MRSA stands for methicillin-resistant Staphylococcus aureus. It causes a staph infection (pronounced "staff infection") that is resistant to several common antibiotics. There are two types of infection. Hospital-associated MRSA happens to people in health care settings. Community-associated MRSA happens to people who have close skin-to-skin contact with others, such as athletes involved in football and wrestling.

Infection control is key to stopping MRSA in hospitals. To prevent community-associated MRSA

• Practice good hygiene
• Keep cuts and scrapes clean and covered with a bandage until healed
• Avoid contact with other people's wounds or bandages
• Avoid sharing personal items, such as towels, washcloths, razors, or clothes
• Wash soiled sheets, towels, and clothes in hot water with bleach and dry in a hot dryer

If a wound appears to be infected, see a health care provider. Treatments may include draining the infection and antibiotics.

Methicillin-resistant Staphylococcus aureus (MRSA) is a cause of staph infection that is difficult to treat because of resistance to some antibiotics.

Staph infections—including those caused by MRSA—can spread in hospitals, other healthcare facilities, and in the community where you live, work, and go to school.

You can help prevent infections and stop the spread of MRSA.

What is MRSA?

MRSA stands for methicillin-resistant Staphylococcus aureus, a type of bacteria that is resistant to several antibiotics.

Outside of Healthcare Settings

In the community (where you live, work, shop, and go to school), MRSA most often causes skin infections. In some cases, it causes pneumonia (lung infection) and other infections. If left untreated, MRSA infections can become severe and cause sepsis—the body’s extreme response to an infection.

In Healthcare Settings

In places such as a hospital or nursing home, MRSA can cause severe problems such as

• bloodstream infections,
• pneumonia, or
• surgical site infections.

Who is at risk?

Anyone can get MRSA. The risk increases with activities or places that involve crowding, skin-to-skin contact, and shared equipment or supplies. Some of the people who carry MRSA can go on to get a MRSA infection. Non-intact skin, such as when there are abrasions or incisions, is often the site of an MRSA infection. Athletes, daycare and school students, military personnel in barracks, and those who receive inpatient medical care or have surgery or medical devices inserted in their body are at higher risk of MRSA infection.

How is MRSA spread in the community?

MRSA is usually spread in the community by contact with infected people or things that are carrying the bacteria. This includes through contact with a contaminated wound or by sharing personal items, such as towels or razors, that have touched infected skin.

The opioid epidemic may also be connected to the rise of staph infections in communities. People who inject drugs are 16 times more likely to develop a serious staph infection.

How common is MRSA?

Approximately 5% of patients in U.S. hospitals carry MRSA in their nose or on their skin.

How can I prevent a MRSA Infection?

You can take these steps to reduce your risk of MRSA infection:

• Maintain good hand and body hygiene. Clean hands often, and clean your body regularly, especially after exercise.
• Keep cuts, scrapes, and wounds clean and covered until healed.
• Avoid sharing personal items such as towels and razors.
• Get care early if you think you might have an infection.

What are symptoms of MRSA Infection?

The symptoms of a MRSA infection depend on the part of the body that is infected. For example, people with MRSA skin infections often can get swelling, warmth, redness, and pain in infected skin. In most cases it is hard to tell if an infection is due to MRSA or another type of bacteria without laboratory tests that your doctor can order. Some MRSA skin infections can have a fairly typical appearance and can be confused with a spider bite. However, unless you actually see the spider, the irritation is likely not a spider bite.

Most S. aureus skin infections, including MRSA, appear as a bump or infected area on the skin that might be:

• red
• swollen
• painful
• warm to the touch
• full of pus or other drainage
• accompanied by a fever

What if I see these symptoms?

You cannot tell by looking at the skin if it’s a staph infection (including MRSA).

Getting medical care early makes it less likely that the infection will become serious.

If you or someone in your family experiences the signs and symptoms of MRSA:

• Contact your healthcare provider, especially if the symptoms are accompanied by a fever.
• Do not pick at or pop the sore.
• Cover the area with clean, dry bandages until you can see a healthcare provider.
• Clean your hands often.

How do I prevent the spread of MRSA?

• Cover your wounds with clean, dry bandages until healed.
  Follow your healthcare provider’s instructions about proper care of the wound. Pus from infected wounds can contain MRSA.

• Do not pick at or pop the sore.
• Throw away bandages and tape with the regular trash.
• Clean your hands often.
  You, your family, and others in close contact should wash hands often with soap and water or use an alcohol-based hand rub, especially:

• after changing a bandage
• after touching an infected wound
• after touching dirty clothes
• Do not share personal items such as towels, washcloths, razors, and clothing, including uniforms.
• Wash laundry before use by others and clean your hands after touching dirty clothes.

Methicillin-resistant Staphylococcus aureus (MRSA) can survive on some surfaces, like towels, razors, furniture, and athletic equipment for hours, days, or even weeks. It can spread to people who touch a contaminated surface, and MRSA can cause infections if it gets into a cut, scrape, or open wound.

How can I keep my hands clean to prevent the spread of germs like MRSA?

Keeping your hands clean is one of the most important steps you can take to avoid getting sick and spreading germs like MRSA. Use soap and water to clean your hands if available. After wetting your hands and adding soap, scrub your hands for at least 20 seconds. If you cannot access soap and water, use an alcohol-based hand sanitizer that contains at least 60% alcohol to clean hands. Apply the sanitizer to one hand, rub your hands together, trying to cover all surfaces of your hands and fingers until your hands are dry.

How can I clean and disinfect surfaces to prevent MRSA infection?

• Cleaners or detergents are products that remove soil, dirt, dust, organic matter, and germs (like bacteria, viruses, and fungi). They lift dirt and germs off surfaces so they can be rinsed away with water. Cleaning with a detergent is necessary to remove dirt that can prevent disinfectants from working. Some disinfectants have a cleaning agent mixed in, check the label to know which product you have.
• Disinfectants are chemical products that are used to kill germs in healthcare settings. Disinfectants effective against Staphylococcus aureus, or staph, are also effective against MRSA. The disinfectant’s label should have a list of germs that the product can kill, along with an Environmental Protection Agency (EPA) registration number. These products are also sold at grocery and other retail stores and may be helpful when someone has an infected wound.

What should I clean to prevent MRSA from spreading?

When cleaning and disinfecting, focus on surfaces that frequently contact people’s bare skin like desks, chairs, benches, gym equipment, lockers, faucets, light switches and remote controls. In particular, clean any surfaces that could come into contact with uncovered wounds, cuts, or boils. In addition to cleaning surfaces, frequently cleaning hands and keeping wounds covered keeps MRSA from spreading.

Large surfaces, such as floors and walls, have not been associated with the spread of staph and MRSA. There is no evidence that spraying or fogging rooms or surfaces with disinfectants will prevent MRSA infections more effectively than the targeted approach of cleaning frequently touched surfaces and surfaces that have been exposed to open wounds.

Which disinfectants should I use against MRSA?

Check the disinfectant product’s label on the back of the container. Most, if not all, disinfectant manufacturers will provide a list of germs on their label that their product can destroy. Disinfectants effective against Staphylococcus aureus or staph are also effective against MRSA. These products are readily available from grocery stores and other retail stores.

How should I use cleaners and disinfectants?

Read the label first. Each cleaner and disinfectant has instructions that tell you important facts:

• Precautions you should take when applying the product, such as wearing gloves or aprons or making sure you have good ventilation during application.
• How to apply the product to a surface.
• Instructions on how to prepare (e.g., dilute) if the product is a concentrate.
• How long you need to leave it wet on the surface to be effective (contact time).
• If the surface needs to be cleaned first and rinsed after using.
• If the product is safe for the surface.
• EPA-registered disinfectants with a label claim for Staphylococcus aureus will also kill MRSA.

How should I clean laundry, equipment and difficult surfaces to stop MRSA from spreading?

Laundry

Routine laundry procedures, detergents, and laundry additives will all help to make clothes, towels, and linens safe to wear or touch. If items have been contaminated by infectious material, these may be laundered separately, but this is not absolutely necessary. Dry laundry in a dryer, if available.

Equipment

Shared equipment that comes into direct skin contact such as helmets and protective gear should be cleaned after each use and allowed to dry. Equipment should be cleaned according to the equipment manufacturers’ instructions to make sure the cleaner will not harm the item.

Keyboards and other Difficult Surfaces

Many items such as computer keyboards or handheld electronic devices may be difficult to clean or disinfect because they could be damaged if they became wet. If these items are touched by many people during the course of the day, a cleanable cover/skin (e.g., keyboard skin) could be used on the item to allow for cleaning while protecting the item. Always check to see if the manufacturer has instructions for cleaning.

Is it clean?

Even when a surface appears visibly clean, it can still have germs. To protect yourself from germs on shared surfaces you can:

• Use barriers, like a towel or clothing, between your skin and the surface.
• Shower immediately after activities where you have direct skin contact with people or shared surfaces or equipment, such as after exercising at a health club.
• Clean your hands regularly with soap and water or an alcohol-based sanitizer.
• Keep cuts and scrapes clean and covered with bandages or dressing until healed.

These precautions are especially important in locker rooms, gyms, and health clubs.

“Staph” is a very common germ that about 1 out of every 3 people have on their skin or in their nose. This germ does not cause any problems for most people who have it on their skin.

But sometimes it can cause:

• skin or wound infections
• pneumonia
• infections of the blood
• sepsis, the body’s extreme response to an infection
• death

Antibiotics are given to kill staph germs when they cause infections. Some staph germs are resistant to several antibiotics, meaning these drugs are no longer able to cure the infections. Methicillin-resistant Staphylococcus aureus or MRSA is a type of staph that is resistant to the antibiotics that are often used to cure staph infections.

Who is at risk?

In healthcare facilities such as hospitals and nursing homes, patients or residents most likely to get an MRSA infection are those with other health conditions making them sick. Also, hospital or nursing home patients who have been treated with antibiotics, have wounds or invasive medical devices such as catheters, or have certain procedures like surgery or dialysis are more likely to get an infection.

Being treated in the same room as or close to another patient with MRSA can also increase a patient’s risk of getting MRSA, as the bacteria are easily spread on unclean hands or medical equipment. In general, the first step in getting a MRSA infection is carrying the germ (also called becoming colonized with MRSA). Once a person has MRSA they are at higher risk for getting an infection.

People who are healthy and who have not been in the hospital or a nursing home can also get MRSA infections. These community infections usually involve the skin. This type of MRSA infection is known as community-associated MRSA. There are steps you can take to prevent MRSA infections in the community where you live, work, and play.

How is MRSA spread?

People who have MRSA germs on their skin or who are infected with MRSA may be able to spread the germ to other people. In addition to being passed to patients directly from unclean hands of healthcare workers or visitors, MRSA can be spread when patients contact contaminated bed linens, bed rails, and medical equipment.

Can it be treated?

Yes, there are antibiotics that can kill MRSA germs. Some types of MRSA infections need surgery to drain infected areas. Your healthcare provider will determine which treatments are best for you.

It is important to get care for MRSA infections early. If left untreated, MRSA can quickly spread throughout the body and cause life-threatening problems including sepsis.

How can doctors prevent it?

To prevent MRSA infections, healthcare personnel:

• Clean their hands with soap and water or an alcohol-based hand sanitizer before and after caring for every patient.
• Carefully clean hospital rooms and medical equipment.
• Use Contact Precautions when caring for patients with MRSA (colonized, or carrying, and infected). Contact Precautions mean:
  • Whenever possible, patients with MRSA will have a single room or will share a room only with someone else who also has MRSA.
  • Healthcare providers will put on gloves and wear a gown over their clothing while taking care of patients with MRSA.
  • Visitors might also be asked to wear a gown and gloves.
  • When leaving the room, healthcare providers and visitors remove their gown and gloves and clean their hands.
  • Patients are asked to stay in their hospital rooms as much as possible. They should not go to common areas, such as the gift shop or cafeteria. They may go to other areas of the hospital for treatments and tests.
• Test some patients to see if they have MRSA on their skin. This test involves rubbing a cotton-tipped swab in the patient’s nostrils or on the skin.
• Apply topical medicines and antiseptics to try to decrease the amount of staph on a person’s body (also called decolonization).

Can visitors get it from me?

The chance of getting MRSA while visiting a patient with MRSA is very low. To decrease the chance of getting MRSA your family and friends should:

• Clean their hands before they enter your room and when they leave.
• Ask a healthcare provider if they need to wear protective gowns and gloves when they visit you.

After the hospital, what do I do?

To prevent another MRSA infection and to prevent spreading MRSA to others:

• Take antibiotics exactly as prescribed by your healthcare provider. Talk with your healthcare provider if you have any questions about your antibiotics, or if you develop any side effects, especially diarrhea, since that could be a difficile infection, which needs to be treated immediately.
• Clean your hands often, especially before and after changing your wound dressing or bandage.
• People who live with you should clean their hands often.
• Keep any wounds clean and covered, and change bandages as instructed until healed.
• If you have wounds or an intravascular device (such as a catheter or dialysis port) make sure that you know how to take care of them to reduce your risk of infection.
• Ask each day if your temporary medical device (for example, a catheter) can be removed.
• If you see the access area start to look infected (red, swollen, warm, draining), call your doctor right away, especially if you have a fever.
• Do not share personal items such as towels or razors.
• Wash and dry your clothes and bed linens in the warmest temperatures recommended on the labels. Tell your healthcare providers that you have MRSA. This includes home health nurses and aides, therapists, and personnel in doctors’ offices.
• Follow other instructions given by your healthcare provider.

If you have questions, please ask your doctor or nurse.

Preventing the Spread of MRSA

In healthcare facilities, such as a hospital or nursing home, MRSA can cause severe problems including:

• bloodstream infections
• pneumonia
• surgical site infections
• sepsis
• death

How is MRSA spread in healthcare settings?

MRSA is usually spread by direct contact with an infected wound or from contaminated hands, usually those of healthcare providers. Also, people who carry MRSA but do not have signs of infection can spread the bacteria to others (i.e., people who are colonized).

How do you know if MRSA is the cause of an infection?

The only way to know if MRSA is the cause of an infection is to perform a culture (a laboratory test) of the bacteria. Obtaining bacteria to culture is a procedure done by a healthcare provider.

How common is MRSA?

CDC is engaged in several short- and long-term MRSA surveillance (infection tracking) projects that involve collaboration with health departments, individual hospitals, and academic medical centers, among others. Understanding the burden of MRSA infections—how much is occurring, where it is happening, and how it is being spread – is essential for developing effective prevention programs and measuring their impact.

Studies show that about one in three (33%) people carry S. aureus bacteria in their nose, usually without any illness. About two in every 100 people carry MRSA. Although many people carry MRSA bacteria in their nose, most do not develop serious MRSA infections.

Significant progress was made to reduce MRSA bloodstream infections in healthcare from 2005-2012, when the rates of MRSA bloodstream infections decreased by 17.1% each year. Declines in MRSA bloodstream infections slowed from 2013-2016, when no significant change was detected.

Where can I find information about MRSA at hospitals near me?

Information about MRSA rates in hospitals across the United States is available through the National Healthcare Safety Network (NHSN), the nation’s most widely used healthcare-associated infection tracking system.

To see how CDC-funded state and local health departments, as well as academic investigators, are working to prevent healthcare-associated infections (HAIs), including MRSA, visit the Antibiotic Resistance Investment Map.

Is MRSA an antibiotic resistance problem?

Yes. Staphylococcus aureus (staph) have become resistant to several antibiotics, making MRSA and other types of resistant staph major antibiotic-resistance problems. In CDC’s landmark report, Antibiotic Resistance Threats in the United States, 2013 [PDF – 114 pages], CDC listed MRSA as a “serious threat.” See the report and the U.S. National Strategy for Combating Antibiotic-Resistant Bacteria to combat antibiotic resistance.

Can MRSA infections be prevented?

Yes. Numerous studies, including a 2019 publication about Veterans Affairs Medical Centers, demonstrate that MRSA prevention efforts can reduce infections.

Successful MRSA prevention requires action both at the healthcare facility level, among healthcare providers and healthcare leadership. See the Strategies to Prevent Hospital-onset Staphylococcus aureus Bloodstream Infections in Acute Care Facilities.

Healthcare facilities can make prevention of MRSA infections a priority, assess their relevant data, implement prevention actions and evaluate progress.

Healthcare providers can follow current prevention recommendations for device- and procedure- related infections, treat infections appropriately and rapidly if they do occur, and educate patients about ways to avoid infection and spread, and about early signs of sepsis.

Progress made to reduce MRSA infections in healthcare facilities has slowed. People are at higher risk for MRSA infection when they

• have surgery,
• have medical devices inserted in their body, or
• use needles to inject drugs.

More action by healthcare providers and administrators—added to current CDC recommendations for reducing the risk of staph infections and spread—can prevent more staph infections in healthcare facilities and the community.

Contact Precautions

CDC recommends the use of Contact Precautions in inpatient acute care settings for patients known to be colonized or infected with epidemiologically important multidrug-resistant organisms (MDROs) including MRSA.

From 2005 to 2014, the overall estimated incidence of invasive MRSA infections from normally sterile sites (i.e., blood, pleural fluid, etc.) in the United States declined by 40% and the estimated incidence of invasive hospital-onset MRSA infections declined by 65%. Interventions designed to decrease risk of device and procedure-associated infections and interventions to reduce transmission, like Contact Precautions and hand hygiene, both likely contributed to these decreases. The relative contribution of Contact Precautions in comparison to other interventions is unknown.

In the past 5 years, more than a dozen studies, review articles, and editorials have sought to address whether Contact Precautions should continue to be recommended for endemic MDROs like MRSA. The impact of discontinuing Contact Precautions for MRSA-colonized or infected patients has been assessed primarily in single-center studies using lower quality quasi-experimental designs that have not identified changes in MRSA infection or acquisition rates. These studies likely underestimate the impact of discontinuing Contact Precautions, including the effect on downstream adverse events (e.g., post-discharge infections).

Based on the current evidence, CDC continues to recommend the use of Contact Precautions for MRSA-colonized or infected patients. CDC will continue to evaluate the evidence on Contact Precautions as it becomes available. In addition, CDC continues to work with partners to identify and evaluate other measures to decrease transmission of MDROs in healthcare settings.

MRSA remains an important healthcare pathogen and the prevention of MRSA infections is a priority for CDC. CDC estimates that MRSA is responsible for more than 70,000 severe infections and 9,000 deaths per year.

Make preventing staph infections (MRSA and MSSA) a priority in healthcare facilities:

• assess your facility’s data,
• implement prevention actions, and
• evaluate progress.

If a MRSA outbreak has occurred, contact your facility’s infection prevention department or your local/state health department.

If You Think You Have MRSA

• If you think you have an infection, make sure it is treated quickly. Tell your
  • parent,
  • coach,
  • athletic trainer,
  • school nurse,
  • team doctor, or
  • other healthcare provider.
• Find the infection and get care early to reduce losing playing time and keep the infection from becoming severe.
  • Look for signs of skin infection such as redness, warmth (area is warm to touch), swelling, pus, and pain at sites where your skin has sores, abrasions, or cuts. Sometimes these infections can be confused with spider bites.
  • Look for infection in places covered by body hair or where uniforms or equipment cause skin irritation or increased rubbing.
• Do not try to treat the infection. Do not pick at or pop the sore.
• Cover possible infections with clean, dry bandages until you can be seen by a healthcare provider (e.g., doctor, nurse, athletic trainer).

Prevention for Athletes

In addition to practicing good personal hygiene, athletes and visitors to athletic facilities should also:

• Keep your hands clean by washing often with soap and water or using alcohol-based hand sanitizer. Soap and water is preferred if hands are visibly soiled. At a minimum, hands should be cleaned before and after playing sports and doing activities such as using shared weight-training equipment, caring for wounds, and after using the toilet.
• Shower immediately after exercise, and do not share bar soap or towels.
• Wash your uniform and clothing after each use. Follow the clothing label’s instructions for washing and drying. Drying clothes completely in a dryer is preferred.
• Wear protective clothing or gear designed to prevent skin abrasions or cuts.
• Cover skin cuts and wounds with clean, dry bandages or other dressings recommended by your healthcare provider (e.g., athletic trainer, team doctor) until healed.
• Follow your healthcare provider’s instructions for when and how often to change your bandages and dressings.

Do not share items that come into contact with your skin

• Avoid sharing personal items such as towels and razors that contact your bare skin.
• Do not share ointments that are applied by placing your hands into an open container.
• Use a barrier (such as clothing or a towel) between your skin and shared equipment including weight-training, sauna, and steam-room benches.

Why does MRSA spread among athletes?

MRSA might spread easily among athletes because athletes:

• Have repeated skin-to-skin contact.
• May have cuts and abrasions that if left uncovered makes spread easier and also may allow MRSA to enter and cause infection. Share items and surfaces that come into direct skin contact.
• Are sometimes not able to shower or wash hands after exercise or after using shared equipment.

How to Prevent Spreading MRSA

• Cover your wounds. Keep wounds covered with clean, dry bandages until healed. Follow your healthcare provider’s instructions about proper care of the wound. Pus from infected wounds can contain MRSA so keep the infection covered to help prevent spread to others. Bandages and tape can be thrown away with the regular trash.
• Do not try to treat the infection yourself by picking or popping the sore.
• Clean your hands often. You, your family, and others in close contact should wash their hands often with soap and water or use an alcohol-based hand rub, especially after changing the bandage or touching the infected wound. Use soap and water if your hands are visibly soiled.
• Do not share personal items. Personal items include towels, washcloths, razors and clothing, including uniforms.
• Wash used sheets, towels, and clothes with water and laundry detergent. Use a dryer to dry them completely. Wash clothes according to manufacturer’s instructions on the label. Clean your hands after touching dirty clothes.

Athletes That Are Most At Risk

Skin infections, including MRSA, are most commonly reported among athletes in sports with a lot of physical contact. This includes wrestling, football, and rugby. However, MRSA infections have been reported among athletes in other sports such as soccer, basketball, field hockey, volleyball, rowing, martial arts, fencing, and baseball.

Even though some sports involve only small amounts of physical contact, MRSA might spread before or after participation, such as in the locker room. Anyone participating in organized or recreational sports should be aware of the signs of possible skin infections and follow prevention measures.

CDC encourages clinicians to consider MRSA in the differential diagnosis of skin and soft tissue infections (SSTIs) compatible with S. aureus infections, especially those that are purulent (fluctuant or palpable fluid-filled cavity, yellow or white center, central point or “head,” draining pus, or possible to aspirate pus with needle or syringe).

Common Clinical Manifestations

A patient’s presenting complaint of “spider bite” should raise suspicion of an S. aureus infection.

Recent data suggest that MRSA as a cause of skin infections in the general community remains at high probability.

The spectrum of disease caused by MRSA appears to be similar to that of Staphylococcus aureus in the community. SSTIs, specifically furuncles (abscessed hair follicles or “boils”), carbuncles (coalesced masses of furuncles), and abscesses, are the most frequently reported clinical manifestations.

The role of MRSA in cellulitis without abscess or purulent drainage is less clear since cultures are rarely obtained.

Possible Therapy

In the community, incision and drainage remains the primary therapy for these purulent skin infections. Empiric antibiotic coverage for MRSA may be warranted in addition to incision and drainage based on clinical assessment (e.g., presence of systemic symptoms, severe local symptoms, immune suppression, extremes of patient age, infections in a difficult to drain area, or lack of response to incision and drainage alone).

Considering Antibiotics

Antibiotic treatment, if indicated, should be guided by the susceptibility profile of the organism. Obtaining specimens for culture and susceptibility testing is useful to guide therapy, particularly for those with more severe infections and those who fail to respond adequately to initial management.

Follow-Up Plan

MRSA skin infections can develop into more serious infections. It is important to discuss a follow-up plan with your patients in case they develop systemic symptoms or worsening local symptoms, or if symptoms do not improve within 48 hours.

Cleaning and Disinfecting

MRSA spreads easily in athletic facilities, locker rooms, gyms, and health clubs because of shared equipment and skin-to-skin contact. Keep surfaces clean to prevent MRSA from spreading.

When should I clean athletic equipment and facilities?

• Always keep athletic facilities, such as locker rooms, and shared equipment clean whether or not MRSA infections have occurred among the athletes.
• Shared equipment should be cleaned after each use and allowed to dry.
• Repair or dispose of equipment and furniture with damaged surfaces that do not allow surfaces to be adequately cleaned.
• Clean equipment, such as helmets and protective gear, according to the equipment manufacturers’ instructions to make sure the cleaner will not harm the item.

How do I keep athletic equipment and facilities clean?

• Review cleaning procedures and schedules with the janitorial/environmental service staff.
• Focus on commonly touched surfaces and surfaces that come into direct contact with people’s bare skin each day.
• Cleaning with detergent-based cleaners or Environmental Protection Agency (EPA)-registered detergents/disinfectants will remove MRSA from surfaces. The products effective against Staphylococcus aureus are sufficient to kill MRSA. See the list of EPA-registered products effective against MRSA (List H).
• Follow the instruction labels on all cleaners and disinfectants, including household chlorine bleach, to make sure they are used safely and correctly.
• Cleaners and disinfectants, including household chlorine bleach, can be irritating and exposure to these chemicals has been associated with health problems such as asthma and skin and eye irritation. Take appropriate precautions described on the product’s label instructions to reduce exposure. Wearing personal protective equipment such as gloves and eye protection may be indicated.

Does disinfectant spraying or fogging work?

There is little evidence that large-scale use (e.g., spraying or fogging rooms or surfaces) of disinfectants will prevent MRSA infections more effectively than a more targeted approach of cleaning frequently-touched surfaces.

Should I read the label?

You should read the label before using products. The labels will tell you:

• How the cleaner or disinfectant should be applied
• If you need to clean the surface first before applying the disinfectant (e.g., precleaned surfaces)
• If it is safe for the surface. Some cleaners and disinfectants, including household chlorine bleach, might damage some surfaces (e.g., metals, some plastics).
• How long you need to leave it on the surface to be effective (i.e., contact time)
• If you need to rinse the surface with water after using the cleaner or disinfectant

Should I use household bleach?

Cleaners and disinfectants, including household chlorine bleach, can be irritating and exposure to these chemicals has been associated with health problems such as asthma and skin and eye irritation. However, they can be effective in reducing MRSA. Take appropriate precautions described on the product’s label instructions to reduce exposure. Wearing personal protective equipment such as gloves and eye protection may be indicated.

If you are using household chlorine bleach, check the label to see if the product has specific instructions for disinfection and sanitizing surfaces. Dilution of product will vary slightly depending on whether you are using commercial 5.25, 6.0, or 8.25% bleach. If no disinfection instructions exist, use 1/4 cup of regular household bleach in 1 gallon of water for product containing 5.25-6.0% bleach (a 1:100 dilution equivalent to 500-615 parts per million [ppm] of available chlorine) or 8.25% bleach use 1 oz (0.125 cups) in a gallon of water for disinfection of pre-cleaned surfaces.

Should I use the product to treat an infection?

Cleaners and disinfectants should not be put onto skin or wounds and should never be used to treat skin infections.

How can I keep MRSA from spreading to surfaces?

Cover wounds to reduce the risks of contaminating surfaces with MRSA.

Closing to Clean or Disinfect

In general, it is not necessary to close entire facilities to “disinfect” them when MRSA infections occur. Routine cleaning practices are enough in most situations. MRSA skin infections are transmitted primarily by skin-to-skin contact and by contact with surfaces that have come into contact with someone else’s infection. Spread can be prevented by simple measures such as hand hygiene and covering wounds.

Notifications

Usually, it is not be necessary to inform the entire school community about a single MRSA infection.

If a MRSA infection occurs in the school:

• Most schools require that any communicable disease be reported to the student’s teacher or administration. Consult with your school about its policy.
• The school healthcare provider should determine whether some or all students, parents, and staff should be notified.
• If medical personnel are not available at the school, consult with the local public health authorities to guide this decision.
• Repeat cases, spread to other students, or complex cases should be reported to the health department for consultation.

Excluding Students with MRSA Infections from School

Students with MRSA infections can attend school unless a healthcare provider tells them not to. But they should not attend school if:

• There is wound drainage (“pus”) that cannot be covered and contained with a clean, dry bandage.
• They cannot maintain good personal hygiene.

Advice for Teachers

• If you observe a child with open draining wounds or infections, take them to the school nurse. If a nurse is not available, call the child’s guardian and tell them to seek medical attention.
• Reinforce the need for hand hygiene by everyone as a part of general good health practice, particularly before eating, after touching potentially infected wounds or soiled bandages, and after using the bathroom.

Advice for School Health Personnel

• Students with skin infections may need to be referred to a licensed health care provider for diagnosis and treatment. School health personnel should notify parents/guardians when possible skin infections are detected.
• Use standard precautions (e.g., hand hygiene before and after contact, wearing gloves) when caring for broken skin (open wounds) or potential infections.
• Use barriers such as gowns, masks, and eye protection if splashing or other contact with potentially infected body fluids is anticipated.

Pests such as insects, rodents, fungi, and weeds can affect the school environment and the people who work and learn there. These pests can cause human health problems, structural damage, and plant damage.

Pests of Concern in Schools

You will need to know what pests you are facing before deciding how to control them. These pest fact sheets will give you a brief overview of some pests that may be issues at your school, including their life cycle, health concerns, and information about control.

• Ants.
• Bed bugs.
• Bees and wasps.
• Biting midges.
• Cockroaches.
• Flies.
• Lice.
• Millipedes.
• Mosquitoes.
• Rodents.
• Termites.
• Ticks.

Where to Look for Pests in Schools

Pests find homes in many places in and around schools, such as:

• Cafeterias - pests are attracted to food and water in confined locations, such as between appliances and in cabinets.
• Classrooms - pest populations increase in untidy areas, such as desks and closets.
• Lockers - clutter and food can quickly collect in lockers throughout the school year, providing a safe harbor and breeding grounds for pests.
• Gyms and locker rooms - these areas can be warm and poorly ventilated, providing breeding grounds for pests.
• Dumpsters - waste receptacles and surrounding areas are vulnerable to pest problems, especially when they are in close proximity to school buildings.
• Exterior conduits - all openings to the outdoors provide easy entry access for pests.
• Landscapes, school grounds and athletic fields - neglected landscapes can attract a wide variety of pests, including those that destroy school structures.
• Buses - present unique pest control challenges when schools initiate programs such as Breakfast on the Bus.

Basic Information on Pest Control in School

By using integrated pest management instead of solely relying on extensive pesticide applications, schools can reduce pest populations and reduce the use of pesticides, making schools safer for children and school personnel.

IPM reduces the use of pesticides by first monitoring pest populations to determine where, when, and what kind of controls should be applied. Schools can reduce pest infestations by identifying and removing conditions that will attract pests.

Preventive measures are easy to implement and often improve the overall maintenance of the school. These measures can include:

• Restricting where food is eaten.
• Moving dumpsters and food disposal containers away from the school.
• Repairing and maintaining leaking pipes.
• Pressure cleaning food service areas.
• Sealing cracks and crevices.
• Instituting sanitation measures.
• Cleaning gutters and directing water flow away from buildings to prevent saturation.
• Educating students and staff about how their actions affect pest management and control.

In addition to adopting preventive measures, the IPM approach includes evaluating a school's pest management practices and choosing lower-risk methods of pest removal and prevention. When developing an IPM program, schools should consider methods that:

• Minimize health risks to humans and the environment.
• Minimize disruption of the natural, outdoor environment.
• Are least toxic to species that are not pests.
• Prevent a recurrence of the pest infestation.
• Are safe and easy to apply effectively.
• Are cost-effective.

If You Think an Athlete Has a Skin Infection

• Refer athletes with possible infections to a healthcare provider such as team physician, athletic trainer, school nurse, or primary care doctor.
  • For athletes younger than 18 years old, notify parents/guardians about the possible infection
• Athletes with active infections or open wounds should not use whirlpools, therapy pools, and other water facilities (like swimming pools) that are not cleaned between uses until infections and wounds are healed.
• Educate athletes about ways to prevent spreading the infection.
• Make sure supplies are available to comply with prevention measures:
  • soap in shower and at sinks,
  • bandages for covering wounds,
  • alcohol-based hand rubs for hand hygiene, if soap and water not available

Protecting Athletes from Infection

Make sure all athletes:

• shower immediately after sports participation
• shower before using whirlpools, therapy pools, or swimming pools
• wash and dry uniforms after each use
• follow a healthcare provider’s advice as to when to return to sports or when to use whirlpools, therapy pools or swimming pools
• keep wounds covered, if a wound occurs
• report possible infections to the school nurse, other healthcare providers, or parents/guardian.

How to Prevent Spreading the Infection

• Use Standard Precautions, including hand hygiene, before and after contact with the patient, and after removing gloves, when caring for broken skin or possible infections.
• Ensure infected wounds on athletes are properly covered (e.g., with a bandage).
• To prevent infection, encourage athletes to cover acute, non-infected wounds such as
  • Cuts
  • Abrasions
  • Blisters
  • Lacerations

Excluding Athletes from Participation

• If sport-specific rules do not exist, in general, athletes should be excluded if wounds cannot be properly covered during participation.
  • The term “properly covered” means that the skin infection is covered by a securely attached bandage or dressing that will contain all drainage and will remain intact throughout the activity. If wounds can be properly covered, good hygiene measures should be stressed to the athlete such as performing hand hygiene before and after changing bandages and throwing used bandages in the trash.
• A healthcare provider might exclude an athlete if the activity poses a risk to the health of the athlete (such as injury to the infected area), even though the infection can be properly covered.
• Athletes with active infections or open wounds should not use whirlpools, therapy pools, and other water facilities like swimming pools until infections and wounds are healed.

MRSA can spread on laundry like sheets, towels, and clothing. Keep laundry clean to prevent MRSA from spreading.

Effective Laundry Procedures

Routine laundry procedures, detergents, and laundry additives will all help to make clothes, towels, and linens safe to wear or touch. If items have been contaminated by infectious material (like blood or puss), they can be laundered separately, but it is not absolutely necessary.

Proper Water Temperature

In general, wash and dry in the warmest temperatures recommended on the clothing label. Hot water washing is not necessary to remove MRSA from laundry. Read and follow the clothing and soap or detergent label instructions. Water temperatures for household laundry depend on the type of fiber or fabric of the clothing. Also, some laundry detergents are made to clean best at certain temperatures. Not following instructions could damage the clothing item or decrease the effectiveness of the detergent.

Using Bleach for Laundry

It is not necessary to use bleach for each load of laundry. Detergent alone will make laundry clean and safe for wear and use. Use of bleach as a disinfectant in laundering is optional, and not all fabrics are suitable for bleach. Read the clothing label instructions.

Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staph bacteria that is resistant to certain antibiotics called beta-lactams. These antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin, and amoxicillin. Most MRSA infections are skin infections that often appear as a bump, a boil, or area that is red, tender and swollen, and is sometimes confused with a spider bite. More severe or potentially life-threatening MRSA infections occur most frequently among patients in healthcare settings.

General Information about Staphylococcus aureus

Staphylococcus aureus [staf I lō-kok is aw ree us] (staph), is a type of bacteria that about 30% of people carry in their noses. Most of the time, staph does not cause any harm; however, sometimes staph causes infections. In healthcare settings, these infections can be serious or fatal, including:

• Bacteremia or sepsis when bacteria spread to the bloodstream.
• Pneumonia, which predominantly affects people with underlying lung disease including those on mechanical ventilators.
• Endocarditis (infection of the heart valves), which can lead to heart failure or stroke.
• Osteomyelitis (bone infection), which can be caused by staph bacteria traveling in the bloodstream or put there by direct contact such as following trauma (puncture wound of foot or intravenous (IV) drug abuse).

Staph bacteria can also become resistant to certain antibiotics. These drug-resistant staph infections include: Methicillin-resistant Staphylococcus aureus(MRSA), Vancomycin-intermediate Staphylococcus aureus (VISA), and Vancomycin-resistant Staphylococcus aureus (VRSA).

Staphylococcus aureus

Populations at risk for Staphylococcus aureus infection

Anyone can develop a staph infection, although certain groups of people are at greater risk, including people with chronic conditions such as diabetes, cancer, vascular disease, eczema, lung disease, and people who inject drugs. In healthcare facilities, the risk of more serious staph infection is higher because many patients have weakened immune systems or have undergone procedures. In healthcare, the risk of more serious staph infection is higher for patients in intensive care units (ICUs), patients who have undergone certain types of surgeries and patients with medical devices inserted in their bodies.

Staphylococcus aureus, often referred to simply as “staph,” are bacteria commonly carried on the skin or in the nose of healthy people. Staph bacteria frequently cause skin infections, such as boils. Most of these infections are not life-threatening.

In addition to skin infections, staph bacteria can cause infections in the blood, in the bones, and in the lungs (pneumonia). In the past, most serious staph bacterial infections could be treated with an antibiotic related to penicillin. However, over the past 50 years, some staph bacteria have become resistant to antibiotics, including the commonly used penicillin-related antibiotics. These resistant staph bacteria are called methicillin-resistant Staphylococcus aureus, or MRSA.

If I have had a methicillin-resistant Staphylococcus aureus (MRSA) infection or been told that I carry MRSA, am I at high risk for developing a serious MRSA infection if I get flu?

The overall risk of developing an MRSA infection after flu appears to be very low. However, CDC continues to work with state and local public health authorities to better understand this association.

What is being done about MRSA infections associated with flu?

CDC is working with state and local public health authorities to monitor and investigate infections with MRSA, including pneumonias and other types of MRSA infections that occur in patients with flu. CDC also acts as a technical advisor to state and local health departments and various professional organizations that are working to control MRSA.