Virginia Department of Health, Office of Epidemiology
October 25, 2007
Adapted from Tacoma/Pierce County Health Department Guidelines
Recommendations for the Prevention of MRSA Transmission in Athletic Settings
Methicillin resistant Staphylococcus aureus (MRSA) is a type of "staph" bacteria that is resistant to penicillin as well as some other common antibiotics. MRSA commonly causes skin infections that may look like spider bites, infected turf burns, impetigo, boils, or abscesses. It is most commonly spread by touching an infected wound or by touching surfaces that have been contaminated with drainage from an infected wound. MRSA can stay on surfaces for days.
Frequent hand washing is the best way to prevent MRSA. It is also important to have students and coaches practice good hygiene, including showering after practice and meets; not sharing personal hygiene items and not participating in practices/meets with a potentially infected skin wound/lesion. A healthy environment should be maintained by routinely cleaning athletic equipment (e.g., balls, bats, rackets) and surfaces, such as benches and wrestling mats.
Ask your athletes to report all potential skin infections to their coaches, the trainer, and/or the school nurse. Open wounds should be covered with a clean, dry bandage that is taped to the skin on all four sides. Do not let athletes participate in activities if a wound cannot be contained by a bandage for the duration of the activity. Consider not letting athletes participate in any contact sport if they have potentially contagious wounds; refer them to medical providers for treatment.
The guidance provided below may refer to policies that are already in place, as well as policies that should be developed and adopted.
General
* All hard environmental surfaces that may come in contact with body fluids should be cleaned (i.e., visible dirt removed) and sanitized (i.e., disinfected, or removal of bacteria) daily, if area is in use. Many commonly available cleaning products are effective against MRSA - a complete list of EPA-approved disinfectants for MRSA is available at www.epa.gov/oppad001/list_h_mrsa_vre.pdf. Refer to the manufacturer's directions for recommended contact times for various disinfectants. Always wear gloves when using disinfectants.
* Note: A bleach solution of 1 part bleach in 9 parts water (e.g., 1 3/4 cups bleach to 1 gallon of water) will kill Staphylococcus aureus, as well as other (tougher to kill) disease-causing organisms such as norovirus and Clostridium difficile, and should be used when possible. In situations where this is impractical, a more dilute solution (e.g., 1 part bleach in 64 parts water, such as 1/4 cup bleach in 1 gallon of water) may be used to disinfect surfaces that may be contaminated with S. aureus. However, it should be noted that bleach solutions more dilute than 1 part bleach in 9 parts water may not kill some disease causing organisms. Another option is to use a 1 part bleach in 9 parts water solution, followed by a rinse with water to remove residual bleach. Bleach solutions should be mixed fresh daily to ensure effectiveness.
* Bleach solutions should NOT be used to sanitize hands or for cleaning wounds.
* All floor and wall padding in athletic area(s) should be washed daily (if the athletic area is used).
* Separate mop heads/ buckets should be used for each activity area, locker room, and restroom. Mop heads and buckets should be cleaned regularly. (Washable micro-fiber heads or disposable mop cloths may be more convenient.)
* Towels/linens laundered on premises should be washed with detergent at a minimum of 160°F and dried in a hot dryer.
Wrestling Room and Mats
* Wall padding and benches should be wiped-down with an EPA-approved disinfectant such as a quaternary ammonium (quat) or 1:9 bleach solution after each practice and meet.
* Mat surfaces with small holes or tears should be repaired with mat tape. When mat sides are in poor condition, mats should be taped together for meets and for practice.
* Mat surfaces should be replaced promptly when there are large holes or surfaces are excessively worn.
* Both sides of mats should be cleaned thoroughly before and after each use for practices and meets.
* Mop heads and buckets should be washed regularly. Consider using a separate mop head/bucket specifically for cleaning mats.
Weight Room
* Weight machine padding should be inspected regularly, and promptly replaced if punctured or torn (padding with small holes or tears may be repaired with appropriate materials).
* Grip areas on weight bars, dumbbells, and machines should not be taped. (Metal surfaces are easier to wipe down.)
* A spray bottle with disinfectant, and paper or small cloth towels, should be available so that athletes can wipe down benches, pads, grip areas on weight bars, dumbbells, and machines, and lift belts after each use by each athlete.
* Wall dispensers of hand sanitizer (>60% alcohol) should be placed at each entry/exit. Athletes and coaches should be instructed to use hand sanitizer when entering/leaving room at a minimum (may be used more often).
* Athletes who use the weight room should wear workout clothing that minimizes contact with benches and weight equipment (e.g., shirt, sweat pants).
Locker Rooms/Shower Rooms
* Liquid, not bar, soap should be readily available and provided by wall dispensers close to sinks and next to showers.
* Soap dispensers should be checked regularly to ensure that soap is present.
* Soap dispensers should have "unit" refills.
* All shower and locker room areas should be cleaned daily (if used).
* Towels should not be shared. If they are washed at school, they should be washed in soap and water at 160°F minimum and dried in a hot dryer.
Sports Equipment
* Whenever possible, equipment and clothing should not be shared.
* All shared equipment that comes in direct contact with the skin of an athlete (wrestling head gear, football helmets, and fencing wires) should be cleaned and sanitized after each use.
* Sports equipment (balls, racket grips, bats, gloves) should be cleaned regularly.
First Aid
* Include alcohol-based hand sanitizer (60% alcohol or greater) in coach's first aid kit so that coaches/trainers will always be able to sanitize hands before and after caring for each injured player when soap and water is not readily available.
* Have disposable gloves readily available in first aid kit for use when caring for the scrapes and cuts of players. Use gloves once and then discard; wash hands or use hand sanitizer immediately after removing gloves.
* Scoops (not hands) must be used to take ice out of cooler to make ice packs for injuries. Scoops should be cleaned daily when in use and NOT stored in the ice container.
* Single-use portions of antibiotics, salves, and other ointments should be removed from any larger dispensing unit prior to application. Any un-used product must NOT be returned to the original dispenser, but discarded.
* Check athletes for skin infections before practice or games/matches. Athletes with open, potentially contagious wounds may generally practice or compete IF the wound can be completely covered with a bandage (and if the player is otherwise medically fit). However, at the discretion of the school, athletes may be prohibited from participating until wounds have healed-even if wounds are covered - if extensive skin-to-skin contact may occur (e.g., wrestlers). Athletes must be kept from participating in contact sports until wounds have healed if wounds cannot be kept covered by a bandage.
* Athletes with potential skin infections should be referred to the team physician or their own medical provider. Culturing wounds that appear to be infected should be encouraged.
Education of Athletes/Parents
* Athletes should be regularly encouraged to follow good hygiene practices, including frequent hand washing, showering immediately following each practice or competition, and NOT sharing "drinking" water bottles.
* Remind athletes NOT to touch other peoples' skin infections. Any draining wound should be considered a potential skin infection.
* Athletes should be instructed to NOT share personal hygiene items (e.g., bar soap, razors, nail clippers, etc.), or topical ointments, antibiotics, deodorants, and salves.
* Athletes should be encouraged to promptly report abrasions, lacerations, or skin infections to a coach/team trainer, or school nurse.
* Cosmetic shaving should be discouraged.
* Athletes with open wounds should be discouraged from using whirlpools or common tubs. Individuals with scratches or open wounds can infect others or become infected in this kind of environment.
* Athletes should be reminded to wash practice clothes/uniforms with soap and warm water and dry in a hot dryer after every use.
* Messages should be repeated regularly (e.g., weekly) and following any observed violations. Rewards for compliance (as well as potential penalties for non-compliance) may help to reinforce appropriate behaviors.
* Visual aids (e.g., posters) should be present and located strategically to remind athletes, staff, and parents regarding proper behaviors.
* Coaches and staff should be role-models for students and parents - they should strive to model correct behaviors.
Outside Groups Using School Athletic Facilities
* Custodians should know the schedule for outside events and be available to clean before students use any of the equipment/facilities.
* Outside groups should use "standard school-recommended" cleaning products if they are responsible for any cleaning (e.g., wrestling mats, weight room equipment, shower facilities).
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