Raise your hands. How many of you know what MRSA is? OK. How many of you worried about it last year? Now how many of you worry about it currently? I bet more of you raised your hands for ‘currently’ Our national media went on­ a MRSA ‘full freakout’ this Fall. Their coverage was quite sensational – you came away with the idea that your kids were going to go to school and die from a raging untreatable skin infection. Sporting events were canceled at the first hint of a student with a skin infection. Entire school districts were disinfected because a single case was identified. In one case a school district spent a quarter of a million dollars cleaning all it’s buildings, school buses, locker rooms, and more. Yet once news broke that they did this, experts made clear that this would not reduce the chance of other students contracting it. It was quite the hysteria for a few weeks.

So exactly what is MRSA?

MRSA is a resistant variation of the common bacterium Staphylococcus aureus. It has evolved an ability to survive treatment with beta-lactam antibiotics, including penicillin, methicillin, and cephalosporins.[2] MRSA is especially troublesome in hospital-associated (nosocomial) infections. In hospitals, patients with open wounds, invasive devices, and weakened immune systems are at greater risk for infection than the general public.

The media much prefers to use the term ‘superbug‘ because it sometimes does not respond to normal antibiotic treatment and ‘superbug’ sounds so much more ‘scary’.

So how does MRSA impact youth soccer and youth sports in general? MRSA is becoming more common among student athletes.

The Journal of the American Medical Association also published a study this week that found that about 95,000 Americans had MRSA infections in 2005, which killed 18,650 people. Most of those cases were in hospitals, where MRSA has long been a problem. The bacterium is becoming more common in other settings, including schools, where it can infect students. Doctors call this kind of MRSA “community-acquired,” meaning that it comes from the community and not from a hospital setting. Athletes are at especially at risk because they often have close physical contact with one another.

So why the media circus and overreaction by school districts? A student in Virginia, died in October due to an MRSA infection, followed by another a week later in New York. It’s tragic anytime someone dies, especially a child. But this, combined with the release of a CDC report on MRSA, led many media outlets to completely freak out. Why? Because the CDC report estimated that MRSA was infecting 94,360 people, resulting in 18,650 deaths in 2005. 18,650 deaths! Our children are in serious danger! That’s huge. That’s more people than AIDS killed in a year! What most in the media failed to note, however, was that the vast majority of MRSA deaths happen in hospitals among already sick patients who contract an MRSA infection, are already weakened, and treatment doesn’t work.

Once the media circus broke out, in part due to the CDC report, Dr. Julie Gerberding, head of the CDC went before members of Congress to bring things back into perspective:

“This isn’t something just floating around in the air,” Dr. Julie Gerberding, head of the Centers for Disease Control and Prevention, told members of Congress on Wednesday.

It takes close contact – things like sharing towels and razors, or rolling on the wrestling mat or football field with open scrapes, or not bandaging cuts – to become infected with the staph germ called MRSA outside of a hospital, she said. But MRSA is preventable largely by common-sense hygiene, Gerberding stressed.

“Soap and water is the cheapest intervention we have, and it’s one of the most effective,” she told a hearing of the House Committee on Oversight and Government Reform.

But the CDC’s report coincided with the death of a 17-year-old Virginia high school student, prompting a spate of reports of MRSA infections in schools. That prompted lawmakers to pepper Gerberding with questions Wednesday:

  • Should schools close for cleaning if a student gets MRSA? That’s not medically necessary, Gerberding said. Bleach and a list of other germicides can be used in routine cleaning of areas and equipment where bacteria cluster.

There’s no need to go in and disinfect a whole school because that isn’t how this organism is transmitted,” she said.

  • How worried should parents be? Some 200 children a year will get serious MRSA, and the vast majority will be treated successfully, Gerberding said. Community-spread MRSA is still easily treated by many other routine antibiotics. So wash and bandage cuts, and seek prompt medical care if they show signs of infection.

Most outbreaks of community-spread MRSA occur not in schools but in prisons, where inmates share toiletries and lack or don’t use soap.

Emphaiss mine. Clearly the media freakout was unwarranted. While it helps to raise awareness of MRSA, when the best defense is common hygiene (washing hands, etc), you know spending a quarter of a million dollars to sanitize a school is a bit over the top.

The reason I’m writing about this is that I’ve had parents asking me about it as well, in large part due to the media coverage. What is the soccer league going to do? How can this be prevented? Our response will clearly be a common sense approach. Soccer is a contact sport. Kids get cuts and there is plenty of skin to skin contact (“Hey ref! He’s pushing my kid!” 🙂 ). Kids should wash their hands often and coaches should be on the lookout for players who have skin lesions. Mom’s Team put together an excellent and well balanced article about MRSA that tried to stress that parents need not panic, but coaches and parents should take some common sense precautions. They also linked to a set of recommendations from the National Athletic Trainers Association for reducing the chance of spreading infectious diseases. Helen Gilson also has an excellent MRSA article online.

One specific area of concern is we have soccer teams that bring towels in dedicated iced down coolers for kids to cool down with during matches in hot weather. There’s no question the weather is getting hotter. When you have 20+ days where the temperatures are above 90 degrees in August, you’re going to have kids that need help staying cool. They get subbed out, grab a cold wet towel, put it on their neck, forehead, etc. and then put it back in the cooler. They are shared. Bacteria can survive freezing temperatures. So it presents a problem. Why?

Because I’m a heck of a lot more concerned about an athlete suffering from heat stroke than I am about them possibly contracting a skin disease from their teammate. Our soccer players are exposed to high temperatures during competitive play on numerous occasions during the year. It’s simply not feasible to cancel competitions when the temperatures go above 95 degrees. We bring canopies to every match where the temps are expected to be above 70 (or it’s raining), but having the towels helped a lot in addition to having plenty of cold liquids. The risk of an MRSA outbreak is very small as the CDC study found the incidence of invasive MRSA in children aged 5-17 was 1.4 per 100,000. The vast majority of MRSA infections are treated successfully, but as the October news shows, not always. So what to do?

Clearly the easiest preventative measure for MRSA is to prohibit the use of cooling towels. Even if they aren’t shared, they’re dipped in a cooler of ice cold water between uses which could spread bacteria. I tried to find scientific data on the ability of MRSA to survive freezing temperatures, but was unable to. But their usefulness in keeping players cool is clear. Using disposable paper towels would generate a ton of trash, and they don’t hold water was well. Perhaps a more sensible approach is to educate coaches and parents that any child with open cuts, sores, or lesions should NOT use the cooling towels, or should have one they keep separate from the rest. We already ensure the towels get cleaned and bleached between uses. My guess is we’ll continue to use the cooling towels for our competitive players, but also work to educate our parents and coaches on how to minimize the chances of an infection. We may investigate getting additional towels so players have 2-3 each and once they use one, they put it in a bag for later cleaning. Thus the towels in the cooler are always clean and sanitized. But that’ll be expensive.

So there you have it. MRSA is something to be concerned with, but clearly not to the level the media would have had you believe in October. While the common preventative measures are common sense, their absolute implementation could expose players to additional, though unrelated, risks.

Does your league have a MRSA policy? Have they published information about MRSA or changed how they do things?