MRSA in Schools

In schools 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).

Almost all MRSA skin infections can be effectively treated by drainage of pus with or without antibiotics.  More serious infections, such as pneumonia, bloodstream infections or bone infections, are very rare in healthy people who get MRSA skin infections.

MRSA is usually transmitted by direct skin-to-skin contact or contact with shared items or surfaces that have come into contact with someone else's infection (e.g., towels, used bandages).

MRSA skin infections can occur anywhere.

Some settings have factors that make it easier for MRSA to be transmitted. These factors, referred to as the 5 C's, are as follows: Crowding, frequent skin-to-skin Contact, Compromised skin (i.e., cuts or abrasions), Contaminated items and surfaces and lack of Cleanliness.

Locations where the 5 C's are common include schools, dormitories, military barracks, households, correctional facilities, and day care centers.

• practice good hygiene (e.g., hand washing with soap and water or using an alcohol-based hand sanitizer and showering immediately after participating in exercise or sports);
• cover skin trauma such as abrasions or cuts with a clean dry bandage until healed;
• avoid sharing personal items (e.g., towels, razors) that come into contact with your bare skin; and using a barrier (e.g., clothing or a towel) between your skin and shared equipment such as weight-training benches;
• maintain a clean environment by establishing cleaning procedures for frequently touched surfaces and surfaces that come into direct contact with people's skin.

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.

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, clean and disinfect surfaces that are likely to contact with 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.

It is important to read the instruction labels on all cleaners to make sure they are used safely and appropriately.

Environmental cleaners and disinfectants should not be used to treat infections.

The EPA provides a list of EPA-registered products effective against MRSA: https://www.epa.gov/pesticide-registration/list-h-registered-antimicrobial-products-label-claims-against-methicillin

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 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.

Consult with your school about its policy for notification of skin infections.

Unless directed by a physician, students with MRSA infections should not be excluded from attending school.

Exclusion from school 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.

Students with active infections should be excluded from activities where skin-to-skin contact is likely to occur (e.g., sports) until their infections are healed.

Cover your wound. Keep wounds that are draining or have pus covered with clean, dry bandages until healed.  Follow your healthcare provider's instructions on proper care of the wound.  Pus from infected wounds can contain staph, including MRSA, so keeping the infection covered will help prevent the spread to others.  Bandages and tape can be discarded with the regular trash.

Clean your hands frequently. You, your family, and others in close contact should wash their hands frequently with soap and water or use an alcohol-based hand sanitizer, especially after changing the bandage or touching the infected wound.

Do not share personal items. Avoid sharing personal items, such as towels, washcloths, razors, clothing, or uniforms, that may have had contact with the infected wound or bandage. Wash sheets, towels, and clothes that become soiled with water and laundry detergent. Use a dryer to dry clothes completely.

If you observe children with open draining wounds or infections, refer the child to the school nurse.

Enforce hand hygiene with soap and water or alcohol-based hand sanitizers (if available) before eating and after using the bathroom.

Students with skin infections may need to be referred to a physician for diagnosis and treatment.  School health personnel should notify parents/guardians when possible skin infections are detected.

Use standard precautions (e.g., hand hygiene before and after contact, wearing gloves) when caring for non-intact skin or potential infections.

Use barriers such as gowns, masks and eye protection if splashing of body fluids is anticipated.