Jan 29, 2015

More Than MRSA

By Dawn Comstock

Recent media attention has athletes, coaches, and parents on edge about methicillin-resistant Staphylococcus aureus, more commonly known as MRSA. However, despite a growing awareness of this potentially life-threatening condition, many student-athletes and parents may be unaware that MRSA is just the tip of the iceberg.

A variety of other skin infections can also plague athletes. Although most only keep athletes out of play for a matter of days, their presence is still unwelcome and yet preventable. During the 2005-06 and 2006-07 school years, the National High School Sports Injury Surveillance Study collected information on skin infections from a representative sample of 100 U.S. high schools.

This study found that U.S. high school athletes participating in nine sports (football, boys’ and girls’ soccer, girls’ volleyball, boys’ and girls’ basketball, boys’ wrestling, baseball, and softball) sustain an estimated 16,000 skin infections every year. Not surprisingly, skin infections are most common in sports with a high amount of contact between athletes. In fact, wrestling accounts for half of all reported skin infections (52.3 percent), while football accounts for one-quarter (27.3 percent).

The majority of skin infections reported to the National High School Sports Injury Surveillance Study did not contain specific diagnosis information. However, of cases with a cited diagnosis, impetigo was most common (35.6 percent), followed by ringworm (24.5 percent) and Staphylococcus/potential MRSA infection (18.4 percent). Skin infections most commonly affect the head/face (19.1 percent), upper arm (10.7 percent), lower leg (10.7 percent), knee (6.9 percent), forearm (5.4 percent), and neck (5.3 percent).

Although almost three-quarters (72.9 percent) of all athletes sustaining a skin infection returned to play in less than one week, 23.3 percent returned in one to three weeks and 3.8 percent either missed over three weeks of play or were forced into an early end of their season. One in 20 players (6.7 percent) sustaining a skin infection had sustained a previous skin infection in the past year. The majority of skin infections were diagnosed by a physician (85.7 percent), often via a physical evaluation (83.8 percent) or laboratory testing (40.2 percent).

Due to their infectious nature, skin infections tend to cluster in schools or regions. In 2005-06, only 21 out of 100 participating study schools reported a skin infection. Specifically, almost half of all skin infections reported among study schools in 2005-06 came from three individual schools that experienced epidemic, but contained, outbreaks. Conversely, in 2006-07, skin infections were reported by numerous schools, with the majority of these schools located in the Midwest. This was a reflection of a regional outbreak that resulted in the Minnesota State High School League enacting an eight-day high school wrestling ban.[1]

Fortunately, skin infections are preventable if proper prevention and quarantine procedures are followed. Various organizations, such as the National Federation of State High School Associations, have developed materials related to the prevention and management of infectious skin disorders. Because skin infections can be transmitted both via person-to-person contact and via objects such as equipment and mats, the most effective plans combine appropriate quarantine of infected athletes with regular equipment cleaning. Ideally, athletes, coaches, and parents work together to eliminate the need for any athletes to miss playing time following a skin infection.

Dawn Comstock, PhD, is a principle investigator at the Center for Injury Research and Policy at The Research Institute at Nationwide Children’s Hospital. She is also an assistant professor at The Ohio State University in the College of Medicine and the College of Public Health. Her research interests include the epidemiology of sports, recreation, and leisure activity-related injuries among children and adolescents as well as the life-long health benefits associated with an active childhood. She can be reached at [email protected].

Resources

• To help in the fight against MRSA, Training & Conditioning is offering nine free posters that can be easily downloaded and displayed in your facilities.

• “Are You Protected?”, an article that appeared in the April 2007 issue of Training & Conditioning, provides a comprehensive look at MRSA, including how it is spread and techniques for prevention.