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

Practical Practical Applications Applications

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MRSA in theMRSA in the

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Practical Applications In Sports Medicine

MRSAMRSA

• Jan. 13, 2005 -- 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.


MRSAMRSA

• "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.


MRSAMRSA

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.


What is MRSAWhat 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


What is MRSAWhat 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


MRSAMRSA

• 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


MRSA FactsMRSA Facts

• MRSA is present in all parts of the country

• MRSA is the number 1 cause of skin infections– Estimated

$5,700,000,000.00 in incremental hospital costs

– Over 98,000 deaths

I’m MRSA MAN and

I’m watching


MRSA FactsMRSA 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


ColonizationColonization

•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.


Important FactsImportant 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


Elements of a good Elements of a good protocolprotocol1. 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


Establish a protocol for Establish a protocol for preventionprevention3. Early treatment

• Avoid prophylactic antibiotics• Be aggressive in

treating suspected infections

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What are the symptoms? 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.


Why does it existWhy 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.


WhyWhy

• 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.


Football and WrestlingFootball 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


Adults and non-athletesAdults 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


Risk FactorsRisk Factors

Four C’s•Contact

•Contaminated surfaces

•Crowding

•Cleanliness


Where have all the showers Where have all the showers gonegone


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


PreventionPrevention• 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)


PreventionPrevention• 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 — 20-30 seconds

• Clean Facilities


Mild to ModerateMild 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


Some Antibiotic ChoicesSome 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)


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TreatmentTreatment

•Severe disease– Presents with

deep tissues abscesses, joint and major organ infection


How does How does HibiclensHibiclens work 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)


Hibistat WipesHibistat Wipes

• An oversized wipe (5x7)– 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


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

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