MRSA in my student

[babyboomer]

I'm a special ed teacher. One of my kids was hospitalized several months ago - the 'spider bite' they thought she had turned out to be MRSA (which I had never ever heard of before this!).

She got it again (on her buttocks - and she is diapered) - we noticed it at school and she was on meds for 10 (?) days.

And maybe within a month, we saw it again... a small wound with a pustule in the middle - it bled when I cleaned her.

This time, things got worse. Wound really really grew; she could barely walk, was on heavy pain meds (she is nonverbal). Finally she was hospitalized again - and they did surgery (to remove the abcess?)

ALL of my students have developmental disabilities - several use diapers. We use handwashing, cleaning the changing table, etc.,... how contagious IS it around other kids?

Is it true - each case needs to be reported to CDC?

Will she keep having it?

[lisa6wks]

Hi,
I am also a special education teacher of children with multiple disabilites so we have a lot of diapering and feeding as well. I understand that MRSA is pretty contagious and usually people get it in the hospital. I would check with your school nurse, that is if they are a real nurse, if not then which ever nurse is in charge of health for your school system. I would think the child should not be in school when she has any open sores.

Hopefully you are all wearing gloves, I know they are a pain in the neck but very necessary, but it is just about impossible not to spread some germs in your situation.

I would definitely check to see what the rules are in your school system.

Lisa

[babyboomer]

Hi...

Interesting you mentioned nurses... we have 2 in our 'unit'... one has been out since August; we've had some 'subs'... which makes things complicated since our 'unit' has several hundred severely handicapped students.

When the MRSA came back again and again, I did a google 'MRSA school' search and found that some school systems have actual plans, procedures, etc., for it. I shared what I found w/ my admininstrator ... we now have a registry nurse who 'needs to be told how to do everything'... really hard for the other nurse - now she's de facto RN for 30+ classrooms of severely handicapped kids!

I'm gonna connect with the administrator re: having a policy re: MRSA in school. I've got another one out sick - he's pretty fragile (g tube, respiratory complications, etc., due to prematurity)...we go through gloves like they're going out of style...

The jury is out, as far as I could tell, re: surface-to-skin exposure being a possibility...

Not too long ago, I had a little one w/ CMV ... nurse had protocol re: cleaning EVERYTHING... no pregnant women staff. WHEW!

One good thing:)... only 3 of my kids are always diapered... all the rest are in various stages of learning to use the BR:) Last year ALL of the kids were diapered:(... am really glad we've made this progress!:):):)

[lisa6wks]

Hi,
I am just interested, where do you work that you have so many severely disabled students in one place?

Lisa

[janster]

Hi~
Each case of MRSA needs to be reported to the CDC. That is correct. The Clinic or hospital that treats the person must report it.

MRSA is a serious staph infection and is very contagious. When I had it I was in the hospital in isolation. I can't imagine any physician clearing any child to go to school if they have active MRSA. Does the child just break out with boils/carbunkles? They are filled with the staph bacteria, but it is not MRSA.

I was a nurse's aide in a nursing home. We had a resident who had MRSA and did not know it. I practiced good hand washing techniques. I still contracted MRSA. They do not know where she got it because she was not in a hospital. MRSA can be contracted anywhere.

There are only a few antibiotics that will eradicate MRSA, and they are given by IV. Once you have MRSA you are more susceptible to get it back because of your now compromised immune system, and it colonizes, but usually stays dormant, in your nose. If MRSA kept coming back and back, I'm wondering if they had it completely eradicated, or maybe the medicine was stopped too soon, or it was the wrong antibiotic, where it was never gone...just a thought.

One last thing about MRSA bacteria. It doesn't have to be spread by direct contact. It can be spread by indirect contact also. That means doorknobs, water faucets, combs, clothes etc. We need to remember it is a bacteria. Think of were bacteria can all live....... MRSA is nothing to mess around with, people can and do die from it, left untreated.

I think having a MRSA plan incorporated into the school's policy would be great. You may not need it, but since you have had MRSA there already, at least it would be there if you would. I'm guessing you would be needing it.

Good luck and let me know how things turn out, if you would. If I can help in any way, I sure will.
Hugs,
Jan

[babyboomer]

re: where I teach - a large urban area (emphasis on LARGE)

I learned the last day my student was in school (over 4 weeks ago) that she had some ointment (I am guessing it was a prescription) for her buttocks, re: MRSA (or diaper rash??? or...?)) The mom told me this when I called her re: bleeding sore on child's buttock. (If we are to administer ANY medication, we need (1) doctor's order along with when/how much/how to administer meds and (2) meds (brought by parent, not sent in backpack) and THEN the nurse writes up a procedures chart and whenever we give meds', feed via g-tube, use nebulizer, etc., the district is ultimately re-imbursed via "fee for service" $... )

Back to the ointment - even though it needs to be put on 2x/day, it sounded like the mom wasn't putting it on in the morning, before school, for whatever reason. She may not have even been using it appropriately - discontinuing it early or doing it twice/day. Maybe the ointment use/misuse played some (unknown to me) role in the MRSA...

From what I've read re: MRSA online, it frequently shows itself via sores - buttocks was listed as one frequent place. So if a person (already colonized w/ MRSA) has an open, bleeding sore on a place commonly associated w/ MRSA, it isn't a leap of thought to think that sore is MRSA-related... Typically when a young child is toileted in school, diapers w/ urine are removed in the bathroom and the child practices toileting - the diaper is bagged, gloves are worn, etc. But if the child has a BM, it's simply easier and more hygenic to use a changing table. And, if the wound is on the buttocks, it may not be seen immediately when the diaper is removed ... even though a paper liner is underneath the child. And then, while the child's bottom is being cleaned, the wound is found... and if it bleeds when it's wiped, the wound is instantly mixed with feces. While everything - table, gloved hands, child's bottom, etc., are cleaned in a sanitary manner, the fact remains that there is the (remote?) possibility that MRSA bacteria travelled somewhere nearby - the rim of the trash can... a wall nearby (the reality is we (and many other SDC's for kids w/ moderate to severe disabilities) cordon off a section of the classroom w/ cabinets and screens/curtains for a 'changing area' - while in an ideal world, every SDC classroom would be equipped with an attached 'full service' bathroom complete with changing table, etc., that is not often the case - especially when an SDC is located on an integrated school site)

One of my little ones was a premie... his lungs are VERY compromised. One day the doctor faxed us a note he could return to school - (child's 1:1 - an RN from another country - heard sounds of congestion and we decided mom should be called - he went home, mom took him to doc) .. well that night the mom had to go to the ER - he had a fever of 103 degrees. And a few days later, he was hospitalized for 2 days with more respiratory things. Little one is a "frequent flier" to doc/hospital.

And both kids are diapered. You do the math... while we sanitize very well, we're not the same as a hospital. (When I talked w/ head administrator re: need for disinfectant for table - we've been using the wipes commercially available - which *I* have been buying - she (admin) mentioned something re: bleach solution - which, according to another RN, becomes ineffective within a day or so. I'm not about to keep a gallon of bleach in the classroom when all we have for 'security' are those plastic baby locks that go through 2 cabinet handles) and mix (and then discard the unused) the stuff. Somewhere "out there" there has to be some disinfectant solution that is safe enough to keep in a classroom - and (hypothetically at least) the 'system' would buy, rather than me. (I already buy TONS of stuff - teaching tools, etc., - I think the System needs to be responsible for important things like sanitation.

So, after winter break, both kids will be in the classroom - one who's colonized with MRSA and diapered, and the other one who gets a respiratory 'problem' at the drop of a hat... and both are diapered. What if one coughs while the other one (across the room) is using the nebulizer? What if one touches (a doorknob, a desk...) and someone else touches the same thing and somehow the other one... who likes to hit... somehow touches someone who touched the doorknob...?

One of the school-related MRSA websites (district policy stuff) basically said 'this' (kid with MRSA, kid w/ weakened system) is a problem and one may need to be removed for the other one's safety.

But... tis winter break ... no one is 'thinking' at the present... and when January (and my two kids) arrive, I shall once again call the admin and the RN and share my concern.

Hopefully, someone will make an intelligent decision.

Or do I tell the mom of the kid w/ weakened immune system myself re: MRSA in the room? (In an ideal world, the RN and the admin... the SYSTEM... would have an effective MRSA po9licy... but this, alas, is the real world, instead)

Maybe I will just declare myself king (AKA admin) and (1) purchase effective disinfectant and accompanying materials, (2) research and write an effective MRSA plan, (3) teach ALL staff = THROUGHOUT THE ENTIRE SYSTEM - 100'S OF STAFF - about MRSA as an extra added incentive to keep everything very VERY clean, and (4) make an appropriate decision re: what to do when MRSA is in a classroom along w/ a child having a weakened system.

Anybody got a crown?

[janster]

Hi~
I can see you are in the right profession. You are a very caring individual. We need more teachers like you! Bless you!

Before I was a Nurse's aide I was a Computer Tech for 11 years in a school district. It was a small district, so I knew each teacher personally. You are one of the elite. Again, bless you!

You should not have to buy supplies yourself, but I know exactly how that goes; I did it myself. The more you do, the more they expect you to. Do you know the Health Officer, or the equivalent in your district? I'm guessing this person would be over the school nurse. I'm also guessing the school does not want this problem to go public. MRSA is a big deal, if in fact that's what it is. If you would go this route, they could make your life at work miserable.

However, there are other ways to maybe get this addressed. I would say one other choice would be to send an anonymous letter to the Health Officer or equivalent at your district, with a cc (carbon copy) to: Superintendent & CDC for your state. I think that will get some attention.

Another choice would be to call the parents of the child whose immune system is compromised, and tell them of the dillema that you think is happening and how you are concerned about their child's well being. You would be trusting them to not reveal the source when taking this to the proper authority though.

This is all my opinion, for what it is worth. I don't know what to tell you to do, if anything.... Good luck, and let me know what happens. I care.
Hugs,
Jan :)

[MaineERnurse]

Wow...

That is all I can say...

Wow


When we have patient with MRSA in the hospital, they are isolated from the other patients until they have 2 negative cultures 72 hours apart. This applies even if their MRSA was from the last visit. IF they come back, their chart pops positive with a MRSA warning and they go on isolation and we culture them.

Now, there is a difference between community-acquired MRSA and hospital acquired MRSA. Here are some links to articles on CA MRSA
http://www.ochealthinfo.com/epi/mrsa/providers.htm
http://www.cdphe.state.co.us/dc/Epidemiology/CO_MRSA_schools5_03.pdf
http://peds.wustl.edu/id/docs/MSRA_School_Information.pdf
http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_public.html
http://www.health.state.ri.us/disease/communicable/providers_mrsa060705.php

Good Luck
Jackie

[babyboomer]

An update... today my kids should have returned to class. My lttle one w/ MRSA did not... just 2 weeks after completing the medication prescribed for her re: MRSA, another abcess was found on her leg. MRSA again.

I have questions -
1 - If MRSA keeps coming back, is there anything that can be done to stop this?
2 - Must she take medication for the rest of her life? (I would think that antibiotics lose their potency or effect after awhile.)
3 - How does one find a MRSA specialist?

Thank you!

[janster]

Hi~
I'm not sure what to tell you. All I can tell you is if I were you I would not be working around diagnosed MRSA. I have had MRSA as I've said, and was hospitalized in isolation--that being no one entered my room without a gown, mask, and gloves. I had disposable eating utensils, plates, thermometer, everything.

If the child is always in the hospital after being diagnosed with MRSA, then cleared from the doctor before coming back to school, all within two weeks, something does not add up--to me. I am not a medical professional though. I was on an IV for 10 days to eradicate the MRSA, then needed more than 4 days to get my strength back, but I was in my 40's.

I would think if this is MRSA it was reported to CDC, and they would be monitoring the case. (It is the law that it must be reported to the CDC) I really don't know what to tell you. Is there a way for you to find out for sure if it is MRSA, and if it is, if it was reported?

There are only a few drugs that are potent enough to eradicate MRSA, that's the "R" (Resistant) in MRSA. That's why it is so hard to treat and why diagnosis is imperative. That's only part of an answer to your question.

As for taking medication for the rest of her life, well, I don't. I can only answer for myself.

As for finding a MRSA specialist, I am unaware if there is such a specialist, but have you tried googling it? I was treated by my GP in my local hospital after MRSA was diagnosed.

I wish I could be of more help to you, but I can only go from personal experience. Maybe someone more qualified will come along with other answers. Keep me posted, ok? I care!
Hugs,
Jan