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MRSA On and Off the Mat

Opener

On Saturdays, my gym has a no gi class with rolling afterward. By the time I’m finished, I’m covered in a mix of my own and my partners’ sweat. I always seem to be more aware of how much I need a shower after no gi classes because I don’t have the skin protection of the gi. Luckily, I’ve been able to avoid any fungal or bacterial skin infections in my jiu-jitsu training so far. Among the most worrying of the skin infections is methicillin-resistant Staphylococcus aureus (MRSA – pronounced “Mursa”).

 

What is MRSA?

The bacterium Staphylococcus aureus – often called Staph aureus or Staph – is a common cause of boils and various eruptions on the skin. It can also cause pneumonia or even blood-stream infections that may lead to infections of the joints, bones, and the heart-valves, among others. Widespread antibiotic treatment of infections began in the early 1940s after the discovery of penicillin by Alexander Fleming in 1928. At the time, most Staph infections were sensitive to penicillin. By the 1950s, however, many Staph infections had become resistant to penicillin. A new antibiotic related to penicillin, called methicillin, was developed to treat these penicillin-resistant bacteria. By the late 1960s, the first cases of methicillin-resistant Staph aureus were found in the US. The use, and especially misuse, of antibiotics selected for the preservation of Staph strains caused the development of  antibiotic resistance. Most of the initial cases of MRSA occurred in elderly people living in nursing homes or in sick patients in the hospital. That changed in the 90s, when more and more MRSA skin infections were found in healthy people who lived in the community. While there are still plenty of cases of Staph that are sensitive to methicillin – called methicillin-sensitive Staphylococcus aureus (MSSA) – the movement of MRSA into the community represented a threat to public health.

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MRSA in the Community:

Although the hospital-associated variety of MRSA is of great concern, community-associated MRSA is the type that most jiu-jitsu practitioners will face. According to the National Institutes of Health, the exact sources of community-associated MRSA are often difficult to pinpoint. Those most often identified are in crowded settings, places with close skin-to-skin contact, and in sports-related areas where equipment, razors, towels, etc are shared. It’s easy to see how a jiu-jitsu gym can be an ideal setting for transmission. The Staph bacterium (both MRSA and MSSA) is estimated to be carried on the skin or in the nose as normal flora in up to 30% of healthy individuals. This colonization of Staph often causes no problems in the host. It can also be carried on clothing – such as a gi – or other surfaces. Infection most commonly occurs when there is a break in the skin that allows entrance of the bacteria.

03Symptoms/Treatment:
The first signs of a Staph infection can be variable, but it often presents as a single raised, red area on the skin that may itch. At this stage, many people think they have a spider bite or a random pimple. Then, the area swells and becomes more painful and warm. There may also be pus draining from the center of the lesion. Don’t wait around and attempt to pop or prick the area with a needle at home; prompt medical attention can help prevent further spread. Treatment varies depending on the presentation, antibiotics, and/or surgical drainage may be needed. Evidence of body-wide infection or lesions that are particularly large will likely require treatment with IV antibiotics in a hospital setting. Fluid or tissue samples are usually taken to help choose the appropriate antibiotic. Speaking of antibiotics, I mentioned earlier that MRSA is resistant to methicillin. That doesn’t mean it is resistant to all antibiotics, for there are many antibiotics that work well for MRSA infections.

General Prevention:
As successful as treatment often is, a quick Google search of MRSA infection images will let you know why prevention is preferred. The Centers for Disease Control and Prevention have made some general guidelines that are fairly easy to follow. The most essential is to wash your hands the correct way. First, wet your hands with water. Use plain soap (no need for the antibacterial variety) and rub your hands together for 15-30 seconds. Rubbing hands together thoroughly is as important as the soap itself. It’s important when washing hands to include fingernails, between fingers, and the wrists. Paper towels are preferred for drying hands since they are single-use and can then be used to turn off the faucet. Another option that’s common among grapplers are Defense Wipes from Defense Soap. Next, if you have any cuts or scrapes, keep those dry, clean, and covered with a bandage until they have completely healed. Also, avoid touching other people’s wounds. Lastly, don’t share personal use items such as towels, razors, combs/brushes, uniforms, etc.

 

Natural Products and Suggestions for Home:

There is a lot of interest in natural products for prevention and treatment of skin infections, and – this is actually unusual – there is a decent amount of published information in the medical literature. Essential oils like tea tree, thyme, and lemongrass, among others, have been shown in many in vitro (laboratory) and human studies to inhibit bacterial growth. Popular jiu-jitsu products like Defense Soap use tea tree oil as an active ingredient. A medical-grade product I wasn’t previously familiar with, called Manuka honey, has also been shown in lab studies to work well as an antimicrobial product – even against MRSA strains. There are many other products that have similar properties and there is a great need for continued research in light of growing antibiotic resistance. The research on natural products is very promising but to echo the American Association of Family Physicians, there is still insufficient evidence (in terms of a lack of strong clinical trials) to either fully recommend or dismiss these products for prevention or treatment of skin infections. One of the easiest and established ways to help prevent resistance is to choose appropriate products for home use. It’s been suggested that triclosan, the ingredient commonly found in antibacterial products, can contribute to increasing resistance in bacteria and accumulate in aquatic species. Further, antibacterial soaps have not been shown to reduce the amount of bacteria on hands any more than plain soap. The reason plain soap is effective, and doesn’t contribute to antimicrobial resistance, is that it doesn’t really “kill” microbes; soap and the friction of rubbing hands together dislodges bacteria from the skin, and then the bacteria is washed down the drain.

 

Dr. Day’s Rx for Infection Prevention in Jiu-Jitsu:
While the prevention guidelines above are general, some more jiu-jitsu-specific guidelines are listed below that can help cut down on the risk of contracting or passing skin infections:

01.    Keep Hands and Feet Clean: Wash hands or use alcohol-based hand sanitizer – as outlined previously – before stepping on the mat. I’ve also seen some academies that have students use sanitizer on their feet as well – definitely not a bad idea. For gym owners, avoid multiple-use cloth hand towels in public restrooms. Also, anytime you step off the mat wear flip-flops/shoes.

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02.    Clean Your Gear: Wear a clean gi, rash guard, shorts, etc… to class, and wash your gear after each use. Gym bags and even (dare I say) belts should be washed often as well. I’d rather replace my belt stripes if they fall off from laundering than pass along unnecessary germs to my teammates.

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03.    Good Body Hygiene: Bathe regularly – you don’t want to be the stinky person in class. Also, keep your fingernails and toenails short and clean. Longer nails can easily cut the skin and allow entrance of microbes.

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04.    Shower After Class: Shower as soon as possible after every class. Even if you don’t roll hard, you have still been in a close-contact environment that increases risk of transmission.

Defense Soap recommends not immediately rinsing after you’ve applied their shower gel to your body, instead lather up, and allow the lather to stay on your skin up to 20 seconds before rinsing.

Defense Soap recommends not immediately rinsing after you’ve applied their shower gel to your body, instead lather up, and allow the lather to stay on your skin up to 20 seconds before rinsing.

 

05.    Clean the Mats: Gym owners or students should sweep and then clean mats with something like a bleach-based cleaner at least daily (ideally after each class).

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06.    Address Possible Infections: Promptly clean any cuts or scrapes with soap and water. Also, do not train or compete if you have an active or draining skin lesion. Keep any lesions clean, dry, and covered with a bandage until healed.

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07.    Adopt a Culture of Clean: If there is someone in class with less-than-stellar hygiene, either speak directly to them or ask your instructor to let the individual know. Instructors should lay the groundwork for good gym-wide hygiene with new white belts, as this leads to the expectation of cleanliness from the start.

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Wrap Up:
MRSA and other skin infections are no joke, and they can be common in jiu-jitsu. Thankfully, common sense practices like properly washing hands, having good personal hygiene, cleaning gear after each use, and keeping the gym mats disinfected can tremendously decrease the chances of contracting or transmitting a skin infection. If gym owners adopt a set of gym cleanliness rules for all members, everyone can benefit from the more sanitary training environment. Unfortunately, no matter how clean you are, it’s still possible to contract a skin infection. If you suspect you may have a skin infection, don’t wait around to seek medical attention.

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