Deverick Anderson, MD, MPH, got an unusual phone call last August. Two NFL football players from the Tampa Bay Buccaneers had been diagnosed with Methicillin-resistant Staphylococcus aureus (MRSA), and there were concerns about the origin of the infections and the prevention of new cases.
Anderson, an associate professor of medicine (Infectious Diseases) and co-director of the Duke Infection Control Outreach Network (DICON), was invited by the team to visit its facilities in September as a consulting physician. He reviewed the team’s infection control policies and developed specific protocols and recommendations to help prevent the spread of infection.
MRSA is a strain of staph bacteria that can cause skin infections and is resistant to antibiotics. It is usually treated with antibiotics and draining of the infection site. Signs of MRSA can show up right away, but infection may not be apparent for up to three weeks.
During Anderson’s initial visit, he reviewed and helped develop new infection control procedures for equipment and other items shared among players. He led education sessions with athletic trainers, who handle much of the players’ daily health care.
Anderson said that athletes in contact sports are more at risk for MRSA than most populations because of their frequent skin-to-skin contact and the higher likelihood for skin abrasions that weaken their defense against infection. Other high-risk populations include children and people who have been in the hospital, generally groups that are in close quarters and have a lot of contact with others, he said.
By October, another Buccaneers player was diagnosed with an MRSA infection, and the team learned that one of the players who had been previously diagnosed and gone through treatment had relapsed. Panic grew and the NFL and the NFL Players Association expressed concerns about the situation and safety of the players.
Anderson returned to the Tampa Bay facilities, where he held educational sessions on infection control and prevention with the players, coaching staff and others in the organization.
He set guidelines for what would be necessary to safely clear a player to return to the playing field, following the same criteria Duke uses for hospital employees. Players had to have gone through treatment (a course of antibiotics and/or draining of the infection site), the wound needed to have stopped draining and needed to be adequately covered. With these safety measures in place, a player could return to the playing field.
“It struck me that if I would allow an ICU nurse to return to treating very sick patients based on these same parameters, then the same criteria would work for an NFL player,” Anderson said.
Duke has a history of helping groups handle infection control. Its DICON group works with community hospitals in North Carolina and other states to improve and implement approaches to infection control. DICON provides sophisticated data analysis and metrics, access to experts in infection control, opportunities to share successful programs and extensive education initiatives related to infection prevention.
DICON has consulted with sports teams and other high-risk groups, making recommendations for infection prevention. For the last few years, the group also has provided the NFL with an infection control newsletter that goes to team physicians.
Anderson’s other recommendations for the team included making sure players were not sharing personal equipment and ensuring that the surfaces of shared equipment were being adequately cleansed and that players and staff maintained proper hand hygiene, which was aided by adding stations with germ-fighting alcohol foam in areas where sinks were not handy.
One thing that was interesting about the cases of MRSA in Tampa Bay, Anderson said, is that none of them were related.
“You can actually look at the specific microbiological data for each of the three MRSA isolates and definitively decide that the infections are unique, that they were three different strains,” Anderson said. “None of these MRSA infections seem to be related.”
Anderson said two of the players who were diagnosed with MRSA had surgical procedures in recent months prior to infection, and one player had a history of this type of skin infection. Both of these factors could potentially increase the players’ risk for infection. Ultimately, it was just bad timing, he said.
“The other part of this that I think is really interesting is that these types of infections probably happen every season in just about every team,” Anderson said. “The reality is that not every team is aggressive about culturing, and you have to culture to identify MRSA.
What was unique about the situation with the Buccaneers is that there were multiple cases around the same time and players missed practice during treatment. This drew media attention, and Anderson helped the team answer questions during a press conference after the third player was diagnosed.
Anderson will follow up with the Buccaneers in early 2014. He said he has had calls from other teams and is looking for opportunities to help groups outside of the NFL.
“We’d love to make it more of a national program, so hopefully other teams will come knocking,” he said.