A school district in southwestern Virginia shut down for a day of deep cleaning last week in the wake of a student death attributed to a virulent strain of bacterium and a national report indicating that such infections may be more common than previously thought.
Researchers based at the federal Centers for Disease Control and Prevention in Atlanta say that methicillin-resistant Staphylococcus aureus, or MRSA, infections represent a “major health-care problem” and are linked to an estimated 18,600 U.S. deaths in 2005, compared with the estimated 17,000 people who died of AIDS in the U.S. that year. Once seen as just a problem in health-care settings, the infections are now popping up among the otherwise young and healthy, including cases of two high school students in Nashua, N.H., earlier this fall, and 14 cases reported since August in the Montgomery County, Md., school district. Two other children have died of MRSA infections in October, according to press reports.
But while school districts have reported engaging in intensive cleaning to quell the spread of the bacterium, experts say that frequent handwashing is one of the best ways to prevent MRSA infection. Students also should not share towels and sports equipment, and should always shower after athletic practices and events.
“This is a cleanliness issue. It doesn’t matter if it’s bacterial, or fungal, or viral. Most of the time, [infections] can be drawn back to hygiene,” said James L. Thornton, the head athletic trainer and director of sports medicine at Clarion University of Pennsylvania, who is a member of the board of directors of the National Athletic Trainers’ Association in Dallas.
“We see kids that will practice or play a game, and following that practice or game, will not shower. Even though we keep hammering them,” Mr. Thornton said. The day after the report was released in the Journal of the American Medical Association, one of his athletes was diagnosed with MRSA.
MRSA stands for “methicillin-resistant Staphylococcus aureus,” which is a bacterium resistant to certain antibiotics commonly used to treat infections. About 25 percent to 30 percent of the U.S. population carries “staph” without the bacteria making them ill. About 1 percent carry the more dangerous MRSA.
The federal Centers for Disease Control and Prevention offers these tips for preventing MRSA infections:
• Keep hands clean by washing with soap and water or using an alcohol-based hand sanitizer.
• Keep cuts and scrapes clean and bandaged.
• Avoid contact with other’s wounds or bandages.
• Avoid sharing items like towels or razors.
Tia Campbell, the school health specialist for the Virginia Department of Education, noted the limited effect of intensive efforts to cleanse school facilities.
“What the epidemiologists are telling us is that our routine cleaning should be sufficient,” she said. “Staph is on us and among us. You may do deep cleaning, but when you open the doors to the building the next morning, you’ve reintroduced staph again.”
Lax hygiene in hospitals has been the main cause for the spread of MRSA, which was first documented in the 1960s. Doctors and nurses who did not wash their hands frequently enough spread infection among patients with open wounds or with catheters or intravenous lines. Staphylococcus bacteria dwell on the skin and in the noses of up to 30 percent of the population, while the strain that is resistant to certain common antibiotics is carried by about 1 percent of the population. Neither strain causes infection unless it enters the body through a break in the skin.
The CDC study, published last week, found that most cases of MRSA infection are still found in hospital settings, or among those who were recently hospitalized or had surgery. The researchers studied cases in nine metropolitan areas that were reported between July 2004 and December 2005. About 85 percent of the cases of MRSA were found in those who had some recent hospital contact, with about 14 percent coming from those who had no previous surgeries or other hospital exposure factors.
Ashton Bonds, the 17-year-old senior from southwestern Virginia, is believed to be one of the cases without a hospital connection. He first complained of a pain in his side, said his mother, Veronica Bonds. It took two trips to the hospital before MRSA was diagnosed, she said in an interview. He was hospitalized Oct. 7 and died Oct. 15 after the infection had spread to his kidneys, liver, lungs, and heart, Ms. Bonds said.
In late September, the Bedford County school district, where her son attended Staunton River High School, sent a letter to parents saying that two other students at the high school had been diagnosed with MRSA, and had been treated successfully. After Mr. Bonds’ death, the school, along with the 20 others in the district, closed for a daylong cleaning.
Ryan Edwards, the spokesman for the 11,000-student Bedford County district, said that the one-day closings were mainly a way to ease worries and educate students and parents, not a matter of necessity from a health standpoint.
“If the general public in the U.S. had not been so ill-informed about this type of bacteria, we would not have closed our schools,” said Mr. Edwards, who believes that the community did not understand, at first, that the infection is generally spread by skin-to-skin contact. “We recognized a serious fear and a serious anxiety with our public, with our parents, and with our students.”
The day after the cleaning, attendance at 1,200-student Staunton River High, normally around 94 percent to 96 percent of enrollment, was about 88 percent, Mr. Edwards said. “For the day after all this took place, we think that’s pretty good,” he said.
In New Hampshire’s 12,500-student Nashua district, the diagnosis of MRSA in two students prompted a thorough cleaning of the locker rooms and other athletic facilities at Nashua North and Nashua South high schools, said Edward J. Hendry, the associate superintendent. One student was a football player, and the other frequently used the weight room.
The school system also sent out two letters alerting parents of the infections, Mr. Hendry said. “Schools have got to take it seriously, but we can’t alarm people,” he said. Both students recovered from their infections.
That similar tactic of alerting parents and cleaning schools was followed by Maryland’s 138,000-student Montgomery County district this year, said district spokesman Brian K. Edwards. Seven of the 14 cases in the suburban Washington district were among football players; the rest were scattered among students at other schools who were not football players. “There’s been no indication we need to take the step” of shutting down schools, Mr. Edwards said last week. Though individual school communities were notified when cases were diagnosed, the school system sent a letter home to all parents last week, after the CDC study was released.
“We wanted to reassure them, and let them know what we are doing and that there are things [parents] can be doing,” Mr. Edwards said.
School officials, particularly coaches and athletic trainers, need to recognize that MRSA is now present in every part of the country, from rural locations to inner cities, said Dr. William Schaffner, the chairman of the department of preventive medicine at the Vanderbilt University Medical School in Nashville,Tenn.
Schools also need to stress the importance of handwashing and general cleanliness, and pay attention to small bumps and lesions on students’ skin that might have once been dismissed as pimples or insect bites, he added.
A version of this article appeared in the October 24, 2007 edition of Education Week