1. Football Players Socks: A Reservoir for Staphylococcal Species Lauren Quinn Public Health Internship Program The University of Texas Austin Mentor: Marilyn Felkner, DrPH Infectious Disease Surveillance and Epidemiology Branch Texas Department of State Health Services

2. Introduction

3. CA-MRSA in Athletes Sports: football, rugby, wrestling, and fencing

4. Risk Factors in Athletes Close contact with infected individuals Skin damage(e.g. turf burns, cosmetic body shaving) Sharing personal items Football Player position

5. Equipment and Uniforms????

6. Survival of staphylococci on inanimate surfaces Hardy and may survive up to 7 months on dry inanimate surfaces Recovered from many surfaces within the hospital Limited research within community

7. Survival on Fabric Isolated from many material items Binds readily to a variety of materials Clothing of Athletes?????

8. Purpose To assess whether football players socks can serve as reservoirs for staphylococcal species, including S. aureus and MRSA

9. Methods

10. Central Texas high-school football team; 9 th through 12 th grade boys; single school district Sample Population

11. Athletic Socks Unpackaged Packaged

12. Sampling Procedure Sample 24 players/week for four weeks One week of control socks (never been worn) Distribute socks to players and worn during 45 minute practice. Junior Varsity vs. Varsity Degree of player contact offensive/defensive ++++ special teams ++ weights/video +

13. Collection and Transport Collect socks and place into baggies Transport to Clinical Bacteriology Lab at TDSHS in car.

14. Laboratory Protocol Swatch Sample Nutrient Broth ORSA Plate MSA Plate CHROM agar Plates (BBL and Hardy) Possible staphylococcal colonies BHI Slant Catalase (+) Gram Stain(+) Coagulase(+) API Staph (+) E Test Blood Agar Slant After catalase

15. Primary Plating Media BBL CHROMagar Hardy CHROMagar

16. Swatches in Nutrient Broth Sock swatches in enrichment broth

17. Identification using API system

18. Results

19. Percentage of Players Socks vs Control Socks Positive for Bacterial Growth, Staphylococcal spp. and S. aureus

20. Control Socks Positive for Growth Staphylococcal spp. by Source Number of Socks Unpackaged #(%) Packaged #(%) Cultured4(100.0)44(100.0) Any Growth 4(100.0)1(2.3) With Staphylococcal spp. 1(25.0)0(0.0)

21. Players Socks Positive for Staphylococcal spp. by Source Number of Socks Unpackaged #(%) Packaged #(%) p-value Cultured46(100.0)124(100.0) Staph spp. positive 32(69.6)72(58.1)0.17

22. Players Socks Positive for Staphylococcal spp. By Practice Conditions Number of Socks Outdoor (offense/defense & special teams) #(%) Indoor #(%) p-value Cultured134 (100.0)36 (100.0) Staph spp. +80 (59.8)24 (66.7)0.45

23. Players Socks Positive for Staphylococcal spp. by Date Number of Socks 9/24/07 #(%) 10/1/07 #(%) 10/15/07 #(%) 10/22/07 #(%) p-value Cultured46(100.0) 42(100.0)36(100.0) Staph spp. +32(69.6)16(34.8)32(76.2)24(66.7)0.0002

24. Proportion of Positive Samples by Player

25. Staphylococcal spp. Isolated aureus epidermidis lugdunensis sciurii caprae warneri xylosis lentus hominis saprophyticus cohnii haemolyticus

26. Conclusions

27. Socks serve as a reservoir for Staphylococci 68% of players always or sometimes shed Staphylococci A variety of species recovered, including those of medical significance S. aureus, S. epidermidis, and S. saprophyticus

28. Preventative Measures Launder personal items after each use Shower after practice or competition Educate athletes about hygiene and viability of staphylococci in the environment Disinfect training equipment Do not share personal items

29. Epidemiological Variables No association Sock source Practice type Practice conditions Inconclusive association: date Unknown association: distribution method

30. Study Limitations Use of two sock sources Unpackaged Packaged Distribution of socks Placement on bench Directly distributed

31. Future Studies Repeat the study controlling the distribution variables Carry out the study in high schools with and without active MRSA outbreaks Conduct a similar investigation in athletes who participate in other high contact sports ( e.g. wrestling)

32. Future Studies Beyond Socks.... Other pieces of the uniforms Inanimate surfaces and objects Training equipment Turf Benches

33. Acknowledgements TDSHS Tamara Baldwin Thomas Allen, L.A.T, Athletic trainer The University of Texas at Austin Dr. Leanne H. Field Nancy Elder, Librarian

34. Hardy Diagnostic

35. Thank you to: The Centers for Disease Control and Prevention Office of Workforce and Career Development