Nine Things You Should Do To Prevent STAPH
Dealing with infectious disease in athletes is, perhaps, not as
dramatic as attending to a sudden on-field injury, but it can have
a much greater effect on the team's success. Military history shows
that infectious disease routinely disables more fighting men than
battle wounds, and the situation is similar in competitive sports.
Just imagine yourself, as a team physician, confronting an outbreak
of herpes gladiatorum on the wrestling team during the final weeks
of the season, or the specter of half your football team suddenly
developing vomiting and diarrhea on Saturday morning just before
facing the toughest opponent of the year, or six simultaneous cases
of influenza on the basketball team in January. Under these
circumstances, the importance of infectious disease prevention in
sports becomes crystal clear.
Luckily, most situations involving infectious disease in sports are
not that sensational, but prevention can play a huge role in
athletes' success. Some infectious disease that may be spread
during sports participation can threaten long-term health or even
life itself. Team members, team physicians, and the entire sports
medicine team must practice the principles of infection prevention
routinely.
Recently, cases of skin infections caused by Methicillin-Resistant
Staphylococcus aureus (MRSA) have been identified in the community.
While most cases have involved athletes, cases involving
non-athletes have also occurred. Staphylococcus aureus, often
refered to simply as "staph," are bacteria commonly carried on the
skin or in the nose of healthy people. Approximately 25% to 30% of
the population is colonized (when bacteria are present, but not
causing an infection) in the nose with staph bacteria. Sometimes,
staph can cause an infection. Staph bacteria are one of the most
common causes of skin infections in the United States. Most of
these skin infections are minor (such as pimples and boils) and can
be treated without antibiotics (also known as antimicrobials or
antibacterials). However, staph bacteria also can cause serious
infections (such as surgical wound infections, bloodstream
infections, and pneumonia).
Some Staph bacteria are resistant to antibiotics. MRSA is a type of
staph that is resistant to antibiotics called beta-lactams.
Beta-lactam antibiotics include methicillin and other more common
antibiotics such as oxacillin, penicillin and amoxicillin. While
25% -30% of the population is colonized with staph, approximately
1% is colonized with MRSA.
The treatment of infections due to Staphylococcus aureus was
revolutionized in the 1940s by the introduction of the antibiotic
penicillin. Unfortunately, most strains of Staphylococcus aureus
are now resistant to penicillin. This is because Staphylococcus
aureus has learned to make a substance called beta-lactamase that
degrades penicillin, destroying its antibacterial activity. Some
related antibiotics, such as methicillin and flucloxacillin, are
not affected by beta-lactamase and can still be used to treat many
infections due to beta-lactamase-producing strains of Staph.
Unfortunately, however, certain strains of Staph, known as MRSA,
have now also become resistant to treatment with methicillin and
flucloxacillin.
Although other types of antibiotics can still be used to treat
infections caused by MRSA, these alternative drugs are usually not
available in tablet form and must be administered through a drip
inserted into a vein.
Staph including MRSA can be spread among people having close
contact with an infected person. MRSA is almost always spread by
direct physical contact and not through the air. However, spread
may also occur through indirect contact by touching objects (e.g.
towels, sheets, wound dressing, clothes, workout areas, or sports
equipment) contaminated with Staph bacteria or MRSA.
Staph bacteria can live on the skin or in the nose of healthy
individuals without causing any symptoms of disease. This is known
as colonization and MRSA can also be carried in this way. However,
injury to the skin (e.g. scrape or cut) can allow an opportunity
for bacteria to enter the skin and cause an infection.
Infections caused by Staph or MRSA are usually mild, limited to the
surface of the skin, and can be treated successfully with proper
hygiene and antibiotics. In rare cases, if left untreated or not
recognized early, MRSA infections can be difficult to treat and can
progress to life-threatening blood or bone infections because there
are fewer effective antibiotics available for treatment.
To diagnose an MRSA infection, a sample from the infected wound
(either a small biopsy of skin or pus taken with a swab) must be
obtained to grow the bacteria in the microbiology laboratory. Once
the Staph is growing, the organism is tested to determine which
antibiotics will be effective for treating the infection. A culture
from a known or suspected skin infection is especially useful in
recurrent or persistent cases of skin infection, in cases of
antibiotic failure, and in cases that present with advanced or
aggressive infections (e.g. bloodstream infections).
Athletes, athletic personnel, and parents can help prevent and
control MRSA infections within the athletic setting by following
these simple health and hygiene practices:
1. Wash hands frequently with soap
and water, especially after using any sports facilities.
2. Avoid sharing personal items (e.g., towels, washcloths, razors,
clothing, or uniforms) that may have had contact with an infected
individual or potentially infectious material.
3. Report any suspicious skin sore or boil to your healthcare
provider and school nurse immediately.
4. If you participate in sports involving close personal contact
(e.g. wrestling and football) shower with soap immediately after
each practice, game, or match.
5. Non-washable gear (e.g. head protectors), should be wiped down
with alcohol after each use.
6. Athletic equipment such as wrestling or gymnastics mats should
be wiped down regularly with an antibacterial solution (e.g.
Hibiclens).
7. Individuals with an infection involving drainage (e.g. pus
drainage), who are involved in close contact sports, should be
excluded from participation in sporting events and practices until
no pus drainage is present and the infected site can be adequately
covered with a bandage and clothing.
8. Any cut or break in the skin should be washed with soap and
water and a clean, dry dressing applied on a daily basis, before
and after participation in close contact sports, and after using
any sports facilities.
9. Tell your healthcare provider (e.g. primary care doctor or
school nurse) and the appropriate athletic personnel if you
currently have or have had a history of an antibiotic-resistant
Staph skin infection(s).
MRSA has been recognized as a problem in the healthcare setting for over 20 years. The CDC believes that MRSA has been emerging in the community over the last several years for reasons that are unknown. It is difficult to determine whether there is an increase in MRSA disease in the community or an increased awareness and recognition of MRSA disease. However, it is clear that some of the recently recognized outbreaks of CA-MRSA are associated with strains that have some unique properties compared to the traditional hospital-based MRSA strains. However, further testing and confirmation of CA-MRSA are needed.
Article Contributed by Tracey Viehland, ATC