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StaphAseptic™ News
Close contact,close calls
November 12, 2006
It can enter the bloodstream through even the tiniest of cuts, and once inside, staph can mean havoc for athletes ... including those at local high schools
BY JEFF KIDD
The Island Packet
The scratch on David Hutton's left shin was an inch long and innocuous -- the kind of "injury" an offensive lineman might suffer dozens of times each season.
Nothing to bring a 6-foot-8, 390-pound beemoth off the field for treatment.
Nothing, for that matter, to interrupt even a kid's backyard game of freeze tag.
But during the bus ride home from Wando High School, Hutton noticed the mark left by an opposing player's cleat had turned red and swollen.
By the next morning, the sore was throbbing and hot.
Two days later, the Hilton Head High School offensive lineman was in a doctor's office, getting pus scooped from the festering wound with a little, meal spoon.
"The doctor dug down about a half inch deep," Hutton winces. "It hurt so bad."
Groggy from the medication he took to stem the infection, Hutton spent the next week trying to stay awake during classes. He was held out of practice so as not to spread infection to his teammates, and when the Seahawks played West Ashley the next Friday, Hutton wasn't in uniform, sidelined by a ubiquitous bacterium that has stricken several local athletes in recent seasons.
Staph, once confined almost exclusively to hospitals, is now appearing with ferocity in locker rooms across the nation. One particularly vicious strain has ended the careers -- and even the lives -- of athletes who contracted it. Hutton was one of several Seahawks infected during the 2005 season, and despite new measures to prevent its recurrence, a few more Hilton Head High players were stricken early in the 2006 season.
It was the same story down the road this year at Hilton Head Preparatory School, where linemen Liam Moore and Breck Roper missed several preseason practices and sat out the Dolphins' season-opener, part of the school's second outbreak of staph in as many years.
In most cases, staph can be easily treated, but it is spread just as easily. And if it goes undetected or undiagnosed for long, it can quickly escalate from a minor irritant to a flesh-eating, life-threatening menace.
The scar on his shin is a tiny reminder of Hutton's run-in with staph. Bluffton High School line coach Steve Broome has a bigger memento -- a 5-inch crag on his right index finger, also the residue of a staph infection.
"Football is a contact sport -- a gritty, dirty, nasty sport," Broome said. "You've got to be careful and take care of yourself. You've got to keep cuts clean, even little ones. ... Staph is a monster."
That monster nearly bit off Broome's finger.
A new menace
Staphylococcus, commonly referred to as "staph," is a group of bacteria that can cause many diseases, either directly by infection or indirectly through toxins they produce, according to the online medical dictionary www.medterms.com. The best-known member of the staph family is Staphylococcus aureus, the main culprit in hospital infections that attack people with weakened immune systems. In that setting, staph can enter the bloodstream through a surgical incision or the wound caused by an intravenous needle.
But in the past decade, staph has become increasingly common in daycare centers, prisons and locker rooms -- venues in which people are in close contact and where hygiene often is lacking.
Public health officials are particularly concerned about a strain called methicillin-resistant Staphylococcus aureus, which is resistant to penicillin and many other antibiotics that eradicate most forms of staph. Researchers are unsure where MRSA came from, but one theory is that it formed as a mutant strain after exposure to over-prescribed antibiotics.
MRSA, like other forms of staph, is problematic only when it enters the bloodstream, usually through an open wound. However, it is unlike other strains in several ways, as noted by the U.S. Centers for Disease Control and Prevention:
MRSA affects otherwise healthy people.
MRSA usually begins as a pimple, a cut or a red bump and becomes serious if left untreated.
MRSA produces a toxin that spreads through surrounding tissue within days, creating severe boils and abscesses. It also can infect bone and deep muscle tissue.
MRSA is not spread through casual contact or when it becomes airborne, as when an infected person sneezes. Neither is it found in dirt or mud, according to the CDC.
Rather, it is contracted through physical contact with an infected person or by sharing objects such as towels, linens, razors, bar soap or weightlifting equipment contaminated by the bacteria.
Among athletes, infections often are passed by skin-to-skin contact in such sports as wrestling and football, as well as from playing surfaces such as old-style artificial turf and wrestling mats.
Staph can be difficult to contain in part because it is so common. The CDC says about 25 to 30 percent of people in America carry regular staph aureus on their skin or in their nasal passages, usually without any ill effects. About 1 percent of the population carries MRSA, and most also do not suffer symptoms.
What's more, in their earliest stages, those symptoms can be so benign, infected athletes don't seek medical attention until the bacteria already has spread -- to other parts of their bodies or to their teammates.
A real attention-getter
MRSA has infested a fencing club in Colorado and a youth soccer team in Florida.
Perhaps the best-known incident of staph infecting a sports team was in 2003, when five members of the St. Louis Rams contracted MRSA. The players were never named publicly, but results of a CDC study on the outbreak were published in the New England Journal of Medicine.
Three of the five Rams had recurring infections that season, and though none was hospitalized, all had abscesses requiring incisions and drainage. They missed a total of 17 practices and games. The report said the bacteria most likely was spread during contact in practice and in games and that MRSA contaminated communal whirlpools.
Also, the San Francisco 49ers developed an outbreak after playing the Rams that season, though the CDC report said the type of MRSA involved is "widely distributed" and might have been acquired independently.
Other incidences of staph-infected athletes include:
Lycoming College football player Ricky Laneti, who in 2003 died within days of contracting MRSA.
A 16-year-old Texas junior varsity football player, who was infected after suffering a scrape on his shoulder during a game. He lost 41 pounds during a three-week hospitalization, some of it spent in intensive care, and was temporarily blinded in his right eye.
Devin Adair, a member of the University of Tulsa football team, who died this past spring following a week-long bout with MRSA, the Tulsa World reported.
A 12-year-old football player, who in 2003 spent five weeks in Texas Children's Hospital in Houston after a cut on his shoulder suffered in practice turned into an MRSA infection and spread to his lungs.
Ten of the 100 players on an unnamed Connecticut college football team. A 2003 outbreak hospitalized two of them, according to the Nov. 15, 2004 issue of the journal Clinical Infectious Diseases.
Former Washington Redskin Brandon Noble, who suffered two bouts of MRSA in a year, the second after minor arthroscopic surgery on his right knee. For much of his recovery, he was confined to a sofa and could walk only with the aid of crutches. Noble has said the infection likely means the end of his NFL career, and he is not on the Redskins' roster this season.
Athletes aren't the only sports figures at risk of contracting MRSA -- the people who work with them are, too.
In 2005, Rams linebackers coach Joe Vitt was hospitalized for three days with a staph infection in his left hand. Broome, Bluffton High School's offensive line coach, could empathize.
A year earlier, as newly opened Bluffton High prepared for its first-ever football game, Broome discovered a cyst about the size of a spider bite on his finger. He picked at with his fingernails, prodded it with tweezers, squeezed it between his fingertips.
Within a few days, his finger was so sore and swollen, the pain kept him up at night. Finally, his wife convinced him to consult a doctor.
"It was swollen to the point where when he went to clean it out, he decided that if it didn't show immediate results, they were going to amputate the finger the next day," Broome said.
The treatment worked, and amputation wasn't necessary. However, Broome was hospitalized in St. Joseph's/Candler Hospital in Savannah for five days and treated with a cocktail of antibiotics. He would have missed the Bobcats' inaugural game had he not "stepped outside the hospital for a breath of fresh air" that Friday evening and wound up on the Bobcats' sideline at Jasper County High School about 40 minutes later. (He checked himself back into the hospital after the game.)
Broome's doctors aren't sure how he contracted MRSA, but he thinks he was infected while tussling with Bobcat linemen during practice drills.
"It really was devastating to think about maybe losing a finger," Broome said. "... I've been in coaching for 25 years, but the new strain of staph is what scares everybody.
"And believe me, it has my attention."
Local teams not immune
In fact, MRSA has a lot of people's attention.
"I was at a national convention last summer, and this was a big issue," said Hilton Head High trainer Shawn Zink, who first warned Hutton that the scratch on his shin might become something more serious. "It seemed like last year, all of the sudden -- I don't know if environmental conditions were conducive to it or what -- but it was a problem, and it was a problem everywhere."
At Hilton Head High in 2005, Hutton was one of a handful of football players infected. It's not certain they spread staph to one another, but in one instance, a player contracted it, then spread it to other family members.
This season at Hilton Head Prep, Moore and Roper were infected with MRSA. In both instances, the infection entered through small bumps on the players' knees.
"Both of those were pretty wicked at the beginning of the year," Dolphin coach Ron Peduzzi said. "Their legs were swollen, and they couldn't move. They couldn't bend their knees."
Bluffton athletics director Dave Adams said he doesn't think any of his athletes have contracted staph in the three years his school has been open, but the coaching and training staffs are aware of the risks. Broome's infection was a cautionary tale, and the bacteria's capacity to cut a swath through a locker room was demonstrated when the Bobcats had to cancel a junior varsity football game against Bamberg-Erhardt earlier this season because several Red Raiders became infected.
Bamberg-Erhardt coach Ron Duncan said one of his players was hospitalized nearly a week with MRSA and that five others were infected. In response, the school canceled all practices and junior varsity games until the locker room was sanitized and the stricken players were no longer infectious. When play resumed, the school provided special soap and encouraged frequent hand-washing and showers after games and practices.
"They had to shut down operations for a while," Adams said. "The outbreak happened on JV, but they didn't have varsity practice at all, either.
"You start to think, gosh, that can happen to us. This is pretty serious stuff, how quickly that can spread. We've been kind of lucky to dodge that."
Keeping staph at bay
Actually, luck might have less to do with the Bobcats' resistance to staph than the measures they take to prevent it.
Adams said a new generation of equipment -- helmets with removable padding and shoulder pads that can be disassembled -- make thorough disinfecting easier than during his playing days. Bluffton's trainers also are vigilant when it comes to treating athletes with open wounds.
Zink, Hilton Head High's trainer, said keeping laundry and equipment clean helps keep staph at bay, too.
So soon after Hutton and his teammates were infected, Seahawks coach Tim Singleton instructed 10 of his players to bring cans of Lysol to school so that equipment could be doused several times a week. When those are empty, 10 other players bring new cans to share with teammates.
Elsewhere, the campaign to prevent the spread of staph and other bacteria has gone high-tech.
Virginia Tech applied anti-microbal coating to its wrestling mats, synthetic turf fields, football pads and saunas, USA Today reported earlier this year. (Makers of the coating claim their product kills microbes without chemical poisoning, by piercing them with spear-shaped molecules.)
Earlier this year, the Minnesota Vikings became the first team in the NFL to protect their synthetic turf training field with a similar coating and joined the Washington Redskins in treating other areas of their training facility.
Several NHL and NFL teams use a box-like, stainless steel device that uses ozone to rid gear of bacteria without soap and water.
Hilton Head Prep replaced the 20-year-old carpet in its locker room after staph cropped up earlier this school year. Head coach Peduzzi said he will recommend that carpet not be installed at all in the locker rooms at the school's under-construction field house and gymnasium because hard, non-porous surfaces are easier to keep clean.
Even simple measures can be effective in stopping staph, the CDC says. The St. Louis Rams, for instance, responded to their outbreak by installing wall-mounted soap dispensers at the team's training facility, so that players no longer had to share bar soap. Rams trainers also instructed players how to care for wounds.
Football coaches and trainers at all four high schools in southern Beaufort County said they instruct their players to clean and cover even the smallest of scrapes, so that staph is neither contracted nor spread. Players with weeping wounds are considered infectious and kept out of contact drills.
More formal monitoring is in place for wrestlers, who have long been inspected during weigh-ins because they're susceptible to skin infections such as ringworm. Teams also are required to sanitize mats before each competition and to repeat the cleansing during multi-round tournaments.
At Hilton Head High football games, Zink and his staff distribute towels to players who ask for one, then gather up any that are left lying about at the end of each quarter so that they are not shared.
Hilton Head Christian Academy, like Bluffton, has never had an outbreak of staph, according to football coach and athletics director Tommy Lewis. That might be because of the intimacy of the Eagles' locker room -- it's so small, the football players barely use it.
"The kids take their stuff home," Lewis said. "We don't have a locker room to keep all the football equipment in, and the kids have to do all their own laundry. When you take that stuff home to mom, mom has to smell it and will usually make sure it's clean."
According to the CDC, it's just as important players keep themselves clean -- that includes showering after games and practices.
"Back when I was in school, we had to shower after PE, shower after practice," Adams said. "Showers aren't used like that anymore. I know of only a couple of kids who shower after PE, and the football guys usually jump in car and go home and shower."
Hutton said he didn't shower in immediately after the game in which he was infected. Since then, he he has made showering part of his postgame routine -- though he said that's more difficult when the Seahawks play on the road -- and carries disinfectant wipes with him to games and practices. He also is sure to treat even the most minor of cuts, bumps and scrapes.
"It's weird when you think of all the trouble a little cut caused me," Hutton said. "It was miserable, and I'm going to try to do whatever I can to make sure I don't go through that again."
www.islandpacket.com
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