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The number of self-reported MRSA cases in Montgomery County Public Schools now totals 19 — eight of them active and 11 recovered, Edwards said. That number is up from 14 one week ago.

Other affected schools so far are Poolesville, Walt Whitman, Sherwood, Rockville and Quince Orchard high schools, as well as Candlewood, Laytonsville and Damascus elementary schools.

Tina Lacey, head of the county’s Disease Control Program, said she has been told there are confirmed cases in private schools, but since there is no reporting requirement for MRSA, the health department has not been officially alerted.

Early last week, MCPS said only the affected schools were being ordered to clean with a 1-to-10 bleach solution. Yet by Thursday, with another elementary school reporting a confirmed case and more suspected cases pending, the call for a systemwide cleaning was issued, Edwards said.

Joe Sacco, principal at Lakelands Middle School in Gaithersburg, didn’t need the mandate. Although his school has not reported a MRSA case, he already planned to take advantage of a nearly empty building on Friday — a day schools were closed — to do a hospital-grade cleaning.

‘‘Parents have been concerned,” Sacco said. ‘‘They’ve wanted to know what the school is doing to prevent staph infections or minimize the outbreak.”

Necessary precautions

On Thursday morning at Laytonsville Elementary, after news of a confirmed MRSA case there, students were required to hold out their hands for a squirt of sanitizer before being allowed to enter the building.

Principal Hilary Roonie asked her building services staff to begin mopping bathrooms and wiping down sinks and faucets with a bleach solution at least three times a day.

She assured parents that every precaution was being taken and tried to reassure students, ‘‘We’re safe at school and we’re taking precautions.”

At Sherwood High in Sandy Spring, where six football players are confirmed to have had MRSA — one of them twice — air dryers have replaced paper towels in locker rooms and physical education areas, the school nurse has hung colorful posters in the hallways saying, ‘‘It’s a dirty world out there; keep your hands clean,” and athletic facilities have received several bleach cleanings, said Principal William Gregory.

And like several schools, Quince Orchard High has added disinfectant wipes to its gyms and locker rooms, said Principal Carole Working.

‘‘This morning our school nurse was on the school television,” Working said Thursday. ‘‘She was explaining to the students the things that we all need to do to prevent catching infections or spreading them. But she was also being reassuring that we are taking all of the precautions that should be taken.”

Wayne Slayton, the night building services manager at Fields Road Elementary School in Gaithersburg, said his team has long used bleach daily.

‘‘We don’t play around. I’ve seen them in action,” he said of some of the youngest students. ‘‘I’ve seen them blow their nose and stick the tissue back in the tissue box.”

His team bleach-cleans bathrooms three to four times a day, and kindergarten teachers bleach sandbox toys, he said. Still, ‘‘kindergarten areas are of concern, because they have a lot more things to play with.”

School officials would not confirm the grades of the four elementary-age students who have contracted MRSA.

A growing problem

MRSA is a strain of the bacterium staphylococcus aureus, or staph, that many people carry on their skin, said state epidemiologist David Blythe.

Over time, the bacterium has learned to resist many antibiotics and can prove deadly if it enters the bloodstream through a wound or opening in the skin.

MRSA made headlines last week when a 17-year-old central Virginia boy died after MRSA poisoned his heart, lungs, liver and other organs, and the Journal of American Medical Associations published a groundbreaking report using data compiled from laboratory reports in nine states, including Maryland, which shows MRSA is far more widespread than believed.

The study, years in the making, marked ‘‘the first time the U.S. had some really good data on the prevalence,” Lacey said.

The study, sponsored by the federal Centers for Disease Control and Prevention, said MRSA caused 94,000 serious infections and nearly 19,000 deaths in 2005.

The number of MRSA cases in county schools is likely to rise as time passes and awareness increases, Lacey said. However, schools provide more of a litmus test than breeding grounds because of their reporting, said Lacey and Blythe, the state epidemiologist.

‘‘In the state of Maryland, there are about 45 diseases that by law have to be reported, MRSA is not one of them,” Lacey said. ‘‘The reason why we have numbers from schools is because there is a public health nurse in each of the county public schools who is able to accept [medical] reports,” she said. The nurses have asked parents to provide the school with the outcome of MRSA cultures.

Schools are where MRSA is evident and being tested, Lacey said, but they ‘‘are not the vehicle.”

Athletes in contact sports are among the most susceptible — due to shared equipment, scrapes and scratches — but anyone with a wound or open pore is vulnerable, Lacey said. Covering wounds and washing hands are key, as colonizers, those who carry staph in noses or throats but have no symptoms, can spread infection through dirty hands and discharges.

School nurses are helping to spot suspicious skin lesions and are working with students and their parents to get testing done when necessary.

A wide-reaching issue

MRSA is ‘‘coming into the schools from the community,” said schools spokesman Edwards, who would not confirm media reports of two dozen more potential cases. Only Sherwood has had more than one student affected. All the other schools have reported one case each.

‘‘The first case was in late June when there was no school,” he wrote in an e-mail to The Gazette on Monday. ‘‘Other information we have received about some of the cases indicates that the infection was not contracted in schools. With the exception of Sherwood, there has been a case here and a case there and no indication that they contracted it from another student.”

School officials will report MRSA cases to the respective school communities as they are confirmed, he said.

‘‘We need the health department to take the lead on this, and then we will give the information to the community,” Edwards said.

Tracing the source of MRSA is impossible, Lacey said.

Medical professionals consider the bacteria to be ‘‘ubiquitous.” People are ‘‘bombarded with germs all day long” and infections may take several days to manifest, Lacey said. Still, the county health department must take the lead providing information to keep MRSA from being transmitted, she said.

‘‘It’s not a school issue, it’s an issue in the community,” Lacey said.

What studentscan do

In an Oct. 17 letter to parents, Superintendent Jerry D. Weast and county Health Officer Ulder J. Tillman advised:

Wash hands thoroughly with soap and water or alcohol-based hand sanitizer.

Keep cuts and scrapes clean and covered with a bandage until they are healed.

Avoid contact with other people’s wounds or bandages.

Avoid sharing personal items such as towels or razors.

Wipe surfaces of exercise equipment before and after use.

To read the letter, go to www.montgomeryschoolsmd.org, and click on ‘‘Health Update on Methicillin-Resistant Staph Aureus (MRSA).”

Cleaning guidelines

Hand soap dispensers in bathrooms, classrooms and kitchens must remain stocked at all times. Maintenance staff must regularly clean the bathrooms and follow a checklist to prevent supplies from running out.

All staff must use a cleaning plan to make sure the school is thoroughly sanitized.

The gymnasium and all purpose-room floors must be cleaned with a 1-to-10 bleach solution every day.

Areas where MRSA has been suspected or confirmed must be cleaned with the 1-to-10 bleach solution.

Workers must use protective gloves.

More forsecondary schools

Lockers, weight training and team rooms must be cleaned with a 1-to-10 bleach solution every day.

Weight training rooms must have sanitizing wipes available for equipment users.

Source: Montgomery County Public Schools