Outbreaks of MRSA (methicillin-resistant Staphylococcus aureus)-related student deaths and infections followed by school closures have been the subject of recent media attention nationwide. Schools have reported MRSA infections among wrestling, volleyball, and most frequently, football teams. Colleges have also reported MRSA infection cases in residence halls.

Given the seriousness of these recent cases, it is critical that school administrators and health officials, day care and camp facility directors, athletic trainers, teachers, students, and even business owners whose employees or facilities might be at risk understand how MRSA infections can spread, how to reduce the spread, and what to do if an MRSA outbreak occurs at a school or other non-health care facility.

What Are MRSA Infections?
Medical research demonstrates that the bacteria known as Staphylococcus aureus (“staph”) is commonly carried on the skin or in the nose of healthy people. Approximately 25-30 percent of the population carries the bacteria, though it is not routinely transmitted or infectious. Sometimes, however, staph can cause serious skin, bloodstream, lungs, and surgical site infections and may be resistant to treatment with antibiotics. These more deadly antibiotic-resistant strains are known as MRSA or the superbug.

MRSA caused more than 94,000 life-threatening infections and nearly 19,000 deaths in the United States in 2005, most of them associated with health care settings, according to a Centers for Disease Control and Prevention (CDC) study published in the October 17, 2007 edition of The Journal of the American Medical Association (JAMA).

Outside of hospitals and health care facilities, at schools, colleges, prisons, and other facilities where there is close contact, a number of factors may contribute to the spread of antibiotic-resistant staph infections (also known as community-associated MRSA or CA-MRSA). These include: close skin-to-skin contact, openings in the skin such as cuts or abrasions, contaminated items and surfaces, crowded conditions, sharing of hygiene-related products such as deodorants, soap, or towels, and poor hygiene. This form of MRSA often manifests itself as a skin infection such as a pimple or a boil in otherwise healthy people, and in some cases can prove life-threatening.

How Should MRSA-Infected Facilities Be Treated?
MRSA can survive on surfaces and fabrics, including privacy curtains, uniforms, desks, sports equipment, etc. As such, following outbreaks in Virginia, North Carolina, Massachusetts and other states, building closures were followed by a complete disinfecting and sanitizing of facilities, including laundering of clothes.

While it is unnecessary to disinfect all surfaces, organizations should follow CDC guidelines for disinfection of high-risk sources of MRSA such as bathrooms, locker rooms, gym equipment, or any other shared or frequently used equipment that could spread infection. In addition, it is important to appropriately launder clothes, uniforms, and towels used in these areas to prevent the spread of MRSA.

The most important factor in reducing the spread of MRSA is proper hand hygiene (hand washing and the use of alcohol-based hand rubs). Wiping down or spray disinfecting equipment on a regular basis have also proven effective in reducing incidents of MRSA. In addition, staff, employees, students, or other personnel with open wounds should be required to keep them covered with an appropriate barrier, and those with open wounds should not be allowed to participate in activities in which there will be an increased risk of direct skin-to-skin contact such as athletic events like football and wrestling.

How Can Facilities Concerned About MRSA Reduce This Risk?
It is recommended that educational institutions, businesses, and other non-health care-related facilities concerned about MRSA undertake a systematic risk reduction and response program which could include the following components:

• MRSA Risk Identification Program
• MRSA Risk Control Prevention Program
• MRSA Staff and Administrator Education Programs
• MRSA Awareness—Student Education Programs
• Community MRSA Awareness—PTO and School Boards
• Post-MRSA Outbreak Response Program

Developing and implementing such an MRSA risk reduction and response program often necessitates support from health care and risk management experts, such as those found at Marsh. We work with schools, universities, community, businesses, and other organizations to create customized programs that meet specific needs and can help to maintain a healthy work and living environment.

For more information on Marsh’s MRSA Awareness and Prevention Programs, please contact your local Marsh representative or one of our Health Care Practice consultants:

Carol Burkhart, RN, MS, CNP
(303) 308-4512 (Denver)
carol.a.burkhart@marsh.com

Cathy Munoz, RN, MJ, CPHRM
(214) 303-8608 (Dallas)
cathy.a.munoz@marsh.com

Denise Fitzpatrick, RN, MBA, CPHRM
(312) 627-6621 (Chicago)
denise.m.fitzpatrick@marsh.com

Sharon Bradley, RN, MBA, CPHQ
(407) 804-5928 (Orlando)
sharon.bradley@marsh.com

You can also call (866) 9ATRISK (928-7475) or send an e-mail to at.risk@marsh.com.

The facts about MRSA cited here come from several sources, but primarily from the Centers for Disease Control and Prevention (CDC).

Additional details about staph and MRSA infections can be found on the Web sites of the following organizations:

• Occupational Safety & Health Administration (OSHA)
• American Medical Association (AMA)
• American Hospital Association (AHA)
• State-level Departments of Health
• Association for Professionals in Infection Control and Epidemiology (APIC)
• MRSA Watch