Deadly Opponent-MRSA: An Invisible Killer

Your team\'s most feared opponent might not be on the field
by: AFM Editorial Staff
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On December 7, 2003, Coach Frank Girardi’s Lycoming Warriors lost 13-9 to Bridgewater (VA) in the quarterfinal round of the NCAA Division III playoffs. A disappointment to the legendary coach, to be sure. But the pain was nothing compared to the tragedy the team suffered less than 24 hours prior with the death of their star wide receiver, Ricky Lannetti. The 3rd team All-American had led Lycoming throughout his senior season, setting team records for most catches in a game (16) and a season (70). But, in less than one week, his life was claimed by MRSA – a deadly bacterial infection that is increasingly threatening athletic programs, especially football, across America.

“Ricky was a very talented wide receiver, who holds many of our receiving records, and was very instrumental in the success of our program,” said Girardi. “More importantly, he was a great leader who had that innate ability to make those around him better. The effect that Ricky's death had on our team was not only extreme sadness and loss, but also a resolve to keep his memory alive forever in the Lycoming football program.” Facing the challenge of playing a game the day following such a great loss was difficult. “The decision to play was made by the team. They felt very strongly that was what Ricky would have wanted,” recalled Girardi.

Lannetti’s tragic illness originally appeared as flu symptoms early in the week leading up to the Bridgewater game and progressively got worse until he was rushed to Williamsport Hospital on Saturday, December 6. By midday, the disease was irreversibly attacking his organs, and he was pronounced dead that evening. It was only after an autopsy that Ricky’s killer was identified as MRSA, a deadly and increasingly common staph infection. What is MRSA, why are football programs especially vulnerable, and what can you do to minimize the threat to your athletes?

MRSA stands for methicillin-resistant Staphylococcus aureus, a strain of staph bacteria that does not respond to conventional antibiotics. The infection usually first appears as a rash, a pimple or boil on the skin that can be swollen and painful. If not detected and properly treated, it can rapidly expand in size, lead to serious complications such as pneumonia and even spread throughout the bloodstream with, as in Ricky Lannetti’s case, tragic results.

While MRSA had been known to primarily afflict patients in hospitals and nursing homes as long ago as the 1970’s, health professionals have seen an alarming rise recently in cases in the community, especially among athletes in contact sports such as football and wrestling. In the last several years, outbreaks of MRSA have been documented on NFL teams, universities and high schools nationwide. The Miami Dolphins, Cleveland Browns and Tampa Bay Buccaneers have reportedly had infections among players, some of which have required hospitalization. At USC, eleven players were infected in 2003 and three Stanford players were infected last season. Reported incidents in high schools are too numerous to list.

Chuck Kimmel has had personal experience with MRSA. Currently Director of the Injury Clinic at Appalachian State University and President of the National Athletic Trainers’ Association, Kimmel’s football program was hit by MRSA in the 2005 season when he was Head Athletic Trainer at Austin Peay State University. “We had 10 cases of infection with football players. Not all were MRSA, but most were and two players had to be hospitalized,” said Kimmel. Typical in many outbreaks, the first case was the worst. “He had a skin rash that originally was diagnosed as a spider bite and eventually spent four days in the hospital on IV antibiotics.”

In athletic settings, the infection is most commonly spread through contact with an open wound or skin abrasion which provides the opportunity for the bacteria to enter the bloodstream. MRSA can spread by direct person-to-person contact or by contact with contaminated items or surfaces such as shared towels, protective equipment, whirlpools or even bars of soap. So it’s no surprise that football players, with their high degree of player-to-player contact, frequent cuts and abrasions, and sometimes poor hygienic conditions in the locker room are prime candidates to get infected with the MRSA ‘superbug.’

The irony is that staph had for years been associated with sick or elderly patients and had seldom been seen in young, healthy individuals. Football players in peak condition are the last ones most people would think of as susceptible to diseases. And the “play with pain” philosophy or “it’s only a rash” attitude might have prevented some early diagnoses in the past. MRSA has changed that perception, and wake-up calls have been issued at all levels of the game. “There’s a much greater level of awareness at institutions that have been hit,” said Kimmel, “and a need for those who haven’t experienced an outbreak to learn about the problem and address it by taking preventative measures.”

As frightening and potentially deadly as MRSA is, there are simple but important precautions that coaches, players, equipment managers and trainers can take to reduce, if not eliminate, the threat posed by this invisible scourge. Locker rooms can be breeding grounds for bacteria, fungi, mold and mildew so it’s critical that proper hygiene practices are enforced. Not sharing personal items or gear, regularly cleaning and sanitizing equipment and uniforms and making sure players shower following practice are important first steps in the battle against MRSA.

Wound care is just as critical, since open cuts and abrasions are the bacteria’s entry point into the bloodstream. Players need to know that every open wound, no matter how minor, needs to be cleaned and bandaged immediately. Equally important is keeping alert to any skin rashes and especially pimples or boils that may be first indications of infection. If diagnosed early, MRSA infections can be effectively treated. But if ignored, the consequences can be deadly.

One Case Leads to Many
If a case of MRSA strikes one of your players, it’s very likely that other players will be infected even if you take aggressive measures to stop it from spreading. In 2005 at Austin Peay, after the first case was identified on September 1, strict rules prohibiting sharing towels and razors were imposed as were strict standards of washing and personal hygiene. All players were monitored and all wounds were carefully treated. Antimicrobial additives were used in the laundry. Equipment, training room tables and whirlpools were sanitized regularly and the weight room was disinfected. Despite these measures, nearly 10% of all football players were infected by MRSA over the next two months. Chuck Kimmel believes that player attitudes are hard to overcome and might be partially responsible. “Part of being a teammate is sharing,” he said. “All it takes is for one athlete to toss another one a used towel for the bacteria to spread.”

According to the National Athletic Trainers’ Association, good hygiene and avoiding contact with discharge from skin lesions are the best methods of prevention. NATA’s official statement recommends the following precautions be taken:

1. Keep hands clean by washing thoroughly with soap and warm water or using an alcohol-based hand sanitizer routinely.

2. Encourage immediate showering following activity.

3. Avoid whirlpools or common tubs. Individuals with open wounds, scrapes or scratches can easily infect others in this environment.

4. Avoid sharing towels, razors, and daily athletic gear.

5. Properly wash athletic gear and towels after each use.

6. Maintain clean facilities and equipment.

7. Inform or refer to appropriate health care personnel for all active skin lesions and lesions that do not respond to initial therapy.

8. Administer or seek proper first aid.

9. Encourage health care personnel to seek bacterial cultures to establish a diagnosis.

10. Care and cover skin lesions appropriately before participation.

To achieve additional protection for your athletes, consider using products designed to provide extra degrees of bacteria-inhibiting protection to surfaces and equipment between washings and disinfecting. Such “antimicrobial” products, usually available in spray form to apply directly to equipment or liquid that can be added to laundry or cleaning solutions, are designed to protect treated articles such as shoulder pads, helmets, uniforms or strength and conditioning equipment while they are being used.

Kimmel has a message for coaches: be prepared. “The most important things coaches can do are always look for signs of MRSA and be prepared to aggressively prevent its spreading if you have an outbreak. At Austin Peay, we were lucky to catch the first case early enough and take serious measures to try to stop it. Even though we had 10 cases, it could have been much worse.”

Above all, be aware. MRSA is a growing threat to football players. Understand and practice the precautions. Share this article with your players and everyone involved with your program. Minimize your risk. And don’t let this opponent ruin your season.

For further information about MRSA, go to the National Athletic Trainers’ Association at NATA.org

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