PFATS Articles

Redskins Defend Against MRSA Through Education and Preparation

Brian Boyls-White, ATC, John Cortes, Bubba Tyer, John Burrell, ATC, Eric Steward, ATC, Larry Hess, MPT, ATC, Adam Peterson, MS, ATC, Shawn Fayard, LaBrent Harrell, ATC

Participants in any contact sport are at risk for contracting skin and/or soft tissue infections.1,2 Consequently, athletic training staffs must be vigilant in preventing undue complications from injuries, such as staph infections. NFL players are subject to intimate surroundings with their teammates and support staff, which if not handled correctly can turn into a breeding ground for infection. Defense against infections must carry over from the football field into the facilities where players seek treatment, rehabilitate, lift weights, eat meals, and gather for team meetings. With the commonality of open wounds among athletes, all members of the team must work to prevent infection.

Educating Athletes on MRSA

Methicillian-Resistant Staphylococcus Aureus (MRSA), Staphylococcus (Staph) and other bacteria that cause infection can take athletes out of play for long and uncertain amounts of time.  MRSA differs from a standard staph infection due to its resiliency to certain types of antibiotics.3  MRSA infected athletes usually require in-hospital care and copious amounts of intravenous antibiotics.  Signs and symptoms of MRSA can resemble something as simple as a pimple, boil or infected hair. In addition, skin may appear to be red, swollen and painful. Sores may contain fluids such as blood or pus.4  If MRSA is suspected, sores should be cultured and laboratory tested to determine the exact type of infection.
Athletes are often unaware of what is really developing underneath their skin so educating them about the warning signs is essential.  Education programs should include information on:

• Transmission methods of fungi, virus and bacteria
• Signs and symptoms of an MRSA infection
• Transmission prevention techniques through proper hygiene, proper whirlpool etiquette and proper towel usage
• Proper wound care, monitoring of wounds, recognition of signs and symptoms, and proper disposal of bandages

Pictures and diagrams can be effective tools when used in combination with bulletin boards, signs and lectures to help the athletes recognize the signs and symptoms of MRSA.  Most importantly, athletes must understand that although transmission occurs primarily through human-to-human contact, it can come from human-to-surface-to human contact.     Posted handout outlining hygiene techniques

 

Cleaning Facilities
The athletic training rooms, locker and weight rooms at both Redskins Park and the preseason practice facilities were sprayed using an aegis microbe shield to clean and guard the facilities from promoting the growth of bacteria and fungus. The treated areas were allowed to sit over night. This chemical misting does not wash or rub off and contains an EPA registered active antimicrobial.  Look for products that carry a positively charged antimicrobial which wards off negatively charged microbials.  The magnetic polarized attraction brings both anti and microbials together. The positively charged antimicrobial kills the microbial instantly. 
As part of the treatment, the buildings’ ventilation systems were inspected and swabbed for any types of mold, fungus or viruses, including multiple sites in the athletic training room, doctors offices, water rooms, locker room, equipment room, bathrooms, showers, steam rooms, weight rooms and ventilation ducts.  Returning the following day with cultures, the results showed traces of mold in part of the air-conditioning ventilation system and an eye fungus located in the players area.  Following the culture results, the entire building was thoroughly cleaned and treated.  The ventilation systems were also cleaned and any ceiling tile and insulation that contained any traces of mold were either cleaned or replaced. 
During planned follow-up visits, sample cultures will be taken to monitor  progression or regression of cleaning habits.  Cleaning techniques will be modified based upon results in order to maintain a high standard working environment for the athletes and staff. In addition, the night cleaning crews are required to clean all surface areas with a disinfectant throughout the building.  A new team jacuzzi was added and the chemicals are checked twice a day. It has an ultraviolet filter and a purifying system taking only 30-minutes to clean the water.

The sports medicine staff has employed various techniques to prevent outbreaks of MRSA. The products and techniques used at Redskins Park are outlined below:

• Tables:
  • Treatment tables are cleaned using SaniZide Plus Germicidal® solution by leaving a wet covering on surfaces for three minutes before wiping clean. To prevent transfer of MRSA, tables are cleaned between each treatment session with special efforts made for post surgical athletes.   
• GameReady® sleeves and ultrasound heads:
  • The dermal contact points on GameReady® sleeve attachments and ultrasound heads and handles are cleaned after each use with Sani-Dex ALC®. The single towel wipes are disposed after use in the standard trash. 
• Steel whirlpools: [Insert 4_4 attachment, no caption]
  • Whirlpools are drained and cleaned each time the water temperature is switched and at the end the day.  Once drained, they are thoroughly sprayed around the sides and bottom with SaniZide Plus® and wiped clean with a towel.  Iso-Quin Germicidal Solution® (Table 1, Figure 1) is then applied around the insides of the pool and wiped dry with a towel. In addition, the seating around the top of the whirlpools are sprayed with SaniZide Plus®  and dried. Lastly, the sides and bottom of the whirlpools are rinsed with hot water and allowed to drain. Condensation on the outside of cold whirlpools is wiped dry at the end of the day.
• Locker room:
  • Proper cleaning of towels and clothing is crucial in the prevention of spreading MRSA. All staff members who handle towels and clothes wear latex gloves as a preventative measure. The Redskins equipment staff washes and dries towels and other clothing throughout the day using cold water and material specific drying temperatures.
    • All towels are dried at 185°F.
    • Cotton and performance clothing are dried at 150°F and 135°F respectively until all articles are completely dry. 
  • Floors in the locker room are vacuumed and cleaned daily. Bathrooms throughout the facility are stocked with an antibacterial soap. Informative and easy-to-read signs are located on the walls of the bathroom displaying transmission prevention techniques.
  • Locker room seating and towels have been modified in order to decrease the opportunity for infection to spread. Recently,  the Redskins changed to individual players towels with inscribed numbers.  In addition, the organization purchased individual numbered stools, removing older single-bench seating.
• General Practice Facility:
  • For player and staff convenience, two Purell® instant hand sanitizing stations with easy applicator hand tops are located in the athletic training room. Two stations are located in the entrance of the dining facility and other stations are located upstairs in the administrative and meeting room sections of the building.
• Weight Room:
  

  The strength and conditioning staff utilizes Soutex, Inc®. disinfectant single use disposable towels, which are located on walls and pillars throughout the weight room within easy reach.  They also provide clean towels and bottles of SaniZide Plus® for players and staff that utilize the weight room facility.  The weight room is cleaned every other day by the strength and conditioning staff, while a night cleaning crew mops the room down daily with J-Works® (Johnson Diversey Product).

            The sports medicine staff takes numerous steps in order to prevent the spread of such infections. The Redskin’s staff utilizes Sports Coatings Inc* . (http://www.csgsport.com). More information can be found on the World Health Organizations (WHO, http://www.who.int/en/) and Center’s for Disease Control (CDC, http://www.cdc.gov/) web sites.

 

Table 1. Cleaning Products

Product	(Producer)- Contents base, Targets
SaniZide Plus	(SAFETEC Product)- EPA register; The alcohol based cleaning liquid is non-corrosive, and effective against Tuberculosis (TB), Human Immunodeficiency Virus (HIV), Hepatitis B (HBV), Vancomycin-resistant Enterococci (VRE).
Sani-Dex ALC	(PDI)- Alcohol based product; The antiseptic hand wash prevent cross-contamination.  The product label states it kills 99.99% of germs, removes soil and bacteria and contains moisturizing aloe, glycerin and vitamin E.
Iso-Quin	(Cramer Products)- Isopropyl alcohol based product; Iso-Quin is a germicidal hand wash. This product minimizes the spread of germs and infection.
Purrell Hand Sanitizing	(Pfizer Company Product) - Ethyl alcohol, water and isopropyl alcohol based product; The product label states it kills 99.99% of most common germs that may cause illness.

References

• Center for Disease Control and Prevention. The Community-Associated MRSA Information for the Public page.  Available at: http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_public.html. Accessed August 25, 2006.
• Dorman, J,M. Contagious Diseases in Competitive Sports: What are the Risks? Journal of America College Health. 2000; 49: 105-109.
• Enright, M,C., Robinson, D,A.,Randle, G., Feil, E., Grundmann, H., Spratt, B. The Evolutionary History of Methicillin-resistant Staphylococcus Aureus (MRSA). PNAS, 2002; 99: 7687-7692.
• Goodman, R.A., Thacker, S.B., Solomon, S.L., Osterholm, M.T., Hughes, J.M. Infectious Diseases in Competitive Sports. JAMA. 1994; 271: 862-967