MRSA Mitigation Education Program Presented Courtesy of United Laboratories

Your Toolkit To Help Prevent The Spread Of MRSA Toolkit Materials: Fact Sheet for General Public on MRSA Guidance for School Health Professionals and Checklist Guidance for Athletic Programs Regarding MRSA and Checklist Guidance for Custodial Staff DuPage County Health Department Letter About MRSA in English and Spanish Contact Information and Weblinks These materials have been adapted from resources including: The Centers for Disease Control and Prevention www.cdc.gov Tacoma-Pierce County Health Department: MRSA Toolkit for Middle & High Schools at http://www.tpchd.org/index.php Illinois Department of Public Health http://www.idph.state.il.us/ DuPage County Health Department http://www.dupagehealth.org

Topics Covered History of MRSA Cause and Effect of MRSA CDC Recognized and Approved Methods to Mitigate MRSA Spreading

History Of MRSA First recognized, discovered in 1964 in the U.K. Was diagnosed as staph infection that resisted traditional antibiotics. In recent years has become apparent in the community outside the health industry. Hence the label CA-MRSA (Community Acquired MRSA). The CDC (Centers for Disease Control) has reported more deaths in 2007 resulting from MRSA infections than from AIDS. MRSA strain has been recorded active on hard surfaces for up to 4 weeks.

“Staph” And MRSA Infections Fact Sheet ? What is Staphylococcus aureus or “staph”? Staphylococcus aureus, often referred to simply as "staph," are bacteria found on the skin or in the nose of 25% to 30% of healthy people. What is methicillin-resistant staph or “MRSA”? MRSA is a type of staph that is resistant to a specific group of antibiotics that are often used to treat staph infections. Who gets staph infections? Anyone can get a staph infection. How serious are staph infections? Most staph skin infections are minor and may be easily treated. Staph also may cause more serious infections, such as infections of the bloodstream, surgical sites, or pneumonia. Sometimes, a staph infection that starts as a skin infection may worsen.

“Staph” And MRSA Infections Fact Sheet Description MRSA is a bacterial infection caused by Staphylococcus aureus (“staph”) bacteria that are resistant to antibiotics called beta-lactams. Mode of Transmission MRSA is primarily spread through contact with the bacteria, either by direct person-to-person contact or indirectly through shared equipment, personal articles/objects or contaminated surfaces. Incubation Period Variable Infectious Period An open wound may contain MRSA bacteria or other pathogen and should be treated as infectious.

Most Common Questions Asked Should the entire school community be notified of every MRSA infection? Should the school be closed to be cleaned or disinfected when an MRSA infection occurs? Should the school be notified that my child has an MRSA infection?

Response Based Upon CDC Criteria 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. Source: CDC

Response Based Upon CDC Criteria Should the school be closed to be cleaned or disinfected when an MRSA infection occurs? 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. Source: CDC Should the school be notified that my child has an MRSA infection? Consult with your school about its policy for notification of skin infections.

Response Based Upon Mayo Clinic Criteria What do the experts say in regards to proper methods in the control on MRSA cross contamination? Cleaning surfaces with detergent-based cleaners or Environmental Protection Agency (EPA)-registered disinfectants is effective at removing MRSA from the environment. The product label should list MRSA. Still, the best way to prevent the spread of germs is for staff and students to wash their hands frequently and to properly disinfect all common surfaces. Source: Mayo Clinic

School Health Professionals Infection Control Guidance Regarding MRSA

How Do We Control The Spread Of MRSA? Cleaning, Disinfecting & Sanitizing Hands Hard Surfaces Airborne Contaminates Multi-Dimensional Surfaces

Infection Control Guidance Regarding MRSA Control of Spread Students or staff members, who are colonized or infected with MRSA, do not need to be routinely excluded from the classroom. Exclusion from school should be reserved for those with wound drainage. Individuals with open wounds should keep them covered with clean, dry bandages. Gloves should be worn if you expect to have contact with non-intact skin or mucous membranes. Good personal hygiene and hand washing with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer. Clean and disinfect environmental surfaces and athletic equipment that has been in contact with potentially infectious wound drainage. Clean and disinfect health room cots regularly (at least daily), and use pillow protectors. If soiled linens and clothing are washed on school premises, wash separately with laundry.

Infection Control Guidance Regarding MRSA Special Considerations for Sports Settings Because bandages can shift or dislodge with activity or when wet, students with draining wounds should not be allowed to participate in practices, games, or physical education classes that involve contact with others until the wound has stopped draining. If MRSA is diagnosed in a student athlete, the school should evaluate the possibility of other cases among their teammates. Instruct students not to share personal hygiene items. Encourage use of a barrier (towel or layer of clothing) between the skin and shared equipment. Establish routine disinfectant cleaning of shared surfaces such as wrestling mats. Strongly encourage athletes and coaches participating in sports involving close personal contact (e.g. wrestling and football) to shower immediately after each practice, game or match. Strongly encourage athletes to wash athletic clothing after each use. Encourage athletes to report skin lesions to coaches and encourage coaches to assess athletes regularly.

Athletic & Physical Education Infection Control Guidance Regarding MRSA

Athletic & Physical Education Background Methicillin-resistant Staphylococcus aureus (MRSA) is a type of “staph” bacteria that is resistant to penicillin as well as some other common antibiotics. Athletics and MRSA Athletes and their parents should be aware that possible risk factors for MRSA skin and soft tissue infection occurring among athletes may result from: Physical contact/skin trauma “Turf burns” (football players) Contact with teammates’ uncovered skin lesions Sharing protective equipment, clothing or towels Sharing sports equipment Sharing personal hygiene items Reuse of unlaundered towels, clothing, uniforms, etc. Inadequate supply of dispensable or individual-use soap Cosmetic body shaving Poor personal hygiene practices, including infrequent hand washing Poor environmental cleaning of locker rooms/sport rooms

Athletic & Physical Education Prevention Through Good Hygiene Frequent hand washing and good personal hygiene is the best way to prevent MRSA. Recognition of Infections Ask athletes to report all potential skin infections to their coaches, the trainer and/or the school nurse.

Athletic & Physical Education Wrestling Room and Athletic Mats Wipe down padding along walls, benches and door pulls/knobs with a quaternary ammonium (quat) after practices/matches. Please refer to the manufacturer’s directions for recommended contact times for the various disinfectants. Clean floors when mats are stored and before mats are used again. Use “dedicated” mops to clean athletic areas, and wash mop heads on a regular basis. May use mop with disposable mop cloths that are discarded after each use. May use mat tape to cover small holes and small tears on top and bottom surfaces of mats. Tape mats together for practice as well as for matches to cover up mat sides that are in poor condition. Promptly replace mat coverings when there are medium to large holes and/or large areas of excessive wear. Clean and sanitize mats before and after practice and matches. When mats are rolled up, all sides of mats should be cleaned before they are rolled up. Use “dedicated” mop heads to clean mat surfaces. Wash these mop heads on a regular basis.

Athletic & Physical Education Coach/Training Staff Include 60% or greater alcohol-based hand sanitizer in coach’s first aid kit. Have disposable gloves readily available in first aid kit. Encourage sports/athletic participants to report wounds and skin lesions to coaches. Refer athletes with potential skin infections to the team physician. Use scoop (not hands) when taking ice out of cooler to make ice packs to treat sports injuries. Do not have shared “drinking” water bottles; each player should have his/her own water container. Shower immediately after matches/games/ practices when there is physical contact with the athletes.

Athletic & Physical Education Outside Groups Using High School Athletic Facilities Continue to ensure that custodians know schedule for outside events and are available to clean before students use any of the equipment/facilities. Instruct outside groups to use the “standard school-recommended” cleaning products if they are responsible for any cleaning.

Institute Policy & Procedures Have documentation for the following areas. Does the staff understand procedures for cleaning and disinfecting? Has the staff been trained on procedures? Does the staff have proper supplies to complete procedures? Is there a method of verification of policy and procedures?

Form Available At www.unitedlabsinc.com

Building Directors And Custodial Staff General Prevention Frequent hand washing and good personal hygiene is the best way to prevent MRSA. Cleaning and Disinfecting The following recommendations, may be incorporated in policies and procedures that are already in place or in development. General Guidance Collaboration with other school personnel such as school administrators, school health professionals and athletic or PE staff. Hard surfaces and equipment such as floors, light switches, door handles, hand-rails, tables, and desks should be cleaned routinely. Athletic equipment and areas such as wrestling mats, wall padding, locker rooms, and shower facilities should also be cleaned routinely. If during a sporting event there is a release of bodily fluids (blood, pus or drainage), cleaning and disinfecting should be completed before the activity is allowed to continue.

Building Directors And Custodial Staff General Guidance Areas All hard surfaces that may come in contact with body fluids should be cleaned using friction. All floors/wall padding in athletic settings should be washed daily (if room is used). Locker rooms, including any shower areas should be cleaned daily, if used. If soap is furnished, it should be accessible from a wall dispenser. Ensure that athletic areas, locker rooms and restrooms all have separate cleaning mops and buckets, and that all mops and buckets are cleaned regularly.

Form Available At www.unitedlabsinc.com

Transportation Drivers, Mechanics And Custodians General Guidance Areas Frequently wash and sanitize hands. Clean all hard surfaces touched with a detergent disinfectant between route runs. All body fluid discharges should be addressed with the appropriate approved clean up kit. Mechanics should clean and sanitize all tools that are shared. Drivers should sanitize all surfaces they are in contact with before trips. Bus should be fogged with the appropriate sanitizer on a daily bases.

DuPage County Health Department

DuPage County Health Department

Resources And Links Used For This Presentation Local Public Health DuPage County Health Department Phone: (630) 682-7400 TTY: (630) 932-1447 www.dupagehealth.org Education DuPage County Regional Office of Education Phone: (630) 407-5800 www.dupage.k12.il.us Website Centers for Disease Control www.cdc.gov U.S. Department of Education www.ed.gov American College Health Association www.acha.org National Association of School Nurses www.nasn.org State Public Health Illinois Department of Public Health Phone: (217) 782-4977 TTY: 800-547-0466 www.idph.state.il.us Federal Centers for Disease Control (CDC) HOTLINE: (800) 232-4636 TTY: (800) 232-6348 www.cdc.gov