Schools deal with stubborn staph infection

A Guilderland High School student and a Berne-Knox-Westerlo student are back at school after being infected with a bacterium that is making nationwide news.
A second BKW High School student was just diagnosed yesterday, joining a half-dozen Capital Region students with methicillin-resistant Staphylococcus aureus, known as MRSA, which is pronounced "mersa." The bacterium causes staph infections that are resistant to treatment with the usual antibiotics.

The state’s health department says there is no reason to panic; MERSA in a community setting, when caught early, is easily treated.

Both Guilderland and BKW were already preparing information on MRSA before the cases were discovered.
"The case in Virginia was all over the national news," said Guilderland Superintendent Gregory Aidala, referring to a 17-year-old high school student who died there. "And there was a case in Ballston Spa," he said of a local school district with an infected student.
"Last Thursday," said Aidala, "before we knew we had a case, as a precautionary measure, we posted information on the district website." Letters with a fact sheet about MRSA and the need for good hygiene were sent home with school athletes.
"That same afternoon, our school nurse confirmed we had a case," said Aidala. The high school student was not an athlete on a school team.

The next day, Friday, Oct. 19, the district sent letters to parents and issued a press release. And the acting high-school principal made an announcement over the school’s public-address system.
Over the weekend, extra cleaning crews sanitized the "heavily traveled public areas" in all seven of the district’s schools, Aidala said. This included weight rooms, locker rooms, bathrooms, and gyms, he said; school buses were also cleaned.
The custodial staff, he said, now has "a heightened sense of awareness" about cleaning.

Aidala said nurses at various Guilderland schools have received calls with questions from parents. Good hygiene practices are being stressed.
At BKW, Superintendent Steven Schrade said, "Because of the publicity generated"we knew it would likely come our way eventually. We thought it would be best to be prepared."

The district focused on education, posting information about MRSA and prevention tips on the district website and sending it out on the School News Notifier, where subscribers are e-mailed information. Staff members and coaches shared information about MRSA with students.

Then, on Tuesday afternoon, following dismissal, the district was informed that a student athlete had been diagnosed and treated for MRSA. The student was back in school on Wednesday.

Schrade learned yesterday that a second student has also been diagnosed with MRSA.

The district was informed by parents, he said, since MRSA is not a reportable disease, and is not tracked by the county health department.

BKW has purchased antibacterial soaps for hand-washing, which is being placed in elementary-school classrooms and in the soap dispensers in the middle- and high-school bathrooms. The district has not added to its routine cleaning schedule.
"It’s my understanding," said Schrade, "that everything could be scrubbed down one day and the next day, someone with an infection could walk in and all the scrubbing would be for nothing."
He concluded of sanitizing school rooms or buses, "We felt it had no practical value."
"We have yet to know whether widespread cleaning is beneficial," said Claire Pospisil, spokeswoman for the New York State Department of Health. "Certainly, hand-washing is important, avoiding the sharing of personal items, and keeping infected wounds covered."

Background on the bacteria

MRSA caused more than 94,000 life-threatening infections and nearly 19,000 deaths in the United States in 2005, according to the Centers for Disease Control. The Oct. 17 edition of the Journal of the American Medical Association says that most of the infections — about 85 percent — come from health-care settings, affecting patients who undergo invasive medical procedures or who have weakened immune systems. Bloodstream infections, surgical-site infections, or pneumonia can result.

MRSA can also infect people in the community at large, as it did the BKW and Guilderland high school students. Infections in community-associated MRSA, known as CA-MRSA, are usually mild and affect the skin with pimples or boils that can be swollen and painful and can drain pus. Otherwise healthy people can have such infections.

MRSA was first recognized in the 1960s, according to the New York State Department of Health. Beginning in the 1990s, MRSA among people in the community, not in a health-care facility, has increased.
"It’s been around for awhile," said Pospisil, when asked why MRSA was suddenly causing such a stir. "I think the CDC report is why everybody now has questions regarding it." The Oct. 17 CDC report said that, between 2000 and 2005, the number of MRSA cases in the United States has tripled, infecting 32 out of every 100,000 people.
"The health officials feel it is being overplayed," said Superintendent Schrade. "Community-associated MRSA is quite treatable."

Until recently, the state health department says, reports of CA-MRSA outbreaks were uncommon. But now in New York State and across the country, outbreaks in community settings are being reported more frequently.

Pospisil said outbreaks are most likely where there are close living conditions — as in a military barracks or in a prison — or where there is close physical contact — as among members of a sports team or among children in a day-care center.

The staph became drug-resistant, she said, partly because of the misuse or overuse of antibiotics. Resistance occurs when bacteria change or adapt in a way that lets them survive in the presence of antibiotics designed to kill them.

According to data from the Centers for Disease Control, the proportion of infections that are antimicrobial-resistant has been growing. In 1974, MRSA infections accounted for 2 percent of the total number of staph infections; in 1995, it was 22 percent; and in 2004, it was 63 percent.
Schrade brought up a conundrum that BKW was faced with. "New York State has required schools to use green cleaning supplies, which do not contain antiseptic ingredients," he said. "And now, we had to special-order antibacterial soaps, because we were following the guidelines and didn’t have it."

The overuse of antibacterial soaps, though, is part of the reason that drug-resistant bacteria have evolved.

Treatment and prevention
There is no cause to panic over community-associated MRSA, Pospisil said. "If it’s diagnosed early, it can be treated."

The infection can look like a spider bite or pimples, she said.

Staph is a common bacterium normally found on the skin or in the nose of two or three out of every 10 people. If symptoms are present, it’s considered an infection.

Typically, abscesses are drained, said Pospisil, and bandaged to prevent the spread of infection. And antibiotics can be administered.
"Community-associated MRSA is a skin infection that can be treated by draining the boils and giving antibiotics as needed," reiterated Pospisil. "Left untreated, it can get out of hand."

Asked when a patient can return to work or school, Pospisil said a doctor’s advice should be followed. Some say normal activities can resume as long as the infected areas are completely covered and there are no other symptoms like fevers and chills.
Asked if Guilderland has a policy on when an infected student or staff member can return to school, Aidala said, "A doctor would advise a student on when it is safe to return to school."
BKW’s Schrade had a similar response. "We’re relying on the advice of the physicians"if they feel it’s safe to be in school and in the proximity of other students."

The students who have returned to school have had no problems with re-entry, the superintendents said; to safeguard their privacy, the schools are not releasing their names.

The state’s health department advises patients not to pick or squeeze their boils, and to keep their wounds covered. They are also advised to carefully dispose of their bandages; to refrain from sports or contact activities; and to wash clothes, sheets, and towels in hot water and detergent.

Pospisil stressed the importance of good hygiene practices in households where someone is infected or where there is close contact with an infected person. This includes frequent hand-washing with warm water and soap; maintaining a clean environment; using clean, dry towels; and not sharing topical treatments, like lotions, or personal-care items like razors.

These are the same measures the local school districts have been advocating.
"Any time you bring a student population together for 180-plus days, students become ill," concluded Aidala. "We tried to be very transparent about this and proactive". All the things we’ve publicized are just good hygiene practices."