Dedicated wrestling room?
- If no, make even more sure mats are cleaned completely before being rolled up

Cleaning mats
- Before and after practice
- Product proven to kill MRSA that is skin friendly in it’s residual state
- Mop heads and MRSA – soak in concentrated disinfectant

Cleaning pads/head gear
- Get them dry if they are absorbent

Practice gear
- Laundry, Home or School. If home, educate parents

Pre-practice
- Wash with Hibiclens to mid biceps to prevent cross contamination

Post-practice
- Shower ASAP

Mat burn treatment
- Cleanse with Hibiclens

Ringworm
- Hibistat: beware of mat burns

MRSA in athletic programs at all levels has become the norm.

Who is at risk?

• All athletes, all sports – we have seen cases in Cross Country
  as well as the obvious contact sports
• Coaches, staff, family of athletes, student population- EVERYONE!

Athletes, and particularly high school, do not shower immediately after activities.

• Athletes will touch and potentially contaminate hundreds of surfaces
  before removing bacteria
• MRSA can live for up to 7 months on common fabrics and surfaces.
• Even if a facility is clean, contamination can & will reoccur on a daily basis

MRSA is present in all parts of the country

MRSA is the number 1 cause of skin infections in the US - Estimated $5,700,000,000.00 in incremental hospital costs - Over 99,000 deaths from hospital acquired infections

APIC (Association for Professionals in Infection Control) released a survey this year
stating MRSA is under reported 800 to 1100% - it is 8 to 11 times worse than was thought.

Life span
MRSA can live for up to...

• 7 month on common fabrics & surfaces
• 7 months on dust
• 56 days on a mop head
• 203 days on a blanket
• 9 weeks on cotton

S.aureus carriage by body site

Colonized means that you are carrying the bacteria on your body,
but have no visible symptoms

• Staph bacteria tends to colonize in the nose
• CA-MRSA is more likely to colonize on the skin

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.

1. Early detection is key

Know what MRSA looks like
- Circle infection to track progress
- Check vitals multiple times during the
day (temp and pulse) for changes

Always look for MRSA – culture to confirm

Train athletes to report everything to
the medical staff

2. Prevention is the goal

Wash areas of high risk before and after practice
and competition (wash with Hibiclens to the mid biceps–
consider this a compromise- a shower would be preferred,
but what are the odds of compliance?)

Wash skin under pads with Hibiclens
(pads are never completely dry which creates a comfortable environment for bacteria)

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
and skin

Clean all surfaces and fabrics that may be contaminated

3. Early treatment

Avoid empiric and prophylactic antibiotics

Be topically aggressive in treating suspected infections

The South Carolina school Study - see below

Four C’s

• Contact
• Contaminated Surfaces
• Crowding
• Cleanliness

Interventions

• Preventive topical antimicrobial use (Hibiclens)
• Establish diagnosis with culture
• Notify health department
• Cover wounds
• Isolation is suggested
• Terminal cleaning of facility
• Education for staff and athletes
• Contact precautions
     -Gloves
     -Masks
     -Gowns
• Additional measures
     -Nasal mupirocin
     -Topical antiseptics (Hibiclens)

Mild to moderate disease

• Presents with “spider bites”, soft tissue abscesses, or 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

Lower level

• Clindamycin (95%)
• Fluoroquinolones (60%)
• Rifampin and trimethoprim-sulfamethoxazole (Bactrim) (95%)
• Tetracycline (92%)

Higher level for serious infections

• Vancomycin (IV for MRSA)
• Linezolid (Zyvox) (Oral or IV)
• Daptomycin (IV) (percentages = efficacy claims vs MRSA)

Severe disease

• Presents with deep tissues abscesses, joint and major organ infection
• Treat with I&D, IV antibiotics

Hibiclens active ingredient is CHG

• CHG bonds to the skin and continues to kill for up to 6 hours after washing and rinsing
• 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.
• - Since body acne provides a portal of entry for MRSA, Hibiclens can help prevent
  more serious infections from occurring
• Hibiclens remains active in the presence of blood and other organic material like sweat
  (alcohol, PCMX and iodine lose efficacy)

Compared to alcohol rubs

• Fact: Alcohol is a great antimicrobial
• Fact: Alcohol stops killing as soon as it dries
    - The next contaminated surface touched can recontaminate the hands
• Fact: Alcohol does not remove debris
    - Combine Hibiclens with alcohol rubs and you get the benefit of residual kill,
      and debris removal from Hibiclens and convenience of alcohol

Minimum Hibiclens use should be first wash of the day, before lunch, last wash of the day

In between use Hibiclens any time hands are visibly soiled or sticky

Wound treatment

• Topical Antibiotic 44.8%
• H2O2 22.4%
• Hibiclens 15.2%
• Saline 9.3%
• Iodine 8.3%

Hand Hygiene

• Soap and water 45.8%
• Purell 22.4%
• Hibiclens 16.0%
• Dial 8.0%
• Vionex 5.9%

H2O2 is a great wound flush immediately after the wound occurs because it oxidizes any organic material in the wound. If used later in the healing process,
the breakdown of H2O2 leaves a pure water which is the ideal environment for anaerobic bacteria which prevent good wound healing Iodine may not be
effective on a wound (see chart above)

Saline has no antimicrobial content.

• 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

MRSA - Tear Pad
Provides examples of what MRSA can look like
in early stages and lists Dos and Don'ts that
can be followed if you suspect a MRSA infection

MRSA - Testimonial Poster
A testimonial of what can happen if a MRSA
infection is ignored from someone that lived
through it. The poster also shows examples
of progressive stages of MRSA