Cleaning to Prevent the Transfer of MRSA

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Cleaning to Prevent the Transfer of MRSA
Other Skin Pathogens During Athletic Activities

• By MaryAnn Custer MS, RN, CMSRN

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History of Pathogens in Athletics

• Multiple infectious disease outbreaks in
  Athletics
• Bacteria
• Fungus
• Viruses
• Reported by outbreaks Most disease
  transmissions during athletics are not reported
• Football and Wrestling most commonly associated
  with disease transmission in athletics
• High School Wrestling had one of the first
  documented outbreaks of CMRSA

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Historical Response to Athletic Disease
Transmission

• Athletics
• Disease transmission undesirable, but not
  surprising
• Majority not reported
• Often times concealed or self-treated
• Prophylactic medications and skin protectants
• Healthcare
• Not much involvement unless outbreak
• General recommendations education, inspecting
  and treatment of infected athletes, universal
  precautions, cleaning and disinfection of
  wrestling mats or examination tables, Dont
  share water bottles.
• Some physicians recommending prophylactic
  medications
• Some discussion in the literature regarding the
  use of bleach on skin infections Not
  recommended

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In Contrast, Healthcare.

• Programs designed to reduce the risks of disease
  transmission
• INFECTION CONTROL PROGRAMS
• Proper handling of blood and other potentially
  infectious materials (OPIM)
• Proper cleaning and disinfection of environmental
  surfaces
• Recommendations for good hygiene practices
• Information for developing educational programs

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Programs to Prevent Disease Transmission in
Athletics?

• No programs specifically directed toward reducing
  the risks of disease transmission in athletics
• CMRSA Increased prevalence in athletics
  (Football and Wrestling)
• Healthcare suggests getting back to the basics
  of Infection Control

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Reduce the Risks of Disease Transmission
through.PREVENTION
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The Prevention ProgramIncludes

• Education on Infection Control
• Encouraging good hygiene practices among student
  athletes
• Proper cleaning disinfection of athletic
  equipment
• Proper handling of blood and OPIM

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Epidemiologic Triangle
Environmental Environmental Surfaces
Equipment, Athletes who practice and/or compete
with infections
Susceptible Host Athletes, Coach Trainers
Causal Agent Ringworm, Staph, MRSA Herpes
Gladiatorum
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Causal Agent

• A causal agent is biological, physical or
  chemical entity capable of causing disease.
• Bacteria Ex Staph Infections (MRSA)
• Antibiotics
• Virus Ex Herpes Gladiatorum
• Antiviral Medication
• Fungus Ex Ringworm
• Antifungal Medication

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Environment

• The environment is all of the external conditions
  that affect the life, development and survival of
  the causal agent.
• EX wrestling mats/athletic equipment, locker
  rooms, showers, whirlpool tubs, athletes who
  continue to practice and/or compete with
  infections

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Susceptible Host

• A person or animal, lacking an effective
  resistance to a particular pathogenic agent.
• One Who Gets Kicked While They Are Down

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By altering one component of the triangle, one
or more of the other components may be changed

• Environmental Surfaces Equipment, Athletes
  who practice and/or compete with infections
  
• Herpes, Ringworm
  Athletes,
• Staph Infections Coaches,
  Trainers
• MRSA

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Alter the Environment
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Student AthleteHygiene Practices
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HAND HYGIENE
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Additional Hygiene Measures

• Shower after practice or competition
• Refrain from sharing equipment, towels, razors,
  water bottles
• Wash practice gear daily
• Athletes with rashes or other potentially
  infectious skin infections seek medical attention
• Do not pick, squeeze, scratch abrasions, rashes,
  etc.
• No practicing or competing with skin infections
• Hepatitis B Vaccination
• NEVER allow chemicals for cleaning or
  disinfection to be used on the skin

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Cleaning and Disinfection of Equipment
Environmental Surfaces
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Choose the Right Chemical
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• Spauldings Classification System
• Instruments, Medical Device-Equipment are divided
  into three categories for disinfection or
  sterilization.
• Critical Instruments or Devices
• -Instruments or objects directly
  introduced into the body
• -Examples Needles, Scalpels
• -MUST BE STERILIZED
• Semi-critical Items
• -Instruments or objects that may come in contact
  with
• mucous membranes, but do not penetrate body
  surfaces.
• -Examples Respiratory equipment, Endoscopes,
  Vaginal
• Specula
• -SHOULD BE STERILIZED, MINUMUM HIGH LEVEL
  DISINFECTION (HLD)

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Non-critical Items

• Not normally in contact with individuals, if they
  do, it is with intact skin.
• Examples Wrestling Mats
• Disinfection with an INTERMEDIATE OR LOW-LEVEL
  DISINFECTANT is appropriate and recommended.

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DESCENDING ORDER OF RESISTANCE TO GERMICIDAL
CHEMICALS

• SterilizationBACTERIAL SPORES
• Bacillus Subtilis Clostridium Sporogenes
  HLD High
  Level Disinfection MYCOBACTERIA Mycobacterium
  Tuberculosis Var. Bovis--------------------ILD
  Intermediate Level TB
    NONLIPID OR SMALL VIRUSES Poliovirus
  Coxsackie Virus
  
• Hepatitis A Virus
• Rhinovirus Common Cold
   
• FUNGI--------------------------------------------
  ------------------------------- LLD Low Level
• Trichophyton Spp. Nail FungusCryptococcus
  Spp.Candida Spp. Yeast
• VEGETATIVE BACTERIA Pseudomonas
  Aeruginosa Staphylococcus Aureus Staph
  Salmonella Choleraesuis Gastroenteritis
• LIPID OR MEDIUM-SIZED VIRUSES Herpes
  Simplex Virus Cold Sores Cytomegalovirus
  CMV Respiratory Syncytial Virus RSV
  Hepatitis B Virus HBV Human Immunodeficiency
  Virus HIV (Adapted From Bond Favaro, 1991)

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(3) Factors that can influence the disinfection
process
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Soil and the chemical can combine
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Soil can precipitate out active chemical
components
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Hard Water

• Calcium and Magnesium

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Follow Instructions for Chemical Use

• All Chemical Germicides and Bleach Solutions
• MIX Appropriately
• USE Appropriately
• READ and FOLLOW LABELS

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Soil coats organism preventing chemical from
getting to the organism
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EX Blood Coats organisms such as HIV/HBV making
it more difficult for disinfectants to kill the
organism
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CLEANING
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Relation to Environmental Services

• 2 types of disinfectants
• Intermediate and Low-Level
• Utilize TUBERCULOCIDAL solutions if potential for
  bloodborne pathogens exist
• Bleach solutions diluted 110 may be appropriate
  solutions on a pre cleaned surface

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Good Hygiene PracticesClean/Disinfected
Surfaces

• Reduced Risk for Disease Transmission

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• LYSOL? Brand ICTM Quaternary Disinfectant
  Cleaner (Concentrate)
• Effective cleaner and disinfectant that kills
  odor-causing bacteria.
• Highly concentrated, cost-effective formula
  dilutes at 1256.
• Virucidal, Fungicidal and Bactericidal.
• Effective against HIV-1, VRE, MRSA and other
  gram-positive as well as gram-negative
  microorganisms.
• Neutral pH in use.
• EPA Registration No. 47371-129-675
• In the presence of 5 organic matter

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• LYSOL ? Brand ICTM Ready to Use
  Disinfectant Cleaner
• Kills 99.9 of bacteria in 30 seconds on hard
  nonporous surfaces
• Meets the requirements of the OSHA Bloodborne
  Pathogens Standard
• Effective against Tuberculosis (TB), Poliovirus,
  and
• Human Immunodeficiency Virus Type 1 (HIV-1)
  (Aids-Virus)
• Contains no bleach, phenol, alcohol, or harsh
  abrasives
• EPA Registration No. 675-55

Bacteria Viruses Salmonella
choleraesuis Influenza A2 (Japan) Staphylococcus
aureus Herpes Simplex Type 1 Pseudomonas
aeuruginosa Herpes Simplex Type 2 Enterococcus
(Streptococcus) faecalis Rhinovirus Type
39 Escherichia coli Rotavirus Mycobacterium
tuberculosis var bovis BCG Respiratory Syncytial
Virus (RSV) Enterococcus faecium HIV-1 (AIDS
Virus) Streptococcus pyogenes Poliovirus Type
1 Campylobacter jejuni Echovirus
12 Adenovirus Type 2 Fungi Hepatitis A
Virus Trichophyton mentagrophytes Parinfluenza

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Routine Cleaning Disinfection of Environmental
Surfaces Equipment

• Follow a written procedure
• Mop mats prior to use
• Clean from the back of the mat toward the front
  using a clean, laundered mop
• Educate all individuals responsible for cleaning
  disinfecting environmental surfaces equipment

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Routine Cleaning Disinfection Cont

• Use a Low Level Disinfectant
• Virucidal, Fungicidal and Bactericidal
• MSDS sheets on chemical germicides
• Label all secondary chemical bottles
• Launder Mops Cleaning Cloths Daily
• Use additional measures to prevent surface
  contamination i.e., for wrestling limit street
  shoes on mats, limit food/drink in wrestling
  rooms, disinfection of wrestling shoes prior to
  walking on mats

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Clean up of Blood and OPIMOther Potentially
Infectious Materials
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Observe Standard Precautions Combination of
Universal Precautions and Body Substance
Isolation Wear personal protective equipment
in accordance with OSHAs standards, and facility
recommendations Gloves are minimum
protection Latex Free Gloves may be used to
avoid latex allergy Goggles, Mask,
Fluid Resistant Gown if chance of splash or
splatter
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Blood OPIM cont.

• Follow a written procedure
• Educate all individuals responsible for cleaning
  up Blood OPIM
• Hepatitis B vaccine available to individuals
  exposed to blood

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Never Spray Athletes with Chemical Germicides
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Blood OPIM cont.

• Antiseptics or chemicals intended for use on the
  skin, should be used to remove blood or OPIM from
  intact skin
• NEVER SPRAY ATHLETES WITH CHEMICAL
• DISINFECTANTS
• Wipe blood from intact skin during competition
  with antimicrobial wipes and encourage athlete to
  wash with soap and water after competition

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Blood OPIM cont.

• Surfaces must be cleaned before they can be
  disinfected
• Use a 110 Bleach or Tuberculocidal solution for
  disinfection
• Note - OSHA standards states that
  EPA-registered disinfectants that are labeled as
  effective against HIV and HBV would be considered
  appropriate disinfectants for bloodborne
  pathogens, provided such surfaces have not
  become contaminated with agent(s) or volumes of
  or concentrations of agent(s) for which higher
  level disinfection is recommended. Thus, when
  bloodborne pathogens other than HBV or HIV are of
  concern, OSHA continues to require the use of
  EPA-registered tuberculocidal disinfectants or
  110 or 1100 bleach solutions.
• Edens,1997
• Infectious waste should be handled according to
  with state and local regulations
• See also OSHAs Bloodborne Pathogens
  Standard 29CFR1910.1200

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? Chemical, bottle not labeled
No antiseptic
No gloves
Improper container for contaminated waste
No Absorbent towels
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Procedure For Cleaning up Blood and OPIM
Absorbent Towels
Gloves
Tuberculocidal Solution
Biohazard Bag
Hand Sanitizer
Antiseptic Wipes
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The Future..

• National Collegiate Athletic Association (NCAA)
  revised guidelines for Bloodborne Pathogens and
  Skin Infections in Wrestling
• Published in 2004-2005 Sports Medicine Handbook
• NCAA sponsored infection control program for all
  collegiate and high school wrestlers
• Available Fall 2005 through the NCAA website
• NCAA sponsored infection control programs for
  football, and other sports

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Future continued..

• Program supported by the National Federation of
  High Schools (NFHS)
• Statewide programs directed toward prevention for
  all athletes
• Healthy People 2010 Reduce antimicrobial
  resistance
• CDC community prevention program
• Health education for physicians, coaches,
  trainers, athletes, parents

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Thank you
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