1. Community-Associated Methicillin Resistant Staphylococcus aureus (CA-MRSA) What is it ? How is it transmitted? How can we prevent it?

2. What is CA-MRSA?  Type of staph bacteria that is resistant to certain antibiotics, including methicillin, oxacillin, penicillin and amoxicillin.  Infection acquired by persons who have not been hospitalized or had a medical procedure.  Infection presents as skin pimples or boils that may be mistakenly identified as a spider bite.  Differs from HA-MRSA which occurs in the hospital setting  Is not new – first identified in 1968

3. Are certain people at increased risk for MRSA infections?  Outbreaks of CA-MRSA have occurred among:  Athletic teams – football, wrestling, rugby, fencing  Correctional facilities  Military barracks  Daycares and schools  Dormitories

4. MRSA Outbreaks among Sports Teams, U.S., 1994-2004 YearSportNo. Infected (Attack Rate) Infection and Transmission Factors 1994 1 High School Wrestling6 (19%)Close contact 2000 2 College Football10 (14%)Close contact, shared items, skin trauma 2003 3 College Football10 (10%)Close contact, skin trauma, poor hygiene 2003 4 Pro Football5 (9%)Close contact, skin trauma, poor hygiene 2003 5 College Football11 (10%)Close contact, shared items, skin trauma 1 Lindenmayer JM, et al. Arch Intern Med 1998;158:895-9. 2 Kainer MA. MRSA among college football team. (CDC unpublished) 3 Begier EM, et al. Clin Infect Dis. 2004;39:1446-53. 4 Kazakova SV, et al. New Engl J Med. 2005;352:468-75. 5 Nguyen DM, et al.Emerg Infect Dis. 2005;11:526-532.

5. How is MRSA transmitted?  Person to person via hands & skin-to-skin contact  Sharing contaminated items such as soap, towels, clothing, athletic equipment, razors and other personal care items  Contaminated surfaces  Breaks in skin, abrasions increase risk of transmission

6. Factors that make it easy for MRSA to be transmitted (5 C’s)  Crowding  Frequent, skin-to-skin Contact  Compromised skin (abrasions, cuts)  Contaminated surfaces  Lack of Cleanliness

7. Frequent Contact Cleanliness Crowding Contaminated Surfaces and Shared Items Compromised Skin CA-MRSA Common Factors Compromised Skin

8. What to Look For

10. How is MRSA treated?  Request culture from health professional to confirm diagnosis  Incision and drainage of wound  Antibiotics – Take all doses!  Don’t share antibiotics or save for future use  Topical anti-microbial  Cover wound at all times  Exclude from close contact if drainage can’t be contained

11. What we need to do to prevent transmission  Practice good hygiene : Keep hands clean by washing thoroughly with soap and water Use alcohol-based hand sanitizer if no access to soap and water Shower daily and after athletic practice or competition Keep cuts and scrapes clean and covered with a bandage until healed. Discard used bandages and tape in garbage Avoid contact with other people’s wounds or bandages.

13. More recommendations to avoid transmission  Avoid sharing personal items such as towels, razors, clothing, washcloths, lotions, cosmetics  Launder all clothing and washable equipment in hot water with detergent and dry in a hot dryer.  Check skin routinely for signs of infection and monitor wound management  Maintain a clean environment by establishing cleaning procedures for frequently touched surfaces and surfaces that come in direct contact with people’s skin

14. Precautions for Athletes  Shower with soap and water as soon as possible after contact sports  Do not share towels, razors, clothing, ointment  Use a barrier (towel) between skin and equipment surfaces  Wash towels, uniforms, scrimmage shirts, in hot water and dry in hot dryer  Transport laundry home in a plastic bag  Inform coach/trainer of skin infections and get approval for return to participation.

15. Additional tips for athletic facilities  Weight Room Wipe down equipment after use No cut off tees in weight room Place antibacterial gel or hand wipes in weight room so that athletes clean hands before picking up or using equipment Names on towels Clean athletic area and sports equipment at least weekly using commercial disinfectant or a FRESH (MIXED DAILY) solution of bleach 1:100 (1 tbsp bleach in one quart of water

16. In the classroom  Children with open draining infections should be referred for medical evaluation  Enforce hand hygiene with soap and water or alcohol-based hand sanitizers before eating and after using the restroom  Use standard precautions (hand hygiene + gloves) when caring for non-intact skin or potential infections

17. Cleaning the environment  Clean surfaces first; then disinfect  Read label and follow directions  Bleach + water 1:100  Lysol/original Pine Sol/EPA registered disinfectant (list @:http://epa.gov/oppad001/chemreindex.htm)  Quaternary ammonia  Leave surfaces wet for 10 minutes (if possible) or dry with paper towels

18. Resources  Center for Disease Control http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca.html http://www.cdc.gov/Features/MRSAinSchools  National Athletic Trainers’ Association https://www.nata.org/members1/canworc/powerpoint/ CA-MRSA%20Dublin_files/frame.htm#slide0114.html https://www.nata.org/members1/canworc/powerpoint/ CA-MRSA%20Dublin_files/frame.htm#slide0114.html

19. More resources  Mich.Dept of Community Health http://www.michigan.gov/domuments/MRSA educational brochures and posters  Massachusetts State Health Dept. http://www.mass.gov/dph/cdc/antibiotic/mrsa MRSA materials translated into different languages

20. CDC posters

21. Recognize…React…Refer Common sense, basic hygiene and disinfection practices CAN control the spread of communicable disease. So smile and go wash your hands!