1. Randy Schutz Molnlycke Healthcare
Practical Applications In Sports Medicine
Randy Schutz Molnlycke Healthcare
MRSA in the
High Schools

2. MRSA
Jan. 13,  Ricky Lannetti was once the picture of health — a big, strong college football player.
In the fall of 2003, he had led his team to a big victory, catching more passes than anyone and securing a spot in the national semifinals. But sometime after that game he caught something else.

3. MRSA
"They didn't know what they had. They were as confused as I was," his mother, Teresa, told ABC News. "They had five different antibiotics in him, but they finally said, 'We can't handle it.'" On Dec. 6, 2003, one week after his last game, Lannetti died.

4. MRSA Methicillin-resistant Staphylococcus Aureus
(MRSA) is a type of bacteria that is resistant to certain antibiotics such as such as penicillin and amoxicillin.
MRSA is a rapidly growing concern
MRSA is an issue wherever there is crowding (athletics, military, corrections, health care, etc)
Everyone is now at risk for MRSA
Dr Loren Miller at UCLA recently concluded a study that demonstrates MRSA is not longer contained to the high risk groups. Everyone is at risk.

5. What is MRSA
Mutated staph infection that is resistant to common antibiotics
CA-MRSA (community acquired)
Most likely what will be seen (300 and 400 strain)
Extremely dangerous – progresses quicker than the hospital version
Ricky Lannetti’s story demonstrates – healthy college athlete went from first symptom to death in 5 days
7-10 day incubation
Can rapidly progress to blood stream, joints and organs

6. What is MRSA Most often mis-diagnosed Spider bite Cellulites Impetigo
Harmless pimple
Most common treatment
Antibiotics
When the Rams had their outbreak, the CDC found their level of antibiotic use at 10 times normal

7. MRSA
MRSA is the kind of germ doctors have worried about for years: some call it a "superbug," a germ the usual antibiotics won't kill.
May look like a spider bite or an ingrown hair

8. I’m MRSA MAN and I’m watching
MRSA Facts
I’m MRSA MAN and I’m watching
MRSA is present in all parts of the country
MRSA is the number 1 cause of skin infections
Estimated $5,700,000, in incremental hospital costs
Over 98,000 deaths

9. MRSA Facts
Life span
MRSA can live for up to 7 months on common fabrics and surfaces.
7 months on dust
56 days on a mop head
203 days on a blanket
9 weeks on cotton
Even if a facility is clean, contamination can reoccur on a daily basis

10. Colonization
Hands are very high on the body areas colonized with the bacteria
If you combine this fact with the life span of up to 7 months on fabrics and surfaces, the magnitude of the problem begins to become clear.

12. Important Facts Common bacteria
Acquired mainly through direct contact (individuals and objects)
Found in nose, armpit, groin, and other similar areas
Causes soft tissue infections such as boils and impetigo
Can cause pneumonia and bloodstream infections
It is treatable with correct antibiotics early

13. Elements of a good protocol
1. Early detection is key
Know what MRSA looks like
Always look for MRSA – culture to confirm
. Prevention is the goal
The best way to deal with MRSA is to not ever get it.
Wash areas of high risk before and after potential exposure (wash with Hibiclens consider this a shower soap substitute)
Wash and Dry all fabrics that are potentially contaminated on HOT if possible. Dry completely – CDC recommendation
Cover all wounds to prevent contact with shared surfaces
Clean all surfaces and fabrics that may be contaminated

14. Establish a protocol for prevention
I’m watching
3. Early treatment
Avoid prophylactic antibiotics
Be aggressive in treating suspected infections

15. What are the symptoms?
Broad range of symptoms depending on the part of the body that is infected. These may include surgical wounds, burns, catheter sites, eye, skin and blood.
Often results in redness, swelling and tenderness at the site of infection. Sometimes, people may carry MRSA without having any symptoms.

16. Why does it exist
In addition, bacterial genes are constantly mutating.
Some strains' genetic makeup will give them a slight advantage when it comes to fighting off antibiotic attack.
So when weaker strains encounter antibiotics, they die, while these naturally resistant strains may prove harder to kill.

17. Why
This means that next time you encounter Staph, it is more likely to be one which has survived an antibiotic encounter, i.e. a resistant one.
The advice from doctors who give you antibiotics is always to finish the entire course - advice which many of us ignore.

18. Football and Wrestling
Most Affected Athletic Program Sectors
- Football (more participants)
- Wrestling (higher percentage)
Anyone else that uses the room “Cheerleaders”
Most likely due to:
- Contact sports (person to person transmission)
- Increased risk of lesions as well as turf and mat burns
- Sites of infections go unnoticed
- Sharing of unclean equipment and/or personal items

19. Adults and non-athletes
Emerging
- Individuals not directly participating in competition being affected (the Athletic Trainer / PT)
- Non-athlete students seem to be the least affected
Most likely due to
- Adults: Cleaning of wounds
- Non-athletes that are cleaning up equipment and clean up after players

20. Risk Factors Four C’s Contact Contaminated surfaces Crowding
Cleanliness

21. Where have all the showers gone

22. They are gross and no one showers “Time to go back”

23. Prevention Nasal swabs checks Topical antiseptics (Hibiclens)
Interventions
Preventive topical antimicrobial use (Hibiclens)
Establish diagnosis with culture
Notify health department
Cover wounds
Educate healthcare providers
Contact precautions when appropriate
Masks
Gowns
Gloves
Goggles
Additional measures
Nasal swabs checks
Topical antiseptics (Hibiclens)

24. Prevention
Don't share towels or wipe your face with a towel you use on equipment. (Sidelines)
Don't ignore skin infections that won't heal.
Shower after a workout.
Use liquid soap, not bars.
Wash your hands — seconds
Clean Facilities

25. Mild to Moderate Mild to moderate disease
Presents with “spider bites”, soft tissue abscesses, boils
If caught early, found to respond to a combination of topical antimicrobials (Hibiclens) and lower level antibiotics if needed
If antibiotics are required, culture to determine susceptibility

26. Some Antibiotic Choices
Lower level
Clindamycin (95%)
Fluoroquinolones (60%)
Rifampin and trimethoprim-sulfamethoxazole (Bactrim) (100%)
Tetracycline (92%)
Higher level for serious infections
Vancomycin (IV for MRSA)
Linezolid (Oral or IV)
Daptomycin (IV)

27. yuk

28. Treatment Severe disease
Presents with deep tissues abscesses, joint and major organ infection

29. How does Hibiclens work
Hibiclens active ingredient is CHG
CHG bonds to the skin and continues to kill for up to 6 hours
Hibiclens kills MRSA and other staph infections
Hibiclens kills Gram positive and negative bacteria, and enveloped viruses (herpes, HIV, avian flu, common flu) - also acne.
Hibiclens remains active in the presence of blood and other organic material like sweat (alcohol, PCMX and iodine lose efficacy)

30. Hibistat Wipes An oversized wipe (5x7) 70% alcohol 0.5% CHG
Removes debris
70% alcohol
Immediate kill
0.5% CHG
6 hours of residual killing activity
For use when a sink is not convenient
On athletes during competition
Medical staff at venue

32. DVD ---- thanks :’}