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MRSA Infections on Campus:
Focus on Athletes
Prevention Strategies
Richard D. Miller, Ph.D.
www.estechlab.com
MRSA Infections
in Athletes
MRSA, a strain of antibioticresistant staphylococcus once
confined to hospitals is striking
athletes at an alarming rate and
with dire consequences
High school, college and professional athletes
Methicillin-Resistant Staphylococcus Aureus
Sports Illustrated Feb 28, 2005
Sports Illustrated Feb 28, 2005
MRSA is not just in athletics!
Prior to MRSA
Staphylococcus – a common human pathogen


Common community and hospital infections
Vary from mild, superficial skin to serious invasive lifethreatening infections
 Had developed moderate antibiotic resistant
 now called MSSA (methicillin-sensitive S. aureus)
1980s
Late 90s- 2000s
MRSA – hospitals only
MRSA- community
?
X
• Extreme antibiotic resistant
• Life-threatening because of
immuno-compromised patients
• Moderate antibiotic resistant
• More virulent (aggressive/invasive,
i.e. more dangerous) than normal staph
• More likely to lead to hospitalization
MRSA Infections
N Engl J Med (2006) - MRSA
infections are now the most common
cause of skin and soft tissue
infections treated at emergency
departments. S. aureus caused 76%,
and of these, 78% were MRSA.
2007 CDC study (2005 data) –
estimated 90,000 cases of invasive
MRSA in U.S., with 19,000 deaths
(17,000 deaths from AIDS in 2005)
Many additional outbreaks in multiple sports including football, rugby,
wrestling, soccer, volleyball, baseball, and even fencing
Single cases and multiple case outbreaks are widespread at the high
school, college and professional levels.
MRSA cases in athletes
Reported Cases
Unreported Cases
Considering that most schools and teams would not
want cases made public, the ones that we know about
are likely to be just the tip of the iceberg.
Why Athletes?
•
General
Athletes are part of the community, and are part of the
increase in community-associated (CA)-MRSA infections
Specific
•
•
•
Athletes may have direct skin contact with other athletes
as part of their sport. (aids disease transmission)
Athletes may have contact with equipment and surfaces
contacted by other athletes (aids disease transmission)
Athletes may have skin abrasions as part of their sport
(essential for initiation of infection)
Skin Abrasions
Required!
MRSA
Colonization, no disease
Normal Skin
Skin Abrasions
Required!
MRSA
• Major abrasions
wound
Disease
Skin Abrasions
Required!
• Major abrasions
– Most often recognized
– Athletes seek medical
attention
– Often treated before they
become infected
Skin Abrasions
MRSA
• Minor scratches, abrasions,
and hair follicle infections
Hair follicle
Disease
Skin Abrasions
• Minor scratches, abrasions,
and folliculitis
– Often not recognized
– Athletes think they are not
serious enough to seek
medical attention.
• Many MRSA infections
begin as apparent “spider
bites”
Skin Abrasions
• Minor scratches, abrasions,
and folliculitis
– Often not recognized
– Athletes think they are not
serious enough to seek
medical attention.
• Many MRSA infections
begin as apparent “spider
bites”
• Infections progress rapidly
to absesses, invasive
cellulitis, even necrotizing
fasciitis, and septicemia
Carriers
Provide a reservoir and promote transmission
of MRSA and other Staph infections
•
Staph Carriers


30% of population carry as
Staph. aureus as normal
flora in the nose or rectum
(no symptoms!!)
Months-to-years
(half-life of 40 months)
Carriers
Provide a reservoir and promote transmission
of MRSA and other Staph infections
•
MRSA Carriers


1-5% of population carry
as normal flora in the nose
or rectum No symptoms!!
Months-to-years
(half-life of 40 months)
Transmission of MRSA in the
Athletic Environment
•
MRSA Carriers


1-5% of population carry
as normal flora in the
nose or rectum
Spread to face and hands
Transmission of MRSA in the
Athletic Environment
•
MRSA Carriers


1-5% of population carry
as normal flora in the
nose or rectum
Spread to face and hands
●●●●
●
●
● ●
Transmission of MRSA in the
Athletic Environment
•
MRSA Carriers (or Infections)


1-5% of population carry as
normal flora in the nose
Spread to face and hands
●
● ●
●
●
●
●
●
Transmission of MRSA in the
Athletic Environment
•
MRSA Carriers



1-5% of population carry
as normal flora in the
nose or rectum
Spread to face and hands
Transmission to others by
direct skin contact
Transmission of MRSA in the
Athletic Environment
•
MRSA Carriers




1-5% of population carry
as normal flora in the
nose or rectum
Spread to face and hands
Transmission to others by
direct skin contact
Break in skin leads to
infection
▲
Transmission of MRSA in the
Athletic Environment
•
MRSA Carriers (or Infections)
●
●

1-5% of population carry as
normal flora in the nose
 Spread to face and hands
 Break in the skin leads to
infection
 Carrier has the highest risk
of infection because of the
high level of skin
contamination
●
●
●
●
● ●
●
●
●
●
●
●
●
Transmission of MRSA in the
Athletic Environment
Shared Facilities
•
MRSA Carriers




1-5% of population carry
as normal flora in the
nose or rectum
Spread to face and hands
Transmission to others
via contaminated
environmental surfaces
MRSA can live for days
or even weeks on
surfaces
Transmission of MRSA in the
Athletic Environment
Towels
•
MRSA Carriers

1-5% of population carry
as normal flora in the
nose or rectum
 Spread to face and hands
 Transmission to others
via contaminated
environmental surfaces
 Break in skin leads to
infection
Transmission of MRSA in the
Athletic Environment
•
Equipment of the sport
MRSA Carriers

1-5% of population carry
as normal flora in the
nose or rectum
 Spread to face and hands
 Transmission to others
via contaminated
environmental surfaces
 Break in skin leads to
infection
Flow Diagram of MRSA Transmission
Different person
MRSA from
Nose or
Disease
MRSA
on Skin
MRSA on
Shared Athletic or
Healthcare Surfaces
MRSA
in Nose
MRSA
on Skin
Skin
Trauma
MRSA
in Wound
MRSA
Disease
Control of MRSA Transmission?
Application of HACCP Critical Control Points
MRSA from
Nose or
Disease
MRSA
on Skin
X
Handwashing/Showering
MRSA on
Shared Athletic or
Healthcare Surfaces
X
Wound Care
Disinfection
MRSA
in Nose
X
Decolonization
MRSA
on Skin
X
Skin
Trauma
Handwashing/Showering
MRSA
in Wound
X
MRSA
Disease
MRSA Infection Control Program - Written
Independent help
and validation
MRSA
Infection Control
Eliminating Carriers
Personal hygiene
Environmental cleaning
Wound care
Educational Awareness
Decolonize
Univ. Georgia MRSA Program
•Former Chair, College and University
Athletic Trainer’s Committee of the National
Athletic Trainers Association (NATA)
•Major address at the 2006 NATA Annual
Meeting in Atlanta, GA
“Antibiotic Resistant Staph Infections:
MRSA and Beyond”
Described the Comprehensive MRSA
Control Program in place at Univ. of
Georgia football program.
Ron Courson
Director of Sports Medicine
University of Georgia
MRSA Infection Control Program
MRSA
Infection Control
Environmental Cleaning and
Microbiological Validation
Eliminating Carriers
Wound care
Educational Awareness
Decolonize
Personal Hygiene and Management
of Staph or MRSA Infections
• Encourage good hygiene,
including showering and
washing with soap after all
practices and competitions
• Ensure availability of adequate
soap and hot water
bacitracin
– pump soap dispensers with
antibacterial soap; no bar soap
– waterless hand disinfectant dispensers
• Aggressively cover all wounds
– if wound cannot be covered adequately,
consider excluding players with
potentially infectious skin lesions from
practice and/or competition until
lesions are healed or can be covered
adequately
– Identify MRSA infections when it occurs
Comprehensive Cleaning/Disinfection Program

Initial Microbiological assessments of the football complex

Analysis for: MRSA, MSSA, other bacteria and fungi

Cleaning and disinfection of facility- supervised with training of

Follow-up microbial sampling to validate the effectiveness
 Locker room
 Treatment room
 Strength room
all personnel, including housekeeping staff
Don’t believe your eyes!
What appeared to be clean visually was often highly
contaminated microbiologically, including MRSA!
MRSA Carrier Decolonization
Carriers have the
highest risk for MRSA
infections-from their
own nose and skin!!
Sports medicine personnel may
also be carriers
Decolonization has
been successful in
athletic populations
Reduce infection rates?
 850 bed organization, 40,000 annual admissions
 universal surveillance with decolonization and isolation
 large reduction in MRSA disease compared to baseline
 during admission and 30 days after discharge
Getting Started with your MRSA Program
Keep it simple and cost effective!



Written Infection Control Program
Education of students and staff about MRSA and
their roles in prevention (for example):
•
•
•
•
Students – personal hygiene, observing for wounds
Medical staff – wound management, surface disinfection
Training staff – towel use and laundry, equipment disinfection
Housekeeping – proper disinfectants and cleaning techniques
Response to MRSA cases
•
•
•
notification?
Identifying breaches in infection control program
Environmental monitoring
Identification of carriers
MRSA Infection Control ProgramsMore than just MRSA
MRSA Infection Control ProgramsMore than just MRSA
MRSA and other
skin/tissue infectons
Respiratory diseases
Athlete’s foot, ringworm
fungus skin infections
Infectious Diseases in Athletes
MRSA Infection Control Program
☺Benefits☺
MRSA and other
skin/tissue infectons
Overall health - both students and staff
More than just MRSA- other infections!
Best athletic performance
Recruiting advantage with parents
Athlete’s foot fungus
Liability protection
Respiratory
infections
Infectious Diseases in Athletes
MRSA Infection Control Program
☺Benefits☺
Best athletic performance
Liability protection
Help promote the good – protect from the bad
Thank you!