November 2, 2007

Dear Parent(s) and Guardian(s):

Recently, there has been a lot in the news regarding Methicillin-Resistant Staph Aureus (MRSA).   MRSA is a “staph” infection; however, unlike most staph infections, this bacteria is resistant to the usual antibiotics.  MRSA is spread to others by direct physical contact with the bacteria.  Staph bacteria are not spread through the air.

As a district, Roxbury has been extremely proactive with its approach to MRSA.  All of  the health-care providers have been educated regarding MRSA and how to deal with it.  Our custodial staff has been using a nontoxic cleaning agent named Lemon Extra Neutral Disinfectant.  This cleaner has unique broad spectrum properties that are effective against a variety of pathogenic organisms, including MRSA.   All school buildings and buses are being cleaned with Lemon Extra Neutral Disinfectant nightly.

Attached is information that we feel might be helpful to you and your family in understanding what you can do to help prevent this skin infection.  Please review the information with your child, paying special attention to proper hand washing and keeping breaks in the skin covered.  If you have concerns regarding skin conditions present on your child, please contact your primary care physician and provide the school with a physician’s note.

Additional information on this topic can be found on the local website (www.roxbury.org) , the state website (www.nj.gov/health/cd/mrsa/index.shtml), The Center for Disease Control (http://www.cdc.gov/) or by calling me at school.

Please know that the entire district “team” is being very proactive in keeping our school clean and safe for all of our students and employees.

Sincerely,

Roxbury Township School District School Nurses

Proper Hand Washing Is The First Line Of Defense Against ALL Infections

Methicillin-Resistant Staphylococcus aureus (MRSA) in Schools:

Prevention and Control

Background

Staphylococcus aureus, often referred to as “staph,” is commonly found on the skin or in the nose of healthy people.  Approximately 25% to 30% of the population are colonized with staph bacteria (i.e., carry the bacteria without becoming ill). Sometimes staph causes a minor skin infection (pimple, pustule, or boil) that can be treated conservatively, without antibiotics.  However, on occasion, staph bacteria can cause more serious illnesses, such as infections involving soft tissue, bone, the bloodstream or the lungs.

Over the past years, treatment of some staph infections has become more difficult because the bacteria have become resistant to various antibiotics. S. aureus that is resistant to methicillin/oxacillin is called methicillin-resistant Staphylococcal aureus (MRSA). While 25% to 30% of the general population is colonized with S. aureus, approximately only 1% is colonized with MRSA. Infections caused by MRSA have historically been associated with ill persons in health-care institutions (e.g., hospital and long-term care facilities).  However, MRSA has now emerged as a cause of skin and soft tissue infections in previously healthy adults and children who have not had prior contact with health-care settings.  This type of MRSA infection is known as community-associated MRSA (CA-MRSA).

CA-MRSA can be transmitted from person to person through close contact.  Risk factors associated with the spread of MRSA includes direct skin-to-skin contact with colonized or infected persons (non-intact skin serves as a point of entry for the bacteria), sharing contaminated personal items (e.g., body towels, razors, soap, clothing), poor personal hygiene, direct contact with contaminated environmental surfaces, and living in crowded settings.

Although outbreaks of MRSA should be routinely reported to the New Jersey Department of Health and Senior Services (NJDHSS), sporadic cases of MRSA infection are not.  Recently, NJDHSS has received increasing reports of both outbreaks and sporadic cases of CA-MRSA infections. Likewise, there has been an increase in the number outbreaks of CA-MRSA skin and soft-tissue infections reported at the national level.  Outbreaks of CA-MRSA have occurred among prison inmates, participants in contact sports (e.g., football, wrestling) and military recruits.

INFECTION CONTROL

Any student with a draining skin lesion could transmit potentially infectious agents to others.  When a student with a suspect or confirmed MRSA skin infection is in the classroom, the following infection control measures (based on Centers for Disease Control and Prevention (CDC) guidance) should include, but may not be limited t

q       Keeping the wound covered.  All skin infections, particularly those that produce pus must be covered with a clean, dry bandage to contain the drainage.  Because bandages can shift or dislodge with activity or when wet, students that participate in contact sports or other contact activities should ensure that the wound dressing stays intact during the anticipated activity.  Keeping the site covered will help control the spread of potentially infectious drainage to others and can protect the environment from contamination.  If a wound cannot be adequately covered or the drainage cannot be adequately contained by the bandage, consider excluding the player from practice or competition until the lesion is healed.  When providing wound care or dressing changes in the school setting, the infirmary staff must follow contact precautions.  Contaminated dressings and other materials associated with the infected lesion should be placed in a plastic bag before discarding, as appropriate.

q       Practicing Good Basic Hygiene.  The infected student, medical staff, sport team staff, and anyone expected to have contact with the infected student must be diligent with hand hygiene.  To this end, ensure availability of adequate soap and hot water.  Advise the MRSA-infected student and all those who might have contact with the infected wound or wound dressing to thoroughly wash their hands using soap and warm water or, if this is not practical, to use an alcohol-based waterless hand sanitizer immediately after contact.  In addition, emphasize the importance of good hygiene overall, including showering and washing with soap after all practices and competitions, before using the gymnasium, or immersing in a whirlpool, hot tub, or swimming pool.

q       Prohibiting students from sharing personal items.  Instruct students and athletes to avoid sharing personal hygiene supplies and other items such as athletic clothing, towels, uniforms, skin balms, skin lubricants, razors, and certain sports equipment at all times.  It is particularly important to avoid sharing personal items that may have been in contact with the infected wound or bandage.  Also, do not permit students to share soap in the shower or at the sink for hand washing by using soap dispensers.  Provide antiseptic waterless hand gel rubs when soap and water is not available.

q       Laundering soiled clothing appropriately.  Parents/caregivers should be instructed to wash clothes and other soiled items (e.g. towels, sheets) with hot water and laundry detergent as appropriate.  They should also be advised to dry items in a hot dryer to help eliminate bacteria when possible.

q       Cleaning environmental surfaces.  Establish a written procedure and schedule for routine surface cleaning of shared athletic equipment.  Clean and disinfect environmental surfaces and athletic equipment that has been in contact with potentially infectious wound drainage, blood, or non-intact skin utilizing and EPA-registered disinfectant cleaner that meets the requirements of the Blood- borne Pathogens Standard developed by the Occupational Safety and Health Administration.  Athletic equipment that is in contact with intact skin or not normally in contact with individuals (e.g., wrestling mats) can be cleaned with an intermediate (e.g., ready-to-use tuberculocidal solution) or low-level disinfectant (e.g., quaternary ammonium solution).

EDUCATION/INCREASED AWARENESS

q       Transmission of MRSA skin and soft tissue infections among students who participate in competitive sports is a concern.  All persons (e.g., coaches, trainers, parent/caregivers, and teammates) associated with the school’s competitive sport activities and sport teams should engage in initiatives to increase awareness and adherence to the school’s policies and procedures designed to prevent transmission of MRSA skin infections.

q       Possible risk factors for MRSA skin and soft tissue infection among students who participate in competitive contact sports include:

Ø      Physical contact/skin trauma

Ø      “Turf burns” (football players)

Ø      Contact with teammates’ uncovered skin lesions

Ø      Sharing protective equipment, clothing, or towels

Ø      Sharing sports equipment

Ø      Sharing personal hygiene items

Ø      Reuse of unlaundered towels

Ø      Inadequate supply of dispensable soap for hand washing or showering

Ø      Poor personal hygiene practices

Ø      Poor environmental cleaning of locker rooms/sport rooms

To reiterate:  Skin infections must be recognized promptly and steps must be taken to limit the spread of infection to others.  Students with any open, weeping, or pustular lesion on the skin should be immediately referred to their primary care provider for appropriate medical management.

WHAT TO DO ABOUT YOUR SKIN INFECTION