In what settings do MRSA skin infections occur?

• MRSA skin infections can occur anywhere.

• Some settings have factors that make it easier for MRSA to be transmitted.

• These factors, referred to as the 5 C's, are as follows: Crowding, frequent skin-to-skin Contact, Compromised skin (i.e., cuts or abrasions), Contaminated items and surfaces, and lack of Cleanliness.

• Locations where the 5 C's are common include schools, dormitories, military barracks, households, correctional facilities, and daycare centers.

What should be done  if an athlete in the school is reported to have MRSA?

Many people, including athletes, carry staph (including MRSA) in their nose or on their skin and do not know they are carrying it. They usually do not get skin infections. They do not have any signs or symptoms of illness.

However, there are some conditions that can lead to MRSA/staph infections among athletes. Factors that have been associated with the spread of MRSA skin infections include close skin-to-skin contact, openings in the skin such as cuts or abrasions (as might occur with body shaving), contaminated items and surfaces, crowded living conditions, and poor hygiene. In addition, MRSA infections sometimes occur among previously healthy persons with no identifiable risk factors.  

Precautions:

• Treat any draining wound as a potential MRSA infection.
• Make sure the wound is fully covered at all times, especially if the athlete participates in direct contact with other athletes.
• Encourage the athlete to be evaluated by a healthcare provider.
• Inform the healthcare provider of the possibility of MRSA.

Caring for MRSA at school:

• Instruct the athlete to practice frequent handwashing and to carry and use hand sanitizer when soap and water are not available.
• Permit the athlete to participate in team activities, but make sure the wound is fully covered at all times.
• Do not allow an athlete with a MRSA infection to use any whirlpools or hot tubs.
• Encourage the athlete to follow good hygienic practices—washing hands, showering, and regularly laundering clothes.
• Clean sports equipment or any part of the athletic area that may come in contact with the wound with commercial disinfectant or fresh solution of diluted bleach before any other athlete comes in contact with the equipment or area.
• Use clean, non-sterile gloves when caring for the wound or touching any broken skin.
• Remove gloves promptly after use and discard before touching uncontaminated items and surfaces and before treating another athlete.
• Wash hands immediately after contact with the wound or broken skin even if gloves were worn.
• Wash hands between tasks and procedures on the same athlete to prevent cross-contamination of different body sites.
• Cover treatment tables. Discard or launder coverings after each use.
• Place disposable items that have come in contact with the infected site in a separate trash bag, and secure the bag before placing in the common garbage.
• Do not give other team members prophylactic antibiotics.

If MRSA infection has been found among the athletes, should all athletes be tested and treated for MRSA?

It is not recommended that all athletes get tested and treated for MRSA if one or more athletes in your school has a MRSA infection. Any athlete with a skin infection should be encouraged to see their healthcare provider. The healthcare provider will determine the best course of treatment.

How do I protect myself from getting MRSA?

• You can protect yourself by:

• practicing good hygiene (e.g., keeping your hands clean by washing with soap and water or using an alcohol-based hand sanitizer and showering immediately after participating in exercise);

• covering skin trauma such as abrasions or cuts with a clean dry bandage until healed;

• avoiding sharing personal items (e.g., towels, razors) that come into contact with your bare skin; and using a barrier (e.g., clothing or a towel) between your skin and shared equipment such as weight-training benches;

• maintaining a clean environment by establishing cleaning procedures for frequently touched surfaces and surfaces that come into direct contact with people's skin.

How to prevent CA-MRSA infection among athletes?

It is important for school athletics professionals to coordinate infection control efforts with school health professionals, residential services, and other colleagues to effectively prevent and control infections such as MRSA.

Practicing good hygiene is the best way to prevent getting and spreading MRSA infections and many other infections. Encourage athletes to:

• Keep hands clean by washing them frequently with soap and warm water or use an alcohol-based hand sanitizer gel.
• Shower with soap and water as soon as possible after direct contact sports, and use a clean, dry towel.
• Keep cuts and scrapes clean and covered with a bandage until healed.
• Avoid contact with other people’s wounds or bandages.
• Not share towels (even on the sidelines at a game), soap, razors, or other personal care items.
• Not share ointments or antibiotics.
• Wash towels, uniforms, scrimmage shirts, and any other laundry in hot water and ordinary detergent, and dry on the hottest cycle after each use. Inform parents of these precautions if laundry is sent home (laundry must be in an impervious container or plastic bag for transporting home).
• Avoid whirlpools or common hot tubs, especially when having open wounds, scrapes, or scratches.
• Inform their coach or athletic trainer if they think they have a skin infection.

In addition, develop procedures for cleaning athletic area and equipment, and educating staff and athletes about these procedures:

• Clean the athletic area and sports equipment routinely—at least weekly—using a commercial disinfectant or a fresh (mixed daily) solution of 1 part bleach to 100 parts water (1 tablespoon bleach to 1 quart of water).
• Clean mats and other high-use equipment before each practice and several times a day throughout a tournament, using a commercial disinfectant or a fresh (mixed daily) solution of 1 part bleach to 100 parts water (1 tablespoon bleach to 1 quart of water).

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: (see margin link above)

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 and sports activities 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.