COMMUNITY-ASSOCIATED METHICILLIN RESISTANT STAPHYLOCOCCUS AREUS (CA-MRSA)
Increased MRSA cases have been reported across the country, with 3 pediatric deaths recently hitting the media from Virgina, Mississippi
and New Hampshire.
More than 90,000 life-threatening illnesses and nearly 19,000 deaths associated with a MRSA infection are estimated to occur annually in
the United States, according to a report released this week by the Centers for Disease Control and Prevention (CDC). The study, published
in the Journal of the American Medical Association, also found that nearly 85% of MRSA cases were connected to healthcare settings.
(JAMA, 2007; 298(15):1763-1771)
However, mild cases of MRSA are diagnosed every day in Delaware, and nationwide. Generally, these cases are easily treated by a
healthcare provider and resolve without complications.
Delaware Division of Public Health (DPH) added MRSA to its list of notifiable diseases in February 2006 under the Regulations for the
Control of Communicable Diseases. The following cases have been confirmed as of 10/18/2007:
This data includes both hospital and community associated infections. Incidence data for the current year should be viewed as a
‘snapshot in time’ as the data is continually changing.
MRSA is now a frequent topic for the media, especially when children and schools are involved. DPH has worked closely with the Department
of Education (DOE) to distribute resource materials to public schools to assist with the education and recommendations for management of
rash illnesses and skin lesions. DPH’sprimary focus is to provide recommendations to help schools, hospitals, etc. implement
control measures to limit transmission. Recommendations have also been developed specifically for sports teams and athletes where
frequent person-to-person contact occurs, thus increasing the possibility of contact transmission.
- The single best way to prevent the spread of CA-MRSA infections is frequent hand-washing. Alcohol based sanitizers should be utilized
when soap and water are not available.
- Cleaning and disinfecting common surfaces that have the potential to come in contact with the MRSA bacteria is necessary to keep the
environment healthy. Germs (bacteria and viruses) are killed during routine cleaning and disinfecting activities. Allergen (mold, pollen,
dust mites and other irritants) are removed during cleaning activities like vacuuming, sweeping and mopping. Surfaces and equipment such
as floors, light switches, door handles, desks, keyboards, handrails and shared items should be cleaned routinely. Athletic equipment and
areas such as wrestling mats, wall padding, locker/weight rooms, protective gear and shower facilities should be disinfected routinely
and after each use. Commercial disinfectants containing phenol or a fresh mixed solution of one part bleach to 100 parts water are
suitable for cleaning.
- Treat any draining wound as a potential MRSA infection. This may include culture, incision and drainage, proper antibiotic usage and
proper exclusion and return policies.
- Treat uncultured wounds as MRSA.
- Avoid sharing personal items such as towels, razors, clothing, protective athletic gear, bar soap, etc.
- Keep cuts, scrapes and wounds clean and covered with a bandage until healed. If a wound cannot be covered adequately, exclusion from
school and/or sporting activities may be indicated.
- Avoid contact with other people’s skin wounds or bandages.
- Encourage good hygiene, including showering and washing with soap after all practices, competitions and physical education classes.
Always dry off with a clean, dry towel.
- Athletes should wash towels, uniforms, scrimmage shirts, and any other laundry in hot water with ordinary detergent. Soiled laundry
from school to home should be contained in an impervious container or plastic bag for transporting home.
- Educate teaching and coaching staff regarding prevention measures. Educate custodial staff regarding environmental sanitation and
disinfection of common surfaces.
- Infections with MRSA can look like ‘spider bites’, turf burns, abscesses, boils, etc.
- The only way to determine if a wound is infected with MRSA is by performing a culture.
- Treat any draining wound as a potential MRSA infection.
- Treat uncultured wounds as MRSA.
- Healthcare providers should culture suspect skin lesions. When the culture is completed the laboratory generates sensitivity patterns
which determine appropriate antibiotic usage.
- Healthcare providers may choose to drain the lesion and treat with topical antibiotics which help to reduce the amount of bacteria on
- Any athlete/sports team member presenting with a suspect Staph infection should be excluded from further athletic activity. This
applies to any activity involving person-to-person contact and use of any shared athletic equipment (i.e., weight room equipment,
wrestling mats, and protective gear).
- If the participant is evaluated by a healthcare provider who chooses to treat with topical medications and wound care, the
participant should continue to be excluded until they are clear of any moist, exudative or draining lesions.
- If MRSA is culture-confirmed, at a minimum, the athlete/sports team member should be excluded for 48 hours after
antimicrobial therapy was begun. However, the participant should be reevaluated as detailed below prior to return to play. As a general
rule, participant’s who have culture-confirmed MRSA should be excluded until they are clear of any moist, exudative or draining
- Dermatologic conditions that are not suspect Staph infections (or other communicable condition) can be covered by a
bandage made of non-permeable material that will withstand the rigors of competition. These participants need not be excluded.
- Under no circumstances shall a participant with a suspect or confirmed Staph infection be allowed to participate until they are clear
of any moist, exudative or draining lesions.
Exclusion: General Student Population
- Any student presenting with a suspect Staph infection that is draining and unable to be thoroughly covered to prevent contamination
of other individuals or common surfaces, should be excluded and referred for medical evaluation.
Reporting to DPH
- MRSA is a reportable disease in Delaware. Healthcare providers have the responsibility of reporting culture-confirmed cases to DPH.
DPH welcomes reports from school nurses and high school wellness centers.
- DPH list of notifiable diseases and reporting requirements can be found at: http://www.dhss.delaware.gov/dhss/dph/dpc/rptdisease.html
Reporting forms can be printed from this site and faxed to the Bureau of Epidemiology to: 302-739-3171
Please note: Some of the files available on this page are in Adobe PDF format which requires Adobe Acrobat Reader. A free copy of Adobe Acrobat Reader can be downloaded directly from Adobe . If you are using an assistive technology unable to read Adobe PDF, please either view the corresponding text only version (if available) or visit Adobe's Accessibility Tools page.
Categories of Health Alert messages:
- Health Alert: Conveys the highest level of importance; warrants immediate action or attention.
- Health Advisory: Provides important information for a specific incident or situation; may not require immediate action.
- Health Update: Provides updated information regarding an incident or situation; unlikely to require immediate action.
NOTE: This page is for informational purposes only and dated material (e.g. temporary websites) may not be available.