MRSA Infections: Information for Jails and Prisons

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

MRSA Infections: Information for Jails and Prisons

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. It is important for the management and staff of jails and prisons to have an understanding of Staphylococcus aureus ("staph"), including MRSA, since transmission and infection may occur among inmates or correctional officers. Should an outbreak of MRSA infection or related situation of concern be identified at a jail or prison, personnel or officials from the facility should contact the local health district director for further guidance.

Background
Staph infections have been around for a long time, causing mild to severe illness. MRSA 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.

Colonization
Approximately 25-30% of the population is colonized with staph, and about 1-2% of the population is colonized with MRSA. Colonization means the organism is carried on the body, either in the nose or on the skin, but is not causing any symptoms or infection. As a result, an inmate or correctional officer could be a carrier, but not be aware of it. These individuals may spread the organism to others who could go on to develop infections.

Conditions for the Spread of Bacteria
Staph, including MRSA, are spread by direct skin-to-skin contact. In correctional facilities, physical contact among and between inmates and correctional officers is routine. Inmates sharing towels, linens, or other personal items potentially contaminated by wound drainage; inmates lancing their own boils or other inmates' boils with fingernails or tweezers; physical searches; and unsanitary tattoo practices are specific ways that staph could get transmitted in a prison environment. Poor inmate hygiene, including limited access to showering and soap, and crowding, may make the spread of staph and infection more likely.

Basic Steps for Prevention

• Practice good hand hygiene and encourage inmates to keep hands washed.
• Provide inmates access to showers and soap to maintain personal hygiene.
• Discourage sharing of personal items.
• Be observant and encourage inmates who develop symptoms of staph infections to report to the healthcare staff.
• Clean woulds and cover them with a clean, dry bandage.
• Use contact precautions for wound care. This includes the use of personal protective equipment (e.g., gloves +/- gown) whenever contact may occur with an inmate's blood or body fluids.
• Wear gloves when handling dirty laundry.
• Clean and disinfect contaminated surfaces.
• Clean sinks, showers, and toilets on a regular basis.
• Disinfect contaminated portable equipment, such as stethoscopes, blood-pressure cuffs, equipment handles, tourniquets, handcuffs, shackles, pagers, and cell phones.
• Disinfect shared athletic equipment on a regular basis.
• 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).*
• House individuals with draining wounds separate from other inmates, to the extent possible.
• Follow the facility's infection control policy.

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 inmates and staff.

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

• Management of Methicillin-Resistant Staphylococcus aureus (MRSA) Infections (Federal Bureau of Prisons)
• Video on MRSA Awareness (Federal Bureau of Prisons)
• MRSA fact sheet (Virginia Department of Health)

* 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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