1. MRSA-staph A Common Sense Approach to Management November 1, 2007 (Advance with Mouse Click or wait for automatic change.)

2. What is Staph? Staphylococcus Aureus are common bacteria found on skin or in the nose. 25-35% of healthy people carry staph In most cases these bacteria are normal and DO not present a health concern

3. Staph in Schools We have seen staph infections in schools for years. Most commonly diagnosed as impetigo Staph live on inanimate objects for months and months! It’s everywhere……supermarket, the mall, restaurants, hospitals, nursing homes.

4. What is ca-MRSA Community Acquired Methicillin Resistant Staphylococcus Aureus A germ that commonly used antibiotics do not kill. Many believe it’s the “over-use” of antibiotics which have led to this “superbug”. Staph…..MRSA….What’s the difference?

5. Ca-MRSA (cont.) MRSA has been seen in hospitals and nursing homes for decades. Now seeing it in the community, hence the name (CA-MRSA)

6. So if it’s that common, why is it in the news so much? Student death triggers chain reaction. Public Health Authorities say there is NO epidemic nor unusual cluster of cases, as those two deaths were unrelated. Public Health Authorities view this as a chance to educate the public about prevention of this and many other diseases.

7. What Does MRSA Look Like? Skin Infections that may appear as: Pustule or Boil Little pus filled bumps May resemble a spider bite Become red, swollen, and painful Commonly occur at sites of visible skin trauma (cuts, abrasions, and areas of body covered by hair).

11. MRSA Treatment Almost all MRSA infections can be treated by drainage of pus with or without antibiotics. More serious MRSA infections require hospitalization, possible wound debridement and IV antibiotics.

12. MRSA Management In Schools The best way to prevent MRSA transmission is by frequent hand washing. If soap and water are unavailable, use 60% alcohol based hand sanitizer. Skin infections must either be covered by a dry bandage which is sealed on all 4 sides or be non- draining prior to returning to school.

13. Who’s Job is it Anyway? This is NOT solely a Custodial Department issue! Everyone plays a part in prevention. Teachers need to make certain their students have frequent hand-washing opportunities. We all need to take ownership within our work environment.

14. Custodial 101 Cleaning- The general removal of soil from surfaces by standard methods. (Detergent, Water and Friction) Sanitizing- Reduce the number bacteria on inanimate objects to a “safe” level, but does not necessarily destroy organisms. e.g-sani-wipes, forks, knives, plates. Disinfecting- A process of destroying disease producing organisms. e.g- Quats, floors, counter-tops, bathrooms Sterilize- Destroy all forms of microbial life. This cannot be done in a school system!

15. Cleaning Clean is first School surfaces require regular cleaning and removal of soil and dust. The effectiveness of Disinfectants is reduced when soil exists. The physical action of scrubbing with detergents and rinsing with water removes large numbers of microorganisms from surfaces.

16. General Strategies for Cleaning School Environment School surfaces can be divided into two groups: Those with Minimal Hand Contact (e.g. floors, ceilings and windows) Those with High-Touch Hand Contact (e.g. doorknobs, hand rails, student desk tops, shared equipment, and restroom surfaces.

17. High touch surfaces should be cleaned/disinfected on a daily basis.

18. Shared Equipment Cots, toys, diaper changing areas, should be cleaned/sanitized in between student use. Gym mats, athletic equipment such as lockers, benches, and weights, should be cleaned/sanitized after each use. Special education equipment such as feeders, chairs and personal care areas should be cleaned/sanitized after each use.

19. Whose job is it? EVERYONE’s. Common sense would say that shared equipment should be wiped down by instructional staff throughout the school day. Accidents containing blood or other bodily fluid would typically be the responsibility of the facilities department.

20. Laundry Personal items such as towels and gym clothes should be taken home on a daily basis for laundering.

21. On-Site Laundry Item such as towels, cover-ups, uniforms and mop heads, laundered at school need to have the following met: Use detergent and wash in hot water cycle Dry in a dryer rather than line dry

22. Products Check to see that your products are registered with the EPA as being effective against MRSA and other common bacteria and viruses. Maintain MSDS sheets. ALWAYS follow manufacturers instructions.

23. The 10 Minute Rule Important to note, most disinfectants need to be on a hard surface for 5-10 minutes to be effective.

24. What about Carpeting???? Studies have shown that microorganisms such as bacteria and fungi readily grow on carpet. However, there is limited evidence indicating that carpets influence health-care associated infection rates. Regular vacuuming can decrease microorganisms

25. Carpet (cont.) Carpet extraction/cleaning should be performed on a regular basis as determined by internal policy. Spills such as blood and other bodily fluids require immediate spot cleaning using standard cleaning procedures and application of chemical disinfectants.

26. Carpet (cont.) Most carpets can tolerate standard liquid chemical disinfectants. According to OSHA, carpeting contaminated with blood or other bodily fluids CANNOT be fully decontaminated.

27. Personal Protective Equipment Gloves and eye protection should be worn when handling chemicals and other disinfectants. Hepa-type bags and filters should be used in all vacuums. They should changed regularly. Custodial equipment shall be maintained in good working order

28. Buses Because the LISD transports special education students who are likely to be medically fragile, we have decided to implement nightly disinfecting of our buses. This is in addition to standard cleaning.

29. MRSA in Schools MRSA awareness, at a minimum, should challenge each of us to examine current practices, identify areas of weakness and strengthen where needed, within reason. It is extremely important not to over-react in response to panic because we CANNOT render a sterile environment.

30. Questions????