UPDATE: The National Association of School Nurses has produced an excellent informational site called Voices of Meningitis. Click here to go to that site.
Bacterial meningitis and viral meningitis are not common infections, but ones that can be serious. They are inflammations of the membranes that cover the brain and spinal cord. There is more than one infectious agent that can cause the condition, and the pathogen that starts the illness can have a lot to do with severity as well as the treatment. This can be a serious infection, but should not be one to cause undue concern among the general population. Caution, not panic is advised.
The first questions that come up when a case is diagnosed and reported are generally, "How contagious is this disease?" and "How do I protect myself?" The modern facility manager will also want to implement the cross-contamination plan designed for this and similar health threats. (Normal cleaning regimens should also include many infection control procedures.) According to the Centers for Disease Control, some forms are contagious, but not by "casual" contact or simply breathing air where a patient has been. The more serious bacterial forms are in particular not considered something casually transmitted, but more often from direct contact. However, as with any contagious disease, there is some percentage of possibility of transmission by common "fomites" or touch points and aerosols from sneezes or coughs and kissing. However, the CDC points out none of the forms are as contagious as the common cold or the flu.
According to the CDC, "...sometimes the bacteria that cause meningitis have spread to other people who have had close or prolonged contact with a patient with meningitis...People in the same household or daycare center, or anyone with direct contact with a patient's oral secretions (such as a boyfriend or girlfriend) would be considered at increased risk..."
So the answer to the second question, "How do I protect myself?" is similar to protection from colds and the flu, even though meningitis is not considered as contagious as those infections:
- Avoid direct contact with infected persons, particularly with oral secretions or surfaces that might harbor them.
- Wash throughly, and use hand sanitizer after contacting common surfaces and before ingesting food.
When visiting patients, follow hospital prophylaxis routines carefully. Family members may consider vaccines, depending on the agent responsible. Vaccines are proven safe and effective.
Environmental and Cross-Contamination Controls
About 25,000 cases of spinal meningitis occur each year in the United States. Because many disinfectants are not EPA tested specifically for the various pathogens that can cause this disease, the process PUR-O-ZONE recommends becomes even more important to environmental controls. PUR-O-ZONE has educational presentations and aids that discuss various methods of stopping the cross-contamination cycle your representative can help you utilize. Here is a brief summary of an overall response plan:
- As with all harmful organisms that can live on fomites (touch points), their removal is important through cleaning, especially because older disinfectants are becoming less effective over time. Use high-flow fluid extraction techniques with devices such as a C3 or Kaivac touch-free system. (Kaivac is so effective, it has been registered by the EPA as a sanitizing device when just used with simple tap water.) HFFE techniques remove up to 60 times more bacteria, viruses and other contaminants from a surface than standard mopping or cleaning with a cloth. Several good "charging systems" for microfiber treatment of desk and countertop surfaces can be tailored to your circumstances and staff. Microfiber, when used in specific ways, is also very effective at removal of microbes from tiny areas common cloth cannot reach.
- Because the specific agent that may cause meningitis is often unknown, at least early after an infection is documented, starting disinfection procedures immediately with a broad-spectrum disinfectant is important. The combination of good HFFE and microfiber removal and sanitizing combined with the power of a broad-spectrum disinfectant should be applied in the areas an infected individual was known to be.
- Being aware of cross-contamination points such as desks, door handles, lockers, showers, mats, sports equipment and balls, dining and breakroom tables, and counter tops is important in treatment. Checklists of these contact points should be available in advance.
- Make your cleaning "restorative" in nature. In other words, start from scratch to do a full cleaning.
- Area fogging systems are available for certain spaces you want to provide extra reassurance in. They should follow your restorative cleaning and disinfection.
- In advance of emergencies, treat common-touch surfaces with a surface protectant such as Bioshield75 which works for weeks and months to make surfaces non-conducive to any kind of cell life. (This product does not use toxicity to kill and works around the clock.) This reduces overall transmission potential.
- As a final precaution, after applying your plan, the CDC often recommends a bleach treatment as backup. Only if your regular disinfectant is not registered against major causes of Neisseria meningitidis, or meningococcal meningitis, or Hib, then a bleach towelette treatment should be used on more prominent areas such as a desk occupied by the patient. Because bleach is toxic and dangerous when contacting many other substances, it should not follow normal disinfection until surfaces are completely dry. Fresh materials should be used for application and removal as well as careful following of guidelines on the label and available on the CDC site.
- As always, promote hand sanitizing and hand washing procedures.
With a well-applied plan, potential communication of bacterial or viral meningitis can be minimized. Although serious, this infection should not create a situation where panic develops. Clear communication of your plan to students, staff, parents and media at the first possible opportunity should help reduce speculation and unnecessary fear.
Caution, not panic, should be the watchword, just as when you cross a street.