This information is being placed here to help educate all students, staff and parents on this potentially harmful infection.

All of this information below can be found at the SC DHEC web site: or by clicking below:

http://www.scdhec.net/health/disease/acute/mrsa.htm

Methicillin-resistant Staphylococcus aureus (MRSA)

MRSA stands for Methicillin-resistant Staphylococcus aureus , a form of staph infection that does not respond to routine treatment with some commonly used antibiotics, although other antibiotics are effective.  While effective treatments are available, the MRSA-related death of a student in Virginia has raised many questions concerning preventing and treating this infection.

DHEC is providing information on this condition, as well as working with local health departments and school districts to address questions about MRSA in schools.

Questions about Community-Acquired Methicillin Resistant Staphylococcus aureus (CA-MRSA)

1. What is Staphylococcus aureus?
2. What is MRSA (methicillin-resistant Staphylococcus aureus)?
3. What is Community-Acquired MRSA (CA-MRSA)?
4. Why are we hearing so much about MRSA?
5. What are the symptoms of CA-MRSA?
6. What should I do if I think that I have MRSA?  Can it be treated?
7. Is it possible that my staph or MRSA skin infection will come back after it is cured?
8. Do people die from CA-MRSA infections?
9. If I have a staph, or MRSA skin infection, what can I do to prevent others from being infected?
10. How can I prevent staph or MRSA skin infections?
11. How can I avoid getting MRSA at my health club?
12. How can my school prevent MRSA?
13. If my child uses athletic facilities (such as the weight room) or is involved in athletics, what additional measures can be taken to prevent and control MRSA infections within the athletic setting?
14. What can teachers do to prevent the spread of MRSA in the classroom?
15. Information for School Nurses and Administrators:  What should I do if a student in my school is reported to have MRSA?
16. Are children with MRSA required to stay out of school?
17. Do I need to alert parents and staff if a student has a MRSA infection?
18. Are there special considerations for students with immune suppression or HIV?
19. How can I get more information about MRSA?
20. Are there websites where I go to get additional information?
21. Do I report cases of MRSA to DHEC?

What is Staphylococcus aureus?

Staphylococcus aureus, often referred to simply as "staph," are bacteria commonly carried on the skin or in the nose of healthy people.  Approximately 25% to 30% of the population carries this bacterium on their skin or in their nose without having any symptoms.  Sometimes, staph can cause an infection.  Staph bacteria are one of the most common causes of skin infections in the United States.  Most of these skin infections are minor (such as pimples and boils) and can be treated without antibiotics (also known as antimicrobials or antibacterials).  However, staph bacteria also can cause serious infections (such as surgical wound infections, bloodstream infections, and pneumonia).

What is MRSA (methicillin-resistant Staphylococcus aureus)?

Some staph bacteria are resistant to antibiotics.  MRSA is a type of staph that is resistant to a class of antibiotics (beta-lactams), which includes methicillin, oxacillin, penicillin and amoxicillin.  While 25% to 30% of the population is colonized with staph, approximately 1% is colonized with MRSA.

What is Community-Acquired MRSA (CA-MRSA)?

Staph and MRSA can also cause illness in persons outside of hospitals and healthcare facilities.  MRSA infections that are acquired by persons who have not been recently (within the past year) hospitalized or had a medical procedure (such as dialysis, surgery, catheters) are known as CA-MRSA infections.  Staph or MRSA infections in the community usually appear as skin infections, such as pimples and boils, and occur in otherwise healthy people.

Why are we hearing so much about MRSA?

In the past, MRSA infections were mostly seen in hospitals.  Now they are prevalent in community settings, too.  Because the occurrence of these infections in community settings is relatively new, some people become alarmed when they hear about them. 

What are the symptoms of CA-MRSA?

The most common signs of any sort of Staph infection are localized redness, swelling, and tenderness.  Staph skin infections can appear as pimples, rashes, pus-filled boils or abscesses, which may drain pus.  They may also appear as impetigo with fluid filled blisters.

Some people with MRSA will have multiple lesions (sores) that look like spider bites.  The involved site is red, swollen, and painful and may have pus or other drainage.

Staph infections also can cause more serious infections, such as blood stream infections or pneumonia, leading to symptoms of shortness of breath, fever, and chills.

What should I do if I think that I have MRSA?  Can it be treated?

If you think you have an infected wound, you should see a medical care provider.  MRSA can be diagnosed only through a laboratory test.

MRSA infections can be treated.  Treatment depends on the site and severity of the infection.  Not all infections require oral antibiotics.  If antibiotics are prescribed, it is important to take them exactly as instructed.  If the infection has not improved within a few days after seeing the healthcare provider, the student should contact the provider again.

Is it possible that my staph or MRSA skin infection will come back after it is cured?

Yes.  It is possible to have a staph or MRSA skin infection come back (recur) after it is cured.  To prevent this from happening, follow your healthcare provider's directions while you have the infection, and practice good hygiene steps described below. 

Do people die from CA-MRSA infections?

CA-MRSA infections are typically limited to the skin and do not usually result in severe disease (such as infection of the bloodstream).  However, on rare occasions, CA-MRSA can cause life-threatening illness and death even when treated quickly.

If I have a staph, or MRSA skin infection, what can I do to prevent others from being infected?

CA-MRSA infections are typically limited to the skin and do not usually result in severe disease (such as infection of the bloodstream).  However, on rare occasions, CA-MRSA can cause life-threatening illness and death even when treated quickly.

How can I prevent staph or MRSA skin infections?

Practice good hygiene:

• Keep your hands clean by washing thoroughly with soap and water or using an alcohol-based hand sanitizer. 
• Keep cuts and scrapes clean and covered with a bandage until healed. 
• Avoid contact with other people's wounds or bandages. 
• Avoid sharing personal items such as towels or razors. 
• Teach children to wash their hands regularly, such as before eating and after toileting.
• Be sure your family members use antibiotics properly.  Take all that are prescribed, even if the symptoms stop before the prescription is used up.  Do not share prescriptions.
• Children who participate in sporting events should wash their hands after each practice and game.  They should not share equipment, uniforms, towels, or other personal items (such as razors).  Wash uniforms and towels with hot water and detergent after each use.

How can I avoid getting MRSA at my health club?
MRSA is transmitted most frequently by direct skin-to-skin contact.  You can protect yourself from infections by practicing good hygiene (such as keeping your hands clean by washing with soap and water or using an alcohol-based hand rub and showering after working out); covering any open skin area such as abrasions or cuts with a clean dry bandage; avoiding sharing personal items such as towels or razors; using a barrier (such as clothing or a towel) between your skin and shared equipment; and wiping surfaces of equipment before and after use.

How can my school prevent MRSA?
See below for advice for coaches and teachers .  In addition, excellent materials have been developed for schools by the Massachusetts Department of Health and the Tacoma-Pierce County (WA) Department of Health.  We have included a number of helpful websites at the end of this document.

If my child uses athletic facilities (such as the weight room) or is involved in athletics, what additional measures can be taken to prevent and control MRSA infections within the athletic setting?

Athletes, athletic personnel, and parents can help prevent and control MRSA infections within the athletic setting by following these simple health and hygiene practices.

• Wash hands frequently with soap and water, especially after using any sports facilities.
• Avoid sharing personal items (such as towels, washcloths, razors, clothing, or uniforms) that may have had contact with and infected individual or potentially infectious material.
• Athletes involved in close contact sports should receive a total body check by the appropriate athletic personnel before any game, match or tournament.
• Individuals with an infection involving pus drainage, who are involved in close contact sports, should be excluded from participation in sporting events and practices until no pus drainage is present and the infected site can be adequately covered with a bandage and clothing.
• Report any suspicious skin sore or boil to your healthcare provider, trainer or school nurse immediately.  All draining wounds must be covered with clean, dry bandages during practices and games.  If the draining cannot be contained, the player should be excused from activities.
• If you participate in sports involving close personal contact (e.g. wrestling and football) shower with soap immediately after each practice, game, or match.
• Any cut or break in the skin should be washed with soap and water and a clean, dry dressing applied on a daily basis, before and after participation in close contact sports, and after using any sports facilities
• Do not allow sharing of any equipment, uniforms, or towels.  Assign equipment and uniforms to one individual for the whole season.  Wash uniforms and towels after each use with detergent in hot water.
• Non-washable gear such as pads or head protectors should be wiped down with alcohol after each use.
• Athletic equipment such as weight benches, wrestling or gymnastics mats, or other equipment that might have skin contact should be disinfected regularly after each practice and in-between uses.  Wipe with an antibacterial solution (e.g. Hibiclens) or an EPA-registered cleaner or bleach solution (1 part bleach to 9 parts water).  Clean BOTH SIDES of mats before rolling them up for storage.
• Tell your healthcare provider (e.g. primary care doctor or school nurse) and the appropriate athletic personnel if you currently have or have had a history of an antibiotic-resistant Staph skin infection(s).

Remember:  Routine cleaning is all that is recommended.  Because the bacteria live on the skin, they may be reintroduced into any environment at any time.  Therefore, hand washing and wound care remain the primary means of preventing staph infections.

What can teachers do to prevent the spread of MRSA in the classroom?

• Observe children for open wounds.  If any are draining or contain pus, refer the child to the school nurse.
• Encourage hand washing before eating and after toileting.

Information for School Nurses and Administrators:  What should I do if a student in my school is reported to have MRSA?

Consider taking the following steps:

• Confirm the diagnosis.  This may require contacting the doctor and family of the student to ensure that accurate medical information is available.
• Follow routine infection control precautions.   Use the following infection control precautions with a student who has MRSA infection:
  • Wear gloves when handling the student, or touching blood, body fluids, secretions, excretions, and any items contaminated with these fluids.  Gloves should be used before touching mucous membranes and non-intact skin.  Gloves should be removed after use, and hand washing performed before touching non-contaminated items and environmental surfaces and before tending to another student.
  • Linens (such as from cots) that may contain blood, secretions, or excretions should be handled in a manner to prevent skin, mucous membrane and clothing exposure.
• Follow routine procedures for cleaning the environment.   In general, use routine procedures with a freshly prepared solution of commercially available cleaner such as detergent, disinfectant-detergent or chemical germicide.

Are children with MRSA required to stay out of school?

Children are excluded from School and childcare based on the SC School and Childcare Exclusion Rules . 

• Draining Lesions:
  Exclude children with draining lesions that cannot be covered with a dressing, or draining lesions that are covered with a dressing but drainage saturates dressing, until drainage stops and the child has received at least 48 hours of effective antimicrobial treatment.
• Non-Draining Lesions:
  Children who do not have draining lesions, who have antibiotics prescribed, may return to school after they have received at least 48 hours of effective antimicrobial treatment and lesions are showing signs of healing (decreasing in size.)  Children who do not have draining lesions, who do not have antibiotics prescribed, may return to school once lesions are showing signs of healing (decreasing in size.)
• Sports:
  Children with lesions on uncovered skin, or with lesions that are draining or oozing, even if covered, may not participate in close contact sports or other athletic activities.
• Contact Precautions
  Contact precautions, including appropriate disposal of infective materials, must be used if/when dressings are changed in the school or childcare setting.
• Outbreaks
  DHEC may change these recommendations in the event of outbreaks or clusters of illness.

Do I need to alert parents and staff if a student has a MRSA infection?

Typically, it is not necessary to inform the entire school community about a MRSA infection.  When MRSA occurs within the school population, the school nurse and school/district medical consultant should deter­mine, based on their medical judgment, whether some or all par­ents and staff should be notified.  You may contact your local [public health department for guidance on responding to MRSA cases and clusters.

Are there special considerations for students with immune suppression or HIV?

Students with weakened immune systems may be at risk for more severe illness if they are infected with MRSA.  These students should follow the same prevention measures as all others to prevent staph infections, including practicing good hygiene, covering wounds (such as cuts or abrasions) with clean dry bandages, avoiding sharing personal items such as towels and razors, and contacting their doctor if they think they have an infection.

How can I get more information about MRSA prevention and control messages?

Contact your local DHEC Health Department , or go to one of the listed websites.  You can find local phone numbers for DHEC Health Departments by clicking on the name of your county.  The 2007 List of Reportable Conditions ( pdf ) has the phone numbers for Regional Health Departments.

Are there websites where I go to get additional information?

• CDC Information on CA-MRSA for the Public
• CDC Information on CA-MRSA for Healthcare Professionals
• CDC-sponsored MRSA Educational posters
• South Carolina School and Childcare Exclusion Rules
• DHEC Fact Sheet on Community-Acquired MRSA ( pdf )
• Guidance for School Health Professionals from the Massachusetts Department of Health
• Guidance for School Athletics Professionals from the Massachusetts Department of Health
• MRSA Toolkit for Middle and High Schools from the Tacoma-Pierce County (WA) Health Department.   The Toolkit includes information for athletic departments, classrooms and custodial staff.
• Cleaning Checklist for School Athletic Programs from the Tacoma-Pierce County (WA) Health Department ( pdf )
• School Custodian Guidance from the Tacoma-Pierce County (WA) Health Department ( pdf )
• Information about Community-Associated MRSA from the Charlotte-Mecklenburg (NC) Health Department, including a link to a video on MRSA prevention for sports teams
• National School Public Relations Association (NSPRA)
• MRSA Toolkit for Middle and High Schools, Tacoma/Pierce County Health Department
• Classroom risk for transmission of MRSA, Children's Hospital in St. Louis ( pdf )

Do I report cases of MRSA to DHEC?

Reporting of individual cases of MRSA is not part of the current DHEC List of Reportable Conditions.  However outbreaks or clusters of cases are considered Reportable Immediately by Phone conditions .  If you have any questions about reporting a possible MRSA cluster, please contact your local public health department at the numbers listed below. 

Reporting of possible clusters of MRSA cases is consistent with South Carolina Law requiring the reporting of diseases and conditions to your state or local public health department.  (State Law # 44-29-10 and Regulation # 61-20) as per the DHEC 2007 List of Reportable Conditions ( pdf ).

Federal HIPAA legislation allows disclosure of protected health information, without consent of the individual, to public health authorities to collect and receive such information for the purpose of preventing or controlling disease.  (HIPAA 45 CAR §164.512).

More information can also be found at the CDC by clicking below:

http://www.cdc.gov/ncidod/dhqp/ar_mrsa.html