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Methicillin-Resistant Staphylococcus Aureus (MRSA)

Background

In New York State and elsewhere throughout the country, reporting of Methicillin-Resistant Staphylococcus Aureus or MRSA infections is becoming more common in community settings, including schools and colleges. Staphylococcus aureus, commonly referred to as “staph,” are bacteria commonly carried on the skin or in the nose of healthy people.

  • Approximately 25% to 30% of the population carry staph bacteria on their skin and in their noses without causing infection (also known as colonization).
  • Infections can start when staph bacteria get into a cut, scrape or other break in the skin. Staph bacteria are one of the most common causes of skin infections in the U.S.
  • Most of these skin infections are minor (such as pimples and boils) and can be easily treated without antibiotics.
  • Staph bacteria can also cause more serious infections, such as blood stream infections and pneumonia, which require more aggressive treatment.
  • Some staph bacteria are resistant to antibiotics. MRSA is a type of staph that is resistant to a certain class of antibiotics. There are numerous other antibiotics to treat MRSA infection when necessary.
  • Antibiotic resistance in general is related to inappropriate use of antibiotics such as over prescribing and failure to finish prescribed courses of antibiotics. Such inappropriate use favors the spread of antibiotic resistant organisms.

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Symptoms of MRSA

  • Most people with MRSA on their skin or in their nose are unaware they are colonized, and never develop a MRSA infection.
  • When MRSA enters a break in the skin, it can cause infections that may look like a pimple or boil and can be red, swollen, painful, or have pus or other drainage.
  • More serious MRSA infections include pneumonia, blood stream infections, or severe skin or wound infections.

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Transmission Routes of MRSA

  • MRSA is transmitted most frequently by direct skin-to-skin contact.
  • MRSA can also be transmitted by:
    • Contact with drainage from infected scrapes, cuts, or other skin wounds.
    • Contact with personal items contaminated with drainage from infected scrapes, cuts, or other skin wounds. These items can include contaminated bandages, towels, washcloths, soap, razors, topical preparations (ointments, balms, lotions, deodorants, antibiotic creams ), athletic or gym equipment, and uniforms or other clothing.
  • Risk of transmission is low from environmental surfaces that are not contaminated by skin wounds or frequent direct skin contact.

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Treatment of MRSA

  • Transmission to others can be prevented by good hygiene including frequent hand washing.
  • Most MRSA infections are treated by good wound and skin care:
    • Keep the area clean and dry.
    • Perform hand hygiene before and after caring for the area. Alcohol-based hand sanitizers should be used if soap and water is not available.
    • Carefully dispose of any bandages.
  • Sometimes treatment requires the use of antibiotics:
    • Antibiotics should be used at the discretion of a healthcare provider.
    • If antibiotics are needed, it is important for the patient to use the medication exactly as directed, including taking the complete prescribed course even if he/she is feeling better before the medication is used up.
    • If the infection has not improved within a few days, the healthcare provider should be contacted for evaluation.

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Prevention of MRSA in Public Settings

  • Staph and MRSA infections can be prevented if staff and students follow basic hygiene measures:
    • Keep hands clean by washing thoroughly with soap (preferably not bar soap) and water or with an alcohol-based hand sanitizer if hands are not visibly soiled.
    • Practice good skin care. Since staph infections start when staph enters the body through a break in the skin, keeping skin healthy and intact is an important preventive measure.
    • Wash any cut or break in the skin with soap and water and apply a clean bandage until healed.
    • Avoid contact with other people’s wounds or bandages.
    • Avoid sharing personal items such as cloth towels.

Students with symptoms should contact the Health Center. Staff with symptoms of MRSA should contact a healthcare provider and all should do the following:

  • Keep wounds clean and covered with a bandage until healed. Change bandages as recommended by the healthcare provider or when soiled. Discard promptly used bandages or tape in the regular trash.
  • Wash hands and forearms before and after caring for wounds and throughout the day. Wash for at least 20 seconds using soap (preferably not bar soap) and warm water and dry your hands on a clean paper towel.
  • Do not share personal items such as towels, washcloths, soap, razors, topical preparations, uniforms, or clothing that may have had contact with an infected wound or bandage.
  • Wash towels, washcloths, uniforms or clothes that become soiled with hot water and laundry detergent. Drying clothes in a hot dryer, rather than air-drying, also helps kill bacteria in clothes.
  • Take all antibiotics as prescribed and for the full length of time prescribed.
  • Report new skin sores or boils to a healthcare provider.

The risk of transmitting MRSA in the classroom is low.

School attendance:

  • Unless directed by a physician, students/staff with MRSA infections should not be excluded from attending.
  • Students/staff with any open or draining wounds, such as MRSA infections, should be excluded from swimming pools, whirlpools, hot tubs, etc. until the wound has healed.

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Prevention Measures for MRSA in the Athletics Setting

  • Hygiene and Infection Control Practices
    • Hand hygiene is the single most important factor in preventing the spread of MRSA.
    • Coaches and trainers should practice appropriate hand hygiene (use alcohol-based hand sanitizer or wash with soap and water) after contact with players, especially when changing bandages and providing care for wounds.
    • Persons who assist another person with the application of clean dressings should wear disposable gloves, and wash their hands and forearms immediately after removing gloves using barrier precautions at all times.
    • In situations where access to sinks is limited (e.g., on playing fields), carry individual containers of alcohol-based hand sanitizer.
    • Provide enough clean towels so players do not need to share them.
    • Educate players on appropriate management of all wounds.
    • Exclude players with draining lesions or open wounds (whether or not they are covered) from swimming pools, whirlpools, ice tubs, saunas and hot tubs.
    • All wounds (e.g., cuts, scrapes, abrasions) should be covered with a bandage until healed, especially when contact with multi-use items (i.e., weight equipment, electric stimulation cuffs) may occur.
    • Wounds (e.g., cuts, scrapes, abrasions) should be completely and securely
    • Students with active skin and soft tissue infection (e.g., draining wounds, boils, abscesses) should not participate in activities where skin-to-skin contact is likely to occur until their infections are completely healed.

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Specific Guidance for Players

  • Do not share towels (even on the sidelines of games), washcloths, soap, razors, topical preparations, or other personal hygiene items with other players.
  • Shower with soap (preferably not bar soap) before using the whirlpool, steam room, or sauna.
  • Shower as soon as possible after EVERY practice, game, or tournament.
  • Shower before and after sports with extensive skin-to-skin contact (e.g., wrestling, football).
  • Avoid contact with draining lesions and contaminated items (e.g., bandages) from other people.

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.

If MRSA infections occur among team members, associated students and staff should be encouraged to report skin changes such as redness, warmth, swelling, tenderness, or drainage, especially when associated with cuts, boils, or sites of skin irritation and abrasions. Coaches and staff observing open or undressed skin lesions on team members should direct the student to a healthcare provider to have the lesion evaluated.

Any player with skin lesion(s) should be referred to a healthcare provider.

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Athlete Exclusion from Participation

  • Individuals with open wounds (e.g., cuts, scrapes, abrasions) need not be excluded if the wounds can be completely and securely covered with clean, dry bandages.
  • Athletes with active skin and soft tissue infection (e.g., draining wounds, boils, abscesses) should not participate in activities where skin-to-skin contact is likely to occur until their infections are completely healed.
  • Soiled linens and clothing should be washed with laundry detergent in hot water (minimum 160°F), add one cup of bleach if water is not 160°F and dry in a hot dryer. Consider wearing gloves when handling dirty laundry.

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Environmental Cleaning if MRSA Infection is Confirmed

  • Disinfect limited areas, such as surfaces that are likely to be in contact with uncovered or poorly covered infections, using a NYS registered product effective against MRSA (list of such products is provided in the Appendix).
    • Environmental surfaces in the classroom(s) and shared equipment where direct-skin contact by multiple users is likely (e.g., desks, counter-tops).
  • Widespread disinfection of entire buildings or vehicle fleets based on the occurrence of a single MRSA infection is not recommended.

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Cleaning and Disinfection of Environmental Surfaces and Equipment in the Athletic Setting

  • A regular cleaning schedule should be established for shared environmental surfaces such as wrestling mats or strength-training equipment.
    • Sanitize all skin-contact points of weight equipment at a minimum once per day.
    • Sanitize mats and other high-use equipment before each practice and several times a day throughout a tournament.
  • Use a clean towel as a barrier between bare skin and shared surfaces (e.g., exercise equipment, sauna bench, leg supports during therapy).
    • ?Use of clean barriers between bare skin and shared surfaces reduces the need for frequent sanitizer application.
    • ?Encourage athletes to sanitize all shared surfaces that come in contact with bare skin (e.g., mats, massage tables, training tables, and therapy machines) between each use.
  • Cover treatment tables. Discard or launder coverings after each use.
  • Repair or discard equipment with damaged surfaces that cannot be adequately cleaned (e.g., equipment with exposed foam).
  • Soiled linens and clothing should be washed with regular laundry detergent in hot water (minimum 160°F), add one cup of bleach if water is not 160°F and dry in a hot dryer. Consider wearing gloves when handling dirty laundry.
  • Consider regular sanitizing or disinfection of shared surfaces and equipment that come into contact with bare skin.
    • ?Use a sanitizer or disinfectant registered for use against MRSA (see list) on surfaces, or use a freshly-mixed solution of one part bleach to 100 parts water (1 tablespoon bleach to 1 quart of water).
    • Follow the directions listed on the labels of all cleaning/disinfecting products with particular attention to the contact times for any sanitizing/disinfectant solution.
  • Disinfection of artificial playing surfaces (e.g., artificial turf) is not recommended.
    • Artificial turf has been reported to be associated with an increased risk factor for MRSA infection, not because it is a reservoir for MRSA, but because skin abrasions are more common from falling and sliding on artificial turf ("turf burns") than from similar falls on natural turf. Turf burns provide a portal of entry for the bacterium.
    • Sunlight and weather reduce survival of bacteria on outdoor artificial turf.

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List of NYSDOH Approved Cleaning Solutions for MRSA

The links will be found in Appendix 1 of this linked document.

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Additional Information

Additional information about MRSA can be found on the web at the following sites:

New York State Department of Health

Centers for Disease Control and Prevention (CDC):
Overview of Community-Associated MRSA
CDC Questions and Answers about MRSA in Schools
CDC MRSA educational materials and posters
New York Statewide School Health Services Center

This information was created from
HEALTH ADVISORY: PREVENTION OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) INFECTIONS IN THE SCHOOL SETTING NYSDOH HEALTH ADVISORY 10/25/07

 

Davis Health Center
Campus Center 004
SUNY Canton
34 Cornell Drive
Canton, New York 13617

Phone: 315-386-7333
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