How to Avoid MRSA in Childcare

Preventing MRSA in Childcare: A Comprehensive Guide for Parents and Providers

Childcare facilities, while essential for working families, present a unique environment where infections can spread rapidly. Among the most concerning is Methicillin-resistant Staphylococcus aureus (MRSA), a type of staph infection resistant to many common antibiotics. While MRSA can affect anyone, children are particularly vulnerable due to their developing immune systems, close physical contact, and often less stringent hygiene practices. For parents and childcare providers alike, understanding and implementing robust preventative measures isn’t just important—it’s critical. This in-depth guide will equip you with the knowledge and actionable strategies to significantly reduce the risk of MRSA transmission in any childcare setting.

Understanding the Enemy: What is MRSA and How Does it Spread?

Before we delve into prevention, let’s clarify what we’re up against. Staphylococcus aureus (staph) bacteria are commonly found on the skin and in the noses of healthy people. Often, they cause no problems. However, if they enter the body through a cut, scrape, or other break in the skin, they can cause infections. MRSA is a strain of staph that has developed resistance to methicillin and other similar antibiotics, making it harder to treat.

MRSA infections often begin as small red bumps that resemble pimples, boils, or spider bites. These can quickly turn into painful abscesses requiring surgical drainage. In more severe cases, MRSA can cause serious infections of the bloodstream, bones, joints, lungs, or heart, which can be life-threatening.

In childcare settings, MRSA primarily spreads through:

  • Direct Skin-to-Skin Contact: This is the most common mode of transmission. Children play closely, hug, and share toys, facilitating the transfer of bacteria.

  • Contact with Contaminated Objects and Surfaces: MRSA can survive on surfaces like toys, changing tables, doorknobs, and shared equipment for hours or even days. If a child touches a contaminated surface and then touches an open wound or their nose/mouth, transmission can occur.

  • Poor Hygiene: Inadequate handwashing, especially after using the restroom or before eating, significantly contributes to the spread.

  • Open Wounds and Skin Lesions: Cuts, scrapes, insect bites, eczema, and even diaper rash can serve as entry points for the bacteria.

  • Shared Personal Items: Towels, washcloths, clothing, and even sports equipment can harbor and transmit MRSA if not properly sanitized.

The insidious nature of MRSA lies in its ability to colonize individuals without causing active infection. These “carriers” can unknowingly spread the bacteria to others, making widespread prevention strategies essential.

The First Line of Defense: Impeccable Hand Hygiene

The single most effective measure against the spread of MRSA, and indeed most infections, is meticulous hand hygiene. This goes beyond a quick rinse; it requires a systematic approach for both children and adults.

For Children: Cultivating a Lifelong Habit

Teaching children proper handwashing from a young age is crucial. It needs to be consistent, fun, and clearly explained.

  • When to Wash:
    • Before eating or handling food.

    • After using the toilet or having a diaper change.

    • After blowing their nose, coughing, or sneezing.

    • After playing outdoors.

    • After touching animals.

    • When visibly dirty.

    • Upon arrival at the childcare facility and before leaving.

  • How to Wash (The 20-Second Rule):

    1. Wet hands with clean, running water (warm or cold).

    2. Apply soap. Any soap will do; antibacterial soap is not necessary and can contribute to antibiotic resistance.

    3. Lather hands thoroughly, including the backs of hands, between fingers, and under nails.

    4. Scrub for at least 20 seconds. This is often taught by singing a short song like “Happy Birthday” twice.

    5. Rinse hands well under clean, running water.

    6. Dry hands using a clean towel or air dryer.

  • Making it Fun and Engaging:

    • Use colorful soaps or fun-shaped soap dispensers.

    • Sing handwashing songs together.

    • Use visual aids like posters illustrating the steps.

    • Make it a routine before every meal and after every restroom break.

    • Lead by example – children mimic adult behavior.

  • Hand Sanitizer as a Supplement, Not a Substitute: Alcohol-based hand sanitizers (at least 60% alcohol) can be used when soap and water are not readily available. However, they are less effective when hands are visibly dirty and do not eliminate all types of germs. Always prioritize soap and water. Example: A childcare provider might use hand sanitizer after assisting a child with a runny nose, but insist on soap and water handwashing for all children before snack time.

For Childcare Providers: Setting the Gold Standard

Childcare providers are critical role models and frontline defenders. Their hand hygiene practices directly impact the health of every child in their care.

  • Frequent and Thorough Washing: Providers must wash their hands rigorously:
    • Before and after changing diapers.

    • Before and after preparing or serving food.

    • Before and after administering medication or tending to a wound.

    • After assisting a child with toileting.

    • After blowing their own nose, coughing, or sneezing.

    • After handling shared toys or equipment that might be contaminated.

    • After cleaning up bodily fluids (vomit, blood, urine, feces).

    • Before and after putting on or taking off gloves.

  • Gloves are Not a Substitute: While gloves offer a barrier, they are not an alternative to handwashing. Hands should always be washed before and after glove use, as gloves can have microscopic holes or become contaminated during removal.

  • Availability of Supplies: Ensure that soap, running water, and drying materials (paper towels or air dryers) are always readily available at designated handwashing stations for both children and adults.

Environmental Control: Cleaning, Disinfecting, and Maintaining a Healthy Space

MRSA can linger on surfaces, making rigorous environmental cleaning and disinfection non-negotiable. This is distinct from general tidiness; it involves specific protocols to eliminate pathogens.

Daily Cleaning and Disinfection Protocols

  • High-Touch Surfaces: Identify and prioritize surfaces that are frequently touched by children and staff. This includes:
    • Doorknobs and handles (cabinet, refrigerator, bathroom)

    • Light switches

    • Faucets and sink areas

    • Changing tables (clean and disinfect after every use)

    • Toilets and potty chairs (clean and disinfect after every use)

    • Tabletops and eating surfaces (clean and disinfect before and after meals/snacks)

    • Shared writing utensils, art supplies, and learning tools.

  • Toys:

    • Hard, Non-Porous Toys: These should be cleaned and disinfected daily, or more frequently if visibly soiled or put in mouths. Toys that have been mouthed by infants or toddlers should be set aside in a designated “to be cleaned” bin and disinfected before reuse. Use a diluted bleach solution (1/4 cup bleach per gallon of water, or 1 tablespoon bleach per quart of water) or an EPA-registered disinfectant effective against staph. Ensure proper contact time as per the product label, then rinse with water and air dry. Example: After free play, all blocks, plastic animals, and stacking cups are collected, washed with soap and water, submerged in a bleach solution for 5 minutes, rinsed thoroughly, and air-dried overnight.

    • Soft, Porous Toys (Plush Animals, Fabric Dolls): These are harder to disinfect and should be laundered regularly (at least weekly) using hot water and detergent, and thoroughly dried. Consider limiting the number of shared soft toys or designating individual soft toys that go home with children for washing.

  • Floors and Carpets:

    • Floors should be vacuumed and mopped daily, especially in high-traffic areas.

    • Carpets should be vacuumed daily and deep-cleaned regularly (e.g., monthly or quarterly). Address spills and accidents immediately.

  • Napping Mats/Cots: Each child should have their own designated mat or cot. These should be wiped down with a disinfectant solution daily and laundered weekly or immediately if soiled. Ensure they are stored separately to prevent cross-contamination.

Choosing and Using Disinfectants Safely

  • EPA-Registered Disinfectants: Select disinfectants that are EPA-registered and labeled as effective against Staphylococcus aureus. Read and follow product labels carefully for proper dilution, contact time (the amount of time the surface must remain wet with the disinfectant to be effective), and safety precautions.

  • Bleach Solution: A diluted bleach solution is a common and effective disinfectant. Prepare fresh solutions daily as bleach loses its potency over time. Always mix in a well-ventilated area.

  • Storage and Safety: Store all cleaning supplies and disinfectants securely out of reach of children. Never mix different cleaning products, as this can create dangerous fumes.

  • Ventilation: Ensure adequate ventilation during and after cleaning and disinfection.

Personal Hygiene and Wound Care: Protecting Each Child

Individual child hygiene and prompt, proper wound care are paramount in preventing MRSA entry and spread.

Promoting Good Personal Hygiene Habits

  • Regular Bathing/Showering: Encourage parents to ensure children are bathed or showered regularly at home.

  • Clean Clothing: Children should arrive at childcare in clean clothes daily. Have a supply of clean spare clothes at the facility for accidents or spills.

  • Discourage Sharing Personal Items: Teach children not to share personal items like combs, brushes, towels, hats, or clothing. Each child should have their own cubby or designated space for their belongings.

  • Nail Care: Keep children’s fingernails short and clean to reduce the harbor for germs.

Vigilant Wound Care

Any break in the skin is a potential entry point for MRSA. Prompt and meticulous wound care is essential.

  • Immediate Attention to Cuts and Scrapes: All cuts, scrapes, insect bites, and abrasions, no matter how small, should be cleaned immediately with soap and water.

  • Covering Wounds: All open wounds must be completely covered with a clean, dry bandage. The bandage should be changed regularly (daily or more often if it becomes wet or dirty). This prevents bacteria from entering the wound and also prevents bacteria from an infected wound from spreading to others. Example: If a child scrapes their knee during outdoor play, the provider should immediately clean the wound with soap and water, apply an antiseptic wipe if available, and cover it with a sterile bandage.

  • Gloves for Wound Care: Childcare providers should always wear disposable gloves when tending to any wound, even minor ones.

  • Monitoring Wounds: Providers should regularly check for signs of infection (redness, swelling, warmth, pain, pus, fever). If an infection is suspected, the parents should be notified immediately, and medical attention sought.

  • Diaper Rash Management: Diaper rash can break down the skin barrier. Frequent diaper changes, proper cleaning with mild soap and water, thorough drying, and the application of barrier creams can prevent severe diaper rash and subsequent infections.

Discouraging “Picking”

Children often pick at scabs, bug bites, or skin irritations. This can reopen wounds and introduce bacteria. Providers should gently discourage this behavior and reapply bandages if necessary.

Isolation and Exclusion: When to Limit Exposure

Sometimes, despite best efforts, a child may develop an MRSA infection. Knowing when to exclude a child and how to manage potential exposure is crucial for limiting outbreaks.

Recognizing Symptoms

Parents and providers should be aware of the early signs of a staph or MRSA infection:

  • Red, swollen, painful bump: Often resembles a pimple, boil, or spider bite.

  • Pus or drainage: The bump may develop a head and drain pus.

  • Fever: May accompany the skin lesion, especially if the infection is spreading.

  • Warmth around the lesion.

Exclusion Policies

  • Active, Draining Wounds: Children with active, draining MRSA lesions that cannot be reliably covered should be excluded from childcare until the lesion has dried and scabbed over, or until a doctor certifies that the child is no longer contagious and the wound can be effectively covered. This is a critical point – a well-covered, non-draining wound may allow for continued attendance with careful monitoring, but active drainage poses a significant risk. Example: A child develops a boil on their arm that is actively oozing. The childcare facility’s policy dictates the child must stay home until the wound is no longer draining and can be fully covered by clothing or a clean, dry bandage.

  • Fever and Systemic Symptoms: If a child has a fever in conjunction with a suspicious skin lesion, they should be excluded and seen by a doctor.

  • Consult with Health Professionals: Childcare facilities should establish clear guidelines for exclusion and re-entry in consultation with local health departments or pediatricians.

Communication with Parents

  • Educate Parents: Provide parents with information about MRSA prevention and recognition.

  • Prompt Notification: If a child develops a suspicious lesion at childcare, parents must be notified immediately to seek medical attention.

  • Confidentiality: If a child in the facility is diagnosed with MRSA, maintain strict confidentiality while informing other parents about the general risk and reinforcing prevention measures without identifying the affected child.

Strategic Environmental Design and Operational Practices

Beyond daily routines, the physical layout and operational policies of a childcare facility can significantly impact MRSA prevention.

Optimizing the Physical Space

  • Adequate Space: Overcrowding increases the likelihood of close contact and transmission. Ensure sufficient space per child according to licensing regulations.

  • Designated Areas:

    • Diaper Changing Stations: Should be separate from food preparation and eating areas. They must be equipped with sinks, soap, and paper towel dispensers. Disposable changing table liners or easily cleanable surfaces are essential.

    • Handwashing Stations: Ensure sinks are easily accessible for children and staff, with appropriate water temperature and soap dispensers.

    • Isolation Area: A quiet, separate area where a child feeling unwell can rest comfortably and be monitored while awaiting parent pickup, minimizing exposure to other children.

  • Ventilation: Good air circulation can help reduce the concentration of airborne pathogens, though MRSA is primarily contact-spread.

  • Easy-to-Clean Surfaces: Choose furniture, flooring, and wall coverings that are smooth, non-porous, and easy to clean and disinfect. Avoid carpeting in areas prone to spills or bodily fluids.

Smart Operational Practices

  • Small Group Sizes: Where feasible, keeping children in smaller, consistent groups (cohorting) can limit the number of contacts and potential transmission chains.

  • Individualized Supplies: Encourage individual cubbies for belongings. Consider individual supply bags for art supplies or personal care items where practical.

  • Laundry Protocols:

    • Linens (sheets, blankets, towels) should be washed in hot water with detergent and thoroughly dried.

    • Soiled clothing and linens should be handled with gloves and placed directly into sealed bags for laundering, avoiding direct contact with other surfaces or individuals.

  • Food Safety: Implement strict food handling and preparation guidelines to prevent cross-contamination. Children should not share food, drinks, or eating utensils.

  • Staff Training: Regular, comprehensive training for all childcare staff on infection control, hand hygiene, wound care, cleaning protocols, and recognizing signs of infection is paramount. This training should be ongoing and updated as needed. Example: Monthly in-service training sessions covering topics like proper diaper changing techniques, bloodborne pathogen safety, and updated cleaning protocols.

  • Health Policies: Develop clear, written health policies that cover illness exclusion, medication administration, wound care, and infection control, and ensure these are communicated to parents and strictly adhered to by staff.

Collaboration is Key: The Parent-Provider Partnership

Preventing MRSA in childcare is a shared responsibility. Effective communication and collaboration between parents and childcare providers are vital.

For Parents: Your Role in Prevention

  • Communicate Health Concerns: Inform the childcare provider immediately if your child has any cuts, scrapes, rashes, or suspicious skin lesions, even if they seem minor. Provide clear instructions for wound care if your child has an existing bandage.

  • Practice Good Hygiene at Home: Reinforce handwashing, regular bathing, and clean clothing habits at home.

  • Keep Sick Children Home: This is the most important contribution parents can make. If your child is unwell, especially with a fever or suspicious skin lesions, keep them home. Don’t send them to childcare “just in case” or because it’s inconvenient. This protects your child and all the others.

  • Provide Clean Supplies: Ensure your child arrives with clean clothes, blankets, and any personal items they need daily.

  • Ask Questions: Don’t hesitate to ask your childcare facility about their infection control policies, cleaning schedules, and staff training. A good facility will be transparent and proactive.

  • Follow Facility Policies: Adhere to the childcare facility’s rules regarding illness exclusion and re-entry.

For Childcare Providers: Building Trust and Transparency

  • Clear Communication of Policies: Provide parents with a comprehensive handbook outlining all health and safety policies, including MRSA prevention and illness exclusion.

  • Daily Health Checks: Implement a quick visual health check of each child upon arrival, looking for signs of illness or new skin lesions.

  • Open Dialogue: Create an environment where parents feel comfortable discussing their child’s health concerns without fear of judgment.

  • Education and Resources: Offer parents resources and information about common childhood illnesses and how to prevent their spread.

  • Respond Promptly to Concerns: If a parent reports a concern or a child shows symptoms, respond promptly and professionally, outlining the steps being taken.

  • Maintain Records: Keep accurate records of illness, absences due to illness, and any instances of suspected or confirmed MRSA. This helps track trends and identify potential issues.

Beyond the Basics: Advanced Considerations

While the core principles outlined above form the foundation, some additional considerations can further enhance MRSA prevention.

  • Skin Condition Management: For children with chronic skin conditions like eczema or severe diaper rash, work with parents and healthcare providers to manage these conditions effectively. Compromised skin is more susceptible to infection. Regular moisturizing and appropriate topical treatments can maintain skin integrity.

  • Laundry Services: If the facility provides linens or clothing, consider professional laundry services or ensure that on-site laundry facilities are robust enough to handle high temperatures and proper disinfection.

  • Staff Health: Encourage staff to practice good self-care and report any suspicious skin lesions they may develop. Staff should also receive prompt medical attention for any active infections.

  • Visitor Protocols: Establish clear hand hygiene protocols for all visitors entering the childcare facility.

  • Regular Review and Updates: Infection control policies should not be static. Regularly review and update them based on new scientific information, changes in regulations, and feedback from staff and parents. Conduct drills or simulations for staff to practice responding to illness scenarios.

  • Consulting with Experts: Periodically consult with public health officials or infectious disease specialists to ensure the facility’s policies align with best practices.

Conclusion

Preventing MRSA in childcare requires a multi-faceted, unwavering commitment from everyone involved. It’s about establishing a culture of hygiene, vigilance, and proactive care. By meticulously implementing rigorous handwashing protocols, maintaining an impeccably clean and disinfected environment, providing prompt and thorough wound care, and fostering robust communication between parents and providers, we can create childcare settings that are not only nurturing and stimulating but also remarkably safe from the threat of MRSA. These actionable strategies, when consistently applied, will significantly protect our children and offer invaluable peace of mind to families.