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Information for Schools on Community-Acquired Methicillin-Resistant Staphylococcus aureus (CA-MRSA)
Background
Staphylococcus aureus (known as "staph") is a common bacterium that is carried on the skin or in the nose of healthy people. Approximately 30% of people carry staph bacteria, and most never develop any symptoms or illness. Staph is a leading cause of skin and soft tissue infection and when an infection does occur, it is usually mild.
Staph skin infections can be just at the surface of the skin or can go into the soft tissue to form a boil or abscess. Invasive staph infections are different from skin and soft tissue infections. Invasive staph infections are more serious, but they occur much less often than skin or soft tissue infections.
Community-Acquired Methicillin-Resistant Staphylococcus aureus (CA-MRSA) is a type of Staphylococcus aureus, which is resistant to some antibiotics that typically are used to treat skin and soft tissue infections. Methicillin, and other penicillin type antibiotics like amoxicillin, is one of those antibiotics.
How Staph Infections are Spread
Staph infections are spread by direct physical contact with the bacteria. It is almost always spread person-to-person, but can be spread through contact with contaminated surfaces, personal items or equipment. Spread of staph infections has occurred through skin-to-skin contact when playing sports, such as football or wrestling, or from surfaces in gyms and locker rooms.
How Staph Infections are Treated
Staph infections are treatable. The treatment may include drainage of the infection site and/or treatment with antibiotics. There are antibiotics available for all forms of staph infections, including CA-MRSA.
How to Prevent/Control Spread
- Students and staff should be encouraged to wash their hands frequently with warm water and soap.
- School health services staff should educate students and staff on the importance of hand washing. If soap is not available, alcohol-based sanitizers should be used.
- Students should shower after every athletic activity using soap and clean towels.
- Students should not share personal hygiene or other items such as towels, soap, clothing and razors. If schools are responsible for washing towels, athletic uniforms, etc. these items should be washed after every use. To avoid sharing of bar soap, schools should consider placing soap dispensers on walls, particularly in locker rooms, etc.
- Skin cuts, scrapes or breaks should be kept clean and dry to minimize the chance of developing an infection.
- Proper bandages should be used to keep all infected wounds covered. Students should not be allowed to participate in athletics, gym class, etc., if an infected wound cannot be covered.
- Schools should have and follow protocols for routine cleaning that includes sanitizers and a regular cleaning schedule. Particular attention should be given to damp or wet areas and those areas that may be contaminated by bodily fluids. Particular attention should be given to locker rooms, showers and the school health services office. It is recommended that a disinfectant that is EPA registered as effective against MRSA to clean surfaces be used.
- Perform daily surface cleaning of locker room surfaces (examples: showers, benches, countertops) and scheduled cleaning of weight room equipment and other gym or other athletic equipment that is shared. These surfaces should be washed after each use with a disinfectant, such as bleach or hospital-grade disinfectant.
Messages for School Personnel
- School closure is not an appropriate response to CA-MRSA infections in students. Response should focus on following the above measures to prevent and control spread of staph to other students.
- If a student is determined to have a skin or soft tissue infection, school health services staff or other designated personnel should clean and cover the wound site and notify the child's parents.
- Parents should be advised to seek further evaluation and/or treatment by their child's doctor.
- Keep a first aid kit with ample dressings available at athletic events.
- Staff should report skin and soft tissue infections to the school nurse and to coaches/athletic
- trainers/physical education teachers so that hygiene practices can be reviewed and corrected if deficient.
- School nurses should consider a CA-MRSA diagnosis in all students who present with signs of skin or soft tissue infection.
- School health services staff and other school personnel who might have contact with students suspected of CA-MRSA infection should use contact precautions.
Messages for Students/Parents
- Good hygiene is the best prevention! Children and youth should be encouraged to wash their hands frequently with warm water and soap. Parents should educate children about the importance of hand washing, particularly after nose-wiping. If soap is not available, alcohol-based sanitizers can be used.
- Skin cuts, scrapes or breaks should be kept clean and dry to minimize the chance of developing an infection.
- Proper bandages should be used and changed daily or more frequently, if necessary to keep all infected wounds clean and covered.
- If your child has a skin infection that is not getting better, contact his or her doctor.
- If your child is taking antibiotics for an infection, make sure they complete the full number of doses as prescribed. Antibiotics should not be shared or saved for future use.
- Take your child to see a medical provider if the skin or soft tissue begins to appear infected- red, hot, swollen, tender or draining pus.
- Students should report skin and soft tissue infections to the school nurse and to coaches/athletic trainers/physical education teachers.
Resources
American Academy of Pediatrics Hot Topics: Community-Acquired MRSA
Centers for Disease Control and Prevention: Community-Associated MRSA Information for the Public
CDC MRSA Educational Materials
Alex, A. & Letizia, M. Community-Acquired Methicillin-Resistant Staphylococcus aureus: Considerations for School Nurses. The Journal of School Nursing. 2007; 23(4):210-213