Measures to Reduce MRSA in Sports

Skin and Soft Tissue Infection Risk in Athletes and Weight Lifters

Dec 12, 2007

Weight lifters and competitive sports teams, including basketball, fencing, football, rugby, soccer, volleyball and wrestling have an increased risk of MRSA infection.

MRSA Skin and Soft Tissue Infection

MRSA is being reported with regular frequency of skin and soft tissue infections among sports participants. Skin and soft tissue infections occur with increasing frequency in teams involved in close contact activities where abrasions and wounds are expected (e.g. wrestling, football, volleyball, rugby, basketball, soccer, fencing).

Traditionally, Staphylococcus aureus and Streptococcus pyogenes (Group A streptococcus) are the two most common bacteria that cause skin and soft tissue infections. In recent years, methicillin resistant Staphylococcus aureus (MRSA) infections have occurred with increasing numbers among schools, athletic teams and sports teams.

Factors associated with MRSA transmission include:

Skin-to-skin contact.
Crowded shared living space conditions.
Poor hygiene.
Care of infected sites.
Cleansing and handling of contaminated items and surfaces.

Possible risk factors for MRSA infection among sports participants:

Physical contact*
Skin trauma (e.g. turf burns, shaving, chafing, abrasions, wounds)
Sharing of equipment
Sharing of unwashed clothing and bath towels
Sharing soaps, balms and lubricants
Shaving of body hair**
Uncovered wounds

*In fact, MRSA infection was found in a few studies to be associated with football player position: cornerbacks and wide receivers who are often involved in scrimmage play and drills showed significant risk of having a MRSA infection over other team members.

**In a number of cases, players with MRSA infection had shaved the area now infected.

What to Watch For?

MRSA should be suspected in outbreaks of boils and other soft tissue infections among sports team members and their close contacts that do not respond to standard antibiotic therapy.

Health-care providers must consider the possibility of MRSA soft tissue infection among sports participants so that appropriate antibiotics can be prescribed.

Implementation of Preventive Measures

Players, coaches, parents, and school and team administrators must develop and implement measures to prevent MRSA transmission.

MRSA transmission control measures include:

Increased hand hygiene.
Showering with soap after activities.
Covering wounds (e.g. cuts, abrasions).
Laundering of personal items after each use (e.g. towels, supporters, etc.).
Disinfection of shared athletic equipments regularly (e.g. pads, helmets, fencing sensor wires, etc.).
Consult with physician for wounds that do not heal.

Nasal carriage (colonization) with MRSA is increased with certain habits as well. Risk factors for nasal carriage included:

having a locker near a teammate with a MRSA infection.
sharing unwashed towels.
living on campus.

Measures to Reduce MRSA Infection in the School and College Environment:

Promotion of showers after practice, play and workouts
Intermittent hexachlorophene (Phisohex) soap showers
Hygiene education
Prevention of turf burns
Education on risks of cosmetic body shaving
Appropriate whirlpool disinfection methods
Frequent disinfection of treatment tables, taping tables and athletic equipment
Promotion of trainer handwashing after each treatment
Use of disposable paper towels on the field
Ensure availability of alcohol-based hand sanitizers
Discard used towels immediately
Adequate laundry facilities: hot water washing and heat dried
Prompt drainage and culture of abscesses
Prompt recognition to ensure appropriate antibiotic therapy
Decolonization in outbreak settings***

***Decolonization of MRSA is a controversial subject: some believe strongly in its merits and others believe it provides a false sense of confidence and encourages further antibiotic resistance due to exposure to decolonization antimicrobials.

Those who support decolonization, at least in the outbreak setting such as on a football team where multiple cases of MRSA infection occur, also support the belief that in outbreak settings there are increased numbers of participants carrying MRSA in their nasal passages. If you treat nasal carriage with nasal crops such as mupirocin, MRSA carriage can be reduced leading to a reduction in MRSA infections.

Those who do oppose decolonization are likely more ready to mention the likelihood that MRSA carriers probably also carry MRSA in their gastrointestinal tract which would suggest one reason why MRSA colonization is generally determined by swabbing the nasal passages and groin area. Although a measure such as mupirocin may suggest that MRSA carriage has been reduced, it is much more likely that MRSA will represent shortly through fecal-skin/fecal-hand contamination and inoculation of the nasal passages.

Sources:

Methicillin-Resistant Staphylococcus aureus Infections Among Competitive Sports Participants

Community-Acquired Methicillin-Resistant Staphylococcus aureus: Prevalence and Risk Factors

Outbreak of community-acquired methicillin-resistant Staphylococcus aureus skin infections among a collegiate football team

Cutaneous community-acquired methicillin-resistant Staphylococcus aureus infection in participants of athletic activities

The copyright of the article Measures to Reduce MRSA in Sports in Microbiology is owned by Judy Arbique. Permission to republish Measures to Reduce MRSA in Sports in print or online must be granted by the author in writing.