Community-Associated Methicillin Resistant Staphylococcus aureus (CA-MRSA)

What is it?How is it transmitted?

How can we prevent it?

What is CA-MRSA? Type of staph bacteria that is resistant to

certain antibiotics, including methicillin, oxacillin,

penicillin and amoxicillin. Infection acquired by persons who have not

been hospitalized or had a medical procedure. Infection presents as skin pimples or boils that

may be mistakenly identified as a spider bite. Differs from HA-MRSA which occurs in the

hospital setting Is not new – first identified in 1968

Are certain people at increased risk for MRSA infections?

Outbreaks of CA-MRSA have occurred among:

Athletic teams – football, wrestling, rugby,

fencingCorrectional facilitiesMilitary barracks Daycares and schoolsDormitories

MRSA Outbreaks among Sports Teams, U.S., 1994-2004

Year Sport No. Infected

(Attack Rate)

Infection and Transmission Factors

19941 High School Wrestling 6 (19%) Close contact

20002 College Football 10 (14%) Close contact, shared items, skin trauma

20033 College Football 10 (10%) Close contact, skin trauma, poor hygiene

20034 Pro Football 5 (9%) Close contact, skin trauma, poor hygiene

20035 College Football 11 (10%) Close contact, shared items, skin trauma

1 Lindenmayer JM, et al. Arch Intern Med 1998;158:895-9.2 Kainer MA. MRSA among college football team. (CDC unpublished)3 Begier EM, et al. Clin Infect Dis. 2004;39:1446-53.4 Kazakova SV, et al. New Engl J Med. 2005;352:468-75.5 Nguyen DM, et al.Emerg Infect Dis. 2005;11:526-532.

How is MRSA transmitted?

Person to person via hands & skin-to-skin contact

Sharing contaminated items such as soap, towels, clothing, athletic equipment, razors and other personal care items

Contaminated surfaces

Breaks in skin, abrasions increase risk of transmission

Factors that make it easy for MRSA to be transmitted (5 C’s)

Crowding Frequent, skin-to-skin Contact Compromised skin (abrasions, cuts) Contaminated surfaces Lack of Cleanliness

Frequent Contact

Cleanliness

Crowding

Contaminated Surfacesand Shared ItemsCompromised Skin

CA-MRSA Common Factors

Compromised Skin

What to Look For

How is MRSA treated?

Request culture from health professional to confirm diagnosis

Incision and drainage of wound Antibiotics – Take all doses! Don’t share antibiotics or save for future use Topical anti-microbial Cover wound at all times Exclude from close contact if

drainage can’t be contained

What we need to do to prevent transmission

Practice good hygiene:

Keep hands clean by washing thoroughly with soap and

water Use alcohol-based hand sanitizer if no access to soap and

water Shower daily and after athletic practice or competition Keep cuts and scrapes clean and covered with a bandage

until healed. Discard used bandages and tape in garbage

Avoid contact with other people’s wounds or bandages.

More recommendations to avoid transmission

Avoid sharing personal items such as towels,

razors, clothing, washcloths, lotions, cosmetics Launder all clothing and washable equipment in

hot water with detergent and dry in a hot dryer. Check skin routinely for signs of infection and

monitor wound management Maintain a clean environment by establishing

cleaning procedures for frequently touched

surfaces and surfaces that come in direct

contact with people’s skin

Precautions for Athletes

Shower with soap and water as soon

as possible after contact sports Do not share towels, razors, clothing, ointment Use a barrier (towel) between skin and equipment

surfaces Wash towels, uniforms, scrimmage shirts, in hot

water and dry in hot dryer Transport laundry home in a plastic bag Inform coach/trainer of skin infections and get

approval for return to participation.

Additional tips for athletic facilities

Weight Room Wipe down equipment after use No cut off tees in weight room Place antibacterial gel or hand wipes in weight

room so that athletes clean hands before

picking up or using equipment Names on towels Clean athletic area and sports equipment at

least weekly using commercial disinfectant or a

FRESH (MIXED DAILY) solution of bleach

1:100 (1 tbsp bleach in one quart of water

In the classroom

Children with open draining infections should be

referred for medical evaluation Enforce hand hygiene with soap and water or

alcohol-based hand sanitizers before eating and

after using the restroom Use standard precautions (hand hygiene +

gloves) when caring for non-intact skin or

potential infections

Cleaning the environment

Clean surfaces first; then disinfect Read label and follow directions Bleach + water 1:100 Lysol/original Pine Sol/EPA registered

disinfectant (list

@:http://epa.gov/oppad001/chemreindex.htm) Quaternary ammonia Leave surfaces wet for 10 minutes

(if possible) or dry with paper towels

Resources

Center for Disease Control http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca.html http://www.cdc.gov/Features/MRSAinSchools

National Athletic Trainers’ Association https://www.nata.org/members1/canworc/powerpoint/

CA-MRSA%20Dublin_files/frame.htm#slide0114.html

More resources

Mich.Dept of Community Health http://www.michigan.gov/domuments/MRSA

educational brochures and posters

Massachusetts State Health Dept. http://www.mass.gov/dph/cdc/antibiotic/mrsa

MRSA materials translated into different languages

CDC posters

Recognize…React…Refer

Common sense, basic hygiene and disinfection practices CAN control the

spread of communicable disease.

So smile and go wash your hands!