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Diseases & Topics

Community-Associated MRSA

Managing CA-MRSA On Athletic Teams

N.C. Public Health Recommendations

Hand hygiene is the single most important factor in preventing the spread of MRSA. Coaches and trainers should perform appropriate hand hygiene (wash with soap and water or use alcohol-based hand sanitizer) after contact with players, especially when changing bandages, providing care for wounds, and after removal of gloves. In situations where access to sinks is limited — e.g., games — carry individual containers of alcohol-based hand sanitizer.

Educate players on appropriate management of wounds (clean or infected), which includes immediate washing of wounds with soap and water; covering wounds with bandage/dressing until healed and no drainage is present; changing dressing at least 2 times/day and when visibly soiled; washing hands after changing dressings; and disposing of dressing in proper containers.

  • Exclude players with draining lesions or open wounds (whether covered or not) from whirlpools, ice tubs, saunas and hot tubs.
  • All wounds should be covered until healed, especially when contact with multi-use items (weight equipment, electric stimulation cuffs) is possible.
  • Wounds should be adequately covered during competition (e.g., bandaged and use of protective sleeve) especially if drainage is present.

Hygiene and Infection Control Practice for Athletes

  • Do not share towels (even on the sidelines of games) or other personal hygiene items with other players.
  • Shower with soap before using the whirlpool, steam room, or sauna.
  • Shower as soon as possible after EVERY practice, game, or tournament.
  • Avoid contact with draining lesions and contaminated items (e.g., bandages) from other people.
  • Wash hands after using multiuse equipment (e.g., weight equipment) and after contact with potentially contaminated items (e.g., another person's wounds, infected skin, or soiled bandages).

Environmental Cleaning

  • Clean all shared surfaces that come in contact with bare skin — e.g., mats, massage tables, training tables, and therapy machines — after each person with a cleaning/disinfecting spray.
  • Clean all skin contact points of weight equipment at a minimum once per day with a commercial disinfectant approved as effective against Staphylococcus aureus by the Environmental Protection Agency (PDF, 350KB) External link, or a solution of 1 tablespoon bleach in one quart of water (must be mixed fresh daily). Follow the directions listed on the labels of all cleaning/disinfecting products.
  • Use a clean towel as a barrier between bare skin and shared surfaces (e.g., exercise equipment, sauna bench, leg supports during therapy).
  • Repair or discard equipment with damaged surfaces that cannot be adequately cleaned (e.g., equipment with exposed foam).
  • Wash towels, uniforms and other laundry in hot water for at least 25 minutes with ordinary detergent and dry on the hottest setting the fabric will tolerate.

Disease Surveillance

MRSA infections spread quickly on athletic teams and can be difficult to control. Therefore, it is important for coaches and trainers to be aware of every skin infection as soon as it occurs to prevent a single case from becoming an outbreak.

  • Instruct players to report suspicious skin changes such as redness, warmth, swelling, tenderness, or drainage, especially when associated with cuts, boils, or sites of skin irritation and abrasions.
  • If MRSA infections occur among team members, coaches and trainers should begin actively checking for new lesions among team members. This may include questioning all team members before practices and referring those with new lesions to their physicians.
  • If MRSA infections occur among players on children's sports teams, consider notifying parents of all team members to enlist their support with reinforcing hygiene measures and reporting of skin lesions to team officials. Care must be taken to maintain confidentiality of players with infected wounds to avoid stigmatization and anxiety.

Diagnosis and Treatment

Consider all draining wounds as MRSA infections.

All players with suspicious skin lesions should be evaluated by a physician or other qualified healthcare provider. There is no single accepted treatment for MRSA skin and soft tissue infections. Decisions about antibiotic treatment should be made by the healthcare provider. Guidelines for management of suspected MRSA infections External link have been developed by N.C. Statewide Program for Infection Control and Epidemiology (SPICE).

Player Exclusion from Participation

Any athlete with a draining wound should be evaluated by a physician or qualified healthcare provider for participation in athletic activities. Decisions regarding participation should be based on the following factors:

  • Ability to cover lesions: Athletes with draining lesions or packed open wounds should be excluded from practice and participation unless the lesions can be adequately and completely covered with a bandage that can withstand the rigors of competition.
  • Presence of infections in other team members: Coaches and administrators should consider excluding all athletes with draining lesions or packed open wounds (covered or uncovered) from practice and participation if there are multiple players on the team with confirmed or suspected MRSA lesions.
  • Nature of contact: Whether a lesion can be adequately covered depends on the nature of the contact. Wrestlers with draining lesions or open packed wounds (covered or uncovered) should not be allowed to participate until all drainage has resolved, or until packing is no longer required in the case of open wounds. Decisions regarding exclusion from other high-contact sports (e.g., football) should be made after consideration of the first two factors.

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