Statement From NYC Health Department Addressing MRSA Alarm In Schools

Main Category: MRSA / Drug Resistance
Also Included In: Sports Medicine / Fitness
Article Date: 01 Nov 2007 - 2:00 PDT

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The recent attention to MRSA has alarmed many NYC parents. The alarm is understandable, and the threat of antibiotic-resistant diseases is real. But the focus on schools is misplaced. The vast majority of serious cases are related to hospitals or other health care settings, such as nursing homes and dialysis centers, and involve patients with many health problems. These are the settings where the effort to prevent, diagnose, and treat MRSA should focus.

In otherwise healthy people, MRSA infections usually heal on their own or with simple treatment. Serious complications are extremely rare. The Health Department estimates that in 2006, there were at least 600 laboratory-confirmed MRSA cases in children 5-18 years old in New York City. Though MRSA is resistant to some antibiotics, it can be cured with other common antibiotics if treatment is required.

MRSA (methicillin resistant Staphylococcus aureus) is a Staph infection. Staph spreads mainly through skin-to-skin contact. Nationally, there have been small clusters of cases associated with school sports teams (e.g., wrestling, football). Neither the City Health Department nor the Centers for Disease Control and Prevention is aware of instances in which MRSA has spread in schools except among members of sports teams. It is not necessary to keep children out of school to prevent MRSA, and there is no health-based reason to disinfect a school building after a single case is diagnosed with a Staph or MRSA infection.

The Health Department and the Department of Education are sending a letter to the school community this week to explain school procedures and describe steps that everyone can take to prevent the spread of infection. The most important ones are:

- Wash hands thoroughly with soap and warm water.
- Don't share towels and other personal items.
- Keep wounds covered.
- If you're concerned about a skin infection that isn't getting better, see your doctor.

Not all people with MRSA infection are diagnosed, and individual cases pose little risk to the school community. When evidence suggests risk of spread within a school, the Health Department will work with schools to address the issue.

If a school nurse receives information from a doctor that a student has MRSA, he or she will contact the health care provider to confirm that culture and antibiotic susceptibility testing were done to confirm the diagnosis.

If an MRSA diagnosis has been confirmed, school health staff will assess the child for additional factors that may increase the risk of transmission in school such as participating on an athletic team with an uncovered wound. Earlier this year one school (non-public) did have a cluster of cases of MRSA in a football team. With simple treatment and hygiene measures at the school, as recommended by the Health Department, there have been no additional cases in more than a month.

How can Staph and MRSA infections be prevented at school?

-- Regular hand-washing is the best way to prevent getting and spreading Staph and MRSA infections.

- Ensure access to sinks and adequate supplies of liquid soap and paper towels.
- Promote the use of alcohol-based hand sanitizers, if soap and water are not accessible.

-- Discourage sharing of personal items such as towels.

-- Those with skin infections should always keep draining lesions covered with clean, dry bandages to prevent direct contact with the wound and allow for proper healing.

- Wash hands with soap and warm water after changing bandages or touching infected wounds.
- Wear gloves when caring for another person's wounds and wash hands before and after.
- Dispose of bandages and dressings containing pus and blood carefully so that others do not come into contact with these items.

Can students and staff with MRSA attend school?

YES, as long as the wound is covered and they are receiving proper treatment. Students and staff do not need to be isolated or sent home in the middle of the day if a suspected Staph or MRSA infection is noticed. Wash the area with soap and water and cover it with a clean, dry bandage. Parents are encouraged to have the wound looked at by a healthcare provider. The wound should be kept covered with a dressing or bandage until it has dried completely.

Specific Recommendations for Sports Teams

1. Players should not share personal items, such as soap, razors, and especially towels.

2. Players should shower immediately after practice and matches, and dry off with clean towels. Ensure an adequate supply of clean towels for showering at the school; they are a necessary part of personal hygiene for school athletes.

3. Coaches, trainers and the school nurse should remind players to report cuts, abrasions and turf burns immediately practices or games. Skin injuries should be cleaned, and then checked daily until healed. Additionally, players should monitor wounds closely for signs of infection (increased redness, pain, swelling or pus).

4. During games and practices, skin wounds should be covered with a clean, dry bandage. Athletes with draining lesions should not participate in any sport that involves skin-to-skin contact and should not enter pools or saunas.

5. Staff should advise players against body shaving

Cleaning and disinfection procedures for sports equipment and facilities

Schools should routinely use an effective disinfectant to clean all surfaces where there is a high level of skin-to-surface contact, especially the surfaces and floors in bathrooms, locker rooms, and showers. These surfaces should be cleaned daily, and immediately if soiled. Physical education staff should identify equipment that involves more intense multi-student use and is likely to involve sweating, friction and uncovered skin (e.g., weight training equipment). Participants should place a clean towel between themselves and the equipment if possible; ideally, this equipment should be wiped down between each use.

http://www.nyc.gov