As Cases Arise, Schools Act to Ward Off Virulent Staph

By Susan Levine and William Wan
Washington Post Staff Writers
Thursday, October 18, 2007

As national estimates focus on an increase in serious infections caused by an antibiotic-resistant germ, officials in the Washington region have identified more than a dozen cases among students and are organizing extensive cleanups of numerous schools.

The confluence of circumstances, highlighted by the death of a teenager this week in Bedford County, Va., has put administrators and parents on edge and pushed the superbug, methicillin-resistant staphylococcus aureus, into the forefront of public attention.

Millions of Americans routinely carry staph bacteria on their skin or in their nasal passages and have no problems. And many infections are relatively mild, with the body successfully fighting the germ. But this virulent strain of the microbe can turn minor cuts and sores into life-threatening conditions.

As of yesterday, Montgomery County schools had 14 cases, and lab results were pending in two dozen suspected cases. Anne Arundel County schools have recorded one MRSA infection and have received 57 reports from parents about possible cases. Two cases have been confirmed at Wilde Lake High School in Howard County.

Administrators in several jurisdictions have sent notices to parents about steps that school systems are taking. Some have adopted policies that include requiring gym equipment to be wiped down after use. In Arlington County, school nurses are giving information to students about how to care for cuts.

Just beyond Northern Virginia, the Rappahannock County school system recently finished a comprehensive cleaning of its two campuses. One of that system's two MRSA cases involved a high school athlete who was hospitalized after his diagnosis. Rappahannock hired a company to clean locker and weight rooms and sent all football equipment to Philadelphia to be professionally washed.

Rappahannock Superintendent Bob Chappell said school employees also followed a local hospital's advice to mop hallways and classrooms with a bleach solution. The cost of the cleanup: more than $10,000.

"It's real easy . . . to point fingers all over the place," said Larry Sells, a parent at Anne Arundel's Severna Park High School, where several cases are suspected. "But the only finger-pointing that does any good is at the problem and how to get it fixed."

Getting ahead of MRSA is a daunting challenge. Hospitals and nursing homes have been dealing for decades with the pathogen, which is especially risky for patients with weakened immune systems or those recovering from surgery or in intensive care.

A report this week in the Journal of the American Medical Association estimates that serious incidences of this strain are far more frequent than previously thought. Every year in the United States, the researchers said, MRSA causes more than 94,000 acute infections and nearly 19,000 deaths.

Part of the surge in the estimates has followed the emergence of MRSA in the community, where awareness has lagged even among health-care providers. As clusters of cases have drawn headlines, some because they involved high-profile athletes, attention and concern have grown.

According to the federal Centers for Disease Control and Prevention, staph bacteria are one of the most common causes of skin infection in the United States. A contaminated cut or scrape can become red, swollen or increasingly painful. The danger with MRSA is that it is often not correctly identified and treated with the right antibiotics, giving the germ a chance to become invasive.

In the case of the 17-year-old Bedford County boy who died Monday, the infection had spread to his kidneys, liver, lungs and the muscle around his heart. Officials there shut down 21 county schools for cleaning.

"What's clear to us is that this bacteria is coming into our schools from the community because the cases are so widespread, and there appears to be no pattern," said Montgomery schools spokesman Brian Edwards.

All 14 Montgomery students with confirmed infections have been treated and are doing well, county Health Officer Ulder Tillman said yesterday. The first of those cases occurred in June with a member of the Sherwood High School football team; in August, diagnoses were confirmed in six of his teammates. The remaining students attend four other high schools and three elementary schools.

With the sudden rise in cases, Tillman and Superintendent Jerry D. Weast sent a joint letter yesterday to Montgomery parents outlining the problem and steps they can take to prevent infection.

School officials in Prince George's County said they have had no confirmed cases of MRSA. Because of reports in other jurisdictions, they have begun cleaning locker rooms and showers with a hospital-grade disinfectant.

A D.C. Health Department epidemiologist said no MRSA cases have been identified in the city's public schools this fall. But officials are counting cases diagnosed in District hospitals. Five facilities, including Children's Hospital, logged more than 1,300 confirmed cases between December and September.

"They come in from all over," said Nalini Singh, chief of the infectious diseases division at Children's Hospital.

Few jurisdictions mandate MRSA reporting, although Maryland is working on a system to track and publicly disclose infections in hospitals and other health-care institutions. An advisory committee is to release its report on implementation in November, and the collection of data from hospitals is expected to begin next year.

By then, more than three dozen facilities in Maryland, the District and Northern Virginia will be involved in a national project to encourage common-sense approaches to block MRSA in institutional settings. Some surprising measures are being put into practice. Clergy visiting patients are covering their Bibles with surgical caps, and housekeeping employees are testing their thoroughness with glow-in-the-dark chemicals.

Staff writer Ian Shapira contributed to this report.

© 2007 The Washington Post Company