Diseases & Topics
Community-Associated MRSA
Managing CA-MRSA in Incarcerated Populations
N.C. Public Health Recommendations
Community-associated MRSA outbreaks, including skin and soft tissue infections as well as invasive infections, have been reported among persons incarcerated in prisons and jails. Some estimates of MRSA colonization in prisons are as high as 80-90%. Crowding and sharing of contaminated personal items may contribute to MRSA spread among incarcerated persons.
Responsibilities for Medical Care and Public Health Management
- For persons incarcerated in county jails, medical care responsibilities reside with the county sheriff. Jail health plans must be reviewed and approved by Local Health Department Directors.
- For persons incarcerated in state institutions, wardens have responsibility for medical care.
- State public health staff may collaborate as needed in outbreaks involving state or county institutions. Correctional health care staff are key partners in MRSA prevention and control. Efforts and education should involve detention staff as well—they will likely have concerns about their own risks as well as roles in MRSA prevention and control among incarcerated persons.
Prevention and Control Measures
Prevention and control measures for MRSA in correctional settings include:
- Skin infection screening and monitoring (e.g., maintaining a log of skin infections and visual skin screening on intake).
- Culturing suspect lesions and providing targeted antimicrobial therapy.
- Efforts to improve inmate hygiene (e.g., education about appropriate hand and body hygiene, appropriate laundering techniques, measures to limit use of shared items, and greater availability of soap).
- Improved access to wound care and trained health-care staff.
Information for Visitors
The risk of transmission to visitors who have casual contact with inmates is low provided that inmates with draining lesions keep the lesions completely and adequately covered and that the visitors do not share personal items such as towels or toiletries that may have been soiled with drainage from an infected wound. Shared contact with non-personal items such as pens, paper, or books does not pose a risk of infection. Hand hygiene is the single most important factor in preventing the spread of MRSA. Visitors in direct contact with inmates who have confirmed or suspected MRSA infections should perform appropriate hand hygiene (wash with soap and water or use alcohol-based hand sanitizer) after contact.
For Additional Information
- CDC: Methicillin-resistant Staphylococcus aureus (MRSA) infections
- CDC: MRSA educational materials
- Federal Bureau of Prisons: Management of Methicillin-Resistant Staphylococcus aureus (MRSA) Infections Clinical Practice Guidelines - These guidelines are applicable to many correctional settings.
- CDC: Methicillin-Resistant Staphylococcus aureus Infections in Correctional Facilities – Georgia, California, and Texas, 2001-2003 - CDC MMWR: Oct. 17, 2003 , 52(41);992-996. Report of 5 investigations about outbreaks in correctional settings identified 4 factors that contributed to spread among inmates. Major findings:
- Barriers to routine inmate hygiene. Access to soap often was limited or was restricted for security reasons, and new alcohol-based hand rubs were difficult to introduce because of misuse of these products. Mental health and behavior problems among inmates might have contributed to poor adherence and hindered efforts to improve hygiene. Inmates' clothing was washed by hand or in bulk loads, and potentially contaminated laundry might not have undergone sufficiently high water temperatures or drying to eliminate bacteria.
- Second, proper access to medical care was hindered by co-payments required for acute care visits and by inadequate supplies and staff for wound care.
- Third, frequent medical staff turnover was a challenge to providing education on proper infection-control procedures.
- Finally, MRSA might have been an unrecognized cause of skin infections among inmates; wounds often were attributed to spider bites, and cultures might have been collected infrequently even in cases in which antimicrobial treatment failed.
- NC SPICE: N.C. Consensus Guideline for Management of Suspected Community-Acquired Staphylococcus aureus (CA-MRSA) Skin and Soft Tissue Infections (SSTIs) - Includes algorithm for clinical management.
- EPA: Registered Cleaning Products Effective Against Methicillin-Resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococcus faecalis or faecium (VRE) (PDF, 350KB)
