A deadly bacterium has killed at least one athlete and has colleges scrambling to make their facilities safe
About a month ago, a senior football player at Bowdoin College went to bed barely noticing what looked like a small pimple on his lower leg. When he woke up the next day, he followed a typical schedule for a college athlete: ate in the dining hall, hung out in his friend’s dorm room, worked out at the gym, stopped by the training room, and attended practice.
Eight hours into his day, that pimple on his shin had become a noticeable lesion — large enough that Dan Davies, Bowdoin’s head athletic trainer, pulled the player aside to take a closer look.
“It was oozing a fluid, it was red and swollen and very scabbish-looking,” Mr. Davies says. “I sent him to the health center immediately.”
Mr. Davies’s fear was one that many college athletics officials share: that this student had contracted methicillin-resistant Staphylococcus aureus, or MRSA, highly contagious staph bacteria that can cause bloodstream infections, pneumonia, and, in extreme cases, death.
In the past, MRSA was mostly confined to hospitals and long-term health facilities, but it has now become a threat to competitive athletes on the high-school, college, and professional levels. In the past three years, outbreaks have occurred on football teams at the University of Southern California, the University of Georgia, and dozens of other colleges and universities. At Lycoming College, in Pennsylvania, a player died from the infection.
The U.S. Centers for Disease Control and Prevention has identified MRSA as an emerging health risk and has issued guidelines for athletics programs to follow to prevent outbreaks, including educating athletics trainers and staff members to check suspicious-looking wounds. The National Collegiate Athletic Association and National Athletic Trainers’ Association have also released statements warning about MRSA, prompting some institutions to hire outside companies to spray antimicrobial shields and ozone-cleansing chemicals throughout their facilities, to the tune of up to $10,000.
Unlike most bacterial strains, MRSA is a superbug, resistant to most standard antibiotics, so it often has to be treated with rarer forms of that medication. Staph bacteria are carried on the skin or in the nose of 25 to 35 percent of healthy people, but cause infection when they have an opportunity to grow through even a tiny scratch or break in the skin. Often people do not know they have the infection until they become ill.
Although there are no statistics on the number of MRSA cases among college athletes, experts say they are on the rise, particularly in contact sports like football and wrestling. One company that started marketing products this summer to disinfect athletics facilities and synthetic turf has already had almost 100 inquiries from college athletics departments.
“It’s so infectious and easy to spread,” says Jeff Benson, a Bowdoin College physician and director of its health services. “It could shut down an entire athletics program.”
First Outbreaks
One of the first known cases of MRSA among college athletes was in 2003, when an outbreak occurred among members of the University of Southern California football team. During that season, 11 players were diagnosed with MRSA and six were hospitalized, according to a study co-written by Russ Romano, the university’s head athletics trainer, which was published this June in the Journal of Athletic Training. All Southern California’s players, including another who contracted the infection during the 2004 season, recovered.
Since then outbreaks have occurred at several other universities. Six football players at the University of Georgia were infected with MRSA between 2003 and 2005. All of those players have fully recovered — but athletes at some other institutions have not been so lucky.
In 2003, Ricky Lannetti, a football player at Lycoming College, contracted MRSA but was not diagnosed until it was too late. He thought he had the flu, and within days the infection had taken over his body. By the time he got to the hospital, his kidneys were shutting down. The senior died in his hospital bed the night before his teammates took the field for a Division III playoff game.
He is not the only casualty. At the University of Tulsa, a football player, Devin Adair, died this April of what has been described as a rarer form of MRSA, called methicillin-sensitive Staphylococcus aureus, or MSSA.
Because of stories like those, many athletics trainers are becoming more vigilant about any open wounds, no matter how minor they might seem. Thanks to an observant trainer, the Bowdoin football player’s lesion — which tested positive for MRSA — was diagnosed in time to ward off illness or hospitalization. (The player did not want his name used.)
Even before the test was confirmed, Bowdoin officials went into action to try to keep the potential infection from hitting other students. The football player had trudged around the campus all day with an open, infectious wound, so college officials — with men in white biohazard suits in tow — retraced his steps to disinfect anything and everything he may have encountered.
Starting in his room that morning, the student went across the hall to a friend’s room. He ate in the dining hall and worked out in the fitness facility. He changed in the locker room, then headed to a team meeting room.
Everything in his path — from weight machines to couches to desk tops — had to be scoured. All the football team’s uniforms and pads were disinfected. Footballs were thrown away, along with other items that could not be properly cleaned, such as pillows. And every person the player had come in contact with had to undergo head-to-toe skin exams.
The entire process, including hiring an outside cleaning company, cost Bowdoin about $5,000.
Because Bowdoin officials knew that the threat of an MRSA outbreak could extend beyond the athletics department, officials responsible for residence life, environmental health and safety, facilities — and even deans — met before the student’s test results even came back to discuss MRSA and its possible implications for the campus.
Officials also began informing students about the bacteria and asked that anybody who discovered a suspicious mark on their skin go to the health center to have it checked out.
As a result, another case emerged, completely unrelated to the football player’s infection. A female student who had spent the summer working at a nursing home had become infected with MRSA through a shaving nick under her arm. Both students were sent to live in rooms with private bathrooms until their infections cleared.
An Ounce of Prevention
As MRSA has spread into more athletics departments, some institutions that have not had outbreaks have started taking the threat just as seriously as those that have. At Virginia Tech, no athletes have been hit with the infection, and officials would like to keep it that way.
After a football player vomited on the team’s synthetic turf field during a practice this spring, the head coach, Frank Beamer, wondered how well such potentially contaminated surfaces were being disinfected — and if anything more should be done to prevent outbreaks of such infections as MRSA. Parents and high-school coaches with similar worries have contacted athletics officials at Virginia Tech in recent months.
After looking into the issue, athletics officials decided they needed to do more. The team signed a contract with SportCoatings, a company that treats sports surfaces, including synthetic turf. Over the summer, the company applied an antimicrobial treatment to the artificial turf, as well as to training rooms, locker rooms, whirlpools, gym mats, and exercise equipment. The company says its application, which only needs to be done once and is guaranteed for a lifetime, does not leach any chemicals or heavy metals into the environment.
Besides preventative treatments and more thorough cleaning, some athletics departments have established tougher infection-control strategies. The University of Southern California requires athletes to shower immediately after their workouts and games, using antibacterial soap provided in the locker rooms.
The program no longer allows players to use cotton towels on the practice field and at games; instead they must dry off with disposable paper towels to prevent the spread of infection. And to kill any bacteria that may linger in dirty laundry, water temperature in the washing machines has been increased to 140 degrees.
Many universities are also spending more time educating students about what MRSA is, what it can look like in its beginning stages, and what students can do to prevent it. (See information below.) Athletics trainers are even using presentations, handouts, and posters to encourage athletes to wash their hands more often, resist sharing towels or razors, and cover their open wounds.
At the University of Georgia, athletics officials encourage students to get even small marks on their skin checked, instead of waiting until symptoms worsen. But that doesn’t always happen, says Ron Courson, Georgia’s director of sports medicine.
“It’s not the type of thing that athletes will typically report to you, like a sprained ankle,” Mr. Courson says. “That’s the issue with wounds, especially among football players and wrestlers who are taught to be tough — they wait until it’s too late to self-report it.”
FACTS ABOUT MRSA
What is MRSA?
Methicillin-resistant Staphylococcus aureus is a staph bacterium, resistant to standard antibiotics, that can cause infection through breaks in the skin, such as pimples or razor burns. If left untreated, MRSA can lead to bloodstream infections, pneumonia, and, in rare cases, death. Most infections are treatable with potent antibiotics.
What does it look like?
MRSA causes a skin infection that may resemble a pimple, boil, or ingrown hair. An infection may be red, swollen, or have pus or other drainage.
Why is MRSA increasing among college athletes?
MRSA is transmitted most frequently by skin-to-skin contact, putting athletes in contact sports like football and wrestling at the greatest risk. The infection has spread quickly in locker rooms and other athletics facilities where people come into close contact with one another, use the same equipment, and often share items such as razors or towels.
How can it be prevented?
Athletes should practice good hygiene: washing hands, avoiding contact with other peoples’ wounds or bandages, and avoiding sharing personal items such as towels or razors. Athletes should cover all wounds with clean bandages, and athletics departments should regularly disinfect all surfaces and shared items.
SOURCE: The U.S. Centers for Disease Control and Prevention; Chronicle reporting
http://chronicle.com Section: Athletics Volume 53, Issue 6, Page A46