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Hygiene in the Locker Room

Skin infections have increased considerably over the past decade both in the community and within the sporting environment.1-4 Skin infections are often ignored in their early stage, but as they progress they have the potential to affect sports participation and performance or lead to disqualification from competition. Close personal contact in locker rooms, practice and during competition make athletes in team sports more susceptible to the spread of these infections than other sports participants.1-4 The majority of skin infections are transmitted through skin-to-skin contact but a significant number are associated with poor hygiene, particularly the sharing of towels and lack of hand washing.

It is important for sports medicine professionals to recognise common skin infections early, so that an appropriate course of action can be implemented. Early detection can reduce the progression of the infection and allow for a faster return to sport.2-3 Chapter 56 of the new edition of the Clinical Sports Medicine textbook (CSM4ed), titled Common sports-related infections, discusses common infections seen in athletes today, particularly skin infections and provides the reader with useful information on clinical assessment, management and preventative strategies. The chapter is co-authored by Doctor Zafar Iqbal , the first team doctor for Liverpool football club in the UK and Doctor Hasan Tahir , a specialist in rheumatology and general medicine who is actively involved in the National Health Service (NHS) in the UK and in research methods at St Matthew’s University Hospital in London.

A recent systematic review by Collins and O’Connell  analysed the prevalence of infectious disease outbreaks in sport over a five year period (2005–2010).1 This review found that the most predominant pathogen was of bacterial origin, community acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) [33%], followed by the fungal infection of tinea [29%]. Skin and soft tissue were the most common sites of infiltration. The majority of outbreaks reported occurred in close-contact sports, such as combat sports (e.g. wrestling, judo) and American football. Over half of these outbreaks were reported in high school or collegiate competitors. Another systematic review assessing infectious risk in sport, covering a period of over 20 years (1990-2011), also demonstrated that the risk of infection from CA-MRSA was the most common (27.4%) followed by tinea (13.7%).4

With a marked global increase in the incidence of CA-MRSA, a timely literature review has focused on summarising the evidence of cutaneous CA-MRSA infection in sport .3 This literature review concludes that there is evidence for an increased risk of CA-MRSA infection during:

  • Intentional body contact among wrestlers during training
  • Skin contact and resultant abrasion against wooden courts among volleyball players
  • Skin contact with small lacerations, acquired through shaving body parts with a razor blade, in footballers
  • The use of the bench press or cold-water whirlpool, without adequate cleaning, in weight lifters and football players
  • Contact of shared sensor wires in fencers and wrestling mats for wrestlers
  • The shared use of towels between football players
  • Sharing of common personal hygiene items such as razors, soap, and skin lubricants among athletes in general

Prevention strategies

Improvement of an athlete’s personal hygiene is essential and education of sports medicine staff, players, coaches, teachers, parents, and even administrators can make a huge impact in prevention. Below are some preventative strategies which can be considered by all sports:1-4

  • Hand washing is the single most effective behavior in preventing transmission of      CA-MRSA; always use soap and warm water and/or sanitation gels
  • Team members should shower, with soap and warm to hot water, as soon as      possible after completion of training and competition
  • When outbreaks occur, soap bars should not be shared and sports teams should consider using liquid soap
  • Players should not share towels, clothing, razors, and other personal items
  • Abrasions and lacerations should be promptly treated and covered. If the wound cannot be adequately covered, exclusion of the athlete with a potentially infectious skin lesion from practice and competitions should be considered
  • Appropriate cleaning and disinfecting of equipment should be routine
  • Team supplied uniforms, towels, and other clothing should be laundered in hot water with detergent or bleach after every use

References

  1. Collins CJ and O’Connell B: ‘Infectious Disease Outbreaks in Competitive Sports, 2005–2010’ Journal of Athletic Training 2012 47(5):516–518
  2. Pecci M, Comeau D, and Chawla V: ‘Skin Conditions in the Athlete’ The American Journal of Sports Medicine 2009 37(2): 406-418
  3. Cohen PR: ‘The skin in the gym: a comprehensive review of the cutaneous manifestations of community-acquired methicillin-resistant Staphylococcus aureus infection in athletes’ Clinics in Dermatology 2008 26: 16–26
  4. Grosset-Janin A, Nicolas X, Saraux: ‘A Sport and infectious risk: A systematic review of the literature over 20 years’ Med Mal Infect 2012 Article In Press

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