School Athletic Department Guidelines

The following guidelines are intended to serve as recommendations for the creation of a policy for the management of methicillin resistant Staphylococcus aureus (MRSA). These guidelines can be adapted to accommodate different facilities and environments.

Antibiotic-resistant bacteria currently pose a significant health threat. Since the summer of 2002, outbreaks of skin infections caused by antibiotic-resistant bacteria have been reported in sports teams including wrestling, volleyball, and most frequently, football teams. A person on your athletic team may have already experienced an infectious disease that has not responded to antibiotics. The development of resistance to any antibiotic is dependent on many factors, including the widespread use of antibiotics, not taking all of the prescribed antibiotics, sharing antibiotics, or inappropriate prescribing. While the situation is alarming, everyone can help in the effective control and prevention of antibiotic resistant infections. This information is provided to assist you specifically in the control and prevention of staphylococcal (commonly called staph) infections. However, these measures are effective against almost all infectious diseases.

BACKGROUND
Staphylococcus aureus Staphylococcus aureus has long been recognized as a common cause of boils and soft-tissue infections as well as more serious conditions such as pneumonia or bloodstream infections. According to the Centers for Disease Control and Prevention (CDC), twenty-five to thirty percent of adults and children in the United States are “colonized” with Staphylococcus aureus—the bacteria are present but do not cause illness. Staphylococcus aureus (commonly called staph or staph aureus) colonization usually occurs in the armpit, groin, genital area, or the inside of the nose, with the nose being the most densely colonized. Although staph bacteria are carried in the nose, it is not typically an airborne pathogen. It is also not found in dirt or mud. Most infections occur through direct physical contact of the staphylococci with a break in the skin (cut or scrape). Inanimate objects, such as clothing, bed linens, or furniture, may also be a source of infection when they become soiled with wound drainage and a non-infected person then comes into contact with the contaminated object. If there is no break in the skin, contact with infected persons or articles may result in colonization. Susceptibility to infection depends on factors such as immunity and general state of health. In the past, these staph infections typically have been easy to treat with an inexpensive, short course of penicillin, cephalosporin, or other usually well-tolerated antibiotics. Times have changed and many of these staphylococci are now resistant to penicillin and other commonly used antibiotics.

Methicillin resistant Staphylococcus aureus (MRSA) A MRSA (often pronounced mer-sa) infection, unlike a common Staphylococcus aureus infection, cannot be treated with the penicillins, including Augmentin ®, dicloxacillin, or other methicillin-related antibiotics. These bacteria are also resistant to the cephalosporins. Consequently, the treatment is often longer, more expensive, and more complicated, with frequent recurrence of infections. Depending on the antibiotic resistance patterns, alternative antibiotics, such as trimethoprim/sulfamethoxazole (Bactrim®, Septra®), minocycline, or clindamycin, may be considered. For serious infections, vancomycin has become the treatment of choice, but this can only be administered intravenously and must be carefully monitored. Other newer antibiotics, such as linezolid or daptomycin, may also play a role in the treatment of serious infections, but these antibiotics, along with vancomycin, may be rendered ineffective through the development of bacterial resistance. The Centers for Disease Control and Prevention recently reported the first two cases of vancomycin-resistant Staphylococcus aureus infections. This underscores the need for aggressive control and prevention measures for all antibiotic resistant organisms. Originally, MRSA was confined to hospitals and long-term care facilities. In the past few years, sporadic reports of MRSA not associated with the healthcare environment have been confirmed. In the past twelve months, the Infectious Disease Epidemiology and Surveillance Division (IDEAS) of the Texas Department of Health has noted an increasing number of reports of MRSA from local and regional health departments, the public, physicians, and school districts. Although MRSA is not a new type of infection, these infections have seldom been reported from the community. The following prevention and control measures are effective against staph infections (including MRSA) as well as many other infectious diseases.