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SPORTS-O-ZONE SANITIZING SYSTEM Staph Germs Harder than Ever to Treat, Studies Say By Marilynn Marchione, Associated Press Writer, Wed, Nov :14 PM EST WASHINGTON – Drug-resistant staph bacteria picked up in ordinary community settings are increasingly acquiring "superbug" powers and causing far more serious illnesses than they have in the past, doctors reported Monday. These widespread germs used to be easier to treat than the dangerous forms of staph found in hospitals and nursing homes. "Until recently we rarely thought of it as a problem among healthy people in the community," said Dr. Rachel Gorwitz of the federal Centers for Disease Control and Prevention. Now, the germs causing outbreaks in schools, on sports teams and in other social situations are posing a growing threat. A CDC study found that at least 10 percent of cases involving the most common community strain were able to evade the antibiotics typically used to treat them. The conference is a joint meeting of the American Society for Microbiology and the Infectious Diseases Society of America.

SPORTS-O-ZONE SANITIZING SYSTEM What is staph? Staphylococcus, or staph, is a group of infectious bacteria which can cause a variety of conditions ranging from skin rashes to abscesses. Staph is actually an extremely common bacteria, living on the surface of all human skin, but it will take advantage of vulnerability in the skin to enter the body, causing infection and discomfort. According to the Center for Disease Control (CDC) 25% to 30% of humans have the staph bacterium on their skin or in their nose.

SPORTS-O-ZONE SANITIZING SYSTEM What is drug resistant staph? Methicillin-resistant Staphylococcus aureus (MRSA) is a type of bacteria that is resistant to certain antibiotics. These antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin and amoxicillin. Staph infections, including MRSA, occur most frequently among persons in hospitals and healthcare facilities who have weakened immune systems. (CDC)

SPORTS-O-ZONE SANITIZING SYSTEM Who has MRSA? Approximately 1% of the U.S. population (roughly 2.3 million persons). Serious MRSA infections occur in approximately 94,000 persons each year and associated with approximately 19,000 deaths. Of these infections, about 86% are healthcare- associated and 14% are community-associated. Journal of the American Medical Association

SPORTS-O-ZONE SANITIZING SYSTEM What is the difference between Healthcare and Community MRSA? Healthcare-Associated MRSA (HA-MRSA) occurs most frequently among persons in hospitals and healthcare facilities who have weakened immune systems. Community-Associated MRSA (CA-MRSA) infections are not acquired by people through hospitalization or medical procedures. Typically these infections manifest themselves as pimples or boils, and occur in otherwise healthy people.

SPORTS-O-ZONE SANITIZING SYSTEM What are the risk groups for MRSA? Athletes (1 st group--wrestling, football, and rugby. 2 nd group--soccer, basketball, field hockey, volleyball, rowing, martial arts, fencing, and baseball.) Military recruits Children Pacific Islanders Alaskan Natives Native Americans Men who have sex with men Prisoners Center for Disease Control

SPORTS-O-ZONE SANITIZING SYSTEM What factors are common to these risk groups? Close skin-to-skin contact Openings in the skin such as cuts or abrasions Contaminated items and surfaces Crowded living conditions Poor hygiene Center for Disease Control

SPORTS-O-ZONE SANITIZING SYSTEM How fast can MRSA attack? Ricky Lannettis story demonstrates – a healthy college athlete went from first symptom to death in 5 days. In 2007, healthy Virginia student from symptom to death in 7 days. 2 cases in California prisons went from first symptom to death in 3 days. CA-MRSA can rapidly progress to blood stream, joints, and organs.

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15 year old with a MRSA infection on right thigh, Fall 2008

SPORTS-O-ZONE SANITIZING SYSTEM Removal of 15 yr old MRSA puss pocket, Fall 2008

SPORTS-O-ZONE SANITIZING SYSTEM 15 yr old MRSA site drainage, Fall 2008

SPORTS-O-ZONE SANITIZING SYSTEM Cost of 15 year old MRSA Removal Emergency Room $ 2, Doctor follow up$ Total$ 2, Missing from total - antibiotics.

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Fig. 1 Chronic MRSA periprosthetic total knee sepsis. Courtesy of Richard P. Evans, MD Athletic trainer-- from scratch on elbow to above in 30 hrs. Close call on potential amputation.

SPORTS-O-ZONE SANITIZING SYSTEM Abscess: Incision and Drainage

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MRSA is often misdiagnosed as: Spider bite Cellulites Impetigo (blistering skin infection) Harmless pimple Most common treatment (the irony): Antibiotics

SPORTS-O-ZONE SANITIZING SYSTEM Reason Resistant bugs exist: Antibiotic Overuse When the Rams had their outbreak, the CDC found their level of antibiotic use at 10 times normal Empiric (doing what weve always done) and prophylactic (preventive) use of antibiotics cited as a leading cause of MDROs (Multi Drug Resistant Organisms)

SPORTS-O-ZONE SANITIZING SYSTEM What does MRSA need to live? Bacteria have the same needs as many other organisms. They must obtain food (dried skin is one), break the food down, and protect themselves from their environment. Ideally warmth, moisture, air (not always), and food (skin and nose).

SPORTS-O-ZONE SANITIZING SYSTEM What is the life span of MRSA? 7 months on dust 56 days on a mop head 203 days on a blanket 9 weeks on cotton

SPORTS-O-ZONE SANITIZING SYSTEM MRSA is much more likely to get worse than better: Antibiotic options are shrinking Exposure increasing Low-risk environments becoming scarce

SPORTS-O-ZONE SANITIZING SYSTEM Conflicting data from medical community?

SPORTS-O-ZONE SANITIZING SYSTEM 60 minutes, November 11, 2007 "Everyone agrees that this an epidemic. And not only is it an epidemic. But, it's an epidemic of our times. It's here in huge numbers," says Dr. Robert Daum, an infectious disease pediatrician at the University of Chicago Medical Center.

SPORTS-O-ZONE SANITIZING SYSTEM AP Washington, November 7, 2007 (AP) Drug-resistant staph infections that have made headlines in recent weeks come from what one of the nation's top doctors calls the cockroach of bacteria -- a bad germ that can lurk in lots of places, but not one that should trigger panic. This isn't something just floating around in the air, Dr. Julie Gerberding, head of the Centers for Disease Control and Prevention, told members of Congress on Wednesday. It takes close contact -- things like sharing towels and razors, or rolling on the wrestling mat or football field with open scrapes, or not bandaging cuts -- to become infected with the staph germ outside of a hospital, she said. Called MRSA, the staph germ is preventable largely by common sense hygiene, Gerberding stressed.Soap and water is the cheapest intervention we have, and it's one of the most effective, she told a hearing of the House Committee on Oversight and Government Reform.

SPORTS-O-ZONE SANITIZING SYSTEM Compliance rates of healthcare workers in hand hygiene are known to be around 50% [1]. Due to the overwhelming evidence of low compliance with hand hygiene, the risk from contaminated surfaces cannot be overlooked [2]. [1] Kampf G, Kramer A: Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs. Clinical Microbiology Reviews 2004, 17: [2] BioMed Central, Infectious Diseases, 2006

SPORTS-O-ZONE SANITIZING SYSTEM The BioMed Central (BMC) Journal, Infectious Diseases, 2006 references the persistence (ability to survive) of clinically relevant bacteria on inanimate surfaces (table, floor, bed rail, operating table, etc.) can vary in duration. The following were documented to survive on inanimate surfaces: Bordetella pertussis (whooping couch) up to five days Chlamydia pneumoniae (community acquired pneumonia) up to 30 hours Corynebacterium diphteriae (diphtheria) up to 6 months Escherichia coli (E. coli) up to 16 months Pseudomonas aeruginosa (pneumonia) up to 16 months and 5 weeks on a dry floor Enterococcus spp., including VRE (vanocomycin-resistant) and VSE up to 4 months Staphylococcus aureus, including MRSA (methicillin-resistant) up to 7 months.

SPORTS-O-ZONE SANITIZING SYSTEM A single hand contact with a contaminated surface results in a variable degree of pathogen transfer. Transmission to hands was most successful with Escherichia coli, Salmonella spp., Staphylococcus aureus (all 100%), Candida albicans (90%)….Contaminated hands can transfer viruses to 5 more surfaces or 14 other subjects. Contaminated hands can also be the source of re-contaminating the surface…. BioMed Central (BMC) Journal, Infectious Diseases, 2006

SPORTS-O-ZONE SANITIZING SYSTEM Fox News, March 17, 2009 NEW YORK Roughly one in three stethoscopes carried by emergency medical service (EMS) providers harbor the superbug MRSA (methicillin-resistant Staphylococcus aureus), a small study carried out at one hospital shows. The investigation checked 50 stethoscopes provided by EMS professionals in an emergency department. Dr. Mark A. Merlin, from Robert Wood Johnson Medical School, New Brunswick, New Jersey, and colleagues found 16 stethoscopes were colonized with MRSA. Sixteen of the EMS personnel could not remember the last time their stethoscope was cleaned, according to the report in the journal Prehospital Emergency Care. Typically, the time from last stethoscope cleaning to the test date was 1 to 7 days. As might be expected, with more recent cleaning, the odds of MRSA colonization fell significantly. "In most busy EMS systems, the concept of cleaning an entire ambulance after every patient is not practical," Merlin's team notes. "Cleaning a stethoscope, however, is not labor-intensive, does not require much time, and does not require any special equipment beyond currently stocked items."

SPORTS-O-ZONE SANITIZING SYSTEM What can be done against MRSA? CDC recommendations>>

SPORTS-O-ZONE SANITIZING SYSTEM Practice good personal hygiene Keep your hands clean by washing frequently with soap and water or using an alcohol-based hand rub. –At a minimum, hands should be cleaned before and after playing sports and activities such as using shared weight-training equipment, when caring for wounds including changing bandages, and after using the toilet. –Both plain and antimicrobial soap are effective for hand washing, but liquid soap is preferred over bar soap in these settings to limit sharing. –If hands are not visibly dirty and sinks are not available for hand washing, for example, while on the field of play or in the weight- room, alcohol-based hand rubs and sanitizers can be used. Alcohol- based hand rubs with at least 60% alcohol content are preferred. Shower immediately after exercise. Do not share bar soap and towels. Wash your uniform and clothing after each use. Follow the clothing label's instructions for washing and drying. Drying clothes completely in a dryer is preferred.

SPORTS-O-ZONE SANITIZING SYSTEM Take care of your skin Wear protective clothing or gear designed to prevent skin abrasions or cuts. Cover skin abrasions and cuts with clean dry bandages or other dressings recommended by your teams healthcare provider (e.g., athletic trainer, team doctor) until healed. –Follow your healthcare providers instructions for when and how often to change your bandages and dressings. Do not share items that come into contact with your skin Avoid sharing personal items such as towels and razors that contact your bare skin. Do not share ointments that are applied by placing your hands into an open-container. Use a barrier (such as clothing or a towel) between your skin and shared equipment like weight-training, sauna and steam-room benches.

SPORTS-O-ZONE SANITIZING SYSTEM Controlling the risk of MRSA (4 areas of concern): 1.Surfaces 2.Equipment 3.Laundry 4.Skin

SPORTS-O-ZONE SANITIZING SYSTEM Surfaces: Floors, furniture, walls, doorknobs, mats, tables, etc. A good cleaner/disinfectant (i.e. KilZone) is recommended for these areas. Follow label directions.

SPORTS-O-ZONE SANITIZING SYSTEM Equipment: Helmets, shoulder pads, leg braces, shin guards, shoes, headgear, etc. A solid equipment cleaning or sanitizing protocol (i.e. Riddells Staph Fighter and/or your own Sports-O-Zone Sanitizing System) is recommended in this area.

SPORTS-O-ZONE SANITIZING SYSTEM Laundry: Wash and Dry on HOT as recommended by clothing manufacturer. All fabrics must be completely DRY when they are taken out of the dryer – per CDC. A solid detergent system along with a sanitizer/bacteriostatic/deodorizer (i.e. KilZone) is recommended in this area. Follow label directions.

SPORTS-O-ZONE SANITIZING SYSTEM Skin: The skin is the bodies layer of protection. If an opening occurs, MRSA can move in. Using a good antibacterial soap (i.e. Hibiclens) is recommended in this area. Follow label directions.