Staphylococcus aureus (Methicillin-Resistant [MRSA] and Methicillin-Sensitive [MSSA])—Child Care and Schools

What is Staphylococcus aureus?

• Staphylococcus aureus is a bacterium that primarily causes skin infections, although, less commonly, these bacteria can cause pneumonia and bone, joint, and blood infections. The "resistant" or "sensitive" part of the name refers to how effectively these bacteria can be treated with methicillin or related antibiotics, such as nafcillin, oxacilliin, and cephalosporins.

• Having a methicillin-resistant S aureus (MRSA) skin infection is no more serious than other staphylococcal skin infections. Either type can sometimes cause severe infections.

• Although community-acquired MRSA is resistant to some antibiotics, there are other effective antibiotics that can be given by intravenous and oral routes.

• Most people who have S aureus bacteria living in their noses, on their skin, and around the anus do not become infected; rather, they are carriers (ie, they just carry the bacteria without becoming ill). These bacteria tend to be carried for months to years. Almost half of children carry some type of S aureus.

What are the signs or symptoms?

• Carriers have no signs or symptoms.

• With an infection, the signs and symptoms depend on the site of infection.

• When S aureus causes skin infections, there may be red bumps that progress to pus-filled pimples, boils, or abscesses.

• Boils may spontaneously drain pus.

• Sometimes, disruptions in the skin barrier from eczema, bug bites, minor injuries, or boils or abscesses can progress to cellulitis, an enlarging, painful, red area of the skin. Cellulitis may be associated with fever.

• Rarely, the infection spreads from the skin into the deeper tissues, causing a rapidly spreading, dangerous, and very painful infection called fasciitis.

• Symptoms of S aureus infection in areas other than the skin include fever, tiredness, pain and swelling of the joints or bones, and cough when the infection is in the lungs.

What are the incubation and contagious periods?

• Incubation period: Unknown.

• Contagious period: Children are contagious with S aureus when they have actively draining sores or boils.

How is it spread?

• Close skin-to-skin contact.

• Crowded conditions.

• Poor hygiene.

• Contact with open sores or boils.

• Contact with toys or surfaces that have been contaminated with the bacteria. A carrier who picks his or her nose could easily contaminate a toy or surface.

How do you control it?

• Use good hand-hygiene technique at all the times listed in Chapter 2 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition.

• Any skin condition that may cause skin breaks, such as eczema, is a risk factor for having a skin infection (including S aureus) and passing this on to others. Educators with eczema on their hands or excessively dry skin should practice good eczema/dry skin control. Educators with cracked skin on their hands should wear gloves during activities that involve touching the skin of the children. Children and staff members who have eczema or excessively dry skin should work with health professionals to control it.

• Avoid sharing personal items, such as dress-up clothing.

• Cover open or draining sores or boils.

• Occasionally, S aureus may cause infections in multiple individuals in a family or early childhood education program.

• Infectious disease specialists may recommend special soaps and/or baths for individuals and families who get recurrent disease caused by S aureus infections; however, the infections may come back despite this treatment.

• Children infected with boils may occasionally have a culture taken; however, more commonly, the health professional may also choose to treat with antibiotics without taking a culture based on their knowledge of local antibiotic resistance patterns.

• Children who do not have symptoms of infection may be carrying S aureus but should not have a culture taken.

What are the roles of the educator and the family?

• Provide hand lotion to use after handwashing to reduce the drying effect of frequent hand hygiene.

• Review Standard Precautions (see Chapter 2 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition), particularly hand hygiene.

• Identify children with red or draining skin lesions, cover the lesions, and report the problem to parents/guardians. Recommend seeking care from their child's health professional.

Exclude from educational setting?

No, unless

• The child is unable to participate and staff members determine they cannot care for the child without compromising their ability to care for the health and safety of the other children in the group.

• The child meets other exclusion criteria (see Conditions Requiring Temporary Exclusion in Chapter 4 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition), or the lesions cannot be covered so that contact with others and surfaces with drainage does not occur.

• Having a MRSA or methicillin-sensitive S aureus (MSSA) infection or harboring MRSA or MSSA bacteria (carrier) is not a reason for exclusion unless other exclusion criteria are met.

Readmit to educational setting?

Yes, when all the following criteria are met:

When exclusion criteria are resolved, the child is able to participate, and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group