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All LCMH Staff & Physicians
Infection Control
Carol Hoffmann MT CIC October 24/
2007
Student athletes and
Community-Associated MRSA Infections
Available in Magic Office Cabinet
"INFECTION CONTROL PUBLICATIONS'"
"BUG BYTES"'--
"Sc1iQQ1S/Students/~A-MRSA ")
STUDENT ATHLETES AND COMMUNITY
ASSOCIATED
Staphylococcus aureus (CA-MRSA)
Infections
To limit the spread of staph
infections including MRSA among
student athletes the Illinois
Department of Public Health has
developed guidance on issues related
to policy infection control and
education/increased awareness.
Please share this with your students
and school adminstrators.
Background:
Staphylococcus aureus, often
referred to as "staph" are bacteria
commonly found on the skin or in the
nose of healthy people.
Approximately 25-30% of the
population carry the bacteria
without becoming ill, Sometimes
staph causes minor skin infections
(e.g., pustules, small boils) that
can be treated conservatively
without antibiotics. However,
sometimes staph bacteria can cause
much more serious skin infections,
as well as bloodstream infections,
pneumonia, etc..
Over the past several years
treatment of some of the staph
infections has become more
problematic because the bacteria
have become resistant to various
antibiotics. Methicillin-resistant
Staphylococcus aureus (MRSA) is a
type of staph that is resistant to
some antibiotics, including
methicillin. Infections caused by
MRSA have historicially been
associated with ill people in
health-care institutions. However,
MRSA has now become a common cause
of skin and soft tissue infections
occurring in otherwise healthy
adults and children who have not had
prior contact with health-care
settings. This type of MRSA
infection is referred to as
community-associated MRSA (CA-MRSA)
.
CA-MRSA can be transmitted from
person to person through close
contact. Risk factors include direct
skin-to-skin contact with infected
people (non-intact skin serves as a
point of entry for the bacteria),
sharing contaminated personal items
(towels, razors soap, clothing), and
just being in crowded settings. CA-MRSA
infections are treatable Early
recognition and good medical
management including surgical
drainage (when applicable) and
proper antibiotic treatment, help
ensure prompt resolution of
infections.
Recomendations:
To limit the spread of staph
infections, including MRSA in school
settings, recommends the following
with respect to policy, infection
control, and education/increased
awareness:
IDPH
1. Policy
The school health service should
take an active role in evaluating
students with skin lesions,
including lesions that resemble a
"bug bite" or other pustule skin
lesions that appear to be infected.
It is recommended that any unusual
skin lesion or other draining wound
be considered as potentially
infectious to others. Infection
control measures should be in place
to prevent the spread of infection.
Students with any open, weeping, or
pustule lesion on the skin (other
than acne) should be promptly
referred to a primary care provider
for consultation.
Transmission of MRSA infection among
students, including student
athletes, can have
substantial impact. Therefore, a
policy for active surveillance for
skin lesions should be implemented
by the school nurse, school
physician, and/or director, coach or
trainer of sports teams (especially
those teams involved in contact
sports) to expedite referral for
medical evaluation. Coaches and/or
athletic trainers should be
encouraged to assess student
athletes for any unusual skin
lesions before practice or
competition.
When MRSA infection is suspected,
athletes should be referred to their
primary care provider for evaluation
and treatment. Following medical
evaluation, confirm that a treatment
plan for the student athlete is in
place. Those infected with MRSA or
other staph infections should follow
their healthcare provider's
treatment plan, including completing
antibiotic therapy if an antibiotic
was prescribed. (NOTE: IDPH has
developed guidance for health care
providers regarding MRSA infections
available at htt: www.id
h.state.il.us health infect MRSA
Provider.htm).
If MRSA is diagnosed in a student
athlete other cases among teammates,
the school should evaluate the
possibility of
Because bandages can shift or
dislodge with activity or when wet,
students with draining wounds should
not be allowed to participate in
practices, games or physical
education classes that involve
contact with others until the wound
has stopped draining. The student
may participate in non-contact
athletic activities such as
weight-lifting,
running or jogging provided he/she
observes good hygienic practices
(washing hands) and the wound is
covered at all times with a clean,
dry, intact bandage.
Clusters of MRSA infection (three or
more lab-confirmed cases during a 14
day period) should be promptly
reported to the local health
department. (Cook County Department
of pUblic Health is our local health
department. Phone# is 708-492-2150).
Typically, it is not necessary to
inform the entire school community
about a MRSA infection. When MRSA
occurs within the school population,
the school nurse and school.
physician should determine, based on
the situation, whether all parents
and staff should be notified.
Consultation with the local health
department is advised, if necessary.
Prior to parent notification,
discuss the issue with the school
administrator.
2. Infection Control
The following infection control
measures are prudent in school
settings in order to reduce the
likelihood of spreading skin
infections.
Keep the Wound Covered
All skin infections, particularly
those that produce pus, should be
covered with a clean, dry dressing
(bandage) to contain the drainage.
Keeping the wound covered will help
control the spread of 'potentially
infectious drainage and can also
protect the environment from
contamination. When providing wound
care or dressing changes in the
school, staff should prevent any
unprotected contact with potentially
infectious material by using gloves.
Contaminated dressings and other
materials associated with the
infected lesion should be placed in
a plastic bag before discarding.
Hygienic Practices to prevent the
spread of MRSA or other infections,
all members of the school community
should be diligent with hand
hygiene. Provide adequate soap, warm
water and towels. Advise any 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 water or
an alcohol-based waterless hand
sanitizer immediately after contact.
In addition, emphasize the
importance of good hygiene overall
with the students. This includes
showering and washing with soap
after all practices and
competitions. MRSA outbreaks have
clearly occurred in settings where
athletes did not have access to, or
did not use, soap for hand washing or
showering.
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. 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 individual
bars of soap.
Provide alcohol-based waterless hand
sanitizer for hand hygiene when soap
and water is not available.
Laundering Soiled Clothing
Team uniforms and clothing worn
during practices should be laundered
with hot water and laundry
detergent. Dry items in a hot dryer
to help eliminate bacteria. Cleaning
Environmental Surfaces
Establish a written procedure and
schedule for routine surface
cleaning of shared athletic
equipment. Ensure cleaning products
are used in accordance with the
manufacturer's instructions. Clean
and disinfect environmental surfaces
and
athletic equipment that has been in
contact with potentially infectious
wound drainage, blood, or non-intact
skin utilizing an EPA-registered
disinfectant
cleaner that meets the requirements
of the OSHA Bloodborne Pathogens
Standard or a 1:10 dilution of
household chlorine bleach (1 part
bleach in 9 parts water,
prepared daily). Use an
EPA-registered low-level
disinfectant (quaternary ammonium
solution} or a general purpose
cleaner to clean environmental
surfaces and
athletic equipment that is in
contact with intact skin. Mats and
other high-use equipment should be
cleaned before and after each
practice and several times a day
throughout tournaments.
3. Education/Increased Awareness
Transmission of MRSA skin and soft
tissue infections among students who
participate in competitive sports is
a significant concern. All people
(coaches, trainers, parents,
caregivers, teammates) associated
with the school's competitive sport
activities and teams should engage
in initiatives to increase adherence
to the school's policies and
procedures designed to prevent
transmission of MRSA skin
infections, and awareness of risk
factors for infections.
Sending a letter to student athletes
and their parents regarding
precautions and preventive measures
related to CA-MRSA is prudent
practice. Athletes and their parents
should be aware that possible risk
factors for MRSA skin and soft
tissue infections occurring among
athletes include:
* * * * * * * * * * *
Physical contact/skin trauma
"Turf burns" (football players)
Contact with teammates' uncovered
skin lesions
Sharing protective equipment,
clothing or towels Sharing sports
equipment
Sharing personal hygiene items
Reusing unlaundered towels.,
clothing, uniforms, etc.
Inadequate supply of dispensable or
individual-use soap Cosmetic body
shaving
Poor personal hygiene practices,
including infrequent hand washing
Poor environmental cleaning of
locker rooms/sport rooms
In addition, since staph infections
start when staph enter the body
through a break in the -skin,
keeping skin healthy and intact is a
good preventive measure. Good skin
care should be encouraged among
student athletes. |
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