infections and infection prevention &control practices in iowa’s high school athletic programs...
TRANSCRIPT
![Page 1: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/1.jpg)
Infections and Infection Prevention &Control Practices in
Iowa’s High School Athletic Programs
Loreen A. Herwaldt Mark Pedersen
The University of Iowa Colleges of Medicine and Public Health
![Page 2: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/2.jpg)
Disclosures• Loreen Herwaldt: 3M, Sage, CDC, AHRQ
research grants• Mark Pedersen: Nothing to disclose
![Page 3: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/3.jpg)
Background• Community-associated methicillin-resistant
Staphylococcus aureus (CA-MRSA) often causes skin and soft tissue infections among young healthy persons.
• CA-MRSA has caused outbreaks among athletes, including:– Football (American) players– Football (Soccer) players– Fencers
![Page 4: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/4.jpg)
Goals
Survey high school athletic departments in Iowa to:– Assess infection control measures and
hygiene practices– Assess the frequency of MRSA skin and soft
tissue infections– Assess the frequency of skin
infections caused by other pathogens
![Page 5: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/5.jpg)
Methods
• Collaborated with staff from the Iowa High School Athletic Association
• Created and administered a web-based survey • Statistical Analyses
– Standard descriptive analyses– Cochran-Armitage trend test– Jonkheere-Terpstra test– Wilcoxon Rank-Sum– Pearson chi-square
![Page 6: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/6.jpg)
Results• 229/393 (58.4%) of the high schools with
athletic programs responded• 219 (96%) were completed by athletic directors• Athletes per program: median = 125;
25th to 75th percentiles = 82-250
![Page 7: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/7.jpg)
Results: Provided by SchoolsSupplies/Equipment Number of Schools Soap for showers 143 (62.7%) Towels for showers 86 (37.6%) Launder uniforms 81 (35.7%)Cardio equipment 181 (80.1%)Weights 228 (99.6%) Whirlpool 124 (55.5%)
![Page 8: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/8.jpg)
Results: Turf, Floor, Mat Burns Managed by:
Person who Manages Lesions NumberAthlete 90 (39.3%)Athletic trainer 68 (29.7%)Manager 23 (10.0%)
![Page 9: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/9.jpg)
Results: Risky ActivitiesActivity Number of SchoolsShave arms and legs (n = 224) 58 (25.9%)
Shave other areas (n = 225) 40 (17.8%)Share razors (n= 223) 1 (0.45%)Share protective equipment (n = 220)
19 (8.6%)
Share towels (n = 226) 23 (10.2%)Share bottles of water or sports drinks (n = 226)
70 (31.0%)
![Page 10: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/10.jpg)
Results: Infections
Infection Number of Schools Reporting
Tinnea 56 (43.1%)S. aureus 36 (27.7%)Herpes simplex 26 (20.0%)Streptococci 17 (13.1%)
![Page 11: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/11.jpg)
Results: Sport, Education, and SSTISport Educate
Athletes0 Athletes w/ SSTI
> 1 Athlete w/ SSTI
Wrestling 164 (71.6%) 113 (53.1%) 75 (35.2%)Football 145 (63.3%) 157 (73.7%) 30 (14.0%)Boys Basketball
106 (46.3%) 201 (94.4%) 1 (0.47%)
Girls Basketball
99 (43.2%) 204 (95.8%) 3 (1.4%)
![Page 12: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/12.jpg)
ResultsClass Number
(%)No. of Athletes(Range)
Employ a CAT (%)*
1A 76 (33) 7-170 25 (33)
2A 81 (36) 50-384 36 (44)
3A 37 (16) 45-620 25 (68)
4A 33 (15) 270-1008 31 (94)
Overall 229 7-1008 117 (51)
CAT = Certified Athletic Trainer; *P < 0.0001
![Page 13: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/13.jpg)
DailyWeeklyWhen SoiledAfter each useOtherNever
Frequency of Cleaning Locker Rooms
Increased by school classification; P = 0.02
![Page 14: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/14.jpg)
Frequency of Cleaning Daily: School Classification
Class Lockerrooms
Showers Train-ingequip-ment
Prac-tice uni-forms
Train-ingtables
Pt care areas
1A 59% 44% 19% 29% 29% 26%
2A 79% 71% 24% 32% 34% 40%
3A 83% 54% 26% 41% 52% 48%
4A 81% 79% 35% 37% 62% 64%
P 0.02 0.012 0.0002 0.055 < 0.0001 0.0004
![Page 15: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/15.jpg)
Frequency of Cleaning After Each Use
• Game uniforms: 69%-84%• Protective equipment: 8%-17%• Wrestling mats, practices: 19%-27%• Wrestling mats, tournaments: 37%-60%• The frequency of cleaning these items did not
vary by school classification.
![Page 16: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/16.jpg)
The Frequency of Cleaning: CAT vs. No CAT
• Training equipment (P = 0.012)– CAT: Daily or after each use = 41%– No CAT: Daily or after each use = 23%
• Protective equipment (P = 0.054)– CAT: Weekly, daily, or after each use = 63%– No CAT: Weekly, daily, or after each use = 42%
• Training table (P = 0.015)– CAT: Daily or after each use = 77%– No CAT: Daily or after each use = 60%
![Page 17: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/17.jpg)
Education, Policies, SSTI, MRSA SSTI:School Classification
Class Educate re. SSTI
Policy re. SSTI
Athletes w/ SSTI
Athletesw/ MRSA
1A 67% 26% 34% 5%
2A 90% 35% 63% 4%
3A 92% 46% 73% 8%
4A 88% 61% 79% 24%
P 0.002 0.0004 < 0.0001 0.002
![Page 18: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/18.jpg)
Education, SSTI, MRSA SSTI:CAT vs. No CAT
0
10
20
30
40
50
60
70
80
90
Educate SSTI MRSA SSTI
CATNo CAT
%
P 0.058 0.011 0.018
![Page 19: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/19.jpg)
Association of Education & Policies with SSTI
0
10
20
30
40
50
60
70
80
90
100
Education Policy
SSTINo SSTI
%
P < 0.0001 0.016
![Page 20: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/20.jpg)
Policies• Preventing participation in practices/games/meets
– Athletes w/ SSTI: 37%– Athletes w/ other infections: 22%
• Requiring hand hygiene– Before taping each athlete: 11%– After taping each athlete: 12%– Before caring for injured athletes: 23%– After caring for injured athletes: 26%
• Requiring gloves when caring for athletes who might be bleeding: 79%
![Page 21: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/21.jpg)
Summary and Conclusions• Wrestling programs >> football programs >
basketball programs reported having > 1 athlete per season with SSTIs.
• CA-MRSA SSTIs still appear to be infrequent among Iowa’s high school athletes.
• Tinnea & S. aureus are the most common skin pathogens.
• School classification, the number of athletes, and having a CAT were highly correlated.
![Page 22: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/22.jpg)
Summary and Conclusions
Ironically, schools;• In higher classifications• That educated athletes about SSTIs• That had certified athletic trainers• That had appropriate policies
were more likely to identify athletes with SSTIs, including MRSA SSTIs.
![Page 23: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/23.jpg)
Summary and Conclusions
• We doubt these are risk factors for infection. But they may indicate that these programs have more resources for surveillance or that they are more aware of the issues.
• One alternative explanation could be that higher numbers of athletes means crowding and that crowding facilitates transmission of infectious agents.
![Page 24: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/24.jpg)
Suggestions for ImprovementAll schools should develop policies:• Specifying when athletic staff and student
managers should do hand hygiene;• Specifying the frequency of cleaning shared
supplies & equipment;• Regarding athletes with SSTI participation in
practices, games, or meets;• Preventing athletes with SSTI from using the
whirlpool or other shared equipment.
![Page 25: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/25.jpg)
Thank you!
![Page 26: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/26.jpg)
Hand Hygiene: PresentLoreen Herwaldt, MD*Hospital Epidemiologist Professor
*I have no relevant conflicts of interest.
![Page 27: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/27.jpg)
Thanks to:
Garrett Wilcox for his work on the survey.
Hsiu-yin Chiang, Sandra Cobb, Melissa Ward, and Laurie Leder for hand hygiene observations.
David Herwaldt for graphic design.
![Page 28: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/28.jpg)
Survey Respondents
601 nurses 419 physicians 319 other HCWs
1,339 Healthcare Workers
![Page 29: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/29.jpg)
Do you know hand hygiene indications?% answering “most” or “all”
physicians nurses other
![Page 30: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/30.jpg)
Unrecognized hand hygiene indications
% physician respondents
beforecontact
beforedevice
moving aftercontact
afterenviron
beforegloves
aftergloves
![Page 31: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/31.jpg)
How much effort does hand hygiene require?
% answering “none” or “a little”
physicians nurses other
![Page 32: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/32.jpg)
How difficult is it to do hand hygiene when indicated?
physicians nurses other
% answering “not at all” or “a little”
![Page 33: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/33.jpg)
Perceived Hand Hygiene Adherence
• % time you do hand hygiene:
median = 90%
• % time your colleagues do hand hygiene:
median = 80%
![Page 34: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/34.jpg)
Why don’t physicians do hand hygiene?
% physician respondents
forgot little contact
no time patientneed
woregloves
![Page 35: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/35.jpg)
How much could you improve your hand hygiene?
% answered "a little bit" or "somewhat"
physicians nurses other
![Page 36: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/36.jpg)
How can hand hygiene be improved?
% physician respondents
knowinfectionrates
betteraccess
signs at doors
mentors,monitors,peers
betterproduct
adherencefeedback
![Page 37: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/37.jpg)
Are your patients interested in your hand hygiene?
% answering “quite interested” or “extremely interested”
physicians nurses other
![Page 38: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/38.jpg)
physicians nurses other
Is your mentor interested in your hand hygiene?
% answering “quite interested” or “extremely interested”
![Page 39: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/39.jpg)
Are colleagues interested in your hand hygiene?
% answering “quite interested” or “extremely interested”
physicians nurses other
![Page 40: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/40.jpg)
Does your hand hygiene affect behavior of colleagues?
% answering “likely” or “extremely likely”
physicians nurses other
![Page 41: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/41.jpg)
• Need SICU graphs here
![Page 42: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/42.jpg)
![Page 43: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/43.jpg)
![Page 44: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/44.jpg)
Perceived Hand Hygiene Efficacy
90.3% of physicians think that hand hygiene is a very
effective or extremely effective way to prevent
healthcare-associated infections
![Page 45: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/45.jpg)
Take Home Question
Which healthcare tasks or procedures can safely
be done right 3 of 4 times or 9 of 10 times?•Placing a central venous catheter?
•Giving a blood transfusion?
•Doing a thoracentesis?
•Passing medications?
•Doing an ERCP?
![Page 46: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/46.jpg)
Take Home Question
If you had a central venous catheter, would you
want someone to manipulate it who had been:•Touching your bedside table
•Handling your Foley catheter
•Typing on a computer key board
•Handling your roommate’s Foley catheter
IF that person had not done hand hygiene?
![Page 47: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/47.jpg)
Want of care does us more damage than want of knowledge . . . . Sometimes a little neglect may breed great mischief.
from Poor Richard’s Almanac
Benjamin Franklin
![Page 48: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/48.jpg)
For want of a nail the shoe was lost; for want of a shoe the horse was lost; and for want of a horse the rider was lost, being overtaken and slain by the enemy, all for want of care about a horse-shoe nail.
Benjamin Franklin
![Page 49: Infections and Infection Prevention &Control Practices in Iowa’s High School Athletic Programs Loreen A. Herwaldt Mark Pedersen The University of Iowa](https://reader035.vdocuments.us/reader035/viewer/2022062713/56649cbf5503460f9498560c/html5/thumbnails/49.jpg)