Athletes & MRSA

Duke Infection Control Outreach Network (DICON)

MRSA Infections in Athletes

Background

MRSA infections are now known to be a common and important problem in amateur and professional athletes. Through long-standing close personal and professional relationships with the Director of Sports Medicine at Duke University Medical Center and the Duke Football Team Head Trainer, we have gained extensive experience in the diagnosis, management and prevention of MRSA infections in Duke University athletes. This experience along with our review of several recent articles concerning the outbreak of MRSA infections among NFL and college football teams has led to the realization that MRSA infections remain an ongoing threat for professional sports. We are aware that medical personnel working for many professional and college teams have recently been contacted by vendors touting chemical or specialized cleaning services designed to prevent MRSA infections in their athletes. We believe that a relatively small number of cheaper, more basic and practical preventive measures will successfully prevent MRSA infections in athletes.

DICON was established in 1997. Since then, we have developed contractual working relationships with 36 community hospitals in the southeastern United States. DICON’s primary focus is to improve outcomes for patients by reducing the rates of healthcare-associated infections and minimizing the costs associated with those infections. Our network-based approach has resulted in significantly reduced rates of healthcare-associated infections in our affiliated hospitals. The DICON article published in Infection Control and Hospital Epidemiology in March 2006 (see article under separate DICON website section “Publications” ) provides data that validates our methodology. Following entry into our network, rates of all major categories of healthcare-associated infections declined in twelve DICON hospitals for the period 1999-2003. Specifically, the rates of MRSA infections declined by an average of 22%.

For many years, MRSA infections were considered to primarily affect people who were or had been hospitalized. However, things have changed. Infections due to Staphylococcus aureus are now well recognized problems in competitive athletes who incur minor skin abrasions or cuts. In the past when such infections occurred, they were rarely serious because inexpensive oral antibiotics were usually highly effective in treating these infections when they occurred.

Recently, highly virulent strains of Staphylococcus aureus (called "community-associated methicillin-resistant Staphylococcus aureus or CA-MRSA) have caused outbreaks of serious infections among professional football and baseball teams and in college and high school athletes. Infections due to CA-MRSA occur surprisingly often in otherwise healthy people residing in the general community as well as in athletes. Infections due to CA-MRSA can manifest as severe boils and other skin infections, infections in joints, pneumonia, and, rarely, even death. If infections due to CA-MRSA are not promptly recognized and treated, surgery and intravenous antibiotic therapy may be necessary to achieve cure.

DICON has expanded its traditional infection prevention activities to include programs to prevent infections in professional athletes. Personnel from DICON have recently provided expert advice and assistance to professional and Division I athletic sports teams regarding the prevention of infections due to CA-MRSA. Specifically, we have given trainers, coaches, and athletes on these sports teams practical advice and a detailed prevention program regarding methods to prevent outbreaks of CA-MRSA.

DICON Educational Program to Prevent MRSA Infections in Athletes

In order to be effective, educational programs that prevent MRSA infections must be specific to each team or institution, and both practical and understandable. Such programs should be based on solid scientific principles. Our educational program encompasses all of the preceding components and includes the following educational services:

Written specific recommendations following interviews with athletic trainers and on-site evaluation of the following:
- Your training and treatment facilities, weight rooms, locker rooms and showers
- Personal hygienic practices of team members, trainers, coaches, and other staff.
- Existing policies related to first-aid, physical and medical therapies, whirlpools, laundry procedures, and disinfection agents
- Existing policies and/or practices related to the evaluation of known or suspected infection
Educational aids (e.g. posters, brochures) and/or programs (lectures) specifically designed for
- Players
- Trainers
- Coaches
- Medical personnel

Educational process maps/guidelines for common problems such as:
- Prevention of MRSA infection following cuts, abrasions, turf burns etc [e.g. when is the use of topical mupirocin advisable].
- Diagnosis and management of minor infections (pimples, boils) [e.g. When and how should cultures should be obtained, referral made, treatment initiated?]
- Advice based on review of the medical literature for treatment recommendations, options and algorithms for empiric and directed therapy for MRSA infections (for use by team or consultant physicians)
- Advice concerning special situations
- Management/referral of athletes with serious or recurrent infections
- Education for family of team members with MRSA infections
- Utility of environmental or nasal cultures (when, why, why not, and how?)
- Utility (or lack of utility) of specialized disinfection systems or products