Staph and MRSA in Athletics: Recognition and Prevention
What is “Staph” / MRSA?
Staphylococcus aureus, often referred to as “staph”, is a common type of bacteria that can live harmlessly on the skin or in the nose of 25 to 35 percent of healthy people (this is often referred to as being “colonized” with the germ). Occasionally, staph can cause an infection. Staph bacteria are one of the most common causes of skin infection in the United States, but most of these infections are minor, such as pimples or boils. Most of these infections can be treated without antibiotics, however, some staph infections can cause serious infections, such pneumonia, bloodstream, bone, and joint infections, and surgical wound infections. In the past, most serious staph bacterial infections were treated with a certain type of antibiotic related to penicillin. In recent years, treatment of these infections has become more difficult because staph bacteria have become resistant to various antibiotics. These resistant bacteria are called methicillin-resistant staphylococcus aureus (MRSA). According to the Centers for Disease Control (CDC) 1% of the population is colonized with MRSA. MRSA is one type of skin infection among several that are of concern in competitive sports.
Who Gets “Staph” / MRSA?
“Staph” infections, including MRSA, have been traditionally associated with outbreaks in health-care facilities, but they are becoming increasingly common in student-athletes participating in close contact sports (e.g. football, lacrosse, etc.), although anyone, including coaches, staff, etc. who come into contact with colonized individuals, can contract the infection. “Staph” and MRSA are spread either by direct physical contact or indirect touching of contaminated objects. This includes touching, using, and/or sharing sheets, towels, clothes, equipment, dressings, personal items, bar soap, etc. which have been used by someone who has “staph” and/or MRSA, along with poor hygiene habits (e.g. hand washing, showering, etc.)
What Does “Staph” / MRSA Look Like?
“Staph” and/or MRSA usually first presents as some type of skin or soft tissue infection such as pimples, abscesses, pustules, and/or boils. Some can be red, swollen, painful, and/or have pus or other drainage. The pustules may be confused with insect bites initially, and may also be associated with existing turf burns and/or abrasions.
What to Do:
Without proper referral and care, more serious infections may cause pneumonia, bloodstream, bone, and/or joint infections, and/or surgical wound infections. If you or anyone you know has what appears to be what looks like “staph” and/or MRSA, please contact an Ohio Wesleyan University Athletic Trainer, Team Physician and/or the Ohio Wesleyan University Wellness Center as soon as possible for evaluation.
Prevention of “Staph” and/or MRSA
Although treatable, there can be complications associated with “staph” and MRSA infections, making prevention the best measure to combat these infections. The Centers for Disease Control suggest the following measures for preventing staphylococcal skin infections, including MRSA:
- Education of Student-Athletes, Students, and General Population – There will also be a colored informational poster with photos of MRSA displayed in each Athletic Training Room and weight room.
- Practice good hand hygiene by washing hands frequently and in a thorough fashion with soap and warm water or using an alcohol-based hand sanitizer.
- Take a shower with hot water and wash with soap (liquid antibacterial soap, not bar soap) following all activities (e.g. strength & conditioning sessions, practices, and competitions).
- Avoid sharing towels, equipment, razors, soap (use liquid soap instead of bar soap), etc.
- Use a barrier (e.g. clothing or a towel) between your skin and shared equipment.
- Wipe surfaces of equipment before and after use.
- Clean and properly cover any open wounds such as turf burns, abrasions, lacerations, etc. with an appropriate bandage at all times.
- Avoid whirlpools, hydrotherapy pools, cold tubs, swimming pools, and other common tubs if you have an open wound.
- Maintain clean facilities and equipment.
- Do not ignore skin infections, pimples, pustules, abscesses, etc. Report these to an Athletic Training staff member, Team Physician and/or the OWU Wellness Center immediately.
Prevention of “Staph” and MRSA at Ohio Wesleyan University
In order to maintain proper sanitary conditions within Ohio Wesleyan University athletic facilities and to prevent the outbreak of Methicillin-resistant Staphylococcus aureus (MRSA) and other harmful infections, the following procedures will be in place. The individual(s) responsible for cleaning and disinfecting the area will adhere to Universal Precautions at all times and wear PPE as needed;
Treatment / Taping Tables, Weight Room / Rehabilitation Equipment, Countertops, Stools, etc.
- Treatment tables, taping tables, weight room / rehabilitation equipment, countertops, stools, etc. must be cleaned everyday and/or following a possible contamination using Zep Venture Cleaner Disinfectant Deodorizer Virucide, Zep Tackle, or other appropriate cleaner.(1:10 diluted bleach solution can be used to clean hard surfaces only)
- Clean / Disinfect tables, equipment, countertops, stools, etc. in the following manner:
- Spray the Zepventure/Tackle cleaner on the surface to be cleaned;
- Wipe down the surface with a towel.
- Pro-Thermo attachments must be cleaned / disinfected following every use.
- Pro-Thermo attachments are to be cleaned using Zep Venture
- Clean / Disinfect Pro-Thermo attachments in the following manner:
- Spray the Zepventure cleaner on the inner surface of the Pro-Thermo attachment;
- Wipe down the Pro-Thermo attachment with a towel.
- Cloth towels should only be used on a single patient and should be laundered following every use.
- Disposable towels should be used whenever feasible on the field/court and should be disposed of after a single use.
Hydrocollator Packs / Covers
- Clothing or a cloth or disposable towel should be placed between the patient and the hydrocollator pack/cover if an open wound exists
- Hydrocollator covers should be laundered every week and/or following a possible contamination.
- Soft goods (e.g. neoprene braces / sleeves, knee / elbow / forearm / shin pads, splints, lace-up ankle braces, shoulder harnesses, walking boot liners, cast shoes, back braces, etc.) should be laundered upon return to the athletic training facility BEFORE being returned to inventory and/or administered to another student-athlete.
- Soft goods that cannot be laundered (e.g. Philadelphia collars, DonJoy Velocity ankle braces, Aircast ankle braces, hard splints, etc.) should be disinfected using the aforementioned guidelines for treatment / taping tables, weight room / rehabilitation equipment, etc.
- Whirlpools shall be cleaned on a daily basis, or as needed following every possible contamination;
- Whirlpools are not to be used by student-athletes with open or draining wounds;
- Whirlpools are to be cleaned using Zepventure Cleaner Disinfectant Deodorizer Virucide or a commercial tub & tile cleaner.
- Whirlpools are to be cleaned in the following manner:
- Spray the whirlpool cleaner in and around the sides of the whirlpool;
- Using a towel scrub all surfaces of the whirlpool, including the bottom, sides, turbine, etc.
- Rinse the tank very well with hot water and allow it to drain;
- Towel dry or air dry;
- Whirlpool turbines are to be cleaned using household bleach or ammonia by allowing the bleach or ammonia solution to circulate through a running turbine with hot water for ten (10) minutes.
DO NOT use bleach and ammonia at the same time as this will create harmful / hazardous fumes.
(Weight Rooms, Locker Rooms, Showers)
- Weight Rooms – Equipment will be cleaned by patrons and the weight room staff, in addition to what B&G performs on a daily basis. Cleaner and towels are provided for this process. There also is Instant Hand Sanitizer available for persons to use either before or after they use the facility.
- Belt Fitness room – Equipment is cleaned by student staff on a daily basis and cleaner is available for all students/faculty members who use the facility to clean both prior to and after their workout. Cloth towels are used and cleaned after each day.
- All other rooms are cleaned by B&G, including all types of flooring and furniture.
- Coaching Staff is responsible to make sure that practice and game uniforms are cleaned between uses.
- It is not recommended to “overfill” the washing machines. This can result in the uniforms going through an inadequate washing cycle.
- Rubber gloves can/will be provided for coaches to use during washing.
- Persons performing the laundry should wash hands after each time touching soiled equipment.
- It is recommended that the persons performing laundry do not place the clean clothes back into the same container that was used to transport the soiled clothes without first cleaning the inside of the container, or you can utilize a cloth laundry bag that can be washed with the soiled clothing.
Athletic Department Responsibilities if an outbreak is suspected:
- If a student-athlete presents with a suspicious skin infection the Athletic Trainer will refer the student-athlete to a physician immediately. Best care is to send student-athlete to the OWU Wellness Center so a culture of the area/lesion can be performed. If a student-athlete informs his/her coach of going to the OWU Wellness Center or other medical facility for a skin infection the coach needs to notify a member of the athletic training staff.
- Anti-biotic of physician’s choice will be prescribed until the results of the culture are known. Once the results of the culture are returned, the appropriate anti-biotic will be prescribed.
- A four oz. bottle of Hibiclens will be purchased ($7) by the student-athlete from the Wellness Center to wash the affected area while at home.
- The coaching staff for the team will be notified to make sure the athlete’s equipment is being washed by itself and not with the rest of the student-athletes’.
- Todd Miller, Head Athletic Trainer will notify Roger Ingles, Director of Athletics, Marsha Tilden, Director of the Student Wellness Center and the student-athlete’s Head Coach.
- Head Athletic Trainer will notify Building and Grounds to make sure the locker area/facility where the student-athlete practices/competes is cleaned.
- If a team has three (3) or more outbreaks of the same skin infection in a two week period the Head Coach, Todd Miller (Head Athletic Trainer), Marcia Tilden (Director of Wellness Center), and Roger Ingles (Director of Athletics) will meet to discuss prevention strategies for that particular team to help control the spread of the skin infection.