1. Community Acquired MRSA CA-MRSA Margaret Teitelbaum School Nurse/Health Educator Westfield High School

2. Staphylococcus Aureus Staphylococcus Aureus Bacteria identified in the 1800’s It has always been the most serious of infections “Granddaddy of all Antibiotics” PENICILLIN was discovered in 1941 –drug of choice for Staph Infections 1960’s Bacteria became resistant to penicillin Methicillin used to treat Staph infection 1961 Staph became resistant to methicillin and MRSA was identified in the hospital setting MRSA can cause serious, sometimes fatal, infections—with early detection, several antibiotics continue to be effective against MRSA

3. Community Acquired MRSA In the 1990’s, MRSA started showing up outside the hospital setting In October, 2007, the American Medical Assoc. suggested that MRSA infections are more prevalent than previously thought Student staph infections and deaths were reported by the media Dr. Gerberdine head of the Center for Disease Control and Prevention told members of Congress recently, “It takes close contact. MRSA is preventable largely by common sense hygiene”.

4. Risk Factors and Transmission of Community Acquired MRSA Community MRSA is transmitted by contaminated hands (skin to skin contact) Contact with contaminated objects with bodily fluids(examples sharing towels, athletic equipment) Open wounds, nicks to skin, turf burns put an individual at risk for infection Increasing numbers of cases are being identified among certain groups of people—children attending day care, athletes, military recruits, and people with weak immune systems

5. Infection Control Encourage proper HAND WASHING- 20sec w/ soap and water Utilize alcohol based hand sanitizers when soap and water not available Cover open wounds- ex small cuts, pimples, boils Launder athletic uniforms and other athletic clothing in hot water and dry them in hot dryer Avoid sharing personal items, soap towels, razors, clothing, uniforms

6. Protocol For Infection Control in the Schools School Nurses are carefully assessing students who sign into the nurses’ office with open wounds. If there are signs of infection including redness, swelling, warmth, tenderness, fever and/or purulent drainage Parents are contacted and encouraged to make a MD appointment Antibiotic regime may be necessary Medical clearance is needed from a physician to return to school—a note is required School Nurse will inform athletic trainer when necessary

7. Protocol For Infection Control in the Schools Continued Aggressive plans for cleaning and sanitizing have been Implemented in the schools Single cases of MRSA are not reportable but if there is a cluster of two or more laboratory confirmed cases within the school, the local health department will be notified School Nurses in Westfield have been in communication with the health department and according to them there are no reported cases in Westfield At this time, there are no reported cases in the schools

8. Steps Westfield Public Schools are Taking Educating the School Community regarding CA-MRSA Proper Hand Washing ”Common Sense Hygiene” Keep personal items personal. Encouraging communication between all students, parents and healthcare providers Encourage students to report suspicious skin lesions to the school nurse and keep open wounds covered

9. Examples of MRSA

10. BOIL

11. BOIL 2

12. Cellulitis

13. LESION

14. ACKNOWLEDGEMENTS Aniltta Alex, MSN, CNP; and Marilo Letizia, PhD, CNP “CA- MRSA: Considerations for School Nurses” The Journal of School Nursing. August 2007 Westfield Health Department New Jersey Department of Health and Senior Services website at www.nj.gov/healthwww.nj.gov/health Center for Disease Control website www.cdc.gov/ncidod/hip/Aresist/ca mrsawww.cdc.gov/ncidod/hip/Aresist/ca