MRSA

1. Methicillin-Resistant Staphylococcus Aureus MRSA

2. Staphylococcus aureus • Bacteria that lives as normal human flora on the skin and nose • 25% -30% of the population has the organism in nose and on skin • Can live in the environment for a long time (days to months)

3. Methicillin-resistant Staphylococcus aureus Methicillin-resistant Staphylococcus aureus (MRSA) is a type of bacteria that is resistant to certain antibiotics. These antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin and amoxicillin. • Multiple-resistant Staphylococcus aureus • Oxacillin-resistant Staphylococcus aureus • Community-acquired MRSA (CA-MRSA) • Hospital-acquired MRSA (HA-MRSA) Other names for MRSA include:

4. Invasive MRSA • 2005 Estimates of Infection in the United States – 94,360 • In 2005, estimated 18,650 persons died during the hospital stay from serious MRSA infections

5. Transmission • Skin-to-skin contact with someone who has a Staph infection • Contact with items and surfaces that have Staph on them • Opening in the skin such as cuts or scrapes • Crowded living conditions • Poor hygiene Incubation period from exposure to infection depends on many factors

6. The 5 c’s Crowding Frequent skin-to-skin Contact Compromised skin (i.e. cuts or abrasions) Contaminated items and surfaces Lack of Cleanliness Common locations Schools Dormitories Military barracks Households Correctional facilities Daycare centers MRSA can occur anywhereSome places have factors that make it more common…

7. HOSPITAL ACQUIRED • 85% of all MRSA infections occurred in the healthcare system • 2/3 occurred outside the hospital setting such as long term care, skilled nursing homes, home care, hemodyalisis centers and physicians offices • 20% of blood stream infections caused by Staph in hospital setting

8. COMMUNITY ACQUIRED • Occurs in community based settings • Community isolates are more sensitive

9. Symptoms How do you know that you have MRSA? In the community most MRSA infections are skin infections that may appear as pustules or boils which often are red, swollen, painful, or have pus or other drainage. These skin infections commonly occur at sites of visible skin trauma, such as cuts and abrasions, and areas of the body covered by hair (e.g., back of neck, groin, buttock, armpit, beard area of men).

10. Symptoms The symptoms of infection depend on the part of the body infected. Skin infections: 1) redness 2) warmth 3) swelling 4) painful lesions (sores) 5) boils and blisters.

14. Symptoms Persons may have the bacteria in their lungs Respiratory illness: 1) fever 2) cough 3) shortness of breath 4) fatigue.

15. Symptoms Infections can also occur in: surgical wounds burns catheter sites blood.

16. Serious Infections More serious infections, such as pneumonia, bloodstream infections, or bone infections, are very rare in healthy people who get MRSA skin infections.

17. Treatment Almost all MRSA skin infections can be effectively treated by drainage of pus with or without antibiotics. Use of non-penicillin antibiotics

18. Symptoms Sometimes persons may be a carrier of MRSA. This means it is living in their body without causing them to be sick.

19. Methods of Preventing MRSA PREVENTION

21. Contact with carriers Is it safe to have contact with persons who are infected with MRSA or those who may be "carriers"? If basic hygiene precautions are followed, MRSA carriers are not a hazard to others including their family and friends.

22. Wound Care • Practice appropriate first aid at all times • Cover all wounds. Clean dressings should be applied daily • Use gloves to avoid exposure and cross-contamination • Handle soiled dressings with gloves • Wash hands frequently after exposure to contaminated person or equipment

23. Prevention • Encourage careful hand washing - the single most effective way to control spread of MRSA. • Encourage frequent hand washing with soap and warm water. • Encourage students to keep their fingernails clean and clipped short. • Avoid contact with other people’s wounds or anything contaminated by a wound.

24. Prevention • Avoid sharing personal items such as razors, body jewelry, towels, deodorant, or soap that directly touch the body. • Clean and disinfect objects (such as gym and sports equipment) before use. • Wash dirty clothes, linens, and towels with hot water and laundry detergent. Using a hot dryer, rather than air-drying, also helps kill bacteria.

25. Prevention • Encourage students who participate in contact sports to shower immediately after each practice, game, or match. • Keep open or draining sores and lesions clean and covered. Anyone assisting with wound care should wear gloves and wash their hands with soap and water after dressing changes.

26. Covering infections will greatly reduce the risks of surfaces becoming contaminated with MRSA. In general it is not necessary to close schools to "disinfect" them when MRSA infections occur. MRSA skin infections are transmitted primarily by skin-to-skin contact and contact with surfaces that have come into contact with someone else's infection. When MRSA skin infections occur, cleaning and disinfection should be performed on surfaces that are likely to contact uncovered or poorly covered infections. Cleaning surfaces with detergent-based cleaners or Environmental Protection Agency (EPA)-registered disinfectants is effective at removing MRSA from the environment. {List available} Should schools be closed because of an MRSA infection ? The decision to close a school for any communicable disease should be made by school officials in consultation with local and/or state public health officials. However, in most cases, it is not necessary to close schools because of an MRSA infection in a student. It is important to note that MRSA transmission can be prevented by simple measures such as hand hygiene and covering infections.

27. Should the entire school community be notified of every MRSA infection? • Usually, it should not be necessary to inform the entire school community about a single MRSA infection. When an MRSA infection occurs within the school population, the school nurse and school physician should determine, based on their medical judgment, whether some or all students, parents and staff should be notified. • Consultation with the local public health authorities should be used to guide this decision. • Remember that staphylococcus (staph) bacteria, including MRSA, have been and remain a common cause of skin infections. Universal Response

28. Who Should Be Excluded ? • Unless directed by a physician, students with MRSA infections should not be excluded from attending school. • Exclusion from school and sports activities should be reserved for those with wound drainage ("pus") that cannot be covered and contained with a clean, dry bandage and for those who cannot maintain good personal hygiene. Consult with your school about its policy for notification of skin infections.

29. Poughkeepsie Journal Editorial – October 31, 2007

30. Thank you for your attention Dutchess County Department of Health Communicable Disease Control Division 845-486-3402 • http://cdc.gov/ncidod/dhqp/ar_mrsa.html • http://www.tpchd.org/page.php?id=364 • http://www.mayoclinic.com/health/mrsa/DS00735 • http://www.cdc.gov/Features/MRSAinSchools/#q3