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Diseases & Topics

Community-Associated MRSA

Managing CA-MRSA in Child Care Settings

N.C. Public Health Recommendations

Cases of MRSA in child care can cause much anxiety for parents and school staff. This document is intended to provide information about MRSA infections in this setting and how to prevent them.

In a 1999 study, researchers found that MRSA colonization was as high as 24% in one child care center and none of the colonized children, nor their households, had contact with health care.

Most colonized children will never get sick from MRSA. MRSA is spread through direct physical contact with an infected person. Draining lesions are highly infectious and represent an important source of spread. MRSA can also be spread by touching objects that have been soiled with drainage from an infected wound or from objects in the environment like toys that may be shared.

Control Measures

We do not know the exact risk of spreading MRSA in the classroom, but we do know that the following universal control measures should reduce the likelihood of transmission in child care settings.

The spread of infection in child care can be controlled if all staff and students adhere to these basic hygiene measures:

  • Keep your hands clean by washing thoroughly with soap and water.
  • Wash any cut or break in the skin with soap and water and apply a clean bandage daily.
  • Avoid contact with other people's wounds or bandages. If a staff member is required to assist with a student's bandage, that staff member should wear gloves, place the used bandage in the trash, and wash his/her hands and forearms immediately after removing gloves.
  • Follow existing N.C. Child Care rules for sanitation of toys and other shared items.

Children/staff with symptoms of MRSA should see a doctor or other qualified healthcare provider and do all of the following:

  • Keep draining wounds clean and covered.
  • Take all antibiotics as prescribed.
  • Report new skin sores or boils to your doctor immediately.

Additional Control Measures

  • Children/staff known to be colonized with MRSA in the nose or skin do not need to be excluded from the child care.
  • Children/staff known to be colonized with MRSA who have draining wounds or skin sores should be excluded from childcare if the wounds cannot be covered, contained, or dressing maintained intact and dry.
  • More complex situations should be assessed on a case-by-case basis in conjunction with the local health department, health care provider, child care director and parent.

The case-by-case assessment should take into account factors such as specific needs or characteristics of the child; the classroom setting; the number and types of children; classroom staffing; and the ability of the program to implement precautions that need to be taken to minimize the risk of transmission.

Decisions about when a child with known or suspected MRSA skin infections can return to child care should be made by a doctor or other qualified healthcare provider. Not all MRSA skin lesions require treatment with antibiotics. Therefore no specific course or duration of antibiotic treatment is required for re-entry unless specified by the healthcare provider.

For Additional Information