A medical alert from the Centers for Disease Control and Prevention regarding an antibiotic-resistant skin infection known as MRSA has prompted the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports to advise vigilance at member institutions.

After a review of the CDC alert regarding methicillin-resistant staphylococcus aureus, the committee recommends that athletics departments -- particularly sports medicine staffs -- review identified risk factors connected with MRSA.

The committee also is advising sports medicine personnel that maintaining good hygiene and avoiding contact with drainage from skin lesions are the best methods for preventing the spread of MRSA.

The CDC reported that MRSA has been reported in "clusters" ranging from a Pennsylvania college football team in 2000 to recent cases involving various sports clubs and teams at the high-school, collegiate and professional levels.

MRSA historically has been associated with outbreaks in health-care institutions, but the bacteria is being spread among participants in competitive sports that often have risk factors for infection, including cuts, scrapes, open wounds, and skin trauma from turf burns and shaving. The bacteria are believed to be transmitted through skin-to-skin contact or sharing towels, equipment and personal items.

Although treatable, there can be complications associated with this type of staph infection, making prevention the best measure for combating MRSA. All persons associated with competitive sports teams can help prevent sports-related skin infections by practicing good hygiene, promoting clean facilities, avoiding sharing towels or equipment, and receiving appropriate first aid for all open wounds and active skin infections.

MRSA is one type of skin infection among several that are of concern in competitive sports, and that are the subject of the following points:

Every year, thousands of athletes at all levels of competition develop skin infections that can result in lost time and occasionally are serious enough to require hospitalization.

Skin infections are easily spread among teammates, particularly in sports in which there is close contact. Early recognition of skin infections and immediate treatment are essential to minimize time lost from practice and competition and prevent transmission. Good hygiene practices can help prevent skin infections.

Types of infections

Skin infections seen in sports include funguses, herpes and bacterial infections in wounds.

Wrestling in particular is a sport that historically has had problems with skin infections, but all athletes are susceptible to these conditions and more athletes are experiencing time-loss injuries due to skin infections. NCAA Injury Surveillance System data from a yearly sample of about 20 percent of wrestling programs notes various types of skin infections (see accompanying chart).

Common fungi include tinea corporis, or ringworm, which gets its name from the ring-shaped pattern that the fungus often takes on the skin. It can be treated with creams or with oral medication. In sports where this is a frequent problem, aggressive treatment with oral medication can help prevent spread to other teammates. Wrestlers should not participate while they have lesions.

Some have advocated the preventative use of medication on teams where tinea is a large problem. The costs, risks and benefits of this approach need to be weighed carefully by the team physician.

Tinea versicolor is another fungus that is common among athletes. This is typically recognized as multiple flat, white spots or blotches. It frequently will be noticed when the athlete begins to tan and is most common on the trunk. It can be treated with creams or oral medications. The athlete should be cautioned against sharing clothing or equipment.

Herpes gladiatorum is a herpes infection of the skin caused by the same virus that causes cold sores. This virus cannot be cured and it is common for the lesion to recur, usually in the same spot from time to time. Transmission to other athletes is most likely when there is a lesion present, but can also happen when no lesion is visible.

Herpes is typically seen on the trunk or other parts of the body in athletes and appears as a cluster of small blisters that often weep fluid. Any athlete with a suspicious lesion should be immediately referred to the team physician. Oral medication can help prevent recurrences and spread of this infection.

A "staph infection" is a wound infected by staphylococcus bacteria. Most can be treated with simple antibiotics, although MRSA is notable for its resistance to antibiotics. If an infection is not healing as expected, the wound should be cultured.

Cuts, wounds and scrapes are susceptible to bacterial infections. Any wound that does not heal as expected, develops redness or soreness around the edges, or has pus oozing from it should be evaluated by a medical professional.

Measures for preventing skin infections

The Centers for Disease Control suggest the following measures for preventing staphylococcal skin infections, including MRSA, among sports participants:

Cover all wounds. If a wound cannot be covered adequately, consider excluding players with potentially infectious skin lesions from practice or competitions until the lesions are healed or can be covered adequately.

Encourage good hygiene, including showering and washing with soap after all practices and competitions.

Ensure availability of adequate soap and hot water.

Discourage sharing of towels and personal items (for example, clothing or equipment).

Establish routine cleaning schedules for shared equipment.

Train athletes and coaches in first aid for wounds and recognition of wounds that are potentially infected.

Encourage athletes to report skin lesions to coaches and encourage coaches to assess athletes regularly for skin lesions.

Additional information about MRSA is available from the CDC Web site at www.cdc.gov/ncidod/hip/aresist/mrsa.htm.

The NCAA education outreach staff emphasizes the following practices to ensure good hygiene in member institutions' sports programs:

Institutional plans for promoting good hygiene practices

Provide in-service education for coaches, students-athletes and sports medicine personnel.

All personnel should wash hands with soap and water frequently.

Automated dispensers are recommended. Multiple-use cloth towels are not recommended for health-care settings.

Do not add soap to a partially empty soap dispenser.

Provide hand lotions or creams to minimize the occurrence of irritant contact dermatitis.

Provide alcohol-based hand antiseptics.

Preventing skin infections for athletes

Practice good hygiene, including showering and washing with soap after all practices and competitions.

Avoid sharing towels, personal clothing and equipment.

Report skin lesions.

Cover all wounds.