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Preventing the Spread of MRSA

Attention youth sports parents: it's time to start listening to warnings from health officials about an antibiotic-resistant skin infection or "super bug" known as methicillin-resistant staphylococcus aureus ("MRSA").

Triple play

The October 17, 2007 MRSA-related death of a 17-year old Virginia high school student, the release that same day of a an article by researchers at the Centers for Disease Control (CDC) in The Journal of the American Medical Association finding that the infection was far more common and lethal than previously believed, and increasingly common reports of cases of community-acquired MRSA at schools nationwide, have prompted renewed efforts by federal and state health officials and others to educate the public about the relatively simple steps that can be taken to prevent its spread.

Don't panic, health officials say

What has prompted widespread public concern were findings by CDC researchers in the AMA journal article that more people in the United States now die from MRSA than from AIDS and that cases of invasive MRSA had more than doubled over the estimated number reported just five years earlier. The percentage of staph infections from MRSA has also increased: according to Florida health officials, MRSA infections now account for 51 percent of infections tested - up from 35 percent in 2003.

But health officials are quick to advise parents and athletes not to panic.

Community-acquired MRSA less dangerous than invasive form

For one thing, the vast majority of cases of MRSA acquired outside of a hospital setting - dubbed "community-acquired MRSA" - are the less dangerous non-invasive form (usually appearing as skin infections).

Although the infection can, in some cases, be virulent enough to lead to bloodstream infections, or bone infections requiring intravenous drug treatment in a hospital, community-acquired MRSA:

  • Is usually mild; Is more easily and effectively treated (by draining the pus, with or without antibiotics);

  • Usually responds well to certain antibiotics, albeit ones that can cost as much as $80 per day; and

  • Preventable.

Good hygiene dramatically lowers risk of infection

For another, as discussed in detail below, the risk of infection can be lowered dramatically by practicing good personal hygiene (hand washing etc.).

Other illnesses pose greater health risk

Finally, it is important to remember, say health officials, that, while MRSA is getting a lot of attention (especially in the wake of the Virginia student's death), ordinary flu poses more of a health threat, killing an estimated 36,000 people this year in the USA.

Risk factors: The 5 C's

According to the CDC, settings that make it easier for MRSA to be transmitted often involve the 5 C's:

  • Crowding

  • Frequent skin-to-skin Contact

  • Compromised skin (i.e. cuts or abrasions)

  • Contaminated items and surfaces; and

  • Lack of Cleanliness.

Health officials generally agree that sports teams seem most at risk for staph infections such as community-acquired MRSA.

In the sports context, the CDC has identified three factors that are seen as contributing to the outbreaks:

  1. Sports resulting in skin abrasions. Athletes, especially those playing on artificial turf, can suffer turf burns, abrasions and other skin trauma. Turf burns "are just the kind of minor skin injury that MRSA can exploit," according to Elliot Pellman, medical liason for the National Football League. Even in sports with less direct contact, protective clothing can be hot and might chafe skin, resulting in abrasions and lacerations (e.g. fencers reported developing skin rashes frequently under protective clothing).

  2. Sports involving frequent physical contact. Some sports for which MRSA infections have been reported involve frequent physical contact among players (e.g., football and wrestling). Infections can be transmitted easily from person to person with direct contact.

  3. Sports requiring athletes to share heavy protective clothing and equipment. Sports such as fencing have limited skin-to-skin contact but require multiple pieces of protective clothing and equipment, which often might be shared. The use of shared equipment or other personal items that are not cleaned or laundered between uses could be a vehicle for transmission.

Recognizing Possible Staph Infections

Because the infection often looks like an ordinary skin wound or boil, diagnosis is difficult. Treatment with penicillin-related antibiotics is ineffective.

Thus, one of the keys to preventing the spread of MRSA and other staph infections is to be able to spot and hence treat skin infections.

Coaches, parents, and athletes should be on the look out for:

  • Skin infections that may appear as pustules or boils at the site of visible skin trauma, such as cuts and abrasions, and areas of the body covered by hair (e.g. back of neck, groin, buttock, armpit, beard area);

  • Fever;

  • Pus or other drainage;

  • Swelling; and/or

  • Pain

"It's important for coaches and parents to be aware MRSA might be a cause of skin problems in children," Dr. Dan Jernigan, a CDC medical epidemiologist, told the Associated Press.

General Prevention Steps

The best ways to prevent the spread of staph infections such as MRSA are to maintain good personal hygiene and avoid direct contact with skin lesions of other players.

All persons associated with competitive sports teams, including players, coaches, teachers, parents, and administrators, can help prevent sports-related skin infections and should be aware of the prevention measures set out below.

The CDC recommends that:

  • Sports team administrators be encouraged to provide facilities and equipment necessary to promote good hygiene, such as clean facilities and adequate supplies of soap and towels.
  • Coaches and parents should:

    • Encourage good player hygiene (e.g. keeping hands clean by washing with soap and water or using an antibacterial hand sanitizer)

    • Teach players to avoid sharing towels, razors or other personal items that come into contact with bare skin, use a barrier (e.g. clothing or towel) between their skin and shared equipment such as weight-training benches, and inform coaches about active skin infections;

    • Be taught to administer proper first aid,

    • Practice appropriate hand hygiene themselves, and

    • Implement a system to ensure adequate wound care and to cover skin lesions appropriately before play.

Prevention Tips: Specific Advice for Athletic Programs

The CDC also recommends the following specific steps to prevent the spread of skin infections among athletes:

  • Launder personal items such as towels and supporters after each use. The water should be at least 160 degrees; washing time should be 25 minutes or more. One product that MomsTeam loves is FabricAide

  • Clean and cover all wounds. If an athlete's skin is injured, it should be washed immediately with soap and warm water, dried and covered with a clean bandage. If a wound cannot be covered adequately, the program should consider excluding players with potentially infectious skin lesions from practice or competition until the lesions are healed or can be covered adequately;

  • Encourage good hygiene, including washing hands often, using soap or a antibacterial gel or lotion, showering and washing with soap after every practice or tournament;

  • Ensure availability of adequate soap and hot water;

  • Discourage sharing of towels and personal items;

  • Establish routine cleaning schedules for shared equipment. Shared athletic equipment, such as pads or helmets, should be cleaned or laundered at least once a week but ideally after each use;

  • Train athletes and coaches in first aid for wounds and recognition of wounds that are potentially infected;

  • Encourage athletes to report skin lesions to coaches; and

  • Encourage coaches to assess athletes regularly for skin lesions.

For the guidelines recently reissued by the National Association of Athletic Trainers on proper prevention of MRSA and other communicable diseases that can be spread by athletic participation, click here

Pro-active schools

Some particularly pro-active school systems are going even further in their efforts to prevent the spread of MRSA, including:

  • Having students apply an anti-bacterial hand sanitizer when getting on school buses;

  • Requiring students to apply anti-bacterial hand sanitizer provided by their teachers first thing in the morning, before lunch, and after using the bathroom;

  • Supplying hand sanitizer to support and maintenance staff; and

  • Installing hand sanitizer dispensers in all classrooms.

Prevention and Treatment at Home

There are a number of steps parents and athletes can take at home to prevent the spread of communicable skin diseases such as MRSA, and to treat the infection, including

 

  • Regularly cleaning commonly touched areas, such as doorknobs, light switches, computer keyboards and games, with a disinfectant (an inexpensive disinfectant can be made by mixing one tablespoon of bleach to one quart of water)

  • Requiring that everyone in the household use his or her own towel;

  • Washing hands before and after making contact with someone or their personal possessions; and
  • Cleaning any cut with soap and water and then applying a topical over-the-counter "maximum strength" or "triple antibiotic" anti-bacterial ointment. While there are, as of yet, no clinical studies to confirm the results, a laboratory study conducted at the College of Pharmacy at Oregon State University (OSU) presented at a December 2007 meeting of the American Society of Health-System Pharmacists found that an ointment containing benzethonium chloride with tea tree and white thyme oil worked best against all four tested MRSA strains, while ointments containing neomycin, polymyxin, and gramicidin also had some antibacterial effectiveness.

    "We know that it takes a large number of bacteria to ultimately produce an infection, and antibacterial treatments can greatly reduce their number" said David Bearden, a clinical associate professor at OSU. "It's reasonable to believe that these products, which are inexpensive and easily available, have a place in protecting a nasty cut or scrape and trying to prevent a more serious infection."

Parents should also think twice about asking their child's pediatrician to prescribe antibiotics for the flu, or another virus, an ear infection, or adolescent acne. Why? Because, health officials say, the overuse of antibiotics has contributed to the resistance staph bacterium have developed to the most common antibiotics. Indeed, the growing public concern about MRSA has prompted many dermatologists (fifty percent, according to one report) to cut back on the use of antibiotics to treat acne.

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