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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.
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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, fencing • Correctional facilities • Military barracks • Daycares and schools • Dormitories
MRSA Outbreaks among Sports Teams, U.S., 1994-2004 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 (CDC unpublished) 3 Begier EM, et al.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 Defense Offense Cleanliness Compromised Skin CA-MRSA Common Factors Crowding Contaminated Surfaces and Shared Items Compromised Skin
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
Recognize…React…Refer Common sense, basic hygiene and disinfection practices CAN control the spread of communicable disease. So smile and go wash your hands!