Prevention of Methicillin-Resistant Staphylococcus aureus (MRSA) Infections in the Camp Setting

Topics

  1. Background
  2. Symptoms of MRSA
  3. Transmission Routes of MRSA
  4. Treatment of MRSA
  5. Prevention of MRSA in the Camp Setting
  6. MRSA Prevention and Camp Athletics
  7. Environmental Cleaning and Disinfection in the Camp and Athletic Settings
  8. Additional Information

1. Background

  • Methicillin-resistant Staphylococcus aureus (MRSA) infections can occur in community settings such as schools and camps, causing anxiety for campers, camp staff, and parents. This document is intended to provide information about MRSA infections in the camp setting and how to prevent and control them.
  • Staphylococcus aureus, commonly referred to as "staph," are bacteria commonly carried on the skin or in the nose of healthy people.
    • Approximately 30% to 50% of the population carry staph bacteria on their skin and in their noses without causing infection and illness (also known as colonization).
    • Infections can start when staph bacteria get into a cut, scrape, or other break in the skin. Staph bacteria are one of the most common causes of skin infections in the U.S.
    • Most of these skin infections are minor (such as pimples and boils) and can be easily treated without antibiotics.
    • Staph bacteria can also cause more serious infections, such as blood stream infections and pneumonia, which require more aggressive treatment.
    • Some staph bacteria are resistant to antibiotics. MRSA is a type of staph that is resistant to a certain class of antibiotics. Fortunately, there are other antibiotics that can be used to treat MRSA infection when necessary.

2. Symptoms of MRSA

  • MRSA infections can cause a broad range of symptoms depending on the part of the body that is infected. Broken skin, such as scrapes or cuts or even surgical wounds, is often the site of a MRSA infection resulting in redness, swelling, and tenderness at the site of infection, sometimes accompanied by a fever.
  • Sometimes MRSA can cause pneumonia, bone, joint, heart, or bloodstream infections, including sepsis, but these more serious infections are rare in healthy people.
  • Many people carry MRSA on their skin or in their nose without ever having any symptoms.

3. Transmission Routes of MRSA

  • MRSA is spread most frequently by direct skin-to-skin contact with someone infected with MRSA, even if that person does not have any symptoms of infection.
  • MRSA can also be transmitted by:
    • Contact with drainage from infected scrapes, cuts, or other skin wounds.
    • Contact with personal items contaminated with drainage from infected scrapes, cuts, or other skin wounds. These items can include contaminated bandages, towels, washcloths, soap, razors, topical preparations (ointments, balms, lotions, deodorants, creams), athletic or gym equipment, and uniforms or other clothing.
  • Risk of transmission is low from environmental surfaces that are not contaminated by skin wounds or frequent direct skin contact.
    • Practical measures, such as cleaning surfaces when they become soiled, will reduce the levels of all bacteria on environmental surfaces. See section 7 for detailed guidance regarding environmental cleaning and disinfection.
    • Microfiber mops can reduce environmental bacteria better than conventional loop mops and can also substantially reduce the use of chemicals for routine cleaning.

4. Treatment of MRSA

Although MRSA is resistant to some commonly used antibiotics, MRSA infections can usually be treated effectively using other types of antibiotics and draining any pus at the infected site.

5. Prevention of MRSA in the Camp Setting

  • Hand hygiene is the single most important factor to prevent the spread of MRSA.
  • The risk of transmitting MRSA in most social settings is low.
    • The risk among those sharing a cabin, athletic equipment, or clothing, as is common at camps, is likely higher.
  • Children's camps should provide ready access to sinks, soaps, and clean paper towels throughout campgrounds, including cabins, dining areas, and other areas of common gathering.
    • In situations where access to sinks is limited (e.g., during hikes, outings, athletic events), camp staff should carry a container of alcohol-based hand sanitizer. Alcohol-based hand sanitizer should be used in accordance with the manufacturer's recommendations. Camp staff should check for known allergies to products prior to use on any camper or staff.
  • Staph and MRSA infections in camps can be prevented if staff and campers follow basic hygiene measures.
    • Keep hands clean by washing thoroughly with liquid soap (preferably not bar soap) and water, or with an alcohol-based hand sanitizer (if hands are not visibly soiled and soap and water is not available). Follow recommendations above regarding use of alcohol-based hand sanitizers.
    • Practice good skin care. Since staph infections start when staph enters the body through a break in the skin, keeping skin healthy and intact is an important preventive measure.
    • Wash any cut or break in the skin with soap and water and apply a clean bandage until healed.
    • Avoid contact with other people's wounds or bandages. If it is necessary for a staff member to assist with a camper's bandage, that staff member should do so under the direction/advisement of the camp medical staff. They should wear gloves, place the used bandage in the trash, and wash their hands and forearms immediately after removing gloves. (Use standard barrier precautions when exposed to body fluids.)
    • Avoid sharing personal items such as cloth towels.
  • Campers or staff with symptoms of staph or MRSA infection should immediately notify camp medical staff and do the following:
    • Keep wounds clean and covered with a bandage until healed. Change bandages as recommended by the health care provider or when soiled. Discard used bandages or tape promptly in the regular trash.
    • Wash hands and forearms before and after caring for wounds and throughout the day. Wash for at least 20 seconds using liquid soap (preferably not bar soap) and warm water, and dry hands with a clean paper towel.
    • Do not share personal items such as towels, washcloths, soap, razors, topical preparations, uniforms, or clothing that may have had contact with an infected wound or bandage.
    • Take antibiotics as prescribed and for the full length of time prescribed.
    • Campers with skin lesions should be referred to the infirmary for evaluation.
    • Report new skin sores or boils to camp staff and/or medical personnel immediately.
  • Camp attendance for campers and staff with staph or MRSA skin infections:
    • Campers and staff with active staph or MRSA infections should be excluded from food preparation until symptoms have resolved and the local health department (LHD) determines that the risk of transmitting MRSA has been eliminated.
    • Campers with any open or draining wounds, including MRSA infections, should be excluded from all swimming and water activities.
    • Campers with active skin infections (e.g., draining wounds, boils, abscesses) should not participate in activities where skin-to-skin contact is likely to occur until their infections are completely healed.
    • Report new skin sores or boils to camp staff and/or medical personnel immediately.
    • Campers whose wounds can be covered and contained with a clean, dry bandage and can maintain good personal hygiene do not need to be excluded from camp or camp activities.
  • Notification
    • All members of the camp community should be aware of the risks of MRSA and should notify camp medical staff of any evidence of MRSA infection.
    • Camps should take care to maintain campers' and staff members' right to privacy and confidentiality with this or any health issue.
    • Typically, it is not necessary to inform the entire camp community about a single MRSA infection.
    • Notification of the camp community and parents should be based on consultation with the New York State Department of Health and the LHD, according to the established camp policy.
  • Considerations for campers with immune suppression
    • Campers with weakened immune systems may be at risk for more severe illness if they get infected with MRSA.
    • These campers should follow the same prevention measures as all others to prevent staph infections and should contact their personal health care provider with any specific concerns. Camps should take care to maintain the campers' right to privacy and confidentiality with this or any health issue.
  • Reporting requirements for MRSA infection
    • As per 10 NYCCR 7-2.8(d), all camper and staff illnesses suspected of being spread by contact shall be reported within 24 hours to the LHD.
    • If transmission within a camp is identified, or an outbreak or an increase in MRSA infections occurs within a camp population, the camp should contact the LHD.
  • Environmental cleaning, surfaces, and disinfection
    • See section 7 for detailed guidance regarding environmental cleaning and disinfection.
  • Disease surveillance
    • It is important for camp staff to be vigilant for skin infections among campers.
    • To prevent a single case from becoming an outbreak, campers and camp staff should report any suspected infection immediately to camp medical staff.
    • Campers and staff should be encouraged to report any skin changes such as redness, warmth, swelling, tenderness, or drainage, especially when associated with cuts, boils, or sites of skin irritation and abrasions.
    • Staff who observe open or exposed skin lesions on campers should direct the camper to the camp infirmary to have the lesion evaluated.
  • Camp infirmary considerations
    • Camp management should ensure infirmary staff are familiar with the signs and symptoms of MRSA infection, basic management of MRSA infections, and current recommendations for prevention and control of MRSA.
    • Camp infirmaries should have ample supplies of occlusive bandages, tape, and antimicrobial ointment.
    • Camp management should identify a facility where people can be referred for evaluation and treatment before camp begins. Camp medical staff may also want to identify an infectious disease consultant if the need for consultation arises during camp.

6. MRSA Prevention and Camp Athletics

  • Hygiene and infection control practices
    • Hand hygiene is the single most important factor to prevent the spread of MRSA.
    • Camp staff, coaches, and trainers should practice appropriate hand hygiene (wash with soap and water or use alcohol-based sanitizer if soap and water are not available) after contact with players, especially when changing bandages and providing wound care.
    • Gloves should be worn when applying or assisting a camper or staff member to apply or change dressings. Hands must be washed immediately after removing gloves.
    • In situations where access to sinks is limited, carry individual containers of alcohol-based sanitizer. For recommendations on use of alcohol-based hand sanitizers, please refer to 5.
    • Provide enough clean towels so players do not need to share them.
    • Educate players on appropriate management of all wounds.
    • Wounds (e.g., cuts, scrapes, abrasions) should be completely and securely covered at all times, particularly during competition (e.g., bandaged and use of protective sleeve).
    • Specific guidance for players to prevent MRSA:
      • Do not share towels (even on the sidelines during games), washcloths, soap, razors, topical preparations, or other personal hygiene items with other players.
      • Shower with soap as soon as possible after EVERY practice or game. Do not share bar soap.
      • Avoid contact with draining lesions and contaminated items (e.g., bandages) from other people.
      • Perform hand hygiene after using multi-use equipment (e.g., weight equipment) and after contact with potentially contaminated items (e.g., another person's wounds, infected skin, or soiled bandages).

7. Environmental Cleaning and Disinfection in the Camp and Athletic Settings

  • Control measures as part of routine building and vehicle cleaning:
    • Follow routine, common-sense procedures for cleaning the camp.
    • Follow regular cleaning and maintenance procedures for equipment and materials that may be shared such as protective eyewear or clothing.
    • Consider using disinfectants (see description, below) on shared environmental surfaces and equipment as part of regular facility maintenance.
      • Most disinfectant products require proper cleaning of surfaces prior to applying disinfectant. Proper cleaning reduces levels of bacteria on environmental surfaces.
    • When laundering soiled linens, wash with laundry detergent. If hot water laundry cycle is used, the temperature should be a minimum 160ºF. Add one cup of bleach if water is not 160ºF. When laundering with water at low temperatures, consider adding one cup of household bleach or use oxygen-activated bleach to help reduce microbial contamination. Dry in a hot dryer. Consider wearing gloves when handling dirty laundry.
    • Clean and disinfect infirmary cots regularly (at least daily) and use pillow protectors. Launder pillow covers and washable pillows between use, following manufacturer's directions.
  • If MRSA infection is confirmed in the camp population:
    • Disinfect limited areas, such as surfaces that are likely to be in contact with uncovered or poorly covered infections, using a U.S. Environmental Protection Agency (EPA) registered product effective against MRSA (see next section immediately below).
      • Environmental surfaces and shared equipment where direct-skin contact by multiple users is likely include sports equipment, outdoor equipment, exercise equipment, horseback riding saddles, etc.
  • Widespread disinfection of the entire facility based on the occurrence of a single MRSA infection is not recommended.
  • Considerations for use of registered disinfectants:
    • The EPA has a list of disinfectant products effective against MRSA. More information about these products can be found on the EPA website. When using a disinfectant, always read and carefully follow the directions on the product label.
    • Routine use of disinfectants is not without risk.
      • Many of the active ingredients in disinfectant products can burn or irritate the skin and eyes, and, in some cases, can cause respiratory irritation.
      • Take precautions, such as ensuring adequate ventilation, use of gloves, eye, and face protection to reduce exposure to applied disinfectants to the extent practical and follow all label directions and precautions.

8. Additional Information

Additional information about MRSA can be found on the web on the following sites:

New York State Laws and Regulations

Title: Section 7-2.8(d) - Medical requirements

Effective Date: 09/29/2004

(d) All camper and staff injuries, illnesses and reportable diseases shall be reported to the camp health director and recorded in the medical log. All camper and staff injuries or illnesses which result in death or which require resuscitation, admission to a hospital or the administration of epinephrine, camper and staff exposures to animals potentially infected with rabies, camper injuries to the eye, head, neck or spine which require referral to a hospital or other facility for medical treatment, camper injuries where the victim sustains second or third degree burns to five percent or more of the body, camper injuries which involve bone fractures or dislocations, camper lacerations requiring sutures, camper physical or sexual abuse allegations and all camper and staff illnesses suspected of being water-, food-, or air-borne, or spread by contact shall be reported within 24 hours to the permit-issuing official. Any camper or staff member suspected of having a communicable disease shall be suitably isolated.