Precautions against MRSA and other multidrug-resistant organisms
There has been a lot of media attention recently about MRSA, a type of antibiotic resistant staph infection. Tragic cases like in West VA where a high school senior diagnosed with MRSA died after being hospitalized for over a week drive public fear and concern. According to the CDC, 19,000 deaths have been attributed to the bacteria since 2005.
MRSA (Methicillin-Resistant Staphylococcus Aureus) is resistant to many antibiotics. In order to address controls over MRSA exposures in a child care environment, there are certain characteristics of the organism that need to be understood. First of all, Staphylococcus Aureus is a common bacteria that can be found on everyone’s skin and on surfaces throughout the environment. Intact skin prevents serious infection however breaks in the skin pose a risk of invasive infection. A MRSA infection is no more aggressive than other staph infections it is simply more difficult to treat therefore prevention is more important than ever to avoid complications.
Asymptomatic colonization of MRSA in a person’s nasal passages or on their skin is common and should not cause alarm. Practicing universal precautions to avoid ANY infection is effective against preventing a MRSA infection. In a child care environment precautions to avoid infections are similar to those you should practice at home and include:
- Hand washing with soap
- Covering cuts, scrapes, and other skin wounds
- Sanitizing surfaces and items that may be soiled with body fluids or secretions
- Changing linens including bedding
- Do not share towels
Seek the advice of a physician if there are children or staff known to be infected. At a child care center where contact with children of different ages and varying home environments takes place it is important to practice the universal precautions consistently. Children are constantly on the run and often have small cuts and scrapes. The cleanliness of a child’s home environment may contribute to whether or not they have colonization of MRSA bacteria. Unless you are specifically told you may not ever know if a child in your care is a “carrier” of MRSA. Although the risk of contracting MRSA at a child care environment is not extremely high the potential severity if an outbreak does occur makes it worthwhile to implement procedures to control exposures.
Common causes of the spread of MRSA in non-healthcare environments include skin to skin contact, and contact with nasal secretions that are colonizing the bacteria. Just like non-resident infections touching the eye or nose or an open skin abrasion when MRSA is present on the hand can spread the bacteria. If bacteria are spread future problems or outbreaks may take place even if an immediate infection does not result. Communities, including child care centers, should practice general precautions to help slow the spread of resistant bacteria. This is why thorough and frequent hand washing remains one of the most important preventive measures according to the Centers for Disease Control.
There are publications from state health agencies that provide proper tips on hand washing and hygiene. It is a good policy to periodically review these with employees. Generally speaking thorough hand washing includes warm running water, applying soap over the entire hand and between fingers and rubbing vigorously for 15 to 20 seconds, drying with a clean paper towel, and turn off the faucet with a towel. If children cannot be taught or expected to properly wash their hands it makes it even more important for teachers and assistants to maintain good hand washing habits.
If warm water and soap are not available it is a good practice to use a hand sanitizer with at least 60% alcohol. Keep in mind though that hand sanitizers work best on clean hands as they are not designed to substitute for soap and water. As soon as practical after using a sanitizer it is a good idea to thoroughly wash your hands. Also, sanitizers designed for hands are NOT effective in cleaning surfaces.
Depending on your center other things to consider are food preparation, laundry, and thorough facility and contents cleaning habits as well as providing education for and opening dialog with parents of children in your care. (There are many resources to assist with education and training at your local health departments.) Cleaning with store bought disinfectants or using bleach and water solution is generally effective in killing bacteria on surfaces and toys. The bleach solution should be one tablespoon bleach to one quart of water and should be mixed each time prior to cleaning to assure evaporation of the bleach does not cause the solution to be ineffective.
There is much more information available on this topic via local health departments, physicians, and publications on the internet. Various sources were utilized in creating this brief article. Most sources used provided similar or identical information.
New York Times: nytimes.com
Centers for Disease Control: cdc.gov
Washington State Department of Health: tpchd.org
Navy and Marine Corps Public Health Center: med.navy.mil