Staphylococcus aureus (“staph”) infections have been around for a long time, causing mild to severe illness. MRSA is a kind of staph infection that may be more difficult to treat but is otherwise the same as a “staph infection”. Mild infections may look like a pimple or boil and can be red, swollen, painful, or have pus or other drainage. More serious infections may cause pneumonia, bloodstream infections, or surgical wound infections.

Staph is passed from person to person through direct contact with skin or through contact with contaminated items. The bacteria may live in people’s noses and on their skin and most of the time do not cause any problem. Staph can enter the body through breaks in the skin and sometimes cause infection. The main ways to prevent staph infection are to wash hands and care for wounds properly.

Practical Advice for Parents

• Clean wounds and cover them with a clean, dry bandage. Wounds that do not heal properly need medical attention. The only way to determine if an infection is caused by MRSA is through laboratory testing ordered by a physician or other health care provider.
• Teach children to wash their hands regularly, such as before eating and after toileting. For additional information (including posters) go to Stopping the Spread of Germs at Home, Work, & School.
• Be sure your family members use antibiotics properly. Take all that are prescribed, even if the symptoms stop before the prescription is used up. Do not share prescriptions.
• Children who participate in sporting events should wash their hands after each practice and game and shower as soon as possible. They should not share equipment, uniforms, towels, or other personal items. Wash uniforms and towels with hot water and detergent after each use.
• Always tell your childcare provider when your child has an infection.

Program Responsibility

• Be sure the program’s policies and procedures are being followed.
• Encourage hand washing upon entering the childcare program, before eating and after toileting.
• Child day care centers and group day care homes should consult with the program’s health consultant.
• Observe children for open wounds. If any are draining or contain pus, the child should be excluded until the child has been seen by their health care provider, and the wound addressed appropriately.
• When wound care is necessary, wear gloves. If a dressing is no longer intact, and a new dressing needs to be applied, the soiled dressing should be secured and kept out of reach of children.
• Refer parent to licensed health care provider. Skin infections may need to be incised and drained and/or need antibiotic treatment based on laboratory testing.

Control of Spread

• Children or staff members, who are colonized or infected with MRSA, do not need to be routinely excluded from the classroom.
• Individuals with open wounds should keep them covered with clean, dry bandages that are taped on all four sides. Bandages should be changed at home.
• Diapers are not bandages because they do not stay dry and must be changed often.
• Exclusion from the childcare program should be reserved for those with wound drainage that cannot remain covered and contained with a clean, dry dressing taped on all 4 sides.
• When MRSA occurs within the program, consultation with the program’s health consultant or the local health department, should occur to determine whether some or all parents and staff should be notified.
• Children with weakened immune systems may be at risk for more severe illness if they get infected with MRSA. These children should follow the same prevention measures as all others to prevent staph infections.
• Gloves should be worn if you expect to have contact with non-intact skin or mucous membranes. Hands should be washed immediately after removing gloves.
• Good personal hygiene and hand washing with soap and water for at least 20 seconds should be implemented.
• If soap and water are not available, use an alcohol-based hand sanitizer with at least 60% alcohol concentration.
• Potentially contaminated surfaces such as eating utensils and food-contact surfaces, changing tables, play tables, high chairs, and door knobs should be cleaned with an EPA-registered disinfectant labeled effective against MRSA, and manufacturers directions should be followed. Household bleach may also be used: 1 teaspoon of liquid bleach for every gallon of water for eating utensils and ¼ cup bleach to 1 gallon of water for general cleaning. A new solution should be made up every day. For eating utensils and food-contact surfaces, use bleach that has an EPA label and directions for use as a food-contact surface sanitizer.
• Clean and disinfect cots regularly (at least daily), and use pillow protectors.
• If soiled linens and clothing are washed on site, wash with water and laundry detergent. Dry clothes in a hot dryer.
• Clean and sanitize mouth toys between children.

Further information about MRSA can be found at:

• Community onset MRSA. (CDC)
• Questions and Answers about MRSA for School Health Professionals.  (MASS)

The Tacoma-Pierce County Health Department in Washington State has developed a MRSA Toolkit for Childcare Centers that may be helpful in responding to questions about MRSA.

This toolkit has been designed to help prevent and stop or reduce the spread of MRSA skin infections in childcare centers. It contains educational materials for childcare center workers, parents and the children who attend childcare centers.

The Environmental Protection Agency's (EPA) list of EPA registered products effective against MRSA.

If you have additional questions about MRSA, please contact your health consultant, your local health department, or the Epidemiology and Emerging Infections Program (860-509-7994).