Staphylococcus aureus and community-associated methicillin-resistant staphylococuus aureus (CA-MRSA) in and around therapeutic whirlpools in college athletic training rooms
Kahanov L, Kim YK, Eberman L, Dannelly K, Kaur H, and Ramalinga A. J Athl Training. 2015. 50(4):432-437.
Take Home Message: Culture samples from 3 whirlpools at a NCAA Division I university demonstrated the presence of staphylococcus aureus (Staph) both before and after sanitization. Further, Staph was found to be present in surrounding areas and was higher following use by patients than prior to treatment.
Staphylococcus aureus (Staph) is a serious infection, which affects many athletes due to their frequent exposure to physical contact with other athletes and equipment. While some data exists regarding the prevalence of Staph in athletic facilities, little information exists with regards to whirlpools. Clinicians need to know how prevalent Staph is in whirlpools to minimize disease transmission. Therefore, Kahanov and colleagues completed a cross-sectional study to determine the prevalence of Staph and Methicillin-resistant staphylococcus aureus (MRSA) in and around cold whirlpools in an athletic training room. Water samples and culture swab (assessing the whirlpool drain, agitator head, turbine switch, wooden steps, and neoprene toe caps) were obtained from 3 cold whirlpools in 2 athletic training rooms at a NCAA Division I university. All cold whirlpools were cleaned daily using an EPA recommended disinfectant spray. Samples were taken both before and at the end of team practice or treatment. During the 15 days of collection, 240 samples were obtained and 109 athletes received cold whirlpool treatments. Staph and MRSA were discovered in 52 (22%) and 2 (0.8%) samples, respectively. Staph was detected both before and following treatments. All sites tested positive for Staph at some point during data collection and the prevalence of Staph increased throughout the day.
The data presented in the current study demonstrates that some current sanitation protocols and products may not be as effective against Staph and MRSA as initially thought. The 2 most alarming findings were the discovery of Staph following sanitation – prior to athlete treatment. This indicates that despite using an EPA recommended sanitizer Staph is still present in and around the whirlpool. This calls the sanitization process into question. Clinicians may benefit from future studies in this area to identify better sanitation procedures as well as identifying the best available sanitizers. Secondly, Staph prevalence increased throughout the day. While this is to be partially expected, clinicians often do not have the time to drain, sanitize and refill whirlpools in between each treatment, which is recommended by the CDC. It suggests that clinicians may further benefit from a sanitizer being added to the water itself (e.g., chlorine) as well as additional hygienic steps such as having athletes shower prior to whirlpool use. Until more research can be completed to better understand how to improve intervention, clinicians should sanitize whirlpools between patients, whenever possible, continue to stringently follow the best available sanitizing procedures, and consider the use of sanitizers in the whirlpool’s water during treatments. After all, we must strive to do no harm and avoid putting our patients at risk for Staph or MRSA, especially in our clinics.
Questions for Discussion: How often are the whirlpools in your facility sanitized? Are you confident that the sanitization procedure being used is the best available?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban