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Thursday, Oct. 18, 1 p.m. ET

Schools Target Virulent Staph

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Judith Covich, RN
Sr. Nurse Administrator, Montgomery County Health and Human Services
Thursday, October 18, 2007; 1:00 PM

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 18 cases among students and are organizing extensive cleanups of numerous schools.

As of yesterday, Montgomery County schools had 14 cases, and lab results were pending in two dozen suspected cases. Fairfax County reported six infections among student athletes at four high schools, dating back to the start of the school year. 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

Judith Covich, senior nurse administrator for Montgomery County Health and Human Services, will be online Thursday, Oct. 18, at 1 p.m. ET to discuss what the schools are doing to combat the spread of the staph infection.

Submit your questions and comments before or during today's discussion.

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Judith Covich: Good Afternoon, I am happy to be here today to respond to your questions about MRSA and provide prevention tips.

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Gaithersburg, Md.: My son attends Poolesville HS. We've received a letter from the principal and the letter yesterday from Dr. Weast, outlining procedures for parents and students to follow. Nowhere do the letters say that the schools are doing anything to prevent the spread of infection. Will gym equipment and lockers be wiped down between uses? If cost is a factor, why not ask parents to donate wipes the same way we already donate kleenex?

Judith Covich: Dr.Weast,MCPS Superintendent, and Dr. Tillman, Montgomery County Health Officer and Chief of Public Health sent a letter to all parents on Oct 17. In it they outlined the preventive measure that MCPS is taking to prevent the spread of MRSA. At schools with suspected or confirmed cases of MRSA, in addition to general cleaning, additional cleaning is being conducted with a 1 to 10 percent bleach solution in locker rooms, weight rooms, and physical education areas Disinfectant wipes have been provided to students for use before using weight room equipment. School nurses have distributed prevention information to students, coaches, PE teachers and others.

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Symptoms: What are the symptoms to look for, especially in children?

I don't want to freak out over what looks like bites or pimples.

Judith Covich: Wounds infected with staph or MRSA may be red, swollen, paoinful or have pus or other drainage. They can look like pimples, boils or spider bites. If you are concerned you may check with your school nurse and/or have your child seen by your health care provider and request a culture.

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Gaithersburg, Md.: What should I tell my child (high school)to do to prevent this disease? Is there a quick test (like for strep) that a doctor can do?

Judith Covich: Prevention is good hygiene: Wash hands, do not share others personal items (towels, razors), shower as soon as possible after phyical activity or working at the gym.
Your doctor can do a culture--results ususally take 48 yours.

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Alexandria, Va.: This is what experts have been warning about for years! How would the average person recognize a problem? Should this prompt an emergency doctor visit if symptoms are seen?

Judith Covich: Again, if a wound or sore is swollen,painful, red, has pus or drainage,or if a sore is getting worse, not better check it out with your doctor.

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Silver Spring, Md.: All of the affected Montgomery County schools are in the upper-middle class areas of Montgomery County. Any thoughts on why the problem is not affecting the downcounty or lower-income areas?

Judith Covich: MRSA can affect all populations.

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Montgomery County: Judith -- thanks very much for taking our questions online. There's so much hype now over MRSA that I'm trying to figure out how concerned I have to be, especially as a parent. Most of the school-age cases reported in MGC seem to be pimples that were caught and treated early and successfully. So what distinguishes an MRSA infection from a regular staph infection? And how effective are older drugs such as doxycycline against MRSA staph? Thanks again.

Judith Covich: You mention being treated early. This is an important factor in prevention. MRSA is distiguished by the fact that it is not responsive to the more generallly used antibiotics, however community aquired MRSA can be treated with other antibiotics.

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North Potomac, Md.: My kids attend Robert Frost MS -- thankfully I don't belive they have had any cases yet -- but how do we prevent it and ensure that our kids are protected.

Thanks,

Judith Covich: Maintain general hygiene by regular bathing; shower after participating in physical activity;launder exercise clothing after each practice;cover draining wounds. If draining wounds cannot be contained, do not participate in sports.

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Skeptical USA: The Post article today talks about "extensive clean up" of the schools. What does that mean? Sounds like a PR campaign. In reality, the schools can't do anything except disseminate information, e.g., don't share razors (thanks for that great tip).

Judith Covich: In addition to regular cleaning with a disinfectant, in schools where students have confirmed or suspected MRSA,MCPS is cleaning weight rooms, locker rooms, physicial education areas with a 1:10 bleach solution which kills MRSA. They are also providing disinfectant wipes in all weight rooms for students to clean equipment before using it.

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Washington, D.C.: When I was diagnosed with MRSA (and VRE) three years ago, hospitals didn't have a standard protocol for dealing with the infections. I know this is a bit out of your baliwick, but do you know if that has changed? (and thank you for taking the time to help people understand the seriousness of the infection. I had less than a 40 percent chance of surviving).

Judith Covich: I believe that you are asking about protocols for hospital acquired MRSA. You may want to check the CDC web site: www.cdc.gov.

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Dallas, Tex.: What is the best prevention? I hear that this is something you can pick up from equipment at the gym -- what should someone do, other than avoid the gym, which isn't a good idea either?

Judith Covich: Take time to wipe down the equipment before using it with a disinfectant wipe. Many public gyms and sports clubs will have them available for you. Take a shower with soap after your work-out and wash your gym wear.

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Brush, Colo.: Is a burning sensation in hands, possible symptum, lasting three days. 14-year-old girl.

Judith Covich: If you have a concern about a skin condition you should contact your health care provider.

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Washington, D.C.: After reading this week's JAMA article on MRSA, I was surprised to find that the mortality rate for community-acquired MRSA was only 0.5 per 100,000 people. The case rate was only 4.6 per 100,000 people. Given that there is such a low risk of getting the infection, much less dying from it, why is there suddenly so much attention being paid to this issue? Aren't there other diseases (influenza, TB, pneumonia) that are also preventable and have much higher morbidity and mortality?

Judith Covich: The JAMA article reports on a study of hospital based MRSA. The cases that we are seeing in recent news reports are community acquired. There is a lot of attention because the rates have not been measured before and many health official believe that it is higher than expected.

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Skeptical USA: And what about little children who have a habit of putting their fingers in their eyes, mouth, and nose?

Judith Covich: Staph is a bacteria which is frequently found on the skin and in the nose. It's important to wash your child's hands frequently. If your child has a cut it should be washed, covered and checked for signs of infection.

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Montclair, Va.: I am concerned that schools didn't send out letters when there have been confirmed cases in a school, with health information. We hear about other communicable diseases. Is this a matter of the newness of MRSA in the non-hospital community?

Judith Covich: As you see from the JAMA article about hosptial-acquired MRSA and the comments from the medical community, there is a higher rate of occurance and mortality than expected.
MRSA is not a reportable disease, like TB. We are only now beginning to be aware of the extend of community acquired MRSA.

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Germantown, Md.: I've read that the staph bacteria can live on surfaces such as shower curtains and on hidden areas that are difficult to clean. Some authorities recommend fumigation to completely eliminate the bacteria. Does MCPS have the capability to fumigate schools if the problem becomes severe?

Judith Covich: MCPS is following CDC recommended cleaning for showers, physical education areas and locker rooms. Cleaning is important, however personal hygiene is essential to prevention. This includes handwashing, showering after physical activity, not sharing personal items and washing athletic clothing after use.

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Editor's Note: washingtonpost.com moderators retain editorial control over Discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions. washingtonpost.com is not responsible for any content posted by third parties.


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