MRSA in Schools
Information for Health Professionals,
Staff, Teachers and Parents
**Special Report from Federal News Services,
a divsion of Paper-Clip Communications**
Over the last few weeks both K-12 and college campuses have experienced outbreaks of MRSA--or methicillin-resistant Staphylococcus. Many schools throughout the United States have chosen to close school or shut down buildings or certain sections within a building in order to disinfect desks, sports equipment and other materials shared by students.
Media reports on the school shut-downs may have parents, students and even teachers wondering about the potential dangers associated with MRSA.We are issuing this special report in an effort to help school health professionals and administrators share accurate and important information about this common skin infection.
MRSA infections are skin infections that may appear as pustules or boils which often are red, swollen, painful, or have pus or other drainage. These skin infections commonly occur at sites of visible skin trauma, such as cuts and abrasions, and areas of the body covered by hair (e.g., back of neck, groin, buttock, armpit, or beard area of men). According to the U.S. Centers for Disease Control and Prevention (CDC), almost all MRSA skin infections can be effectively treated by drainage of pus with or without antibiotics. More serious infections, such as pneumonia, bloodstream infections, or bone infections, are very rare in healthy people who get MRSA skin infections.
MRSA is typically transmitted by DIRECT skin-to-skin contact OR contact with shared items or surfaces (e.g. used towels, bandages, shared sports equipment, etc.). Therefore, shutting down schools is typically a step taken to allow janitorial staff to fully clean and disinfect areas in which these items (and other shared equipment) might be found.
Hospital-associated MRSA has been known since the 1960s, but community-associated strains--like those appearing in schools throughout the U.S.--have emerged only in recent years. Children of school age are especialy susceptible to MRSA. In fact, it is estimated that Staphyloccocus aureus bacteria are carried by 30-50% of the population, and is very easily passed from one person to another. This is especially troublesome for students participating in contact sports and for children playing on playgrounds.
According to Margaret Bissett, registered nurse and School Health Professional advisory board member, the nature of the school setting makes children particularly susceptible to MRSA and other communicable diseases. Bissett recommends that nurses and health educators share with both students and parents the importance of handwashing and hygeiene early and often. "Prevention is the best defense," explained Bissett. "Many schools focus on hand washing before mealtime but they should also encourage children to wash their hands after recess and sporting events." Bissett also recommended the following tips that schools should consider to prevent MRSA:
o Clean desktops regularly with antibacterial cleanser.
o Santitize athletic equipment on a routine basis.
o Provide hand sanitizers in classrooms, cafeterias, gymnasiums and locker rooms.
o Teach children proper hygeiene--espeically in regard to handwashing (not just before meal time).
o Clean and cover open wounds well.
Additionally, school health professionals should be notified of any signs or symptoms of infection, including:
o Boils, rashers or ingrown hairs--often occuring in the area of the armpits, groin, neck and/or buttocks where Staphylococcus bacteria colonize and thrive.
o Unexplained fever, muscular pain and/or fatigue, especially in the several months following a skin infection.
The CDC also offers the following guidelines for schools in regard to the prevention, treatment and reporting of MRSA infections in schools.
Should schools close because of an MRSA infection?
The decision to close a school for any communicable disease should be made by school officials in consultation with local and/or state public health officials. However, in most cases, it is not necessary to close schools because of an MRSA infection in a student. It is important to note that MRSA transmission can be prevented by simple measures such as hand hygiene and covering infections.
Should the school be closed to be cleaned or disinfected when an MRSA infection occurs?
• Covering infections will greatly reduce the risks of surfaces becoming contaminated with MRSA. In general it is not necessary to close schools to "disinfect" them when MRSA infections occur. MRSA skin infections are transmitted primarily by skin-to-skin contact and contact with surfaces that have come into contact with someone else's infection.
• When MRSA skin infections occur, cleaning and disinfection should be performed on surfaces that are likely to contact uncovered or poorly covered infections.
• Cleaning surfaces with detergent-based cleaners or Environmental Protection Agency (EPA)-registered disinfectants is effective at removing MRSA from the environment.
• It is important to read the instruction labels on all cleaners to make sure they are used safely and appropriately.
• Environmental cleaners and disinfectants should not be used to treat infections.
• The EPA provides a list of EPA-registered products effective against MRSA: http://epa.gov/oppad001/chemregindex.htm
Should the entire school community be notified of every MRSA infection?
Usually, it should not be necessary to inform the entire school community about a single MRSA infection. When an MRSA infection occurs within the school population, the school nurse and school physician should determine, based on their medical judgment, whether some or all students, parents and staff should be notified. Consultation with the local public health authorities should be used to guide this decision. Remember that staphylococcus (staph) bacteria, including MRSA, have been and remain a common cause of skin infections.
Should the school be notified that my child has an MRSA infection?
Consult with your school about its policy for notification of skin infections.
Should students with MRSA skin infections be excluded from attending school?
• Unless directed by a physician, students with MRSA infections should not be excluded from attending school.
• Exclusion from school should be reserved for those with wound drainage ("pus") that cannot be covered and contained with a clean, dry bandage and for those who cannot maintain good personal hygiene.
• Students with active infections should be excluded from activities where skin-to-skin contact is likely to occur (e.g., sports) until their infections are healed.