One of the most common causes of skin infections is Staphylococcus aureus, a bacterium generally known as “staph.” It is the same bacterium that causes impetigo, boils, pimples, and blisters.

Most commonly, staph is transmitted indirectly through contact with towels, bandages, or surfaces used by an infected person. Staph infections also can begin when the bacteria enter the skin through an open cut or sore after direct contact with the skin of an infected person.

Staph is more prevalent than you might expect. About one in every three persons carries staph on the skin or in the nose without any signs of an infection. This means the person is “colonized” with staph. Healthy people can be colonized and have no ill effects, but can pass the infection to others.

What is MRSA?

Methicillin-resistant staphylococcus aureus (MRSA) is a specific type of staph infection that is resistant to certain antibiotics which were designed to kill penicillin-resistant staph. MRSA is sometimes pronounced as a single word, “mersa,” or by saying all four letters, “M-R-S-A.”

MRSA infections were first identified in hospitals and nursing homes about three decades ago and continue to be a serious, widespread problem. In the 1980’s, MRSA became more common in healthy people who have never been in the hospital. These strains of staph are referred to as “community-acquired MRSA” or “CA-MRSA.”

CA-MRSA outbreaks are commonly reported among healthy young people who participate in competitive contact sports, such as fencing, football, and wrestling. These outbreaks may occur because these types of athletes have more physical contact, skin damage, and sharing of equipment or clothing.

CA-MRSA infections are spread the same way as other staph infections and, like other staph infections, are usually mild and look like a pimple, rash, boil, infected hair follicle, or an open wound. They are commonly mistaken for spider bites. These infections also can be spread through nose secretions of persons colonized with CA-MRSA. Fortunately, CA-MRSA skin infections usually are mild and heal by themselves if kept clean and dry. But when treatment is required, it is important to recognize the infection properly because CA-MRSA is resistant to certain antibiotics.

Because CA-MRSA is similar to other staph infections, it may be misdiagnosed, resulting in incorrect treatment. Doctors may assume that a CA-MRSA infection is a common staph infection and treat with antibiotics that do not kill MRSA. Specific lab tests are required for accurate diagnosis.

This potential delay in recognizing and treating more serious CA-MRSA infections can result in rare but life-threatening infections of the blood, heart, and bones. Some CA-MRSA, just like some staph, may produce substances that cause more severe infections.

CA-MRSA and Childcare

CA-MRSA infections among healthy young children are becoming more and more common. Children who have been hospitalized recently, or those with contact with adults who are colonized with CA-MRSA or who have an active CA-MRSA infection, are at highest risk.

Children in childcare also are at risk for CA-MRSA because of the close contact with groups of children and their caregivers. CA-MRSA can be spread via direct contact with open wounds, contaminated surfaces, or by sharing clothing, sheets, towels, and toys with a person who has CA-MRSA infection.

It is important for childcare providers to take proper steps if a child is diagnosed with CA-MRSA infection. CA-MRSA is a “reportable disease” in several states, meaning that the diagnosing physician is required to report the infection to your state health department.

Some state and county health departments now require childcare staff or children with CA-MRSA infections to remain at home until the skin lesion is healed. Check with your local health department for specific guidelines.

Childcare programs should address CA-MRSA in policies related to exclusion of children and staff due to illness. Families of enrolled children need to know if their children have been exposed to CA-MRSA, and if so, what steps they should take to monitor their children and protect their health.

Remember that anyone can get CA-MRSA. Adults and children with open wounds, particularly ones that do not heal with antibiotic treatment, should consult with a doctor or other health care provider.

It is good practice to treat all open or oozing wounds, boils, insect or spider bites, and pimples as MRSA until diagnosed otherwise, and to follow standard precautions and disease prevention guidelines.

Infection Control

If an adult or child has an open skin wound, pimple, or boil, the skin area should be cleaned with mild soap and water and completely covered with a clean, dry bandage each day before coming to childcare.

Caregivers should wear disposable gloves when changing a bandage or touching an infected area. Always wash hands before putting on gloves and after removing them. Place soiled bandages and gloves in closed, properly labeled trash receptacles.

Discourage children from scratching the area, picking off scabs, or popping blisters. Children should wash their hands immediately if they have contact with open wounds, pimples, or blisters. Follow sanitation guidelines when changing diapers or assisting with toileting.

Handwashing is the most important step in preventing infectious diseases. Correct handwashing technique includes applying liquid soap to palm of one hand and rubbing hands together working soap into wrists, hands, fingers for at least 15 seconds. Rinse hands with running water and dry thoroughly using a disposable towel. Turn off the faucet with a paper towel.

Liquid hand sanitizers do not take the place of proper handwashing. However, if alcohol-based sanitizers are necessary (such as on a field trip), generously apply the product to the palm of one hand and rub hands together until wet. Allow hands to dry without using a towel. Keep hand sanitizer out of children’s reach.

Soiled wash cloths, towels, and linens should be washed in hot water and dried in a hot dryer, versus air drying. Avoid having children or adults share personal items such as towels, clothing, etc.

Wash toys and other objects that are shared with detergent, and disinfect with a diluted bleach solution made by mixing one tablespoon bleach with four cups (32 oz.) water. A new batch of bleach solution must be mixed daily.

Internet Resources

Allegheny County Health Department, www.achd.net/mrsa/MRSADayCare.html

California Child Care Health Program, www.ucsfchildcarehealth.org/html/pandr/hsnotesmain.htm

Minnesota Department of Public Health, www.health.state.mn.us/divs/idepc/diseases/mrsa/index.html

Virginia Department of Health, www.vdh.virginia.gov/epidemiology/Surveillance/MRSA/Child_Care_and
_MRSA_Infections.htm

Resources

Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333;
800-CDC-INFO; www.cdc.gov/ncidod/dhqp/ar_mrsa_ca.html and
www.cdc.gov/Features/MRSAinSchools