Battling Staph Infections in Schools

November 13, 2007

Battling Staph Infections in Schools

Guests:
Sandi Delack is the president-elect of the National Association of School Nurses, based in Silver Spring, Md. Ms. Delack is also a practicing school nurse based in Rhode Island.
Richard Kelley is the principal of Silver Lake Regional High School in Kingston, Mass. Mr. Kelley had two unrelated cases of MRSA among his students this year.
Jim Thornton is the head athletic trainer and director of sports medicine at Clarion University of Pennsylvania, and a member of the board of directors of the National Athletic Trainers’ Association in Dallas.

Christina A. Samuels (Moderator):

Hello everyone, and welcome to today’s chat on schools and methicillin-resistant Staphylococcus aureus, or MRSA. My name is Christina Samuels, and I cover student health issues for Education Week. There are lots of great questions already coming in, so let’s get started.

Christina A. Samuels (Moderator):

There’s a lot of “what is staph?” questions coming in, so it seems worthwhile to explain just what MRSA is -- and what it isn’t. Staphylococcus aureus bacteria, or “staph,” is all around us in the environment. In fact, about 30 percent of the population carries it on their bodies with no ill effects (it likes to dwell in the nose, which is another good argument for covering your mouth and nose when you sneeze!) Staph can cause skin infections, which people can sometimes fight off on their own, or that sometimes have to be treated with antibiotics. The use of antibiotics is what has led to a mutated form of staph, formally known as Methicillin-resistant Staph. aureus, or MRSA. Doctors have known about this strain since the 1960s. It’s resistant to common antibiotics. MRSA breaks down into two “families:" hospital-acquired MRSA, or HA-MRSA, and community-acquired MRSA, or CA-MRSA. Of the two, HA-MRSA is FAR more common -- about 85 percent of the cases of MRSA in a recent study were among people who were in hospitals, were recently hospitalized, or were recently in health-care settings. This strain is potentially more dangerous, because patients in hospitals tend to have open wounds, catheters, or IVs that allow the bacteria a straight shot into their bloodstream. HA-MRSA is also resistant to more drugs, so it’s harder to fight. The people who die of MRSA are far, far more likely to have this strain.

Christina A. Samuels (Moderator):

CA-MRSA, which has been the focus of a lot of recent media attention, accounts for about 14 percent of MRSA cases, according to the same study. No area of the country is immune. Though CA-MRSA has gotten the lion’s share of attention because of deaths among school-aged children, it is still very curable in the majority of cases. Simple hygiene steps like washing your hands with soap and water, keeping your body clean, and not sharing towels and personal items goes a long way toward fighting staph. Infectious disease specialists say that staph is most commonly spread by direct skin-to-skin contact. Because staph is all around us, constant cleaning of objects is less effective against MRSA, because everything will eventually get recolonized with bacteria. However, the Environmental Protection Agency has registered cleaners that are effective against MRSA and many other bacteria and viruses. You can get the list here: http://epa.gov/oppad001/chemregindex.htm

Question from Margaret Givens:

what is the difference between the community type of resistant Staph infection and the hospital based resistant infections. Is one more dangerous to get than the other? why are we hearing of deaths from the community MRSA? Do medical Professionals not take the infections seriously undertreating an infections so that a young person becomes very ill?

Sandi Delack:

Since the late 1990’s, we have seen a genetically distinct strain of MRSA that has emerged in community settings among healthy individuals who have not had contact with health care facilities. We are seeing a rise in outbreakds of this infection in healthy children and adults. Like MRSA, CA-MRSA (Community Acquired MRSA) may be present on the skin, mucous membranes, and in the nostrils of healthy people. Most of these people do not develop infection, but they may be carriers. CA-MRSA causes skin infections which may be mild to severe. CA-MRSA strain tends to be less resistant to antibiotics, so can be treated with antibiotics other than beta-lactams and erythromycin. However, in contrast to MRSA, CA-MRSA produces a toxin that can lead to severe infectin in otherwise healthy children and adults. CA_MRSA strains multiply more quickly thatn hospital MRSA strains. Because of these qulities, there is an increased prevalance of CA_MRSA nationwide. I think we are hearing more about deaths from the community both because there is an increased prevalance and because it has caought the attention of the media. I believe that most medical professionals take all infections seriously. However, not all infections are treated with antibiotics. In some cases, health care providers recommend keeping the area clean and covered as the first course of treatment. It is hard to guess at the cause of some infections progressing so rapidly. It is important that anyone with a skin infection that is warm, red, and has pus seek the assessment of his/her health care provider as soon as possible.

Question from Eileen Vargo, RN, Collier County Public Schools:

At what point is it recommended or considered appropriate to notify parents and the community about MRSA infections? Does a single case warrant parental notificaiton?

Richard Kelley:

A single case is enough to warrant parent notification. We notified with our first case. It is important to let everyone know what is happening. Failure to inform parents can sometimes be construed as “hiding information”.

Question from Dave Burton, PE Teacher and Coach, Cheltenham High School:

I am a Physical Education Teacher and Coach, and I want to know what precautions are an absolute must in preventing MRSA and any other infection from being spread.

Jim Thornton:

One of the most important aspects of prevention is proper cleanliness of workout gear and the recepticle the athlete or student uses to transfer gear from home to shool and back again. The scenario is that the student will take the gym bag home and most likely throw it on the laundry room floor to be handled by the parent. It may or may not get taken care of that night so the dirty clothing remains in the bag over night. Just before leaving for school the dirty clothing is taken out and replaced with clean clothing which sits in the bag all day until class or athletic practice. Infections grow in an unsanitary, dark, warm, moist environment. If the student and parents can be sure to empty the bag, turn it inside out and spray with a disinfectant and let it dry over night I think you would see a decrease in a number of infections.

Question from Nancy Purcell, Parent:

A student in our local high school has MRSA. The school did not close, and school janitors wiped down all the desks and areas that the student would contact throughout the day. Is this proper procedure? What is the likelihood that MRSA would spread to the rest of the student and school population?

Sandi Delack:

MRSA is spread primarily through skin to skin contact. It may also be spread through indirect contact by touching objects (towels, clothing, gym equipment) that has been contaminated by the skin of a person infected with MRSA. Although the decision to close schools should be made by school officials in conjunction with local and/or state public health officials, it is generally not recommended that schools closed because a student has a MRSA infection. Most MRSA infections can be well controlled. Wounds and lesions should be covered with dry bandages. The bandages should be changed if drainage soaks through. A school nurse with knowledge of infection control should manage care of the student and dressing changes while in school. To reduce the risk of spread of infection, the student should be excused from physical education and sports until the lesion is healed. Surfaces that may have been contaminated with drainage from lesions should be disinfected with an appropriate disinfectant. These procedures, plus proper hand hygiene practiced by all staff and students, should significantly reduce the risk or spreading the infection.

Question from Karen Freeman, nurse, Beggs Elementary:

At what point, if any, is a student excluded from school?

Sandi Delack:

The decision to exclude a student from school because of MRSA should be made by the student’s health care provider. Rarely do students need to be excluded once they have been evaluated and treated. It is important, however, that their lesions are covered with a dry bandage and that the bandage is changed if it becomes wet with drainage. Exclusion from school may be considered for a those with wound drainage that cannot be covered and contained with a clean, dry bandage and for those who are not able to maintain acceptable personal hygiene. Students should not, however, participate in sports or other activities where skin-to-skin contact may occur until their lesions are healed.

Question from Troy Baker, Athletic Director, Jonesboro High School:

Is Virex an effective solution for fighting staph?

Jim Thornton:

I assume you are talking about Zovirex which is a medication for Viral infections. Viral meds are not appropriate for treatment of staph because staph is a bacterial infection.

Christina A. Samuels (Moderator):

If you are talking about Virex II cleaning solution, a quick check of Google indicates that the manufacturer advertises it as being effective against MRSA and several other microorganisms. Many other products are also effective.

Question from Nadine Schwab, Health Services Supervisor, Westport:

While immediate showering after athletics (presumably in school showers)is recommended by public health officials, if after play students are being picked up by parents and going home where they can shower in their own home and get their clothes washed, might the latter practice actually be better in terms of controlling the transmission of skin infections? In school showers, students share showers and locker areas with dirty clothes atop each other, used towels strewn around, bare feet, etc. - and dirty clothes are often not brought home. What would you recommend if going home via the family’s vehicle and showering there is an option for most students?

Jim Thornton:

workout gear should never be stored in locker rooms. Gear should be taken home and washed every day. The problem with showering at home is that some students will do it and some will wait until the following morning or hours later. I would recommend monitoring showering following activities with antibacterial soap and mandatory gear removal for laundry...you may want to even consider clean gear and locker part of the grade for the class.

Question from Laurie Taylor, Reading Speciaist, Richardson Independent School District, Richardson, Texas:

What kinds of things are being done at the high school and junior high level to maintain a clean environment for young athletes? What are some maintenance measures that can be done on a personal level to keep from coming down with another case of MRSA, other than washing hands, not re-using towels, not sharing things in locker rooms, etc. Do you think that the awareness level has been raised enough to require schools to keep up with a consistent schedule of cleaning their equipment, etc? How can we ensure that the public is being educated, so parents know what to look for and how quickly they need to react?

Richard Kelley:

As with everything else in the school house, communication is the key. We sent home letters to parents, did a reverse phone call and contacted every student’s home, posted on our web site and did a live announcement here at school. Students have been emptying their athletic lockers and PE lockers every Friday afternoon. Our custodial staff sanitizes over the weekends. We also installed “Purell” type foam handwashing stations in every classroom and in common areas.

Question from A. Warren, Teacher, Haralson County High School:

We don’t even have hot water to wash our hands in the bathrooms. Will the cold water do as effective a job at cleaning our hands?

Sandi Delack:

Although warm water is preferable and certainly feels more comfortable, it is important that students and staff wash their hands with soap and water of any temperature. Remember to rub hands together to make a lather and be sure to reach all surfaces of hands, including between fingers and back of hands. Wash for at least 20 seconds (teach students to sing Happy Birthday as a guide to adequate washing time), rinse thoroughly, and dry on a clean paper towel. Use the paper towel to turn off the water and open the bathroom door, so as to not re-contaminate.

Question from Susan McDonald,RN,ST. Johns School:

Mr. Kelley, Did you inform your school parents of the two cases of MRSA? We are trying to determine our responsibility as when and what info we need to send to our parents. We have sent out a generalized letter only so far. Thank you!

Richard Kelley:

Yes, we notified parents twice. We sent out letters and phone calls and web postings after the first incident and then repeated the process for the second incident. I also went on our televised morning announcemtns to quell rumors among the student body.

Question from Keona Gardner, education reporter, Ft. Pierce Tribue:

How should schools release information about MRSA cases in the schools district?

Richard Kelley:

I feel that every avenue available should be used. High school students are not likely to bring home written notices to parents. Therefore, we flood the market. We use our web site, email, reverse phone calls to all homes, PTO meetings, and monthly newsletters to keep the community informed. We also work closely with the local Boards of Helath.

Question from Cynthia:

The middle school students have p.e. everyday...should we recommend students bring clean p.e. clothes daily to help prevent an outbreak?

Jim Thornton:

Absolutely!!!

Question from Jan Persson LSN:

My health assistants want to know how to tell if a skin boil or leision is suspect. I’m sure you will tell us. I’m interested in what to tell our HS staff.

Sandi Delack:

I would recommend that any skin boil or signifcant lesion be evaluated by the student’s health care provider. As a school nurse, I will assess for skin and soft tissue infections for signs of redness, swelling, pain, and purulent (pus) drainage. CA-MRSA infections often present intially like a pimple or boil, sometimes attributed to a possible spider bite.

Question from John Russo, Brevard Federation of Teachers:

In our district, there is a school with at least two students diagnosed with MRSA. The clinic nurse, who is under the supervision of the county health department, reportedly is not following proper sanitary procedures, and her supervisor has not responded as if this is an urgent issue. Any suggestions?

Richard Kelley:

I suggest that you show them the Center for Disease Control procedures and have them read the articles in Education Week. While this is not a panic situation, it is serious and should be dealt with accordingly.

Question from Wendy DeGraffenried, School Nurse, Mat-Su Borough School District:

We have one confirmed case of MRSA in our school. This same student was diagnosed with Swimmer’s Itch two months ago, with lesions all over her body. The Swimmer’s Itch in gone but now they have one major MRSA lesion on her leg, which is healing very slowly. She also has small lesions on her hands, which physician reports are not MRSA. This student plays basketball (a contact sport) and was cleared to play as long as the sores on her hands were covered. My questions are these: How concerned should we be about these hand lesions and the accessibility of transmitting MRSA through simple peer to peer contact (even if lesions are covered with bandages)? Do other schools across America have MRSA exclusion protocols and if so, can those be shared in this forum? Was the Swimmer’s Itch the portal of entry or perhaps MRSA itself, misdiagnosed?

Jim Thornton:

I have never heard of the term “Swimmers Itch” but I am assuming it was some kind of contact dermatitis associated with the chlorine in the pool. As to the lesions on her hands, I would make sure you confirm the nature of what is causing them. In the Sport of wrestling, the only legion that can be covered to permit participation is a fungal infection. If the lesions on her hands are viral or bacterial then they may be systemic and transferrable regardless of covering.

Question from alan warshinsky, kindergarten teacher, gilpin county school re-1:

Is it o.k. to share a bar of soap for the whole class to wash their hands with everyday?

Sandi Delack:

Although sharing a bar of soap within a family at home is common practice, it is less commonly seen in public settings. It is preferable to have soap dispensers for multiple users in these settings.

Question from Debbie Wallace,Head Custodian,Twin Spruce Junior Hihg:

If there is a case in the school shouldn’t they let everyone know, so they can take precations also

Richard Kelley:

Absolutely, we inform students, staff, parents, and the community at large. All stakeholders need to be kept abreast of the situation at every step of the way.

Question from Keona Gardner, education reporter, Tribune:

How should schools alter cleaning of school buses to combat the spread of MRSA?

Richard Kelley:

This has come up several times as a parental concern. Most busses are used throughout the day by numerous schools and maybe even school districts. We have instituted the sanitizing of busses after every run.

Question from Michael Mcevoy,Environmental Health,Safety, & Security, Chesterfield County Public Schools:

How long should you clean after a confirm case of MRSA in a student athlete example: (football player-locker room)

Jim Thornton:

I don’t think length of time is the issue. I think the issue is quality of the process following an outbreak. Keep in mind though that it is more important that the athletes are practicing proper hygene and maintaining cleanliness of equipment more so than surfaces.

Question from Suzey Delger:

Is hand sanitizer better than a good mechanical scrub?

Sandi Delack:

I think it is more important to clean hands properly, regardless of the method. When soap and warm running water are available, I think this method provides the advantage of physically flushing dirt and germs from the hands. However, hands should be lathered well and washed for a full 20 seconds. They should be well-rinsed then dried with a clean paper towel. It is important to then avoid touching the faucets or door handles to prevent re-contamination. Hand sanitizers are effective against germs but not dirt. The manufacturer’s directions for the specific sanitizer should be followed and it is important that all hand surfaces are cleansed.

Question from Sally Weener, RN District Nurse, Grandville Public Schols:

Some of our parent organizations would like to stock hand sanitizers in the classrooms. Can you address pros and cons of this?

Richard Kelley:

We installed foaming sanitizer dispensers in classrooms. The cons are that most sanitizers are alcohol based and pose other concerns. Also, cost can be a factor.

Question from Suka, Teacher, Connecticut School System:

Our school system has sent out information to teachers and parents about ways to avoid getting MRSA, but what other steps can school systems do to prevent MRSA?

Richard Kelley:

Handwashing is the most effective defense against contracting MRSA. Therefore, we made as “easy” as possible for all members of our school to frequently wash hands by installing foaming hand wash stations in every classroom and in common areas such as the library and cafeteria.

Question from JoAnn Pellegrini school nurse wyoming area:

Where do we stand legally; in regards to HIPPA or FERPA when we release a note to parents that a case of CA-MRSA is confirmed in the school.

Richard Kelley:

As long as no names are mentioned, there is no violation of HIPPA.

Question from Betty Manning,R.N.:

How prevalent is VRE in relation to recent school outbreaks

Sandi Delack:

Most VRE (Vancomycin-resistant enterococci)infections occur in hospitals. those at increased risk include persons who have been previously treated with vancomycin and combos of other antibiotics, persons wtih weakened immunue systems, people who have undergone abdominal or chest surgery, and those with invasive medical devices. At this time, we are not seeing school outbreaks of VRE of which I am aware.

Question from Rochelle Rudnick, parent, Teaneck, New Jersey:

The principal of my child’s school shakes hands with every child every morning as they arrive. Although the school reviewed good hygiene procedures in connection with MRSA, I know that the students don’t have time to wash their hands before their first class, and probably don’t do so later. I’m actually less concerned about MRSA and more concerned about flu/strep/cold viruses spreading. Should I worry about the principal’s practice, or should I just forget about it ?

Richard Kelley:

Perhaps you should discuss your concerns with the principal.

Question from M. Murphy, Assistant Principal:

Is there a standard letter that goes home to parents? What information would the letter need?

Richard Kelley:

We don’t use a form letter but we do use a format. We state the facts and let the community know everything that we know at the time. Of course we do not divulge student names.

Question from Kathy Maloney Johnson Art Teacher Our Lady of Lourdes School:

I have old t-shirts for the kids to use to cover their clothes when they paint. When they’re done they toss them into a basket where they’re stored. Normally I only wash them a couple of times a year. Should I change this? Should each child have his/her own shirt? Storage is a problem with the entire school using the room.

Sandi Delack:

CA-MRSA is spread mainly by skin-to-skin contact. Although the t-shirts pose a low risk of contamination, it is probably best if each child had his/her own shirt. CA-MRSA is one of many infections/illnesses that can be spread. I would recommend that each child keep his/her own “paint shirt” in their desk, back-pack, or locker.

Question from Sallie Evans, SDFS Supervisor, LPSB:

Are there specific video programs or DVD’s that provide instructional training steps that can be purchased for school or district SDFS Coordinators? How do we get this information out to area daycares, restaurants, hotels and churches? and res

Sandi Delack:

The Following webistes contain a wealth of information and resources related to CA-MRSA and schools. CDC: http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca.html The National Association of School Nurses (NASN: http://www.nasn.org/Default.aspx?tabid=460 American Academy of Pediatrics: http://www.aap.org/new/mrsa.htm I would also suggest working with your local and/or state Health Department to help disseminate information within the community.

Question from Barbara Pereyra School Nurse, Delbarton:

what is the best product and method of cleaning to keep weight rooms and equipement clean?

Jim Thornton:

I would be hesitant to recommend any specific product but there are a number out there that kill virus, bacteria, and fungus. I think more importantly than the brand is the frequency and quality of use of these products. They will make those recommendations on the container.

Question from Robin Waxenberg, president, Robin Waxenberg & Associates:

What percentage of schools have athletic trainers on staff to ensure prevention and treatment of MRSA on and off the playing field?

Jim Thornton:

I am assuming you are talking about the secondary schools. The national percentage is 42%. This number is misleading though because a significant part of this percentage represents secondary schools that only have part time coverage or only coverage for events. The percentage of secondary schools that have full time staff is somwhere in the 20s. It is unfortunate that this is the case. Often times financing is cited for this but all it takes is a catastrophic head or neck injury or an outbreak of MRSA to valadate the need. I hope more parent and booster groups will look very hard at the day to day needs of the athletes.

Question from CSForte, CSNT:

As a parent and school nurse, in the past, I have witnessed many a wrestling mactch when my son was in middle school. I used to cringe when the mats were not washed down in between students/matches. Are school taking measures to wash all of the excercise/wrestling/high jump mats? Are policies being written specifically for athletic personnel. What is happening at meets across the state? Thanks, CSForte, RN

Jim Thornton:

Mats are not usually sanitized between bouts because it is important that the cleaners used are very well dried before next competition. The mats should be cleaned and sanitized after and before the next competition especially if the mats are used by other student groups. If the cheer team uses the mat and are running around with bare or stocking feet and the mats are not cleaned you may see an increase in fungal infections. The most important issue is the cleanliness and hygene of the contestants. Surfaces are important but not nearly as important as personal hygene.

Question from Benjamin Troge, Principal, Divine Savior Academy, Doral, FL:

How do I reassure parents that aside from encouraging good hygiene, there isn’t a whole lot more we as a school can do? At the end of the day, isn’t it the responsibility of the parents/guardians to make sure their child(ren) are practicing good hygiene?

Richard Kelley:

By providing the means for children to properly sanitize during the day can only help with good hygeiene.

Question from kathleen reese east providence district nurse coordinator:

How do we get people to change old habits and to increase awareness about the importance of handwashing?

Sandi Delack:

It seems that every time we have a “scare’ related to a communicable disease, people become more aware of handwashing. Handwahing is the single most effective step we can take to slow the transmission of communicable disease. It is important that we carry this message forward following the immediate attention it has received related to CA-MRSA. Handwashing will help decrease the spread of colds and flu, norovirus, and so many other illnesses that we see in schools and other public places. We must continue to share that message through newsletters, posters, websites, etc. We can also take the time to teach children proper hand washing technique and allow them the time in school to wash following use of the bathroom, before eating, and any time their hands may have become contaminated. Handwashing is a seemingly simple thing to do and yet is so effective in preventing the spread of diesease.

Question from Mindy McCartin, RN, Montgomery County HHS, MD, School Health Services:

When would you exclude a student athlete, diagnosed with MRSA, from participating in PE and school team sports?

Jim Thornton:

Anyone with an active lesion should not participate in athletics. This decision should be made by the Attending physician and athletic medical staff. A bacterial infection that is active and is giving off fluid should not be covered to allow participation. The infection may be systemic in nature and therefore communicable.

Question from Joan Simpson, District School Nurse, New Richmond, WI:

When assesing wounds in the school age child, when is it appropriate to refer them on to have the wound medically evaluated for MRSA?

Sandi Delack:

Any student who presnets with a skin and soft tissue infection which becomes red, swollen, painful, or exhibits pus-like drainage should be evaluated by his/her health care provider. This is particularly true for infections which are persistent and have not responded to typcial first-line antibiotic therapy.

Question from Lori Mido, School Nurse, School #23, NJ:

What type of contact precautions school school nurses use in dealing with MRSA wounds. Gowns? masks?

Sandi Delack:

Contact precautions should be determined in relation to the severity of the infection and ability to control the drainage. It seems that exlusion should be considered for any infection that is so severe that the drainage cannot be contained in a dressing while in school. Gown precautions in hospitals are primarily im place for protection against drainage from large lesions and in bed linens, johnny’s, etc. Gloves should be adequate to treat the lesions of students who are in school (along with proper disposal of bandages, disincting surfaces, and proper handwashing). CA-MRSA is present in the nares of many healthy people in the community. I have not heard of any recommendations for masks at this time.

Question from Allison C., Teacher, Quincy Public Schools:

How is staph transmitted and spread? Can it be spread via sharing textbooks, papers, desks, etc.., or is a more direct contact necessary?

Sandi Delack:

Staph infections are spread mainly by direct skin-to-skin contact. If wound drainage occurs onto environmental surfaces, there is a smaller chance that the infection can be spread that way. When lesions are covered and dry and the student practices good hand-hygiene, there is little concern of cross-contamination in sharing books, papers, etc. Athletic equipment where there is direct skin contact can present a problem and should be cleaned regualry with an appropriate disinfectant.

Question from Reta Gundlach, Intervention Specialist, Morgan High School:

Our school has just received several recumbent exercise bikes that students and staff will be sharing. What is the best way to keep from sharing MRSA, also?

Jim Thornton:

The bottom line is cleanliness. They should be wiped off with a disinfecting solution after each use and allowed to dry before the next person uses the equipment.

Question from Dawn Miller RN JCPS Early Childhood Dept.:

If a child is allergic to Amoxicillin, what other antibiotics are effective for treatment? Also, how long should a child remain at home once treatment has begun?

Sandi Delack:

I assume that you are asking about treatment for CA-MRSA. Amoxicillin is generally not an effective agent to treat this infection. Students with mild to moderate infections are treated with clindamycin, trimethoprim-sulfamethoxazole, or a fluoroquinolone. For more serious infections, children may be admitted to the hospital for intravenous treatment. The decision related to exlusion/readmission to school should be made by the heatlh care provider. In general, students who have been diagnosed and are undergoing treatment can return to school as long as the lesion(s) can be covered with a dry bandage and the drainage can be contained. Studetns with CA-MRSA should, however, be exluded from phsyical education and contact sports until the lesion is healed.

Question from Nadine Schwab, Health Services Supervisor, Westport Public Schools:

What strategies may be effective in getting students to bring home their phys ed and athletic practice clothes for washing on a daily basis?

Jim Thornton:

Daily cleaning of PE and Athletic Gear should be mandatory. If the school doesn’t have laundry services then the student and parents should be educated. The gear should go home, the bag should be emptied, turned inside out and disinfected with spray disinfectant, hung and allowed to dry over night. I believe this will cut down on a number of infections whether fungal, bacterial, or viral.

Question from Kari Segebart LA teacher Denison Middle School:

Our school was using Purell and then we were told that it had too high of a level of alcohol to be safe around kids. Is there another option for us?

Sandi Delack:

Some school systems have installed non-alcohol based hand sanitizers. It is important to check the independent research related to the safety in addition to the effectiveness of the product when a decision is being made regarding purchase of supplies. Soap and water may be a less expensive option. When hands are washed properly, soap and water provide a very effective method of handwashing.

Question from Keona Gardner, education reporter, Ft. Pierce Tribune:

What conditions are needed to foster the spread of MRSA?

Jim Thornton:

Essentially the most likely condition is the presence of a resistant strain of staph on the skin and the occurance of skin to skin contact. Surfaces are an issue but not nearly as much as human contact and unsanitary clothing or poor hygene.

Question from Laurel Grady, Assistant Director of Student Services, The Curtis Institute of Music in Philadelphia:

What advice is there for students who are musicians? Also do flu shots help in any way to help stave off MRSA? As they get ready to travel home for the holidays what travel advice is there to help prevent spread and contraction of MRSA?

Sandi Delack:

Musicians should practice the same good hygiene habits as all other students. Hand-washing is the most effective method of preventing the spread of disease. Also, students should be reminded to not share personal items, clothing, etc. Flu shots will not prevent the spread of MRSA, but will help protect against the flu, so I would recommend that musicians who are traveling and who will come in contact with many people would benefit from a receiving a flu shot.

Question from Lisa Long, Teacher, Glide Elelmentary School:

Some on the west coast are not as aware of this illness threat and think that it is only on the east coast. What are the statistics on this and how can we best deal with it in a school situation?

Jim Thornton:

I am not sure of statistical distribution but I don’t think it has anything to do with location. It is more societal than geographical.

Question from shelly santos RN school nurse at AMHS:

We have purschased personal laundry bags for each individual wrestler-therefore bag and all can be laundered. we also purchased staphaseptic for all new wounds to help prevent staph from getting into the wound. Do you agree with these practices. we purchased chlorox wipes to wipe down head gear and wt lifting benches

Jim Thornton:

These are excellent measures for preventing not only staph but also fungus and viral infections as well.

Question from Chaney Williams-Ledet, Ed.D:

In some Texas public schools there are Health Clinics on campus, in light of the situation shouldn’t more clinics or mobile units be placed on campuses?

Sandi Delack:

I believe that all students should have access to a school nurse or health care professional during the school day. CA-MRSA is one of many infections, illnesses, and chronic conditions that we see in school students.

Question from Mindy McCartin, RN, Montgomery County, MD School Health Services:

What are your recommendations for cleaning gymnastic mats and wrestling mats in schools?

Jim Thornton:

They should be cleaned with a cleaner that kills bacteria, viruses, funga, and left to dry before use. Most mat companies are making recommendations as to cleaning and there are also a number of cleaners on the market that will do the job.

Question from Donna C., Director, Family Center Daycare:

I have two questions. The first one is that we have seen so much in our area (Pgh, PA) about how the schools are handling this, but have not seen anything about daycare centers. Our center serves infants through school age children, many younger ones have older school age siblings. We already wash hands, disinfect, clean and launder. What else is there to do to prevent any outbreaks? Also, one staff member has a son in school who swims several times a week. They already know to launder clothes, etc., but is there any increase in risk in the pool itself?

Sandi Delack:

Teh recommendations to prevent outbreaks in day care would be the same as in schools. Proper handwashing is critical, in addition to early referral to a health care provider for any suspcious lesion, especially if it is draining. Cleaning of surfaces, especially where diapering takes place, is also essential. Cleaning procedures are so important in day care centers where young children may touch many objects and not hav developed good handwashing practices.

Question from Anonymous:

Should I be concerned about contracting MRSA from a child who has been diagnosed in the past with MRSA deep in his lungs? (He is cared for by Health Techs. who suction his mouth (sometimes in the hallway) and deep suction him in an isolated bathroom that is regularly sanitized.

Sandi Delack:

MRSA can be spread through droplets related to respiratory infection. I would advise seeking an opinion as to necessary precautions from the child’s health care provider or the medical director for your institution.

Question from J.D. Mahood, Vice Principal:

What disinfective agents show the most efficacy with regard to wrestling mats, P.E. locker rooms and Health Office furniture?

Jim Thornton:

There are a number of disinfectants out on the market that take care of Bacteria, viruses, and funguses. Read the label and make sure you are following application and drying criteria for use.

Christina A. Samuels (Moderator):

Thanks everyone for a great hour-plus! There were many questions that our panelists could not get to. I wanted to direct you to a resource that the federal Centers for Disease Control and Prevention in Atlanta has developed just for MRSA in the school environment, http://www.cdc.gov/ncidod/dhqp/ar_mrsa_in_schools.html You can get many answers there.

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