Last fall, a fever gripped the nation _ an overheating of news stories about the so-called super bug: methicillin-resistant Staphylococcus aureus, "staph," or simply "MRSA." The media fever may have subsided, but MRSA has not gone away. From Connecticut to California, school district managers are grappling with a potentially deadly infection. The good news is that your schools can fight the super bug without taking extraordinary measures.
The panic over MRSA started when an October 2007 article in the Journal of the American Medical Association documented that more than 94,000 cases were recorded in 2005, including nearly 19,000 deaths. Previously thought of as a health-care facility issue, the infections were found to be increasingly common in other locations, the article noted, such as schools. When several students around the country died from MRSA infections, the heat was on.
"We had Fox News, ABC, CNN, World News Tonight all camped out at the school," says Ryan Edwards, the policy and public relations coordinator at Bedford County (Va.) Schools, where a high school student died after being hospitalized for a week with MRSA. "The community was scared to death about the issue."
MRSA is a type of staph bacteria. More than a quarter of the population carries these bacteria on their skin or in their nose at any given time, without a health risk beyond the occasional minor skin infection. The bacteria are not airborne contaminants, but when they enter a person's body through cuts, abrasions or other breaks in the skin, they can cause infections, which can appear as red or swollen pustules or boils.
If staph bacteria go deeper in the body, they can weaken the immune system and lead to severe skin and bloodstream infections and pneumonia. And if untreated, these conditions can cause death.
Infections with the MRSA staph bacteria are more worrisome because they are resistant to antibiotics that are commonly used to treat infections, including oxacillin, penicillin and amoxicillin. If a doctor relies on these drugs to halt the infection, it won't work. Last December, a special education teacher in the Montgomery County (Md.) Schools died following a MRSA infection, and in January, a boy from the San Dieguito Union High School District in California died from it.
"But that doesn't mean it can't be treated," notes Nicole Coffin, a spokesperson for the federal Centers for Disease Control and Prevention (CDC). "Sometimes antibiotics aren't necessary, and there are other kinds of antibiotics that are effective."
When a medical professional tests the bacteria and ensures the correct medication is administered, MRSA can be overcome. "The bottom line is that most MRSA infections are not life threatening, but they can cause death, so we want people to take this seriously," Coffin says.
Addressing the Issues
The CDC recommends that school district leaders contact local health departments to create a plan for limiting the spread of the bacteria and to report known incidents of a MRSA infection. "We work very closely with the county health department," says Kristine Liptrot, a spokeswoman for the Oswego Community (Ill.) Unit School District 308, just west of Chicago.
The Illinois district, which covers 15,000 students in 19 schools, used information gathered from the CDC and the Kendall County health department to send a letter to parents with children at one of the high schools notifying them that a student had contracted MRSA earlier this year. In that instance, the student had a relatively mild infection and was back at school within several days.
"We had heard that if the school didn't have more than two cases, they were not required to notify parents, but MRSA has such an impact that we decided to be proactive," Liptrot says. "The worst thing is misinformation, so we want to be sure parents are hearing the correct information." Many schools have put information about MRSA on their Web sites or in newsletters, even without a confirmed case at a school, in large part because of the concerns of parents who have heard about the infections through the media.
Solid information about MRSA is important particularly because much of what can be done to limit the spread of infections is tied to daily hygiene on the part of students and staff . The bacteria are generally spread from one person to another through casual interpersonal contact or touching an item that has been in contact with someone's infection. The CDC has a list of five C's that cause MRSA to be transmitted: Crowding, frequent skinto-skin Contact, Compromised skin (i.e., cuts or abrasions), Contaminated items and surfaces, and lack of Cleanliness.
Students should be encouraged to wash with soap and water frequently, cover any skin trauma with a clean, dry bandage as soon as possible, and not share personal items such as towels or razors. Many schools have placed hand sanitizers in lunchrooms and classrooms to help keep the bacteria at bay. Any student that has a MRSA infection can attend school unless a physician recommends against it, although they should cover their wounds, according to the CDC.
Some schools have closed in order to clean all surfaces in all buildings once district leaders have discovered a case of MRSA, but experts don't recommend such a drastic measure. Bedford County Schools kept its 11,000 students out of school for one day while it sanitized all 22 schools last fall after the student's death. Most school cleaning supplies are up to the task of killing MRSA bacteria if the cleaning process is thorough.
But Edwards says the choice to dismiss students for a cleanup was in part due to the fact that the staff and public were much less savvy then about the nature of the infections. Now they recognize that a schoolwide cleaning is a temporary solution at best, since an estimated 1 percent of the population is carrying the MRSA bacteria. "You can clean the whole building, every nook and cranny and get rid of every existing bacteria, but it won't stop the bacteria from coming back with the students the next day," he explains.
Aurora (Ill.) School District 129 has instituted a "super cleaning procedure" in instances when a student has been diagnosed with MRSA, where the staff retraces the student's schedule through the day and gives an extra cleaning to the places he or she has been. Besides that, however, the district has stuck with its standard cleaning policies, relying on reminders of the importance of following the procedures to clean everything from desks to doorknobs.
"We believe it's a question of doing a good job of what the schools should be doing all the time anyway," says Superintendent Jim Rydland of the Aurora School District 129. "For example, MRSA has just reinforced with us that we need to keep reminding everyone that washing your hands is an easy and effective thing to do. I know I wash my hands a lot more."
Because of how MRSA is spread, athletic activities are part of the school day that districts should pay close attention to, particularly sports that are more likely to open a wound or put students in contact with commonly used equipment. In Bedford County, Edwards says that about three out of four cases of MRSA over the last year or so have been in the high schools, and he credits much of that to increased time in gym and after-school contact sports such as football and wrestling.
"Make sure you clean gym equipment after every class," suggests Dr. B.J. Anderson, a member of the National Federation of State High School Associations' medical advisory committee. "You should wash all the gym clothes and have clean towels every time." Anderson concedes that it can be a difficult decision to determine how often all the surfaces and floors in a locker room are cleaned, but he suggests that the coaches and janitors map out a regular routine and stick with it.
Defense against Other Ills
If there's any silver lining over the concerns about MRSA, it is that the measures that help limit the infection's spread-hand washing, good cleaning routines, and not sharing personal grooming items-are also the first line of defense against contracting common colds, the flu and other illnesses that take staff and students out of school for days or weeks.
Aurora's Rydland notes that the time spent working with the local health department and school staff on the issue can also create stronger bonds for other health issues that may arise.
"MRSA is a great example of how emergency preparedness thinking really needs connections to other agencies in the community and that people in the building all need to know what to do," Rydland says. "People in the community are dependent on us to have the right facts and information."
Carl Vogel is a freelance writer based in Chicago.