1. MRSA Methicillin-resistant Staphylococcus aureus Education for School Personnel Presented by: Kim Lubrant, RN, Licensed School Nurse Milaca Public School 500 Highway 23 West Milaca, MN 56353 kim.lubrant@milaca.k12.mn.us Methicillin-resistant Staphylococcus aureus Education for School Personnel Presented by: Kim Lubrant, RN, Licensed School Nurse Milaca Public School 500 Highway 23 West Milaca, MN 56353 kim.lubrant@milaca.k12.mn.us

3. MRSA  Our goal for today is to increase awareness and educate on the prevention and spread of MRSA.  It is not to strike fear in our community but increase awareness through education.  Our goal for today is to increase awareness and educate on the prevention and spread of MRSA.  It is not to strike fear in our community but increase awareness through education.

4. MRSA Methicillin-resistant Staphylococcus aureus Methicillin-resistant Staphylococcus aureus

5. MRSA  Staphylococcus aureus (staph) is a bacterium commonly found in the nose and on the skin of healthy people.  When people get a staph infection that is resistant to a common group of antibiotics it is referred to as MRSA.  Staphylococcus aureus (staph) is a bacterium commonly found in the nose and on the skin of healthy people.  When people get a staph infection that is resistant to a common group of antibiotics it is referred to as MRSA.

6. Types of MRSA  HA-MRSA Healthcare - associated MRSA  CA-MRSA Community - associated MRSA  HA-MRSA Healthcare - associated MRSA  CA-MRSA Community - associated MRSA

7. Trends  MRSA started in hospitals and nursing home settings 20-30 years ago.  Affecting the elderly or people already sick.  MRSA started in hospitals and nursing home settings 20-30 years ago.  Affecting the elderly or people already sick.

8. Trends  Today we are seeing this in the community in healthy young individuals.

9. Statistics  2.3 million Americans carry the bacteria without symptoms as reported by the CDC in 2006.  Highest population at risk for CA-MRSA is children 2-18 years old.  Especially young men involved in athletics.  2.3 million Americans carry the bacteria without symptoms as reported by the CDC in 2006.  Highest population at risk for CA-MRSA is children 2-18 years old.  Especially young men involved in athletics.

10. How is MRSA contracted?  Any break in the skins protective barrier can set the stage for infection.  A razor nick  A scratch  Even nose picking  Any break in the skins protective barrier can set the stage for infection.  A razor nick  A scratch  Even nose picking

11. How is MRSA contracted?  Coming in direct contact with infected blood or body fluids of a person with MRSA.  Or coming in contact with contaminated objects or surfaces.  Coming in direct contact with infected blood or body fluids of a person with MRSA.  Or coming in contact with contaminated objects or surfaces.

13. What does MRSA look like?  A boil  Blisters  Pimples  A boil  Blisters  Pimples  Infected/draining wound  Red streak that travels up a vein.  Spider bites  Infected/draining wound  Red streak that travels up a vein.  Spider bites

14. Impetigo  Sores on the skin that produce a thick golden yellow discharge that dries and crusts and sticks to the skin.

15. Impetigo

17. Symptoms  Redness  Warm to touch at infected area  Swelling  Tender to touch-Pain  Redness  Warm to touch at infected area  Swelling  Tender to touch-Pain

18. Treatment  Treated with antibiotics or lanced and drained by a physician.  When the bacteria gets into the blood stream, joints, lungs, and heart, MRSA becomes serious and potentially life threatening.  Treated with antibiotics or lanced and drained by a physician.  When the bacteria gets into the blood stream, joints, lungs, and heart, MRSA becomes serious and potentially life threatening.

19. Why MRSA is so difficult?  People are still contagious when on antibiotics.  They may have new sore erupt when on antibiotics.  May need multiply antibiotic treatments  May spread from one family member to another and back again.  People are still contagious when on antibiotics.  They may have new sore erupt when on antibiotics.  May need multiply antibiotic treatments  May spread from one family member to another and back again.

20. Advice for teachers  If you notice a suspicious cut or sore refer to the School Nurse.

21. Teachers-cont.  Encourage proper hand washing  20-30 seconds.  Vigorous motion with soap and create a good lather.  Rinse with warm water  Use paper towel to shut off faucet.  If soap or water are not available use alcohol based sanitizers.  Hand washing before eating and after bathroom use.  Encourage proper hand washing  20-30 seconds.  Vigorous motion with soap and create a good lather.  Rinse with warm water  Use paper towel to shut off faucet.  If soap or water are not available use alcohol based sanitizers.  Hand washing before eating and after bathroom use.

23. Teachers-cont.  If a minor cut, have the student wash properly and have the student put the bandage on themselves.  Any time blood or body fluids are involved, encourage student to do as much as possible for themselves to protect both student and staff from infection.  If a minor cut, have the student wash properly and have the student put the bandage on themselves.  Any time blood or body fluids are involved, encourage student to do as much as possible for themselves to protect both student and staff from infection.

24. Advice for Coaches  Cover ALL wounds. If a wound cannot be covered adequately, consider excluding players with potentially infectious skin lesions from practice or games until lesions are healed or can be covered.

25. Coaches-cont.  Ensure good hygiene, including showering and washing with soap after practice and games.  Discourage sharing of towels and personal items (e.g., clothing or equipment)  Establish a routine cleaning schedule for shared equipment.  Ensure good hygiene, including showering and washing with soap after practice and games.  Discourage sharing of towels and personal items (e.g., clothing or equipment)  Establish a routine cleaning schedule for shared equipment.

26. Coaches-cont.  Train athletes and coaches on first aid for wounds and recognition of wounds that are possibly infected.  Encourage athletes to report skin lesions to coaches and encourage coaches to assess athletes regularly for skin lesions.  Train athletes and coaches on first aid for wounds and recognition of wounds that are possibly infected.  Encourage athletes to report skin lesions to coaches and encourage coaches to assess athletes regularly for skin lesions.

27. Exclusion from school  Should be reserved for those with wound drainage that cannot be covered and contained with a clean dry dressing taped on all 4 sides.  May be excluded if physician directed.  Should be reserved for those with wound drainage that cannot be covered and contained with a clean dry dressing taped on all 4 sides.  May be excluded if physician directed.

28. Exclusion from Sports  Students should not participate in contact activities unless their physician has approved their return to the activity. (The wound has healed and no new sores are erupting.)

29. Prevention

30.  #1 Hand Washing  Antibiotics prescribed for any use must be taken until prescription is gone.  “If we are not smart about using the few weapons we have left, this super bug will definitely morph again, to become resistant to even more antibiotics.” Henry Chambers, MD, chief of infectious disease at San Francisco General Hospital  #1 Hand Washing  Antibiotics prescribed for any use must be taken until prescription is gone.  “If we are not smart about using the few weapons we have left, this super bug will definitely morph again, to become resistant to even more antibiotics.” Henry Chambers, MD, chief of infectious disease at San Francisco General Hospital

32. Prevention -cont.  Dirty clothes can spread MRSA  Clean clothes everyday.  Wash in warm or hot water, bleach if possible  Dry in warm or hot dryer until completely dry  Wash hands after handling dirty clothes  Dirty clothes can spread MRSA  Clean clothes everyday.  Wash in warm or hot water, bleach if possible  Dry in warm or hot dryer until completely dry  Wash hands after handling dirty clothes

33. Prevention-Cont.  Stay healthy  Follow Physicians recommendations  Stay healthy  Follow Physicians recommendations

34. Remember Flu Shots  Having the flu lowers resistance fight to CA-MRSA.  Flu can allow MRSA to jump from the nose to lungs.  Health officials are looking at the flu deaths from 2006 that may have had “staph infection” along with the “flu”.  Having the flu lowers resistance fight to CA-MRSA.  Flu can allow MRSA to jump from the nose to lungs.  Health officials are looking at the flu deaths from 2006 that may have had “staph infection” along with the “flu”.

35. Resources  Centers for Disease control http://www.cdc.gov/  Minnesota Department of Health http://www.health.state.mn.us/  Microsoft PowerPoint - MRSA SWATA.ppt  Cool, Lisa. “Deadly Super Bugs” Readers Digest. August 2007. Pages 87-94.  Centers for Disease control http://www.cdc.gov/  Minnesota Department of Health http://www.health.state.mn.us/  Microsoft PowerPoint - MRSA SWATA.ppt  Cool, Lisa. “Deadly Super Bugs” Readers Digest. August 2007. Pages 87-94.