Child Care and MRSA Infections

Virginia Department of Health, Office of Epidemiology
October 25, 2007

Child Care and MRSA Infections

MRSA stands for methicillin-resistant Staphylococcus aureus, a form of staph infection that does not respond to routine treatment with some commonly used antibiotics, although other antibiotics are effective. Should an outbreak of MRSA infection or related situation of concern be identified in a child care setting, staff or the director should contact the local health district director for further guidance, especially if considering closing the child care program.

Background
Staphylococcus aureus ("staph") infections have been around for a long time, causing mild to severe illness. MRSA is a kind of staph infection that may be more difficult to treat but is otherwise the same as a "staph infection". Mild infections may look like a pimple or boil and can be red, swollen, painful, or have pus or other drainage. More serious infections may cause pneumonia, bloodstream infections, or surgical wound infections.

Staph is passed from person to person through direct contact with skin or through contact with contaminated items. The bacteria may live in people's noses and on their skin and most of the time do not cause any problem. Staph can enter the body through breaks in the skin and sometimes cause infection. The main ways to prevent staph infection are to wash hands and care for wounds properly.

Practical Advice for Teachers and Directors

• Observe children for open wounds. If any wounds are draining or contain pus, recommend the child be seen by a doctor. If the wound drainage cannot be contained by a bandage, then consider excluding the child from the center.
• Use gloves when providing wound care. This includes wearing gloves when cleaning wounds, changing bandages, or during other situations where a staff member may come in contact with a child's body fluids or blood.
• Encourage hand washing before and after eating, and after toileting.
• Do not share personal items, bed linens, and towels.
• Staff should immediately report any signs of infection or illness that may affect the health or safety of children or adults to the director of the child care program and the parents or guardian of the ill child(ren).

Practical Advice for Parents

• Clean wounds and cover them with a clean, dry bandage. Wounds that do not heal properly need medical attention. The only way to determine if an infection is caused by MRSA is through laboratory testing ordered by a physician or other health care provider.
• Teach children to wash their hands regularly, such as before eating and after toileting.
• Be sure family members use antibiotics properly. Take all that are prescribed, even if the symptoms stop before the prescription is used up. Do not share prescriptions.
• Children should wash their hands before and after eating, after toileting, and after playing. They should not share equipment, clothing, towels, or other personal items.
• Wash clothes and towels with hot water and detergent after each use.

Cleaning and Disinfection

• All toys and equipment should be cleaned and disinfected between uses.
• Contaminated surfaces should be cleaned and then disinfected using an EPA-registered cleaner or a bleach solution (1/4 cup bleach to 1 gallon of water or 1 tablespoon bleach per quart of water).*
• Routine cleaning is all that is recommended. Because the bacteria live on the skin, they may be reintroduced into any environment at any time. Therefore, hand washing and wound care remain the primary means of preventing staph infections.

Public Health Reporting
Suspected outbreaks of staph infections should be reported to the local health department (see http://www.vdh.virginia.gov/lhd/). Health department staff may be able to provide additional guidance in identifying causes of transmission, and recommendations for reducing the risk to children and staff.

Resources
Further information about MRSA can be found on the website links listed below:

• Virginia Department of Health
• MSRA fact sheet
• Hand washing poster

* Note: A bleach solution of 1 part bleach in 9 parts water (e.g., 1 3/4 cups bleach to 1 gallon of water) will kill Staphylococcus aureus, as well as other (tougher to kill) disease-causing organisms such as norovirus and Clostridium difficile, and should be used when possible. In situations where this is impractical, a more dilute solution (e.g., 1 part bleach in 64 parts water, such as 1/4 cup bleach in 1 gallon of water) may be used to disinfect surfaces that may be contaminated with S. aureus. However, it should be noted that bleach solutions more dilute than 1 part bleach in 9 parts water may not kill some disease causing organisms. Another option is to use a 1 part bleach in 9 parts water solution, followed by a rinse with water to remove residual bleach. Bleach solutions should be mixed fresh daily to ensure effectiveness. Bleach solutions should NOT be used to sanitize hands or for cleaning wounds.

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