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

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.

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

Related Posts:

Kahanov, L., Kim, Y., Eberman, L., Dannelly, K., Kaur, H., & Ramalinga, A. (2015). Staphylococcus aureus and community-associated methicillin-resistant staphylococuus aureus (CA-MRSA) in and around therapeutic whirlpools in college athletic training rooms Journal of Athletic Training, 50 (4), 432-437 DOI: 10.4085/1062-6050-49.3.96