Athletic Activities: Microbial Presence, Transfer, Control …€¦ · · 2017-10-04turf, towels...

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Synthetic Turf and Athletic Activities:Microbial Presence, Amplification,

Transfer, and Control

New Orleans, LADecember 9, 2008

D. Rod Walters II, DA, ATCLexington, South Carolina

• Thank you for the opportunity to address your group of suppliers, designers and contractors for sports facilities

• I would like to give you some general• I would like to give you some general background on MRSA.

American Sports Builders Association © 2008 Walters, Inc. All Rights Reserved

• There has been a lot of information about MRSA and synthetic turf sports fields– Do synthetic turf sports fields could harbor more MRSA than natural grass fields?D th d t b di i f t d?– Do they need to be disinfected?

– Is there a higher incidence of MRSA among athletes/teams that play on synthetic turf?

• If so why would that be? • Anything suppliers, designers, contractors, ASBA can/should do to help prevent the incidence of MRSA among athletes who use the surfaces they build?


The Ground Rules

• Be careful not to try to correlate the emergence of MRSA and STAPH in sports to turf, because there is no such link.

• All surfaces (carpets, training tables, weight rooms, lockers, ceiling tiles, towels, uniforms, turf, hydro areas, t ) h thl t / ti / letc…) where athletes prepare/practice/play are susceptible to a wide variety of bacteria

• This presentation is not suggesting that wrestling mats, turf, towels or any other surfaces are responsible for these microbes – just that they are popular transmission routes that athletes are coming in contact with.


Terms Relative to Presentation• Germ ‐ A generic term for a microorganism which causes illness; examples

include bacteria, viruses, protozoa, fungi, and parasites. • Microbe ‐ A disease causing organism. • Fungi ‐ A microscopic plant that obtains its food by dissolving organic

matter. Mold is a type of fungi that is spread by air‐borne spores. • All‐purpose cleaners ‐ Penetrate and loosen soil, soften water and prevent

soil from redepositing on cleaned surfaces Some all‐purpose cleanerssoil from redepositing on cleaned surfaces. Some all purpose cleaners contain disinfectants. Antimicrobial ‐ A general term for any substance or product that inhibits the growth of microorganisms, such as bacteria, fungi, or protozoa.

• Antibacterial ‐ A chemical substance or product that either kills or inhibits infectious bacteria.

• Bacteria ‐ One of several different types of microorganisms or germs that multiply by division of a single cell into two bacterial cells. Infectious bacteria are responsible for a large number of human diseases, but not all bacteria are harmful.


Terms Relative to Presentation

• Disinfectant ‐ An agent that reduces the risk of infection by destroying harmful bacteria. Disinfectants may not destroy bacterial spores. Disinfectants have to be registered with the EPA and consumers should look for an EPA registration number on the product. In addition, the instructions on the label MUST be followed to ensure that the product will be effective.

• Cross‐contamination ‐ The transfer of germs from one surface, food, or person to h F l i h h ki h d i h h hanother. For example, it can occur when shaking hands with someone who has a

cold, when picking up a remote control that has been handled by a sick family member, or when wiping a counter top with an unwashed sponge.

• Pesticide ‐ An ingredient in products which are designed to prevent, destroy, repel or reduce pests including microorganisms. Antimicrobial products can be considered pesticides.


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Terms Relative to Presentation• Sanitizer ‐ An agent that reduces the number of bacterial contaminants to

safe levels as determined by public health requirements. • Treated articles ‐ Typically refers to articles or substances which are

impregnated with, or have antimicrobial compounds incorporated into them, to protect the articles from microbial degradation.

• Non‐treated articles ‐ Articles, surfaces, or other inanimate objects which are not impregnated with, or do not have antimicrobial compounds p g , pincorporated into them during, or after manufacture.

• Public health pesticide claims ‐ A claim that a product is intended to control infectious microorganisms that may present a hazard to human health.

• Non‐public health pesticide claims ‐ A claim that a product will control or inhibit odor‐causing bacteria (i.e. bacteria causing spoilage, deterioration, or fouling of materials such as paint or industrial fluids).


What is Biofilm?

• You may not be familiar with the term "biofilm," but you have certainly encountered biofilm on a regular basis. – Plaque on your teeth and– Plaque on your teeth and

causes tooth decay is a type of bacterial biofilm.

– “Gunk" that clogs your drains is also biofilm.

– If you have ever walked in a stream or river, you may have slipped on the biofilm‐coated rocks.


Biofilm Formation

• Bacteria adhere to surfaces in aqueous environments and excrete a slimy, glue‐like substance that can anchor to all kinds of material –metals, plastics, soil particles, medical implant materials, and tissue.

– Form by a single bacterial species or many species of bacteria, as well as fungi, algae, protozoa, debris and corrosion products.

– Biofilm may form on any surface exposed to bacteria and some amount of water.


What is the industrial significance of biofilm?

• Microbial biofilms on surfaces cost the nation billions of dollars yearly in equipment damage, product contamination, energy losses and medical infections.


Temperature for Bacterial Growth

• Most bacteria thrive at temperatures at or around that of the human body 98.6°F (37°C)

• S. aureus can grow at a temperature range of 15 to 45temperature range of 15 to 45 degrees (59o – 133 F.) and at NaCl concentrations as high as 15%.

• Todar's Online Textbook of Bacteriology


Micro‐Habitats in Turf

• 1968, Tartan Turf came to Neyland Stadium.

• 1968 – Polyturf was installed in Conrad Stadium –Appalachian.

• 1970 – Polyturf was installed h O B lat the Orange Bowl.

• 1975 – Concern for staining due to moisture– Binders had susceptibility to

deterioration to microbe activity

– Biofilms – “plugged” drainage properties


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Problems Associated with Infill Systems

• Microbes are afforded expanded opportunities due to soil and rubber presence where microbes can establish growth patterns on increased myriad of surfaces

• Question: how much ultraviolet rays actually penetrate turf to effect microbes


Visible

• Carpet stains• Walls and windows• Ceilings• Closets• Maintenance Reports


Odors

• Noticeable

• Musty

• Putrid

• Ammonia• Ammonia

• Sour

• Fishy

• Rotten Egg


Conditions for GrowthConditions for Growth

• Water/Moisture• Nutrients• Temperature• Receptive Surfaces• Receptive Surfaces


Synthetic Grass Fibers• Polyethylene • Polyethlyene/Polypropylene

Blend

Microbial Habitats Microbial Habitats Synthetic Turf ComponentsSynthetic Turf Components

Blend

Sand• Processed

Crumb Rubber• SBR or PU


Aerobic Algae

MicrobialMicrobialHabitatsHabitatsOxygenOxygen

Micro-aerophilic

Anaerobic

Fungi

Bacteria


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Intense Algae

Microbial HabitatsMicrobial HabitatsLightLight

Dark

Fungi

Bacteria


AlgaeWarmerlichens

Microbial HabitatsMicrobial HabitatsTemperatureTemperature

Fungi

BacteriaCooler


Rain

Dew Cycles

“C li ” W t

Algae

Microbial HabitatsMicrobial HabitatsWaters/MoistureWaters/Moisture

“Cooling” Water

Sweat

Retained

Drained

Fungi

Bacteria


Materials of Construction

DirtAlgae

Microbial Habitats Microbial Habitats NutrientsNutrients

Skin

Body FluidsFungi

Bacteria


Microbial HabitatsMicrobial Habitats

The same but differentMicrobial: Populations and

SpeciesAmerican Sports Builders Association © 2008 Walters, Inc. All Rights Reserved

Understanding Staphlococcus aureusp

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Developing Resistance

Levels of Bacteria

• Normal skin flora – Colonization‐ 1000/per sq. cm

• Oral – Over 600 Different Types of Bacteria and Counting!and Counting!

• Critical colonization ‐ Infection 1,000,000/per sq. cm or greater


Colonization of S. aureus

• Commensal on Human Skin – Nasal Occurrence

• 25% to 30% of the population is colonized (bacteria present, but not causing an infection) in the nose with S. Aureus

• 1 % colonized with MRSA• 1 % ‐ colonized with MRSA

– Scalp– Armpits– Groins

• Finding S. aureus does not always indicate infection and does not always require treatment.


Misguided Antibiotics

Fact:• Indiscriminate use of antibiotics contributes to bacterial resistance

• Many patients expectMany patients expect an antibiotic to get well!


Evolution of Drug Resistance in S. aureus

Penicillin-

The initial Problem: S. aureus

resistant S. aureus 1970’s

MRSA1990’s Vancomycin

intermediate resistant

S. aureus (VISA)

Vancomycin-resistant S. aureus

(VISA)2002


Entry Points

• S. aureus infects other tissues when normal barriers are breached (e.g. skin or mucosal lining).

• Leads to furuncles (boils) and carbuncles (a collection of furuncles).

D l it t d S i f ti b• Deeply situated S. aureus infections can be very severe.

• Prosthetic joints patients at risk for septic arthritis

• Staphylococcal endocarditis (infection of the heart valves) and pneumonia may be rapidly fatal.


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Impetigo

• Impetigo ‐ skin infection affecting skin but in the area around the nose and mouth.

• Common among wrestlers – Large blisters contain fluid Large blisters contain fluid

• Initially clear, then cloudy.• Blisters may burst, ooze, and

develop a honey‐colored crust. • Impetigo may itch, and spread

by scratching.

• Treated with a topical prescription and oral antibiotics may be added.


Folliculities

• Infection of hair follicles• Tiny white‐headed pimples appear at the base of hair shafts

• Without treatment• Without treatment, folliculitis can may heal within 1 week or become boils.


Boils• The staph infection spreads

deeper and wider, often to subcutaneous tissue and sebaceous glands. – STAGE 1: Area of skin either begins

to itch or becomes mildly painful– STAGE 2: Skin turns red and begins

to swellto swell – STAGE 3: The skin above the

infection becomes very tender and a whitish "head" may appear. The head may break, and the boil may begin to drain pus, blood, or an amber‐colored liquid.

• Boils occur anywhere ‐ especially under the arms or on the groin of children.


Why is MRSA Important?

• Pathogenicity—many virulence factors enable MRSA to cause disease in normal hosts.– Causes of healthcare‐associated bloodstream and catheter‐related infections. E i f it i t d i f ti– Emerging cause of community‐associated infections

• Limited treatment options– Vancomycin and two newer antimicrobial agents (linezolid and daptomycin) are among drugs used to treat severe hospital acquired MRSA infections.

• MRSA is transmissible


How Does Staph Spread?

• Human‐to‐Human Contact• Contact with pus from an infected wound

• Skin‐to‐skin contact with an infected person• Contact with Contaminated Objects• Contact with Contaminated Objects

• Towels and sheets

• Clothing

• Athletic Equipment


Types of MRSA

• Hospital Acquired (HA‐MRSA)• Staph infections, including

MRSA, occur most frequently among persons in hospitals and healthcare facilities (such as nursing homes and dialysis centers) who have weakened

• Community Acquired (CA‐MRSA)

• MRSA infections acquired by persons not recently (within the past year) hospitalized or had a medical procedure (dialysis surgery catheters)centers) who have weakened

immune systems.• Resistant to certain antibiotics

(methicillin, oxacillin, penicillin and amoxicillin).– May require Vancomycin

(dialysis, surgery, catheters)• Staph or MRSA infections in

community usually manifested as pimples or boils

• Less responsive to antibiotics


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What does it look like?

• Often described as a “spider bite”• Signs: red, swollen, and pus or other drainage

• Generally resistant to antibioticsAmerican Sports Builders Association © 2008 Walters, Inc. All Rights Reserved

MRSA in Athletics

• 1998 ‐ 1st report of MRSA infection on sport team– Methicillin‐resistant Staphylococcus aureus in a high school wrestling team and the surrounding community.

• Lindenmayer JM, Schoenfeld S, O'Grady R, et al: Arch Intern Med 1998;158(8):895‐899

• Clusters of MRSA outbreaks in sports settings reported by the CDC.

• Methicillin‐resistant Staphylococcus aureus infections among competitive sports participants—Colorado, Indiana, Pennsylvania, and Los Angeles County, 2000‐2003. MMWR 2003;52(33):793‐795


Risk Factors

• Skin‐to‐skin contact

• Cuts or abrasions

• Crowded living conditions

• Poor hygieneyg

• Main transmission is with contaminated hands:– Colonized or infected

individuals

– Devices or contaminated surfaces – staph or MRSA


Can staph survive on surfaces?

• Study to determine the survival of gram‐positive bacteria (vancomycin sensitive and –resistant enterococci and methicillin‐sensitive and resistant staphylococci) on five common hospital materials: • smooth 100% cotton• 100% cotton terry • 60% cotton–40% polyester blend • 100% polyester• 100% polypropylene plastic

• All staphylococci tested survived for at least 1 day on all fabrics and plastic. Staphylococcal viability was longest on polyester (1 to 56 days) and on polypropylene plastic (22 to 90 days).

JOURNAL OF CLINICAL MICROBIOLOGY, Feb. 2000, p. 724–726 Vol. 38, No. 2, Survival of Enterococci and Staphylococci on Hospital Fabrics and Plastic, ALICE N. NEELY AND MATTHEW P. MALEYAmerican Sports Builders Association ©

2008 Walters, Inc. All Rights Reserved

Prevention is the Key

• Ensure availability of adequate soap and hot water

• Shower after practices and competitions

• Encourage good hygiene• Wear clean clothes to practicep• No sharing personal items

• Towels• Uniforms• Clothes• Singe use of braces


Official Statement from NATA Official Statement from NATA on Communityon Community‐‐Acquired MRSA InfectionsAcquired MRSA Infections (CA‐MRSA)

• Keep hands clean by washing thoroughly• Encourage immediate showering following activity.• Avoid whirlpools or common tubs with open wounds/scrapes/scratches.

• Avoid sharing towels, razors, and daily athletic gear.P l h thl ti d t l ft h• Properly wash athletic gear and towels after each use.

• Maintain clean facilities and equipment.• Inform health care personnel of all active skin lesions and lesions that do not respond to initial therapy.

• Administer or seek proper first aid.• Encourage health care personnel to seek bacterial cultures• Care and cover skin lesions appropriately before participation.


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Power of PreventionHealth Care Worker Protocols

• Wash hands frequently with antibacterial soap

• Encourage pump soap dispensers with antibacterial soap

• Use PPE when tending to• Use PPE when tending to wounds

• Properly dispose of used or contaminated supplies


Cavicide – Static TreatmentsSurface Disinfectant/Decontaminant

Cleaner• CaviCide® is a convenient, ready‐to‐use, intermediate‐level disinfectant

which is effective against TB, HBV, HCV, viruses (hydrophilic and lipophilic), bacteria (including MRSA and VRE) and fungi. It is safe for all areas of the facility including NICU, operating rooms, isolation rooms, patient care areas and laboratories. When used as directed, it will also effectively clean and decontaminate critical and semi‐critical instrumentation. CaviCide® does the job of three products, thus saving money by reducing repetitive inventory and timeinventory and time.

• CaviCide® is safe for use on non‐porous surfaces. It is perfect for cleaning and decontamination of environmental and medical device surfaces.

• Features– Effective against TB in 3 minutes– Effective against HIV, HBV & HCV in 2 minutes– Disinfectant, cleaner and decontaminant all in one – Compatible with most medical device material – For use on nonporous surfaces, even in neonatal and infant care areas


What We Found – USC Report

• Pre‐Treatment Report • Staphlococcus species (non‐aureus)

• Pseudomonas stutzeri• Corynebacterius speciesCorynebacterius species• Flavobacterium odaratum

• Post‐Treatment Report• No Bacteria found

• One Year Report??


Antimicrobial Dressing

• Treating gauze with 0.2% PHMB prevented the migration of 106 bacteria through the gauze and kept underlying skin relatively free of bacteria.

• Binding PHMB to the gauze• Binding PHMB to the gauze fiber was more effective than adding iodophor solution to the gauze in a protein‐rich environment.

• These results indicate that binding 0.2% PHMB to gauze provides an effective barrier to bacterial penetration.


Antimicrobial in Industry

• Many companies have moved to inclusion of antimicrobial technology:– Adidas: sporting goods

clothingclothing

– Home Depot: counter tops

– Coviden: AMD dressings

– Many companies: shoes

– Burlington industries: socks

– Franklin: pads and gloves


Summary

• Over the past two years, I have presented over 30 formal presentations on antimicrobial topics, and my message mirrors CDC recommendations:– Keep hands clean ‐ wash thoroughly with soap and water.– Keep wounds clean and covered with a bandage untilKeep wounds clean and covered with a bandage until healed.

– Avoid contact with other people’s wounds or bandages.– Avoid sharing personal items such as towels or razors.

• Regularly clean surfaces of gym equipment with disinfectant before and after use.


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Microbial Control

“Clean, clean, clean”“Disinfect, Disinfect, DisinfectRealistic Expectations


Recent Outbreaks

• The media has exploded on the scene following recent outbreaks

• The sports phenomenon – the media often embellishes a situation involving an athlete toembellishes a situation involving an athlete to get the public’s attention– Peyton Manning

– Tom Brady

– Jack Snow


Dealing with Antimicrobial Concerns in 2008 and Beyond

• What many have realized – we are not cleaning facilities properly (using disinfectants per their recommended procedures)

• We are not using the best products• We are not using the best products

There are solutions today which provide a dynamic protection – protection following the cleaning


Power of PreventionSport Surface Implications

• When cleaning wrestling mops, follow established procedures:

• Prepare cleaning solutions daily.• Change the mop head at the beginning of each

day or after cleaning up large spills of blood or other body substances. (Oie and Kamiya 1996)

• Use single-use, disposable mop heads and cloths. • Mops, stored wet, supported bacterial growth to very

high levels and could not be adequately decontaminated by chemical disinfection.

• Laundering and adequate drying provided effective decontamination, but build-up of bacterial counts occurred if mops were not changed daily or if disinfectant was omitted from the wash-water. (Westwood, Mitchell et al. 1971)

• Use of an antimicrobial that protects 24/7


Power of PreventionHydrotherapy

• Many high schools, colleges, and professional sports clubs now offer community whirlpools for therapeutic and recreational use.

• It is generally accepted that these facilities should be reserved for patients free of open wounds. In therapeutic uses in clinics, health care providers generally drain and clean hydrotherapy equipment (tubs, whirlpools, whirlpool spas) after each use. W k d t di i f t• Workers are encouraged to disinfect equipment surfaces with EPA‐registered products. If no EPA‐registered product for water treatment, add sodium hypochlorite at a rate to maintain 15‐ppm chlorine residual in the water of small tanks and tubs. For large pools, use pH and chlorine residual levels appropriate for indoor pools. (Sehulster and Chinn 2003)


Guidelines for Environmental Infection Control in Health-Care Facilities -Recommendations of CDC and the Healthcare Infection Control Practices AdvisoryCommittee (HICPAC) June 6, 2003 / 52(RR10);1-42

Power of PreventionCleaning Blood and other Bio‐Spills

• Use germicides registered by the EPA for use as hospital disinfectants

• EPA‐registered sodium hypochlorite product is preferred– If not available, use generic sodium hypochlorite solutions (e.g., household chlorine bleach)

• 1:100 dilution to decontaminate nonporous surfaces after cleaning a spill of either blood or body fluids in patient‐care settings

• If a spill involves large amounts of blood or body fluids, use a 1:10 dilution of germicide


Guidelines for Environmental Infection Control in Health-Care Facilities - Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC) June 6, 2003 / 52(RR10);1-42

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Power of PreventionLaundry Protocols

• Hot‐water laundry cycles – wash with detergent in water >160ºF (>71ºC) for >25 minutes

• Low‐temperature washing – use proper p g p pconcentration if low‐temperature <160ºF (<70ºC)– Commercial laundry facilities often use water temperatures >160°F and 50‐150 ppm of chlorine bleach to remove microorganisms from contaminated linen


Power of PreventionLaundry Protocols

• Satisfactory reduction of microbes achieved at water temperatures lower than 160°F if laundry chemicals suitable for low‐temperature washing– Decreasing the temperature of laundering procedures,

ll th i i i i lmay allow pathogenic microorganisms survival.

• In hospital studies, it was found S. aureus was found to survive laundering at 60 degrees C, (140o F.) but no microorganisms were found at 75 degrees C. (167o F.) – (Fijan, Koren et al. 2007)


Guidelines for Environmental Infection Control in Health-Care Facilities - Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC) June 6, 2003 / 52(RR10);1-42

Power of Prevention Sports Antimicrobial System (SAS)


How does it work?STEP #1: The STEP #1: The SilaneSilane Base covalently bonds to surfaces providing the extreme durabilityBase covalently bonds to surfaces providing the extreme durability

STEP #2: The Long Molecular Chain pierces the cell membraneSTEP #2: The Long Molecular Chain pierces the cell membrane


How does it work?• Microbes’ cell membrane is

negatively charged. • Positively charged

antimicrobial attracts microbes.

• “Sword shaped” antimicrobial pierces cell pmembrane.

• Contact with Nitrogen molecule electrocutes cell.

• Nothing consumed in process, microbes cannot adapt and antimicrobial layer remains intact and ready


Technology in Action

Before AfterAmerican Sports Builders Association © 2008 Walters, Inc. All Rights Reserved

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SportsAideProtection for where they prepare

• Adds long lasting, durable protection 24/7 to a variety of sports surfaces including…

• Locker Rooms• Whirlpools• Training/Weight Rooms• Protective Gear• Exercise Equipment

h / h• Showers/Bathrooms

• Can be applied on all types of surfaces

• Will not affect the performance of the equipment

• Not affected by high temperatures, water or chlorine

• Backed by extensive warranties and service agreements


SportsAide

• Adds long lasting, durable protection 24/7 to a variety of sports surfaces including… – Locker Rooms– Whirlpools– Training/Weight Rooms– Protective Gear– Exercise Equipment– Showers/Bathroom

• Applied on all types of surfaces• Will not affect the performance of

the equipment• Not affected by high temperatures,

water or chlorine• Backed by three year warranty


Summary

• Staph is a growing concern among the medical community.

• MRSA is but one type of staph, and is becoming increasingly challenging CAMRSAbecoming increasingly challenging – CAMRSA.

• Staph can survive on inanimate objects.


Thank you!

Rod Walters, DA, ATC

Email: [email protected]

www.rodwalters.com

Athletic Activities: Microbial Presence, Transfer, Control …€¦ · · 2017-10-04turf, towels...

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Transcript of Athletic Activities: Microbial Presence, Transfer, Control …€¦ · · 2017-10-04turf, towels...