Methicillin-Resistant Staphylococcus aureus (MRSA) in Schools:

Prevention and Control Recommendations
Staphylococcus aureus ( S. 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 more 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. There has been an increase in the number outbreaks of CA-MRSA skin and soft-tissue infections reported at the national and local level, including students. Strategies for the Prevention and Recognition of MRSA in School Settings To limit the spread of MRSA infections in school settings, Centers for Disease Control and Prevention (CDC) recommends the following with respect to procedures, infection control, and education/increased awareness:

*The school nurse should take an active role in evaluating students who complain of painful skin lesions, including lesions that resemble a “bug bite,” or other pustule skin lesion that appears to be infected. Any unusual skin lesion or other draining wound is potentially infectious to others and infection control measures should be in place to prevent the spread of infection.

*Transmission of MRSA infection among students and student athletes can have substantial public health impact. Therefore, a procedure for active surveillance for skin infections should be implemented by the school nurse; school physician; and/or director, coach or trainer of sports teams (especially those teams involved in contact sports) to expedite referral for medical evaluation. Coaches and/or athletic trainers should be encouraged to assess student athletes for any unusual skin lesions before practice or competition.