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Advice from New Jersey State Athletic Control Board on dealing with staph

By Zach Arnold | June 25, 2010

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When I wrote a detailed article about the doctors who cleared Matt Hamill to fight with the mark on his back last Saturday, it was a revealing article in many ways. Some good things and some bad things.

The good is that for those of you who read it, I got great feedback from you about the topic.

The problem is that people largely weren’t interested in reading the article or discussing it. I learned a long ago time as a writer that in order to gain traction with a story, you need to have the following three factors:

  1. Feed the beast. (A new story or taking a known story and giving it life with new information.)
  2. Media interest in talking about your story.
  3. Reader interest in your story.

In the case of the examination we did about the medical background of doctors who cleared Matt to fight, we did feed the beast but the media largely ignored it (outside of a couple of outlets like MMA Torch) and the readership interest wasn’t there. I found the latter to be highly ironic because at times on both this site and on other MMA sites or message boards, you often hear the criticisms that there isn’t good writing or good journalism going on in the online MMA world. However, once something does meet their standards, suddenly they don’t want to read or comment on it and instead choose to surface on another topic that they deem to be of lower standards. Amusing.

When I addressed the issue of staph in MMA, it’s obviously a topic that I think everyone should take very seriously because we don’t need the fighters having nasty diseases and fighting in unsafe environments. Which brings me to a couple of articles I recently received about what Dr. Sherry Wulkan of the NJSACB wrote on the topic and what fighters, trainers, and others can do to prevent outbreaks of staph and what to do if you do get some sort of infection.

Dr. Sherry Wulkan (NJSACB)

THINGS YOU CAN DO TO PROTECT YOUR ATHLETES FROM MRSA AND OTHER GYM INFECTIONS

Have a hand sanitizer dispenser at the entrance to each locker room and encourage use prior to entering the gym. If you cannot install a hand sanitizer dispenser, follow proper hand washing technique.

Proper technique for washing includes manual rubbing or scrubbing hands for about 15 seconds, drying with a clean, disposable towel, and using a towel to turn off the water faucet. Hand sanitizer solution can be used in place of soap and water, but the cleanser must contain minimum of 62% alcohol or equivalent strength disinfectant.

Wash mats with bleach and water (one part bleach to four parts water) twice daily. Allow to dry. Rinse with clean water. Clean all communal equipment in the same manner ( bags, kicking shields, speed bags etc.). RINSE MOP AND BUCKET THOROUGHLY WITH SOAP AND WATER AFTER EACH CLEANING.

Avoid sharing towels, water bottles, Vaseline, and personal items such as razors, nail clippers and hand wraps.

Encourage athletes to keep nails clipped short and filed.

Do not allow athletes with any open skin wounds, rashes or boils to roll and /or spar or take class. Have the competitor get medical clearance prior to return to active training. Emphasize that the athlete is not the only one at risk; their family members will also be exposed. Young children, diabetics, the elderly and people with heart or other chronic health conditions are particularly susceptible to infections, and may have worse outcomes than otherwise healthy young athletes.

Encourage athletes to wipe down exercise equipment with a clean towel after use. Personal equipment (gloves, thai pads, punch mitts) should be cleaned after each use first with a Clorox wipe and then with a hand wipe. Place cleaned equipment directly into your equipment bag; do not put your clean equipment down on the floor of the cage or ring, or on the mats.

Clean handrail/handles/seats of exercise equipment daily with a product that contains a minimum of 10% bleach or an equivalent cleaning solution that can kill staph bacteria. Disposable wipes are acceptable.

In the event an athlete gets cut during sparring, or in the event of vomiting after a difficult workout, the following precautions should be taken.:

“I Feel Fine Doc, Why Can’t I Train”?
Common Gym Scourges and How to Avoid Them
By Dr. Sherry Wulkan MD, NJSACB ringside physician

Your gym is running smoothly, training sessions for your fight team are on schedule, and remarkably, no one’s been injured this time around. Then one of your top fighters pulls you aside and says, “hey coach, what the “F’ is this on my arm”? Doesn’t look like much, maybe an ingrown hair or something, so he goes home. Two days later, he calls to tell you he’s not feeling well. His sparring partner and three other fight team members all have the same rash. MRSA. You’ve lost at least one week’s training time.

Sounds all too familiar I’m sure.

Now you have an idea about what this article’s about. Hopefully it will provide you with some practical guidelines to prevent the spread of infectious disease, to help you suspect a serious infection and circumvent its spread, and to give you some insight into what the team doctors’ concerns might be about some common gym ailments.

Let’s start with an annoying, although non-life threatening problem:

TINEA CORPORIS (Ringworm)

Ringworm is a fungal infection of the skin. It may initially appear as a small pimple-like lesion, and then grow into an area with central clearing with a scaly raised, red, border. It may be itchy. It is highly contagious, but not dangerous, (except potentially to those who are immunocompromised), although it is sure to turn off your significant other. It is most frequently spread throughout the gym from dirty mats, and between wrestlers, jujitsu practitioners and those repping the Thai clinch; the close proximity between workout partners and the open pores of sweating competitors provide a perfect breeding ground for this opportunistic infection. There are a lot of creams that cure ringworm. The most effective require a prescription. For those of you who are uninsured, or are on a tight budget, a quick trip to the vag – itch isle (sorry guys) for chlortrimazole cream (1%) mixed 1:1 with hydrocortisone cream (1%) is the equivalent of Lotrisone and is a lot cheaper.

In my experience, most people treat this illness incorrectly. They apply the cream four times daily while they see the problem, but forget to continue treatment for the two weeks after the ring(s) disappear. Why bother? Because if you don’t, it’ll definitely be back, larger, stronger and more annoying than before; you’ll have to start the whole process over again, and take another few days off from training. For those of you who are curious, there are five cell layers in the most superficial portion of the skin (or epidermis). The cell layers are seated upon each other roughly like a pile of neatly stacked bricks. The middle layer or dermis is composed of connective tissue, and the deepest layer, of subcutaneous tissue. The fungus has roots analogous to those of a plant that reach the lowest skin cell layer of the epidermis (outermost skin layer). As the skin cells age, the top layers are shed. New skin cells form from the bottom layer. The migration of the bottom layer of the skin to the surface takes approximately two weeks. Therefore, to literally and figuratively get to the root of the problem, you need to treat this infection for two weeks after the lesions disappear.

There are some simple precautions one can take to prevent the spread of ringworm:

Use one of the many barrier creams marketed for this purpose. The cream should be applied to all areas of exposed skin. Read the directions on the product you’re using; some may be applied safely to the face, others not.

Wear a long sleeved rash guard.

Wash your gym clothes after each use.

Use soap and a little bit of water to wash the exterior surface of your gloves and other equipment after each use.

Keep all open wounds (blisters, scratches) covered.

Wash all gym attire at very high heat. (140-160 degrees).

HERPES LESIONS

Some of you may remember that Paul Bradley had to be sent home during the filming of Spike’s Ultimate Fighter 7 series because of an outbreak of Herpes gladiatorum. The illness is very contagious, and can potentially be extremely harmful. It is really common among wrestlers (transferred by skin to skin contact): an estimated 20% of all grapplers carry the virus. It is predicted that combat athletes have a 33% chance of contracting this skin infection while sparring with an infected competitor. (transferred by sweat or contaminated equipment). (Anderson ,2003).

The infected athlete typically describes a stinging or burning sensation before developing a small lesion that may be mistaken for a pimple. If suppressive doses of the prescription drug valcyclovir are taken at the onset of these symptoms, the lesions can usually be avoided, and the risk of spreading infection to a gym partner is much less. After the initial stage, a small cluster of red lesions with blister like apices (vesicles) occur. At this stage, the competitor is highly contagious. The rash eventually scales and forms a crust. Without medications the outbreak may last anywhere from 7-14 days, since new crops of vesicles may appear.

Once you have acquired the herpes virus you can never get rid of it, but there are some medications that can suppress it. Fortunately, the longer you have the virus, the fewer the number of eruptions per year. Unfortunately, both stress and very intense workouts can precipitate an outbreak, since both situations can cause mild immunosuppression. As an aside, if you’re a fan of tanning before a fight and you know you have Herpes, you might want to reconsider, since this activity can activate a dormant virus.

Why are doctors so worried about this illness?

The lesions look a little nasty, but that’s not why. What concerns us most are the very real, and very potentially life altering consequences of transferring this infection during sparring sessions or mixed martial arts competition. Meningitis, arthritis or severe eye infections that can result in blindness, are just some of the conditions that concern us. It really bothers ringside physicians to have to scratch an otherwise well-prepared fighter during the pre-fight physical for this issue, but now you’re aware of our reasoning.
How can we minimize the spread of this illness?

Keep away from the gym if you know you carry Herpes and are prodromal (suspect you may have an outbreak). If you have a lesion or lesions stay away from the gym until it (they) have completely crusted.
Clean your equipment after each use.

Wear long sleeved, sweat-wicking rash guards

Wash all gym clothes after each use.

Keep all scratches covered.

Bacterial HEADLINERS: MRSA (Methicilln –resistant Staphylococcus Aureus)

Initially found only in hospital settings, MRSA has recently been making headlines because of its spread into the general community and, as its name implies, because of its resistance to previously effective antibiotics. MRSA can have devastating effects; serious infections have been occurring in otherwise healthy people in the community, notably athletes who share equipment or personal items. . A seemingly benign (mild) condition can become life threatening in a short period of time if treatment with the appropriate medicine is delayed.

It is estimated that 33% of the population carry staph on the skin or in their nostrils. People who are colonized with staph, but who are asymptomatic (aren’t sick) are known as “carriers”. The bacteria may be transferred from a carrier to a new host by skin-to-skin contact: an abrasion, or the open pores of a perspiring competitor facilitate the transfer of bacteria from a carrier to a new host.

The lesions initially look like pimples, boils or even spider bites, but they can rapidly turn into painful abscesses that require surgical intervention. The bacteria sometime spread throughout the body, potentially resulting in the destruction of joints or in life threatening illnesses of bones, lungs, or heart valves.

Once again, there are some simple precautions you can take to minimize your risk of infection, or to contain an outbreak if it occurs.

  1. Stay away from the gym until your private doc or the team’s physician sees you if you have a draining wound, or one that’s red, swollen, painful and warm to the touch. Do not return until the lesion(s) has (have) healed. Use bleach and the hot water cycle to sanitize clothes and linens.
  2. Wash your hands with soap and water. Use a disposable towel to dry your hands and another to shut the faucet. Carry a hand sanitizer with a minimum content of 60% alcohol.
  3. Shower as soon as possible after athletic competitions or practices.
  4. Keep cuts and abrasions covered.
  5. Avoid sharing towels, razors, clothing or athletic equipment.
  6. Ask your doctor if you should be tested for MRSA if you have a skin infection that requires prescription therapy.

It is advisable to have nasal swabs done on all team members and sparring partners to see whether they have become MRSA carriers if someone has tested positive in your facility. Simple treatment with
intranasal Bactrobam ointment can alleviate the carrier state and avoid future outbreaks in most instances.

What’s new in the fight against MRSA?

Investigators have recently developed an intranasal vaccine that protects laboratory mice against MRSA lung and skin infections. It is therefore likely that a human vaccine is probably just a few years away.

Hepatitis B, C and HIV

Save yourself a lot of time, headache and a potential lawsuit; suck it up, dish out the money and get vaccinated against hepatitis B if you haven’t already done so. The risk – benefit ratio is a no-brainer. N.Y.State began mandating hepatitis B vaccinations for all elementary school children as of 1999. Check with your physician if you’re not sure whether you’ve had this series. A booster is required approximately every 10 years. If you’re a fighter, you will probably not need to check immune status as often; check with your Athletic Control Board to determine how often you’d need to demonstrate immunity once you’ve undergone the immunization. This will probably save you some money in the long run.

Hepatitis literally means “inflammation of the liver”. There are many subtypes of this virus, some of which cause mild illness and some of which cause potentially life-threatening ailments. For example, Hepatitis A usually causes a relatively mild illness. In fact, the majority of people who contract this illness rarely seek medical advice.

Hepatitis B, on the other hand, manifests completely differently. It is estimated that 400 million people in the U.S. are infected with hepatitis B.

10%-20% of people with hepatitis B infection develop a chronic carrier state and ultimately, cirrhosis (scarring of the liver). Of the 10%-20% with chronic infection, 10% develop liver cancer. Hepatitis C also has similar devastating consequences.

Hepatitis B and C are very strong; they can “survive” on mats for approximately two weeks. Transmission is usually via blood borne contact in gym settings, although the sharing of needles for illicit steroid injections. or for B12 injections may also spread this disease. Initial symptoms include fever, fatigue, muscle aches and pains, and possibly the sensation of abdominal fullness. Some patients develop jaundice (yellowish discoloration), which is most easily noticed in the sclerae (whites) of the eyes. Urine may appear dark, even if you are well hydrated, and stools appear light (clay colored).

I would strongly recommend that any owner of a mixed martial arts school require all sparring participants to submit the results of hepatitis B, (if not vaccinated), C and HIV 1 and 2 annually.

HIV 1 and 2 are chronic, devastating viruses that destroy the cellular immunity of the host predisposing the victim to any one of a myriad of bacterial, fungal and protozoan infections. Although there has never been a well-documented case of gym transmission in either boxing or MMA, I would not recommend risking the chance of being first in this instance.

Mats should be washed two- three times daily, depending on the number and types of classes. (bleach: water – 1:7-1:10).

Try to avoid throwing sweaty rash guards on the floor while changing; put it on your bag and take it home to be laundered.

All sparring participants should undergo the hepatitis B vaccination series. It’s worth the initial expense, since a booster is not required for 10 years, and you will save yourself the worry about whether you might have contracted this illness. There is an added benefit to obtaining the series if you are a fighter; you should not need to repeatedly prove immunity to hepatitis B once immunity has been established after vaccination; in the long run this will save you a good sum of money.

From the individuals’ point of view, good personal hygiene helps a lot.

  1. Try to keep fingernails and toenails short. Keep a clipper and a file in your bag. Avoid sharing these items with friends.
  2. Shower as soon after your workout as possible.
  3. Wash wraps and gym clothes after each use.
  4. Carry a hand wash with at least 60% alcohol content.

Hopefully, by following these simple guidelines, everyone will benefit; fighters by preventing lost time from training, or loss of income and, worst case scenario, their career, and gym owners, by maintaining their reputations by providing safe, effective, and healthy environment in which to train.

PROACTIVE MEASURES THAT HELP PREVENT GYM INFECTIONS

Most of the following recommendations will seem obvious to you once stated. They’re not terribly time consuming, and not difficult to implement once you’re aware of them.

  1. Avoid using one towel to remove sweat or blood from multiple sparring partners.
  2. Wear gloves in the corner during sparring sessions in your own gym.
  3. Vaseline should not be communal (shared) either, unless removed from the container with a tongue depressor (new one for each athlete). Vaseline containers should be closed immediately after each application.
  4. Communal headgear should be sanitized after each use, as should shin guards. Weights, cardio- conditioning equipment, and core strengthening equipment should be cleaned at least 2-3 times per week.

Topics: Media, MMA, Zach Arnold | 8 Comments » | Permalink | Trackback |

8 Responses to “Advice from New Jersey State Athletic Control Board on dealing with staph”

  1. First edition says:

    Hey Zach, no offense intended here at all, but the disclaimer at the top of the Hamill piece saying you’ll need 15-30 minutes was like an invitation to go click on someone else’s blog. I don’t have 30 minutes of my life to dedicate to Matt Hamill’s staph infection. If I did have that much time to kill and I wanted to be outraged, I would read stories on the war or the oil spill. Part of good journalism is getting to the point and presenting your points in a clear and concise manner. You’re not quite there yet. I have a feeling this comment will be deleted, but it is meant as constructive criticism.

    • Zach Arnold says:

      If I didn’t tell people to devote some time aside to read it instead of skimming it like a talk radio post, that would be doing it a disservice.

      And that’s the whole point — the article wasn’t just about Matt Hamill. You didn’t bother reading it. There were many different issues raised in the piece.

      There was a reason why I asked people to take their time reading it and to click on all the links — to get a fair, accurate portrayal of what was being discussed.

      • First edition says:

        Well, you seem disappointed in your readers for not being interested in the piece, so I’m just letting you know why I skipped it. Whittle the cogent points down to something I digest in 5-10 minutes and you’ll have me.

        • Zach Arnold says:

          Fire me an e-mail (through contact link) and I’ll listen to anything else you have to say if you’re interested. (and I won’t reveal an identity.)

      • DJ TE says:

        There really wasn’t much to comment on that hasn’t been said in every other forum, except the comments had the “can’t she just cut it out” for extra charm, and no updates for comment threads unless I want to add individual posts to an RSS reader.

        It boils down to an AC hires brutally incompetent people.

        Every forum/blog has stated this ad nausea.

        Unless you get this kind of stuff to Bob Costas or an advocacy group, I don’t know what kind of shock and outrage you expect from people like your readership. Most of them (and myself) are jaded to the ABC bureaucracy. Who here thinks anything short of a pregnant Olsen Twin being cleared to fight Aleks in a brass-tacks match on a barge in the flaming Gulf of Mexico will change things via interwebs outcry?

        Hopefully you can prove me wrong.

  2. Mr. Roadblock says:

    Staph is disgusting. So is ringworm and the rest of the skin diseases.

    I got ringworm back in HS along with about 85% of my team. I got a couple of staph infections from a well-known gym along with lots of people that train there. These things move like wildfire through facilities. You can shower right after and still get sick because someone else came into the gym from a construction site and had dirt on them.

    Also the reality as far as the Pro Athletes is that almost all of them get sick during camp from being worn down and those that are susceptible from staph or have herpes get outbreaks during camp. They can’t stop training because there is a fight coming up and other people get it to.

    It’s simply a cost of doing business in this field. Bottom line. End of story.

    The NFL has similar problems with players too. They’ve done a lot in recent years from what I’ve heard to upgrade hygenie standards.

    If people were more committed to washing their rashguards, knee pads, wraps and protective gear it would probably cut down on staph somewhat. A lot of gyms are also cheap when it comes to cleaning supplies. Plus you have people walking all over gyms with their shoes on then you have barefoot people walk in the same spots then onto the mats.

    Staph is definitely a problem in MMA but you can’t cancel fights over it. The argument you’re making is that Mat Hamil shouldn’t have gotten paid the other night and Jardine should have had no shot at a win or performance bonus and the show doesn’t have a main event.

    I won’t start blowing up the names of guys and their medical conditions because I don’t believe in doing that but I can tell you I personally know of several PPV main event fights that would have been canceled due to staph.

  3. DJ TE says:

    Great guide. I hope they release it as a poster every gym can put up, but at the minimum it should be required reading with a signature for understanding like any employee reg manual.

    I wonder how much machismo is involved with “being afraid of getting dirty?”

  4. Guy Sako says:

    Wrestlers and fighters for years have been using Defense Soap to protect them from Ringworm, Athlete’s Foot, Jock Itch, MRSA, Staph and other skin infections that they can catch from the mats. Defense Soap is a 100% natural line of soap that is no longer just for the combat athlete.
    Visit Defense Soap at http://www.defensesoap.com

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