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MRSA (Methicillin-resistant Staphylococcus aureus)

Information adapted from the NC General Communicable Disease Control Branch website.



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MRSA in Schools | MRSA on Athletic Teams | MRSA in Child Care Settings | Resources



What is MRSA?

Staphylococcus aureus, often called “staph”, is a common type of bacteria that can be found in the nose and on the skin of about one out of every three people. Methicillin-resistant Staphylococcus aureus, also called MRSA, are staph that are not killed by many of the antibiotics doctors used to prescribe most commonly for staph infections.

Until the mid-1990s, MRSA mainly affected patients in hospitals and other healthcare settings. Since that time, a new strain of MRSA has emerged. This new strain is called community-associated MRSA, and has rapidly become one of the most common causes of skin and soft tissue infections among otherwise healthy people in the community.



How are MRSA infections spread?

Many people carry MRSA on their skin, and most will never get sick from it. Skin infections occur when the bacteria get in through small scrapes or cuts, sometimes too small to notice. The infected area usually begins with a red bump that resembles a pimple or insect bite. If untreated, the lesion may become hard and painful or may drain pus (often called a “boil” or a skin abscess).

MRSA is most often spread through direct physical contact with an infected person. Draining lesions are highly infectious and represent an important source of spread. MRSA can also be spread by touching objects that have been soiled with drainage from an infected wound- e.g., bandages, towels, or athletic equipment- although this is less common than direct person-to-person spread. Outbreaks of MRSA have occurred in households, on sports teams, in prisons, in daycare centers, and in other settings where people have close contact or share equipment and personal items.


How can MRSA infections be treated?

Unlike hospital-associated MRSA, most community-associated MRSA infections can be treated with several types of antibiotics, including some that can be taken by mouth.

Not all MRSA skin infections require antibiotics; treatment decisions should be made by a doctor or other licensed healthcare provider. Occasionally, community-associated MRSA can cause blood stream infections, joint infections, pneumonia, or other severe infections in an otherwise well person.


To prevent MRSA skin infections, practice good hygiene:

  • Keep your hands clean by washing thoroughly with soap and water or using an alcohol-based hand sanitizer.
  • Wash any cut or break in the skin with soap and water and apply a clean bandage daily.
  • Avoid contact with other people’s wounds or bandages.
  • Avoid sharing personal items such as towels or razors.


If you have symptoms of MRSA, see your doctor:

  • Keep draining wounds clean and covered.
  • Wash your hands and forearms before and after caring for the wound and frequently throughout the day. Use soap and warm water for 15 seconds and dry your hands on a clean towel or paper towel.
  • Take all antibiotics as prescribed.
  • Report new skin sores or boils to your doctor immediately.



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MRSA in Schools

Cases of MRSA in schools can cause much anxiety for parents and school staff. MRSA can be found in up to 10% of school-aged children; most of these children will never get sick from it. MRSA is spread through direct physical contact with an infected person. Draining lesions are highly infectious and are an important source of spread. MRSA can also be spread by touching objects that have been soiled with drainage from an infected wound (like bandages, towels, or athletic equipment) although this is less common than direct person-to-person spread.

Control Measures for Schools

The risk of transmitting MRSA in the classroom is low compared to settings with a higher degree of physical contact (e.g., athletic teams) or frequent sharing of personal items (e.g., households, locker rooms). The spread of infection in schools can be controlled if all staff and students adhere to these basic hygiene measures:

  • Keep your hands clean by washing thoroughly with soap and water or using an alcohol- based hand sanitizer.
  • Wash any cut or break in the skin with soap and water and apply a clean bandage daily.
  • Avoid contact with wounds or bandages. If a staff member must help with a student’s bandage, that staff member should wear gloves, place the used bandage in the trash, and wash his/her hands and forearms immediately after removing gloves.
  • Avoid sharing personal items such as towels.

Students or staff with symptoms of MRSA should see a doctor or other qualified healthcare provider and do all of the following:

  • Keep draining wounds clean and covered. Change bandages at least twice per day and when soiled.
  • Place used bandages in the trash immediately.
  • Wash your hands and forearms before and after caring for the wound and frequently throughout the day. Use soap and warm water for 15 seconds and dry your hands on a clean towel or paper towel.
  • Take all antibiotics as prescribed.
  • Report new skin sores or boils to your doctor immediately.

Decisions about when a child with known or suspected MRSA skin infections can return to school should be made by a doctor or other qualified healthcare provider. In general, students with draining lesions should not be excluded from school if they are able to keep the lesions adequately and completely covered with a dry bandage. Not all MRSA skin lesions require treatment with antibiotics. Therefore no specific course or duration of antibiotic treatment is required for re-entry unless specified by the healthcare provider.




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Control of MRSA on Athletic Teams

Staff:

  • Hand hygiene is the single most important factor in preventing the spread of MRSA. Coaches and trainers should perform appropriate hand hygiene (wash with soap and water or use alcohol-based hand sanitizer) after contact with players, especially when changing bandages, providing care for wounds, and after removal of gloves. In situations where access to sinks is limited (like games) carry individual containers of alcohol-based hand sanitizer.
  • Educate players on appropriate management of wounds (clean or infected), which includes immediate washing of wounds with soap and water; covering wounds with bandage/dressing until healed and no drainage is present; changing dressing at least 2 times/day and when visibly soiled; washing hands after changing dressings; and disposing of dressing in proper containers.
  • Exclude players with draining lesions or open wounds (whether covered or not) from whirlpools, ice tubs, saunas and hot tubs.
  • All wounds should be covered until healed, especially when contact with multi-use items (weight equipment, electric stimulation cuffs) is possible. Wounds should be adequately covered during competition (e.g., bandaged and use of protective sleeve) especially if drainage is present

Players:

  • Do not share towels (even on the sidelines of games) or other personal hygiene items with other players.
  • Shower with soap before using the whirlpool, steam room, or sauna.
  • Shower as soon as possible after EVERY practice, game, or tournament.
  • Avoid contact with draining lesions and contaminated items (e.g., bandages) from others
  • Wash hands after using multiuse equipment (like weights) and after contact with potentially contaminated items (like another person’s wounds, infected skin, or soiled bandages).

Cleaning Equipment:

  • Clean all shared surfaces that come in contact with bare skin (like mats, massage tables, training tables, and therapy machines) after each person with a cleaning/disinfecting spray.
  • Clean all skin contact points of weight equipment at a minimum of once per day with a commercial disinfectant approved as effective against Staphylococcus aureus by the Environmental Protection Agency, or a solution of 1 tablespoon bleach in one quart of water (must be mixed fresh daily). Follow the directions listed on the labels of all cleaning/disinfecting products.
  • Use a clean towel as a barrier between bare skin and shared surfaces (like exercise equipment, sauna bench, leg supports during therapy).
  • Repair or discard equipment with damaged surfaces that cannot be adequately cleaned (like equipment with exposed foam).
  • Wash towels, uniforms and other laundry in hot water for at least 25 minutes with ordinary detergent and dry on the hottest setting the fabric will tolerate.


Disease Surveillance on Athletic Teams

MRSA infections spread quickly on athletic teams and can be difficult to control. It is important for coaches and trainers to be aware of every skin infection as soon as it occurs to prevent a single case from becoming an outbreak.

  • Tell players to report suspicious skin changes such as redness, warmth, swelling, tenderness, or drainage, especially when associated with cuts, boils, or sites of skin irritation and abrasions.

  • If MRSA infections occur among team members, coaches and trainers should begin actively checking for new lesions among team members. This may include questioning all team members before practices and referring those with new lesions to their physicians.

  • If MRSA infections occur among players on children’s sports teams, consider notifying parents of all team members to enlist their support with reinforcing hygiene measures and reporting of skin lesions to team officials.

  • Care must be taken to maintain confidentiality of players with infected wounds to avoid stigmatization and anxiety.


Diagnosis and Treatment on Athletic Teams

Consider all draining wounds as MRSA infections.  All players with suspicious skin lesions should be evaluated by a physician or other qualified healthcare provider. There is no single accepted treatment for MRSA skin and soft tissue infections. Decisions about antibiotic treatment should be made by the healthcare provider.



Player Exclusion from Participation

Any athlete with a draining wound should be evaluated by a physician or qualified healthcare provider for participation in athletic activities. Decisions regarding participation should be based on the following factors:  

  1. Ability to cover lesions: Athletes with draining lesions or packed open wounds should be excluded from practice and participation unless the lesions can be adequately and completely covered with a bandage that can withstand the rigors of competition.
  2. Presence of infections in other team members: Coaches and administrators should consider excluding all athletes with draining lesions or packed open wounds (covered or uncovered) from practice and participation if there are multiple players on the team with confirmed or suspected MRSA lesions.
  3. Nature of contact: Whether a lesion can be adequately covered depends on the nature of the contact. Wrestlers with draining lesions or open packed wounds (covered or uncovered) should not be allowed to participate until all drainage has resolved, or until packing is no longer required in the case of open wounds. Decisions regarding exclusion from other high-contact sports (e.g., football) should be made after consideration of the first two factors.



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Control of MRSA in Child Care Settings

MRSA in child care centers has not been widely studied in the United States. From the literature we believe that MRSA colonization in child care centers indicates faster spread of MRSA in the community. We also believe that MRSA accounts for an increasing proportion of all pediatric S. aureus infections. A Canadian study suggested that CA-MRSA transmission can occur in the child care setting. Cases of MRSA in child care can cause much anxiety for parents and school staff.


The following universal control measures should reduce the chance of transmission in child care settings:

  • Keep your hands clean by washing thoroughly with soap and water.
  • Wash any cut or break in the skin with soap and water and apply a clean bandage daily.
  • Avoid contact with other people’s wounds or bandages. If a staff member must help with a student’s bandage, that staff member should wear gloves, place the used bandage in the trash, and wash his/her hands and forearms immediately after removing gloves.
  • Follow existing NC Child Care rules for sanitation of toys and other shared items.

Children/staff with MRSA symptoms should see a doctor or other qualified health care provider and do all of the following:

  • Keep draining wounds clean and covered.
  • Take all antibiotics as prescribed
  • Report new skin sores or boils to your doctor immediately.



Additional Measures for Child Care Settings

  1. Children/staff known to be colonized with MRSA in the nose or skin do not need to be excluded from the child care.
  2. Children/staff known to be colonized with MRSA who have draining wounds or skin sores should be excluded from childcare if the wounds cannot be covered, contained, or dressing maintained intact and dry.
  3. More complex situations should be assessed on a case-by-case basis in conjunction with the local health department, health care provider, child care director and  parent.


The case-by-case assessment should take into account factors such as specific needs or characteristics of the child; the classroom setting; the number and types of children; classroom staffing; and the ability of the program to implement precautions that need to be taken to minimize the risk of transmission.

Decisions about when a child with known or suspected MRSA skin infections can return to hild care should be made by a doctor or other qualified healthcare provider. Not all MRSA skin lesions require treatment with antibiotics. Therefore no specific course or duration of antibiotic treatment is required for re-entry unless specified by the healthcare provider.



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