Brady's policy paper

Brady Helmink
Methicillin-Resistant Staphylococcus Aureus (MRSA) Among Athletes

Athletics play an important role in our society today. Many young men and women dream of playing a college sport someday, and others have even higher aspirations of reaching the professional level. There are numerous roadblocks that prevent athletes from either reaching their full potential or participating at the highest level and among them are the potential dangers of disease and infection. With the spread of infection and disease among athletes soaring to new levels, reaching these goals can become even more difficult due to health problems that are associated with contracting such an infection or disease. Methicillin-resistant Staphylococcus aureus (MRSA) is one of many common infections spreading among athletic teams, including the men’s basketball team at Morningside College.
MRSA is a type of infection caused by bacteria known as Staphylococcus aureus. Staphylococcus aureus, otherwise recognized as “staph,” is a type of bacteria that lives on the surface of the skin or in the nose of humans. In fact, twenty to thirty percent of healthy people have S. aureus bacteria growing on their skin and are unaware. These bacteria are known to cause minor skin infections such as boils or pimples, but can be treated with antibiotics. However, staph bacteria can also lead to major problems such as pneumonia or bloodstream infection (3). Some types of Staphylococcus aureus bacteria are resistant to certain antibiotics. MRSA is a type of staph bacteria that is resistant to methicillin, an antibiotic first introduced in 1959. MRSA is resistant to a whole class of antibiotics known as beta-lactams, which include methicillin and more common antibiotics such as penicillin, amoxicillin, and oxacillin (5). This class of antibiotics contains a four-membered ring consisting of three carbon atoms and one nitrogen atom, known as the beta-lactam ring. This ring is the active portion of all beta-lactam antibiotics. When beta-lactam antibiotics do their job correctly, they kill bacteria in or on the body by attacking the bacteria’s peptidoglycan cell wall. However, some bacteria have become resistant to this specific class of antibiotics because of an enzyme known as beta-lactamase. This enzyme separates the beta-lactam ring from the structure of methicillin, which makes the antibiotic inactive (4).
There are two common types of MRSA: healthcare acquired, HA-MRSA, and community acquired, CA-MRSA. HA-MRSA is the most common form, and is found in people with weakened immune systems who are currently a patient in a hospital or healthcare facility. CA-MRSA is a newer form that affects healthy people that have no previous health problems. Most of those who contract CA-MRSA live in crowded settings and share personal items that become contaminated, which explains the problem of MRSA spreading among athletic teams (3). Any sport in which there is skin-to-skin contact between teammates can cause the spread of the infection. From 2002-2004, the University of Southern California conducted a study of a CA-MRSA outbreak among a collegiate football team. It was determined that there were a total of fourteen infections caused by MRSA over the three-year study. From 2002 to 2003, there was an increase in the number of cases of MRSA from two to twelve. Then in 2004 the experimenters implemented a series of preventative measures to protect against the possible outbreak of MRSA, and the number of infected players dropped to only one (1).
Over the past three years, the head coach of men’s basketball at Morningside College had indicated an increasing number of MRSA outbreaks among players. To this point, the training personnel believes that they have done all they can to help prevent the spread of the infection. After spending time researching and debating what could be done to protect players from the spread of MRSA, the coaching staff feels it is vital that a policy be written and followed to address the concerns related to this problem.

I. Policy
A. Each men’s basketball team member will be required to have a physical examination of their health prior to beginning workouts for the upcoming season. As part of the physical, all athletes will be examined by school physicians for physical symptoms of MRSA. If the examining physician feels that an athlete may be infected, that athlete will be required to be tested. If tested positive the athlete will be prescribed a topical antibiotic such as Bactroban to treat the infection. He must refrain from all team practices or games until cleared by the physician.
B. Each team member must wash their hands with soap and hot water prior to, and following, every workout, practice or game. Hand hygiene is the single most important way to prevent the spread of MRSA (2).
C. Following each workout, practice or game, all team members are required to shower in the locker room before leaving the building. Without showering, an infection that may have spread during physical activity could also be spread in other areas such as the school cafeteria or dormitory the athlete lives in.
D. Each team member will be provided their own towels: one for the workout, practice or game, and one for showering afterwards. There will be no sharing of towels or clothing between teammates. According to a study done on a college football team in the state of Pennsylvania in 2000, one of the major risk factors for infection among teammates was the sharing of unwashed bathing towels (2).
E. After use, towels and practice gear will be washed immediately by the equipment manager in order to prevent the spread of infection.
F. The school weight room, basketball court floor, and basketballs will be cleaned with disinfectant prior to, and following, each practice or game.

Opponents of this policy might argue against the way to determine if an athlete is infected with MRSA. Some suggest culturing the nares to determine if a player carries MRSA. This alternative is argued to save time and money in comparison to conducting physical examinations and making doctor appointments. However, culturing each team member’s nares is unnecessary because it will only tell if an athlete carries MRSA. These carriers don’t necessarily have the infection present on their skin, where it is contagious. Therefore, setting up appointments to test whether a boil or pimple on the skin is positive for MRSA is indeed an effective way of determining if a player is infected. It is also cost-effective in that the school saves money from not having to culture every single player.
Another argument opponents might bring to the table is how athletes are expected to disinfect equipment before and after each physical activity. Morningside College currently staffs one person who disinfects the equipment once daily, including between each basketball practice. Therefore, the players will not be required to complete this task.
In recent years, the number of MRSA-infected athletes on campus at Morningside College has increased at an alarming rate. With proper enforcement of this new policy, the Morningside men’s basketball team hopes to see a significant drop in the number of cases of MRSA. This policy is not only important for the men’s basketball program, but it will also help other athletic teams on campus such as football, women’s basketball, and wrestling put a stop to the spread of this dangerous infection. It is the goal of the men’s basketball program to educate other athletes about the dangers of MRSA and what can be done to prevent future outbreaks. This is the reason coaches for each of the other team sports have been contacted by the men’s basketball team staff and informed about this new policy. With proper prevention and training, more Mustang student athletes will be able to work and train safely without the fear of developing infections which would inhibit them from reaching their full potential.

References

1. Romano, R., et al. “Outbreak of Community-Acquired Methicillin-Resistant Staphylococcus aureus Skin Infections Among a Collegiate Football Team.” Journal of Athletic Training. Vol. 41(2): 141-145 (2006).

2. Gantz, N., et al. “Methicillin-Resistant Staphylococcus aureus Infections Among Competetive Sports Participants—-Colorado, Indiana, Pennsylvania, and Los Angeles County, 2000—2003.” Morbidity and Mortality Weekly Report. Centers for Disease Control. Vol. 52(33); 793-795 (2003).

3. Daines, R.F. “A Guide for Coaches: Preventing the Spread of Bacteria Among Your Athletes.” New York State Department of Health. 2007. Oct. Google Scholar. 2008. Sept. 16.

4. Salyers, Abigail A., and Whitt, Dixie D. Revenge of the Microbes: How Bacterial Resistance is Undermining the Antibiotic Miracle. American Society for Microbiology Press. Washington, D.C. 2005. 54-60.

5. LaRue, J., et al. “Interim Guidelines for the Control and Prevention of Methicillin-Resistant Staphylococcus aureus (MRSA) Skin and Soft Tissue Infections in Non-Healthcare Settings.” Montana Department of Public Health and Human Services, Communicable Disease Control and Prevention Bureau. Helena, MT. 2007. Aug. 1-24. Google Scholar. 2008. Sept. 18.

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