

CContact; ontact;

CCrowding; rowding;

CContaminated items; ontaminated items;

CCompromised skin integrity; and ompromised skin integrity; and

CCleanliness.leanliness.

What increases the risk of What increases the risk of MRSA infection?MRSA infection?

Close skin contact w/someone who has Close skin contact w/someone who has MRSAMRSASkin disease or injurySkin disease or injuryLack of good hygieneLack of good hygieneSharing personal items or sports equipmentSharing personal items or sports equipmentOvercrowded living conditionsOvercrowded living conditionsLack of access to healthcareLack of access to healthcareIncorrect use or overuse of antibioticsIncorrect use or overuse of antibiotics

How is MRSA spread?How is MRSA spread?

Skin to Skin ContactSkin to Skin Contact

– Touching MRSA infected skinTouching MRSA infected skin

– Touching drainage from MRSA skin infectionTouching drainage from MRSA skin infection

Surface to Skin ContactSurface to Skin Contact

– Sharing personal items (bar soap, towels, clothes, sports Sharing personal items (bar soap, towels, clothes, sports equipment)equipment)

– Touching surfaces that have MRSA on them like phones, Touching surfaces that have MRSA on them like phones, keyboards, doorknobskeyboards, doorknobs

Is MRSA the “flesh-eating” Is MRSA the “flesh-eating” bacteria? bacteria?

Many bacteria can cause severe illness, Many bacteria can cause severe illness, including a very severe skin and soft including a very severe skin and soft tissue infection called “necrotizing fasciitis.tissue infection called “necrotizing fasciitis.

This kind of life-threatening infection is This kind of life-threatening infection is rare and can be caused by “staph”, rare and can be caused by “staph”, including MRSA, and other kinds of including MRSA, and other kinds of bacteria.bacteria.

How are MRSA skin infections How are MRSA skin infections treated?treated?

By a healthcare provider who may: By a healthcare provider who may:

Drain the infection and/orDrain the infection and/or

Prescribe an antibiotic based on culture Prescribe an antibiotic based on culture results and/orresults and/or

Help reduce the amount of bacteria on the Help reduce the amount of bacteria on the skin and noseskin and nose

Should schools close because of Should schools close because of an MRSA infection?an MRSA infection?

The decision to close a school for any The decision to close a school for any communicable disease should be made by school communicable disease should be made by school officials in consultation with local and/or state officials in consultation with local and/or state

public health officials. However, public health officials. However, in most in most cases, it is not necessary to close cases, it is not necessary to close schoolsschools because of an MRSA infection in a because of an MRSA infection in a student. It is important to note that MRSA student. It is important to note that MRSA transmission can be prevented by simple transmission can be prevented by simple measures such as hand hygiene and covering measures such as hand hygiene and covering infections.infections.

Should the school be closed to be cleaned Should the school be closed to be cleaned or disinfected when an MRSA infection or disinfected when an MRSA infection

occurs?occurs?Covering infections will greatly reduce the risks of surfaces Covering infections will greatly reduce the risks of surfaces becoming contaminated with MRSA. becoming contaminated with MRSA. In general it is not In general it is not necessary to close schools to "disinfect" themnecessary to close schools to "disinfect" them when when MRSA infections occur. MRSA skin infections are MRSA infections occur. MRSA skin infections are transmitted primarily by skin-to-skin contact and contact transmitted primarily by skin-to-skin contact and contact with surfaces that have come into contact with someone with surfaces that have come into contact with someone else's infection. else's infection. When MRSA skin infections occur, cleaning and disinfection When MRSA skin infections occur, cleaning and disinfection should be performed on surfaces that are likely to contact should be performed on surfaces that are likely to contact uncovered or poorly covered infections. uncovered or poorly covered infections. Cleaning surfaces with detergent-based cleaners or Cleaning surfaces with detergent-based cleaners or Environmental Protection Agency (EPA)-registered Environmental Protection Agency (EPA)-registered disinfectants is effective at removing MRSA from the disinfectants is effective at removing MRSA from the environment. environment. – The EPA provides a list of EPA-registered products The EPA provides a list of EPA-registered products

effective against MRSA: effective against MRSA: http://epa.gov/oppad001/chemregindex.htmhttp://epa.gov/oppad001/chemregindex.htm

Should the entire school community Should the entire school community be notified of every MRSA be notified of every MRSA

infection?infection?Usually, it should not be necessary to inform the entire Usually, it should not be necessary to inform the entire school community about a single MRSA infection. When school community about a single MRSA infection. When an MRSA infection occurs within the school population, an MRSA infection occurs within the school population, the school nurse and school physician should the school nurse and school physician should determine, based on their medical judgment, whether determine, based on their medical judgment, whether some or allsome or all students, parents and staff should be students, parents and staff should be notified. Consultation with the local public health notified. Consultation with the local public health authorities should be used to guide this decision. authorities should be used to guide this decision.

Remember that staphylococcus (“staph”) bacteria, Remember that staphylococcus (“staph”) bacteria, including MRSA, have been and remain a common including MRSA, have been and remain a common cause of skin infectionscause of skin infections

Should the school be notified that Should the school be notified that my child has an MRSA infection?my child has an MRSA infection?

Consult with your school about its policy Consult with your school about its policy for notification of skin infections.for notification of skin infections.

Should students with MRSA skin Should students with MRSA skin infections be excluded from infections be excluded from

attending school?attending school?

Unless directed by a physician, students with Unless directed by a physician, students with MRSA infections should not be excluded from MRSA infections should not be excluded from attending school. attending school.

Exclusion from school and sports activities Exclusion from school and sports activities should be reserved for those with wound should be reserved for those with wound drainage ("pus") that cannot be covered and drainage ("pus") that cannot be covered and contained with a clean, dry bandage and for contained with a clean, dry bandage and for those who cannot maintain good personal those who cannot maintain good personal hygiene. hygiene.

Practical Advice for TeachersPractical Advice for Teachers

If you observe children with open draining If you observe children with open draining wounds or infections, refer the child to the wounds or infections, refer the child to the school nurse. school nurse.

Enforce hand hygiene with soap and water Enforce hand hygiene with soap and water or alcohol-based hand sanitizers (if or alcohol-based hand sanitizers (if available) before eating and after using the available) before eating and after using the bathroombathroom

Advice for School Health Advice for School Health PersonnelPersonnel

Students with skin infections may need to be Students with skin infections may need to be referred to a licensed health care provider for referred to a licensed health care provider for diagnosis and treatment. School health personnel diagnosis and treatment. School health personnel should notify parents/guardians when possible should notify parents/guardians when possible skin infections are detected. skin infections are detected.

Use standard precautions (e.g., hand hygiene Use standard precautions (e.g., hand hygiene before and after contact, wearing gloves) when before and after contact, wearing gloves) when caring for nonintact skin or potential infections. caring for nonintact skin or potential infections.

Use barriers such as gowns, masks and eye Use barriers such as gowns, masks and eye protection if splashing of body fluids is anticipated. protection if splashing of body fluids is anticipated.

How do we reduce the spread of How do we reduce the spread of MRSA?MRSA?

Protect others from infected woundsProtect others from infected wounds

Report all potential skin infections to the school Report all potential skin infections to the school nurse or health technurse or health tech

Keep wounds covered with clean, dry Keep wounds covered with clean, dry bandages taped on all four sidesbandages taped on all four sides

Don’t touch other people’s skin lesionsDon’t touch other people’s skin lesions

Stay home if wound drainage cannot be Stay home if wound drainage cannot be contained by clean, dry dressingcontained by clean, dry dressing

How do we reduce the spread of How do we reduce the spread of MRSA?MRSA?

Hand washingHand washing is the most important way! is the most important way!

Wash your hands with soap and water for at least 20 Wash your hands with soap and water for at least 20 secondsseconds

(Antibacterial soap is (Antibacterial soap is not necessary) not necessary)

Use alcohol based hand sanitizer (60% or greater) Use alcohol based hand sanitizer (60% or greater) when soap/water not available -when soap/water not available -

(Supervise young children) (Supervise young children)

Wash visibly dirty hands with soap and water ––always!Wash visibly dirty hands with soap and water ––always!

How do we reduce the spread of How do we reduce the spread of MRSA?MRSA?

- - Do not share personal items:Do not share personal items:

Bar soap, clothes, towels, beddingBar soap, clothes, towels, bedding

- - Shower:Shower: Regularly after participating in team sportsRegularly after participating in team sports

How do we reduce the spread of How do we reduce the spread of MRSA?MRSA?

- Use barriers:- Use barriers:

Gloves for cleaningGloves for cleaningTowels on gym equipments/benchesTowels on gym equipments/benchesPaper towel to turn off faucet after washing hands and to Paper towel to turn off faucet after washing hands and to open bathroom doorsopen bathroom doors

- Clean & disinfect: - Clean & disinfect:

Environmental surfaces that come in direct contact with skinEnvironmental surfaces that come in direct contact with skinSports equipment & gym matsSports equipment & gym mats

How do we reduce the spread of How do we reduce the spread of MRSA?MRSA?

- - Clean and disinfect surfaces: Clean and disinfect surfaces:

Clean first ––remove soil w/cloth, soap & waterClean first ––remove soil w/cloth, soap & waterDisinfect ––wipe down surfaces with Disinfect ––wipe down surfaces with disinfectant, may use wipes such as “Clorox” disinfectant, may use wipes such as “Clorox” or “Lysol” (follow manufacturers directions)or “Lysol” (follow manufacturers directions)Establish routine cleaning and disinfecting Establish routine cleaning and disinfecting schedulesschedules

Teachers & administrative staff –Teachers & administrative staff –Team up with custodiansTeam up with custodians

- Clean & disinfect:- Clean & disinfect:

– KeyboardsKeyboards– PhonesPhones– Desktops, lunch tablesDesktops, lunch tables– Doorknobs, light switchesDoorknobs, light switches

Physical education teachers –Physical education teachers –Team upTeam up

- - Clean & disinfect :Clean & disinfect :

Equipment (sports gear) that directly touch skin Equipment (sports gear) that directly touch skin after each use after each use

Practice surfaces (gym mats) after each use Practice surfaces (gym mats) after each use

Help families team upHelp families team up

- Encourage:

• Frequent hand washing & use of 60% alcohol sanitizer when soap & water not available• Showering immediately after sports• Wearing athletic uniforms once, then washing them with soap/hot water & drying in a hot dryer• Reporting skin infections to school nurse or health tech

Protecting students from infections Protecting students from infections helps protect you …and your familyhelps protect you …and your family

Things to RememberThings to Remember

Wash your hands frequently and thoroughlyWash your hands frequently and thoroughly

Do not share personal itemsDo not share personal items

Clean and disinfect surfaces Clean and disinfect surfaces

Keep cuts covered to protect yourself and Keep cuts covered to protect yourself and othersothers

Report all skin infections to the school nurse or Report all skin infections to the school nurse or health tech health tech

ResourcesResourcesCenters for Disease Control and Prevention Centers for Disease Control and Prevention – www.cdc.gov/ncidod/dhqp/ar_mrsa_ca.html www.cdc.gov/ncidod/dhqp/ar_mrsa_ca.html

County of Los Angeles Department of Health ServicesCounty of Los Angeles Department of Health Services– www.lapublichealth.org/acd/mrsa.htmwww.lapublichealth.org/acd/mrsa.htm

Tacoma/Pierce County Health Department, Tacoma, WATacoma/Pierce County Health Department, Tacoma, WA– www.tpchd.org www.tpchd.org

Washington State Department of Health Washington State Department of Health – www.doh.wa.gov/ www.doh.wa.gov/

Commonwealth of Massachusetts Department of Public HealthCommonwealth of Massachusetts Department of Public Health– www.mass.gov/dph/cdc/antibiotic/mrsa_about.htmwww.mass.gov/dph/cdc/antibiotic/mrsa_about.htm