MRSA Shows No Mercy

Sports-related injuries are a dynamic that most personal trainers expect to encounter at some point in their careers. Whether it is a weekend-warrior client who wants to pack the most punch into his once-a-week session, or a client training for a challenging competitive race, eventually someone will suffer a sprain, pulled muscle, or joint pain of one variety or another.

Lurking unobtrusively in most gyms and fitness centers, however, there just may be a quiet yet insidious situation which can make all other sports injuries pale in comparison.  The culprit is none other than Methicillin-resistant Staphylococcus aureas, better known as MRSA.

MRSA is a strain of bacteria that causes skin infections. The danger lies in the treatment of such an infection, since MRSA is resistant to the majority of antibiotics available today. While research studies indicate that about one in every three individuals carry fairly innocuous Staphylococcus bacteria in their nose, only 2% of individuals within a given community carry the virulent and highly dangerous drug-resistant strain.

MRSA was first observed in hospital settings, often being identified as the causal agent of bloodstream infections in patients whose immune systems were already compromised due to other diseases and conditions. Today we see varieties of MRSA outbreaks that occur in community settings, often referred to as CA-MRSA, or Community-Acquired MRSA. These infections have the preponderance of affecting the skin of otherwise healthy individuals.

In the past several years, CA-MRSA seems to have made an appearance in an arena previously thought to be associated with very healthy individuals: the world of contact-sport athletes.  The bacteria and subsequent infection can easily be transmitted via skin-to-skin contact. While such MRSA infections can occur in participants of any type of sports, the likelihood dramatically increases in contact sports, such as football, wrestling and rugby.

In assessing the risk of transmission, it is important for fitness professionals and athletic trainers to become well-versed in recognizing the signs and symptoms of an emerging MRSA infection. Initially, the skin site may resemble an infected-looking pimple or spider bite, often progressing to the stage of abscess formation.  Swelling of the affected area usually occurs, accompanied by a warming of the skin. Occasionally an athlete will present with what seems to a clinician to be cellulitis; however, the associated pain tends to be disproportionate to the wound.

In more advanced cases of MRSA, joints become infected and swollen. In severe cases of infection, this can lead to endocarditis, septicemia, necrotizing fasciitis, osteomyelitis, and multisystem organ failure.  Once sepsis sets in, death becomes a dire concern. The mortality rate from Staph aureus bacteremia is currently estimated to be a high as 10-20%.

Even athletes who engage in traditionally non-contact activities may be at more of a risk for infection than they realize. If the person at your gym who used the 50-pound dumbbells right before you had drainage from an open MRSA skin infection, coming into contact with those weights may cause you to become infected with MRSA bacteria.  Something as innocuous as grabbing your training buddy’s towel by mistake, and wiping it across your freshly-shaved (and possibly nicked) face, takes on an entirely new and frightening dimension, should he be harboring an open wound.

According to a 2011 study released in the American Journal of Infection Control, shared gym supplies such as yoga mats and boxing gloves offer the greatest potential for infection transmission.  These items can be “a haven for dirt, sweat, and grime,” says Neal Pire, spokesperson for the American College of Sports Medicine and owner of Inspire Training Systems.  Practicing good hygiene, such as wiping machines before and after use with an anti-bacterial solution, as well as washing hands thoroughly with warm/hot soapy water, will go a long way toward preventing the spread of potentially hazardous bacteria.

Contact sports do indeed put athletes at increased risk for a MRSA infection. While it is not fair to gender-bias in any situation, it appears as though teenage boys — known to be less attuned to hygiene practices than their female counterparts — are at a higher risk for such an infection, according to William Schaffner, MD, an infectious disease specialist at Vanderbilt University School of Medicine. “There are a number of studies now that have indicated that boys and locker rooms need some hygienic revitalization,” Schaffner says. “Boys need to be encouraged during football practice or playing basketball to absolutely take a shower after those activities. Use soap. It sounds pretty elementary but it’s important. Do not share towels and make sure your uniform and your towels are washed or laundered frequently.”

Although previous research has focused on MRSA outbreaks among college athletes, a new study is one of the first to look at athletes who carry the bacteria without displaying any symptoms.  The study followed 377 athletes from Vanderbilt University, engaging in 14 different sports, including football, soccer, basketball, lacrosse, baseball, cross-country and golf. Each month, the researchers took nose and throat swabs from the athletes to test for MRSA bacteria.

In this study, contact sports athletes were found to be more than twice as likely to carry MRSA in their noses and throats, and they tended to carry the microbe for longer periods of time, as compared to athletes in non-contact sports such as baseball and golf.

Over the course of the two-year study, between 8 and 31 percent of contact sports athletes carried MRSA at any given time, compared with 0 to 23 percent of athletes in non-contact sports, and 5 to 10 percent of the general population.  While none of the college athletes had symptoms of a full-blown MRSA infection, merely harboring the bacteria can increase the likelihood of infection emerging, the researchers said.

“This study shows that even outside of a full-scale outbreak, when athletes are healthy and there are no infections, there are still a substantial number of them who are colonized with these potentially harmful bacteria,” observed Natalia Jimenez-Truque, a research instructor at Vanderbilt University Medical Center in Nashville, Tennessee.

The study was presented this year at the annual meeting of the Infectious Diseases Society of America (IDSA), the Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA) and the Pediatric Infectious Diseases Society.

The Centers for Disease Control and Prevention (CDC) has published a list of practical recommendations for preventing the spread of CA-MRSA, and many major university football programs have incorporated the following into their training protocol:

  • Educating staff, coaches, administrators and athletes about the CDC guidelines
  • Increasing surveillance of “spider bites,” pimples and boils that could be early signs of MRSA infection
  • Identifying CA-MRSA carriers with nasal cultures (especially at beginning of season)
  • Encouraging frequent hand hygiene by all medical staff and athletic trainers
  • Introducing 3 percent hexachlorophene or 4 percent chlorhexidine in shower soap dispensers intermittently during the season
  • Making alcohol-based hand sanitizers available on the practice field and at games
  • Spraying treatment tables, taping tables, and weight-training and rehabilitation equipment with disinfectant frequently throughout the day
  • Using disposable towels on the field during practices and games to prevent the spread of bacteria, and immediately discarding used towels
  • Using unit-dose massage lotions and gels rather than large containers with pumps
  • Barring athletes with open wounds from using the whirlpools
  • Ensuring that the water used for laundry and showers is at least 140°F (60°C)
  • Incising and draining pimples and boils presenting as painful spider bites, and performing wound cultures
  • Warning players about possible consequences of these infections and showing them pictures of wounds that had gone untreated.

In the absence of a vigilant coaching staff, how can one protect oneself while at the community gym or fitness center? Essentially, much of the same logic applies here as well. Keeping open wounds covered protects both parties – the one with the infected cut as well as the one with a paper cut that is open but not yet compromised. Refraining from using stretching/yoga mats that are cracked is another good tip, since infectious bacteria tend to congregate and thrive in dark, warm, moist environments.

Be considerate of your fellow gym patrons by wiping down equipment both before and after you use it. While a brief wipe with a plain towel is preferable to leaving behind a puddle of sweat, use of an antibacterial wipe or spray is ideal. Most gyms will provide complimentary disinfecting agents, so there are no excuses for opting out of cleanliness.  Likewise, prior to entering a swimming pool or hot tub, it is advisable to shower briefly, to prevent introducing bacteria into an environment known to be hospitable to germs.

Hands are not the only appendages that need to be washed thoroughly. According to the American Podiatric Medical Association, much can be done to prevent infection by simply practicing good foot hygiene at the gym. Wearing flip-flops in the shower, and avoiding barefoot exposure while traversing the locker room floor, both can help mitigate the contact of and spread of dangerous disease-causing bacteria.

While staying informed regarding MRSA infections may cause a bit of alarm, remember that the ounce of prevention in this case may well be worth more than we realize. Cultivating a healthy respect for a potentially deadly bacterium is one thing; however, it should not in any way be construed as an excuse for avoiding the gym or cancelling a club membership. Exercise is a vital part of daily life; and the majority of athletes, both professional and recreational, will most likely never encounter a MRSA outbreak. Odds may be low, but the risk is still present. That tried-and-true adage is still probably the best advice: there is no substitute for “clean living”!

References:

1. http://www.cdc.gov/mrsa/community/index.html

2. http://www.cdc.gov/mrsa/community/team-hc-providers/index.html

3. http://emedicine.medscape.com/article/108972-overview#aw2aab6b7

4. http://www.achd.net/mrsa/MRSAAthlete.html

5. http://health.usnews.com/health-news/articles/2014/10/09/contact-sports-boost-spread-of-superbug-germs-study-says

6. http://www.nata.org/NR031605

7. http://www.mayoclinic.org/diseases-conditions/mrsa/in-depth/mrsa/art-20047876

8. http://www.aaos.org/news/bulletin/oct07/clinical1.asp

9. http://www.huffingtonpost.com/2014/10/10/contact-sports-mrsa-athletes-college-football_n_5966024.html

10. http://thenationshealth.aphapublications.org/content/41/6/32.full

11. http://health.usnews.com/health-news/articles/2012/04/25/dont-get-sick-at-the-gym-7-ways-to-prevent-infection

12. http://clubindustry.com/forprofits/truth-about-germs-health-clubs

About the Author

Cathleen Kronemer is an AFAA-Certified Group Exercise Instructor, NSCA-Certified Personal Trainer, competitive bodybuilder and freelance writer. She is employed at the Jewish Community Center in St. Louis, MO. Cathleen has been involved in the fitness industry for more than two decades. Look for her on www.WorldPhysique.com.

About

Guest authors offer experience and educational insights based on their specific area of expertise. These authors are contributing writers for the NFPT blog because they have valuable information to share with NFPT-CPTs and the fitness community at-large. If you are interested in contributing to the NFPT blog as a guest, please send us a note expressing your interest and tell us how you can contribute valuable insights to our readers. We look forward to hearing from you! Send to [email protected]