Randy Schutz Molnlycke Healthcare

1. Practical Applications InSports Medicine Randy SchutzMolnlycke Healthcare MRSA in the High Schools

2. MRSA • 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.

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. 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 $5,700,000,000.00 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 • 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 — 20-30 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) • 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 :’}