Methicillin-Resistant Staphylococcus aureus (MRSA) in Schools:

Prevention and Control Recommendations Background

Staphylococcus aureus, often referred to as “staph,” is commonly found on the skin or in the nose of healthy people. Approximately 25% to 30% of the population are colonized with staph bacteria (i.e., carry the bacteria without becoming ill). Sometimes staph causes a minor skin infection (pimple, pustule, or boil) that can be treated conservatively, without antibiotics. However, on occasion, staph bacteria can cause more serious illnesses, such as infections involving soft tissue, bone, the bloodstream or the lungs. Over the past years, treatment of some staph infections has become more difficult because the bacteria have become resistant to various antibiotics. S. aureus that is resistant to methicillin/oxacillin is called methicillin-resistant Staphyloccoccal aureus (MRSA). While 25% to 30% of the general population is colonized with S. aureus, approximately only 1% is colonized with MRSA. Infections caused by MRSA have historically been associated with ill persons in health-care institutions (e.g., hospital and long-term care facilities). However, MRSA has now emerged as a cause of skin and soft tissue infections in previously healthy adults and children who have not had prior contact with health-care settings. This type of MRSA infection is known as community-associated MRSA (CA-MRSA).

CA-MRSA can be transmitted from person to person through close contact. Risk factors associated with the spread of MRSA includes direct skin-to-skin contact with colonized or infected persons (non-intact skin serves as a point of entry for the bacteria), sharing contaminated personal items (e.g., body towels, razors, soap, clothing), poor personal hygiene, direct contact with contaminated environmental surfaces, and living in crowded settings.

Although outbreaks of MRSA should be routinely reported to the New Jersey Department of Health and Senior Services (NJDHSS), sporadic cases of MRSA infection are not. Recently, NJDHSS has received increasing reports of both outbreaks and sporadic cases of CA-MRSA infections. Likewise, there has been an increase in the number outbreaks of CA-MRSA skin and soft-tissue infections reported at the national level. Outbreaks of CA-MRSA have occurred among prison inmates, participants in contact sports (e.g., football, wrestling), military recruits, and men who have sex with men.