With the start of the new academic year, schools will be filled with excitement, challenges, friendships and, unfortunately, bacterial infections. Most Staphylococcus aureus (staph) bacteria, commonly found on the skin and in the nose, usually do not cause illnesses in healthy people unless the bacteria enter a skin wound or cut.

In most cases, staph can be treated successfully by thoroughly cleaning the wound with an antibacterial soap, applying a topical antibiotic cream or ointment prescribed by a physician, covering the area with a sterile bandage and taking oral antibiotics. However, Methicillin-resistant Staphylococcus aureus (MRSA) is a staph bacterium that, according to the U.S. Centers for Disease Control and Prevention (CDC), will not respond to traditional oral antibiotics including methicillin, oxacillin, penicillin and amoxicillin.

The CDC estimates that Americans make 12 million visits to doctors each year for skin infections caused by staph. More than half of those patients are diagnosed with MRSA. According to the CDC's website, MRSA is spread by having direct contact with another person's infection; sharing personal items, such as towels and razors, that have touched infected skin; and touching surfaces or items that are contaminated with MRSA.

Although MRSA infections can occur anywhere, the CDC recognizes factors that increase the possibility of MRSA transmission. These factors, called the "5Cs," are: Crowding, frequent skin-to-skin Contact, Compromised skin, Contaminated items and surfaces, and lack of Cleanliness. Each of the five Cs can be found in schools.

"The best way to prevent the spread of MRSA in schools is to educate our customers about proper housekeeping procedures to prevent the spread of MRSA," says Laura Craven, director of communications for Dade Paper Co., based in Miami. "Our education program originally was launched for long-term care and assisted living facilities. We now have a version targeted to schools."

Education with school personnel should be ongoing, even during the summer months when a MRSA outbreak is less likely a problem, says Phil Consolino, president of SouthEast LINK in Atlanta.

"It's important not to let this subject slip off the table during the off season," he adds. "Summer is an excellent time to do a thorough disinfection of specific areas in the school building such as locker rooms."

Frequent hand washing or hand sanitizing is recognized by jan/san distributors as a primary way to prevent a MRSA outbreak.

"In keeping the school environment healthy, so much comes down to personal hygiene," says Chris Martini, director of marketing and special projects for Central Sanitary Supply, Modesto, Calif. "We now look at hand sanitizing as a part of everyday life."

However, it's not just about placing hand sanitizing dispensers on a wall; it's about changing the culture to make hand cleaning a priority and teaching the proper way to do it. The challenge is to ensure that schools are promoting this fairly basic approach to good health.

"We provide the schools we serve with attractive and fun posters and signs that focus on the importance of hand washing and sanitizing," says Craven. "We also help our customers choose the best locations for the posters and sanitizer dispensers. If we create awareness about proper hand hygiene, we can instill a behavior about hand washing and sanitizing that will make MRSA less prevalent once school starts."

Areas Most Susceptible To Infection

When students return from summer break, distributors must be prepared to help end users prevent possible MRSA outbreaks. Staph infections could happen in nearly every room of a school, but the gym and locker rooms are the most likely areas for MRSA exposure.

"Locker rooms and athletic equipment are not getting the attention they deserve," says Michael Glass, president of M.D. Stetson Co., in Randolf, Mass. "Intentions are good, but schools lack staffing and funds."

Wrestling mats, shin guards and shoulder pads are items of concern along with towels, lockers, benches, hydrotherapy tubs and artificial turf.

"Educating coaches can prevent MRSA outbreaks," says Consolino. "Uniforms with sweat and blood on them should not be hanging around the locker room because staph infections can get onto clothing and cause cross-contamination. They need to be taken home and laundered."

Consolino advocates the establishment of a protocol for disinfecting locker rooms including the inside of lockers. This includes the use of an air ionizer as part of the school's regular cleaning routine, especially in areas with anchored fixtures.

"With this technology, you can sanitize a locker room without ever opening up a locker," says Consolino. "Our customers report unbelievable results."

Cleaning results can be routinely measured using ATP (adenosine triphosphate) rapid-monitoring systems, which provide a numerical value of the organic content of a particular material. Measurements can be used to help validate cleaning efforts to school boards and concerned parents.

"As part of our regular customer service, we do the initial reading and then instruct custodians how to use ATP tools to identify bacteria," says Craven.

When An Outbreak Occurs

If a MRSA outbreak occurs in a school, jan/san distributors should be onsite immediately assessing whether disinfection protocols are being followed. Most times, if there is a breakout, there has been a breakdown in the cleaning process, says Consolino.

"We recommend a complete and ongoing top-to-bottom disinfecting process," says Craven. "We encourage school officials to make sure any people who acquired the infection do not return to the school until they are released by their doctors."

Following a site survey, areas in need of attention are identified and disinfected with products rated for killing MRSA. Frequently-touched items including student and teacher desktops, doorknobs, water fountains, restroom fixtures and copy machines should be disinfected.

Fogging individual rooms works well, says Glass, but he adds that fumigating the entire school is not necessary. In fact, CDC guidelines state that, in general, it is not necessary to close schools during the disinfecting process.

Jan/san distributors note that there are a lot of products available to kill the MRSA bacteria, but end users must be trained to use them properly.

"If the product isn't used right in the right places, it is going to be ineffective," says Craven. "Jan/san distributors are not in the business of just shipping cleaning products. We must provide continual training with new products and identify ways for our customers to save money and improve the safety and health of building occupants."

Catherine Dinsmore is a freelance writer based in Watertown, Conn.

Tips For Preventing MRSA

The U.S. Centers for Disease Control and Prevention (CDC) suggests these steps for protecting against MRSA:

  • Practice good hygiene by washing hands with soap and water or an alcohol-based hand sanitizer and shower immediately after physical activity.
  • Cover cuts and abrasions with a clean, dry bandage until healed.
  • Avoid sharing personal items (towels, razors) that come into contact with bare skin and use a barrier (clothing or a towel) between skin and shared surfaces such as weight-training equipment.
  • Maintain a clean environment by establishing cleaning procedures for frequently touched surfaces that come into direct contact with people's skin.