MRSA in Schools

Symptoms and Diagnosis: Methicillin-resistant Staphylococcus aureus, better known as MRSA or Staph infection, is a bacterium which lives atop the superficial layers of human skin and is generally harmless on its own. However, it can potentially become a problem if it gets into the deeper layers the skin via an open cut, abrasion, or wound because deep MRSA infections are not easily treated (Wash). If not treated, it can reach into the organs which can in turn become infected, causing serious complications. MRSA is highly contagious and can be spread easily by skin-to-skin contact with an infected person, as well as through contact with an object that an infected person has had contact with. There are two types of MRSA infection, one which affects those living or working in a health care facility, called health care-associated MRSA (HA-MRSA). Health professionals are likely to come into contact with MRSA if they work in hospitals, nursing homes, other dialysis centers, or anywhere they could be exposed to a patient’s open wounds. The other type of MRSA is community-associated MRSA (CA-MRSA), which can be spread among those living in crowded or unsanitary conditions, those participating in contact sports, or men who have sex with men. Even sanitary environments such as daycare centers, dormitories, and classrooms, among others; CA-MRSA cases account for 14% of reported MRSA cases. (CDC) Being in close quarters with others is one of the most common ways Staph infections occur, because even the slightest brush with an infected person can be the beginning of a new case (dermnetz), especially in someone with a weak immune system. MRSA causes a wide range of symptoms in infected persons; symptoms may vary by the stage of the infection. Usually a Staph infection begins resembling small spider bits covering the infected area. They may become inflamed, red, and very uncomfortable. It is not uncommon for these pustules to become painful and secrete drainage like pus. If not treated they will turn into deep abscesses; this happens when the bacteria burrow inside the body, beneath the shallow layers of the skin. These deep infections can adversely affect the bloodstream, lungs, heart valves, bones, and joints, which can be potentially fatal. The lungs are particularly susceptible, meaning Pneumonia is another serious complication of an untreated, long-term MRSA infection. Visible signs and symptoms commonly start on areas of the skin which have been scarred, bruised, or cut, or sometimes areas which are covered by hair. Symptoms will vary depending on the type and stage of an infection, as well as which setting it takes place in (CDC). MRSA is the result of years of overuse of antibiotics, due to lack of treatment knowledge. Its strong resistance can be attributed to the mec gene of the bacterium, a penicillin-binding protein. The gene inhibits the ability of the methicillin to bind to the cell, resulting in a futile effort to cure it. Unfortunately, MRSA has recently been referred to as “multiple resistant s. aureus”, because it is becoming defiant to more and more drugs. (CDC). A Staph infection can be diagnosed by testing a tissue sample from an infected area, and check it for the drug-resistant bacteria. It is placed in a Petri dish and saturated with nutrients which bring about bacteria within 48 hours. There is no at-home cure for MRSA, any attempt could worsen the infection, and potentially spread it to others. In the case of a superficial abscess a physician will drain it instead of treat it with drugs. MRSA is not easily treated with antibiotics due to its increasing resistant nature, but few options are available including a limited number of antibiotics and creams. Prevention is the best medicine, and preventing a Staph infection is very simple. In order to nip it in the bud, those persons who are most likely to be in contact with the bacteria should wash their hands often and thoroughly, keep cuts and abrasions clean and covered until they are healed, and avoid sharing personal hygiene items such as towels, razors, or soap with roommates or coworkers. In the case of someone who is already infected, a patient can prevent spreading their infection by covering the wounds, staying clean, keeping their surroundings clean, and keeping out of contact with others’ personal items.

Prevention and Intervention: When antibiotics were first discovered, one of their primary targets was the bacteria Staphylococcus aureus. Over the years, misuse of these medications has lead to strains of the bacteria that are resistant to medication, often referred to as “superbugs”. These resistant bacteria are called Methicillin Resistant Staphylococcus aureus (MRSA). Approximately one fourth of the population has colonies of these bacteria in their nose; however, less than 2% of these people carry MRSA. In fact, until recent years MRSA was primarily considered a hospital acquired infection and was very rarely seen in the community. Unfortunately, this is no longer the case and these community acquired infections have been increasing exponentially each year. As children ranging in age from infants to 18-years old are the most vulnerable population, this has become an issue of great concern in schools. Fortunately, there are many simple steps that the faculty and students can take in order to prevent contraction and spread of this disease. The Centers for Disease Control sites factors referred to as the 5C’s that make it easier for MRSA to be transmitted: crowding, contact, compromised skin, contaminated items and surfaces, and cleanliness. By targeting these factors within schools, prevention of MRSA is possible. As athletes, especially football players and wrestlers, have a significant amount of skin-to-skin contact and use of public equipment, they are at higher risk. Thus, it is important to implement prevention strategies and ensure that coaches and athletes are aware of them. Such strategies include cleaning exercise equipment and sports equipment, such as wrestling mats, with detergent-based cleaners or disinfectants that the Environmental Protection Agency has recommended. Furthermore, all other frequently touched surfaces within schools should be cleaned with these products routinely. It is important that the directions on the label of the products be followed. Taking such steps will kill the bacteria that may be living on these surfaces, preventing transmission. A seemingly obvious method of prevention is to encourage staff and students to practice good hygiene. Hand washing is a simple, but effective, tool at preventing many infectious diseases. It is important to encourage proper hand washing techniques, such as ensuring that they rub their hands vigorously for at least 20 seconds. Also, be sure to scrub the wrists, between the fingers, and under the fingernails. Antibacterial soap is not necessary as studies have shown that it is no more effective at killing germs than regular soap. Athletes should also shower immediately after sporting events. It is important to note that MRSA is not contracted by simply coming into contact with the bacteria; to cause an infection it must enter the skin. Thus, students must take appropriate precautions when they have cuts or abrasions. It is through these skin breaks that the bacteria can enter, so they must be covered with a clean dry bandage until healed. In particular, athletes should be certain to check for cuts or abrasions often, and to cover them accordingly before participating in sports. Finally, students with active MRSA infections may still attend school as long as their wounds can be sufficiently covered. However, these students should be prevented from participating in contact sports or activities. Treatment of MRSA often includes drainage of the infection and/or prescription of antibiotics. If prescribed an antibiotic it is essential that all of the doses are taken. MRSA is resistant to many antibiotics, including: oxacillin, penicillin, methicillin, and amoxicillin. The two primary antibiotics used in the treatment of these infections are vancomycin and linezolid. Unfortunately, there are even strains emerging that are resistant to those antibiotics. Therefore, much research is being conducted in search of an alternative to present remedies. One such alternative may be anti-pathogenic drugs. These do not kill the bacteria but block the activation of proteins essential for toxin release by the bacteria. Another promising discovery lies in the brains and nervous systems of cockroaches and locusts. Molecules from these tissues were shown to kill 90% of MRSA bacteria in a study at the University of Nottingham. Though these and other discoveries show potential in fighting antibiotic resistant bacteria, they are not yet available to the public. Therefore, it is important that healthcare professionals prescribed antibiotics wisely and that patients use them as directed.

References “Antibiotic Resistance.” doh.wa.gov. 2010. Washington State Department of Health. 2 August 2010. http://www.doh.wa.gov/topics/antibiotics/mrsa.htm “Definition of MRSA”. Centers for Disease Control and Prevention. August 2010. 8 September 2010. http://www.cdc.gov/mrsa/definition/index.html

“Do Cockroaches Hold the Key to MRSA Treatment?”. Food Consumer. August 2010. 8 September 2010. http://www.foodconsumer.org/newsite/2/other_diseases/do_cockroaches_hold_the_key_to_mrsa_tretretre_090820101153.html

“MRSA Infections.” cdc.gov. 2010. Centers for Disease Control and Prevention. 9 August 2010. http://www.cdc.gov/mrsa/index.html “MRSA in Schools”. U.S. Department of Education. October 2007. 8 September 2010. http://www2.ed.gov/admins/lead/safety/emergencyplan/mrsa.doc “MRSA Overview for Schools: Methinillin-Resistant Staphylococcus aureus”. Department of Health and Senior Services. 10 September 2010. http://www.dhss.mo.gov/MRSA/MRSASchools.pdf “Methicillin resistant Staphylococcus aureus.” Dermnetnz.org. 2010. DermNet New Zealand. 18 September 2010. http://dermnetnz.org/bacterial/methicillin-resistance.html “Researcher Discovers New “Anti-Pathogenic” Drugs to Treat MRSA”. PhysOrg. September 2010. 16 September 2010. http://www.physorg.com/print/203871637.html Rowson, Kevin.”Staph Infections Growing Exponentially in Children”. September 2010. 16 September 2010. http://www.11alive.com/cleanprint/?1284680888450 “Treatment of MRSA Infections”. Centers for Disease Control and Prevention. August 2010. 8 September 2010. http://www.cdc.gov/mrsa/treatment/index.html