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MRSA Infections on Campus: Focus on Athletes

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Presentation on theme: "MRSA Infections on Campus: Focus on Athletes"— Presentation transcript:

1 MRSA Infections on Campus: Focus on Athletes
Prevention Strategies Richard D. Miller, Ph.D.

2 MRSA Infections in Athletes
MRSA, a strain of antibiotic-resistant 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

3 Sports Illustrated Feb 28, 2005

4 MRSA is not just in athletics!

5 X ? 1980s Late 90s- 2000s Prior to MRSA
Staphylococcus – a common human pathogen Common community and hospital infections Vary from mild, superficial skin to serious invasive life- threatening infections Had developed moderate antibiotic resistant now called MSSA (methicillin-sensitive S. aureus) 1980s Late 90s- 2000s MRSA – hospitals only MRSA- community X ? Moderate antibiotic resistant More virulent (aggressive/invasive, i.e. more dangerous) than normal staph More likely to lead to hospitalization Extreme antibiotic resistant Life-threatening because of immuno-compromised patients

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7 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)

8 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.

9 MRSA cases in athletes Unreported Cases Reported 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.

10 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)

11 Skin Abrasions Required! MRSA Colonization, no disease Normal Skin

12 Skin Abrasions Required! MRSA Major abrasions wound Disease

13 Skin Abrasions Required! Major abrasions Most often recognized
Athletes seek medical attention Often treated before they become infected

14 Skin Abrasions MRSA Minor scratches, abrasions, and hair follicle infections Hair follicle Disease

15 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”

16 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

17 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)

18 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)

19 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

20 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

21 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

22 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

23 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

24 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

25 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

26 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

27 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

28 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

29 Control of MRSA Transmission?
Application of HACCP Critical Control Points MRSA from Nose or Disease X MRSA on Skin Handwashing/Showering MRSA on Shared Athletic or Healthcare Surfaces X Wound Care Disinfection X X X MRSA in Nose MRSA on Skin Skin Trauma MRSA in Wound MRSA Disease Decolonization Handwashing/Showering

30 MRSA Infection Control Program
- Written MRSA Infection Control Independent help and validation Eliminating Carriers Personal hygiene Environmental cleaning Decolonize Wound care Educational Awareness

31 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

32 MRSA Infection Control Program
Environmental Cleaning and Microbiological Validation Eliminating Carriers Decolonize Wound care Educational Awareness

33 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 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 bacitracin

34 Comprehensive Cleaning/Disinfection Program
Initial Microbiological assessments of the football complex Locker room Treatment room Strength room Analysis for: MRSA, MSSA, other bacteria and fungi Cleaning and disinfection of facility- supervised with training of all personnel, including housekeeping staff Follow-up microbial sampling to validate the effectiveness

35 Don’t believe your eyes!
What appeared to be clean visually was often highly contaminated microbiologically, including MRSA!

36 MRSA Carrier Decolonization
Decolonization has been successful in athletic populations Carriers have the highest risk for MRSA infections-from their own nose and skin!! Sports medicine personnel may also be carriers Reduce infection rates?

37 850 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

38 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 Identifying breaches in infection control program Environmental monitoring Identification of carriers notification?

39 MRSA Infection Control Programs- More than just MRSA

40 MRSA Infection Control Programs- More than just MRSA
MRSA and other skin/tissue infectons Respiratory diseases Athlete’s foot, ringworm fungus skin infections

41 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 Respiratory infections Athlete’s foot fungus Liability protection

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43 Infectious Diseases in Athletes
MRSA Infection Control Program ☺Benefits☺ Best athletic performance Liability protection Help promote the good – protect from the bad

44 Thank you!


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