1. (METHICILLIN RESISTANT STAPH AUREUS)
NOROVIRUS AND MRSA
(METHICILLIN RESISTANT STAPH AUREUS)

2. NEARLY 400 GUESTS BECAME ILL AT
Great Escape Lodge & Indoor Water Park
NEARLY 400 GUESTS BECAME ILL AT
SIX FLAGS GREAT ESCAPE LODGE & INDOOR WATERPARK IN QUEENSBURY, NEW YORK.

3. Great Escape Lodge & Indoor Water Park
People were getting sick within 4 hours of checking-in.
So many people were vomiting, the resort ran out of towels.
We learned that people were getting sick within 4 hours of checking-in. One couple told of the fact that the facility had so many people vomiting that it was out of towns.

4. Great Escape Lodge & Indoor Water Park
New York officials linked the Great Escape to the illnesses of nearly 200 people.
More than 300 called the hotline to report symptoms of diarrhea and vomiting after visiting the resort
The mystery illness is looking more and more like Norovirus. New York officials have linked the Great Escape to the illnesses of nearly 200 people and more than 300 have called the departments hotline to report symptoms of diarrhea and vomiting after visiting the resort or to get more information.
NOROVIRUS IS SUSPECTED

5. University of Connecticut Sorority
30 Sorority Women were treated at the Univ. of Conn’s infirmary after dining at the nearby Adams Mill Restaurant.
A University of Connecticut sorority picked the wrong place to hold its banquet. About 30 sorority women were treated by UConn’s infirmary after dining at the nearby Adams Mill Restaurant. Norovirus is suspected.
NOROVIRUS IS SUSPECTED

6. Villanova University Outbreak of gastrointestinal illness
More than 100 students became sick January 23rd.
Most recovered on their own, however, some required intravenous fluids.
Villanova University is experiencing an outbreak of a gastrointestinal illness. School officials said it is most likely Norovirus, the so-called “cruise ship virus”. Students began getting sick January 23rd. Most of the 100 or so students recovered on their own, however, several went to local emergency departments because they were dehydrated. They received intravenous fluids, and they were released.
NOROVIRUS IS SUSPECTED

7. Two Schools in New Jersey
Sandwiches supplied to two schools caused illness…
Sandwiches supplied to two schools in New Jersey were to blame for the Norovirus outbreak last week.
NOROVIRUS IS SUSPECTED

8. Royal Caribbean Cruise Ship
One passenger unleashed Norovirus that sickened 116 passengers.
Ship returned to port and underwent deep cleansing & decontamination.
Port Everglades, FL, a single passenger may have unleashed a Norovirus that sickened 116 passengers aboard a Royal Caribbean cruise and caused the ship to return to port to undergo a deep cleansing and decontamination process. The Miami Herald reported Sunday. The Herald said that cruise workers distributed letters to passengers who were preparing to board Saturday as the trip went back out on the sea, detailing the cleaning process and explaining the need for proper hand-washing. The cleaning involves the use of disinfectants, especially in “high-touch” areas such as countertops, railings, exercise equipment, remote controls, light switches, elevator buttons, and computer keyboards, according to the Herald.
NOROVIRUS IS SUSPECTED

9. WHAT IS
NOROVIRUS?

10. Norovirus is A common cause of food poisoning
Belongs to a group of viruses
Causes severe inflammation of the gastrointestinal tract (stomach flu)
Strikes quickly, feel very sick
Runs its course usually within 1-2 days.
Norovirus is a group if viruses that are a common cause of food poisoning and acute inflammation of the gastrointestinal tract (many times referred to as “stomach flu”) that can strike quickely with force and make a person feel very sick, but which typically resolves within 2-3 days.

11. Symptoms of Norovirus Nausea Vomiting Diarrhea (not bloody)
Abdominal cramping
Fever, if present, is low-grade
Dehydration is main complication especially infants and the elderly.
The characteristic symptoms are nausea, vomiting, diarrhea, and abdominal cramping. The diarrhea is not bloody. Fever, if present, is low-grade. Dehydration is the main complication, especially in infants and the elderly, and may need medical attention.

12. Spreading Norovirus
Primarily from one infected person to another (by the fecal-oral route)
Kitchen workers can contaminate a salad or sandwich as they prepare it
Fishermen can contaminate oysters
Norovirus infection has become a genuine plaque on cruise ships.
The virus is spread primarily from one infected person to another (by the fecal-oral route). Infected kitchen workers can contaminate a salad or sandwich as they prepare it if they have the virus on their hands. Infected fishermen have contaminated oysters as they harvest them. Norovirus infection has become a veritable plague on cruise ships.

13. Are Noroviruses Contagious?
YES !
Extremely contagious
Spreads easily from person to person
Take particular care of children in diapers with diarrhea.
Noroviruses are very contagious and can spread easily from person to person. Both stool and vomit are infectious. Particular care should be taken with young children in diapers who may have diarrhea.

14. How Long are People Contagious?
From the moment they begin feeling ill to at least 3 days after recovery
Some may be contagious for as long as 2 weeks after recovery
How long are people contagious? People infected with Norovirus are contagious from the moment they begin feeling ill to at least 3 days after recovery. Therefore, it is particularly important for people to use good hand washing and other hygienic practices after they have recently recovered from Norovirus illness.
USE GOOD HAND WASHING PRACTICES AND OTHER HYGIENIC PRACTICES AFTER RECOVERING FROM NOROVIRUS

15. How Do People Become Infected with Noroviruses?
By eating food or drinking liquids that are contaminated with Norovirus
Touching surfaces or objects and placing their hand in their mouth
Direct contact with another person who is infected
Noroviruses are found in the stool or vomit of infected people. People can become infected with the virus in several ways including: 1) eating food or drinking liquids that are contaminated with Norovirus 2) Touching surfaces or objects contaminated with Norovirus and then placing their hand in their mouth. 3) having direct contact with another person who is infected and showing symptoms (for example, when caring for someone with illness, or sharing food or eating utensils with someone who is ill).

16. How Do People Become Infected with Noroviruses?
Day-Care Centers and Nursing Home employees should pay special attention to children or residents who have Norovirus illness.
The virus is very contagious and can spread rapidly throughout such environments.
Persons working in day-care centers or nursing homes should pay special attention to children or residents who have Norovirus illness. This virus is very contagious and can spread rapidly throughout such environments.

17. How Serious is Norovirus?
No long-term health effects
People feel very sick & vomit for 1 or 2 days
May be unable to drink enough liquids to replace lost liquids
Dehydration may require medical attention
People may feel very sick and vomit many times a day but most people get better within 1 or 2 days, and they have no long-term health effects related to their illness. However, sometimes people are unable to drink enough liquids to replace the liquids they lost because of vomiting and diarrhea. These persons can become dehydrated and may need special medical attention. This problem with dehydration is usually only seen among the very young, the elderly, and persons with weakened immune systems.

18. Community Associated Methicillin-Resistant Staphylococcus Aureus Infections
(CA-MRSA or MRSA)
MRSA Magnified 20,000 x

19. Staphylococcus Aureus
Bacteria commonly carried on the skin or in the nose
25-30% population is colonized with “staph”
Cause of infections
Minor (skin and soft tissue)
Major infections (blood, pneumonia, surgical site)
Staph is the most common cause of skin infections
Discuss difference between infection and colonization, and its implications for transmission

20. Methicillin Resistant Staphylococcus Aureus- MRSA
The staphylococcus bacteria has developed resistance to antibiotics that are normally used to treat infections (methicillin, oxacillin, penicillin, amoxacillin)
1% population is “colonized” with MRSA

21. Reported Outbreaks of MRSA
Close-contact sports
Football
Wrestling
Rugby
Soccer
Fencing
Correctional Facilities
IV drug-users
Military Bases
Daycare Facilities
United States

22. Risk factors for the spread of MRSA
Close skin-skin contact
Openings in the skin such as cuts or abrasions
Exposure to contaminated items or surfaces
Crowded living conditions
Poor hygiene

23. MRSA on the leg

24. MRSA under the arm

25. MRSA on the cheek

27. MRSA Modes of Transmission
HANDS which become contaminated by contact with:
Colonized or infected individuals
Contaminated devices, items, or environmental surfaces
Direct skin-to-skin contact
Not unlike HA-MRSA transmission occurs via contamination with MRSA infected hands, surfaces

28. CA-MRSA Risk Groups Children Athletes (high school and college)
Daycare (attendees/care givers/family members)
Elementary School (attendees/teachers/family members)
Residential School for Developmentally Delayed (attendees/teachers/care givers)
Athletes (high school and college)
Football
Wrestling
Other = fencing, kayaking, etc.
Prison Inmates
Jail
Prison
Military Recruits
Homeless Individuals
Injecting Drug Users
Men who have Sex with Men
Here listed are reported outbreaks and clusters of CA MRSA. We’ll be discussing two incidents that occurred in here in Michigan in 2005

29. MRSA Risk Factors Previous MRSA Infection/Colonization
Close skin-to-skin contact
Breaks in skin (cuts, abrasions, skin disease, surgical sites)
Contaminated items and surfaces
Crowded living conditions
Inadequate personal hygiene
Corrections officer’s comment about transmission in his household between his daughters who shared the community razor in the shower and bar soap.

30. This is not a Spider-bite!
Often time wounds like this will be attributed to a spider bite, or pimple but are usually caused by CA-MRSA. Culturing the wound is key to determine appropriate antibiotic coverage. May just require good wound care protocol.

31. This is a Spider bite (Brown Recluse)

32. MRSA Prevention- Athletics
Keep hands clean (soap & water or alcohol-based hand sanitizer), especially after contact with a wound
Shower after working out
Keep cuts and abrasions clean and covered until healed
Discard used bandages and tape in garbage
Avoid contact with other people’s wounds & bandages
Avoid sharing personal items (towels, washcloths, bar soap, razors, balms, lotions, clothing, uniforms, equipment)
Use barrier between skin and shared equipment
General prevention principles apply for all potential environments

33. MRSA Prevention (2)-Athletics
Clean and disinfect shared items, equipment, surfaces between use with:
Soap and warm water
Bleach
Lysol
Wash clothes, towels, sheets with warm/hot water and laundry detergent
Dry clothes, towels, sheets in a hot dryer (no air-drying)
Report persistent draining, non-healing wounds
Infected individual should refrain from public contact (no school, no sports, no common areas) if wound drainage cannot be contained under a bandage
MDCH in Association with MARR are developing informational brochures for public information on reduction strategies
Also prescribing habits will follow local antibiogram data

34. #1 Prevention is Primary
A two pronged approach to prevent antimicrobial resistance is judicious use of antibiotics and sound infection control principles. ASK DAWN TO TALK ABOUT MICHIGAN 4TH VRSA CASE if time permits
Protect patients…protect healthcare personnel…
promote quality healthcare!

35. Hand Hygiene Turn on the water slowly do not use hot water
Apply soap to the hands and wrists
Vigorously rub hands in a rotary motion paying special attention to between fingers, knuckles and nails
Wash hands for a minimum of 15 seconds
Hold the hands and wrists down under the running water allowing the water to rinse
Dry hands using a single paper towel
Use the paper towel to turn off faucet
Discard paper towel

36. When to Wash Hands Before going off duty
Before and after performing a bodily function i.e. tissue, contact with the face, contacts, hair, use of toilet
Before preparing, serving, or eating food
Before preparing or administering medicine
After direct or indirect contact with patient excretions, secretions, or blood even if with gloves
After removal of gloves
When hand are visibly soiled.

37. Once Infected With MRSA, Prevent the Spread
Cover the wound
Clean the hands
Do not share personal items (towels, soap, razor, tweezers, clothing)
Notify new or additional healthcare providers of the history of MRSA

38. Infection Control in Recreation Areas
Do not share towels, soap, ointments, or other personal items.
Shower after participating in close-contact skin-to-skin activities.

39. MRSA (School) Website

40. The Dow Chemical Company Foundation
This Children's Environmental Health presentation was made possible through a grant from
The Dow Chemical Company Foundation

41. Credits
Charles Lichon, R.S., M.P.H., Creator of Children’s EH Program, Midland County Health Department (CHD) Michigan
Nancy Atwood, M.S., Midland CHD (MI) Sanitarian
Christine Rogers, Meth Response Coordinator, Kalamazoo CHD, MI
Robert Wolfe, R.S., Midland CHD (MI) Sanitarian
John Demerjian and Linda Van Orden, Wayne CHD, MI, Body Art
National Environmental Health Association (NEHA.org) for website storage and oversight.
NOTE: Permission to use this and all Children’s EH Power Point presentations is granted thru NEHA, however, all grant and credit notices and informational slides must be used during each presentation.

42. Other presentations include:
Body Art
Careers in Environmental Health
Food Safe Issues
Household Hazardous Waste
Meth & Teens
Recreational Water
Sun Wise
Norovirus & MRSA
Contact NEHA.org for more information

43. For more Information about this presentation, contact:
(Local Health Dept Name here)