Football Players’ Socks:A Reservoir for

Staphylococcal Species

Lauren QuinnPublic Health Internship Program

The University of Texas Austin

Mentor: Marilyn Felkner, DrPHInfectious Disease Surveillance and

Epidemiology BranchTexas Department of State Health

Services

Introduction

CA-MRSA in Athletes

Sports: football, rugby, wrestling, and fencing

Risk Factors in Athletes

Close contact with infected individuals

Skin damage(e.g. turf burns, cosmetic body shaving)

Sharing personal items Football

Player position

Equipment and Uniforms????

Survival of staphylococci on inanimate surfaces

Hardy and may survive up to 7 months on dry inanimate surfaces

Recovered from many surfaces within the hospital

Limited research withincommunity

Survival on Fabric

Isolated from many material items Binds readily to a variety of materials • Clothing of Athletes?????

Purpose

To assess whether football players’ socks can serve as reservoirs for staphylococcal species, including S. aureus and MRSA

Methods

Central Texas high-school football team; 9th through 12th grade boys; single school

district

Sample Population

Athletic Socks

Unpackaged Packaged

Sampling Procedure

Sample 24 players/week for four weeks One week of control socks (never been worn)

Distribute socks to players and worn during 45 minute practice.

Junior Varsity vs. Varsity

Degree of player contact offensive/defensive ++++ special teams ++ weights/video +

Collection and Transport

Collect socks and place into baggies

Transport to Clinical Bacteriology Lab at TDSHS in car.

Laboratory ProtocolSwatch Sample

Nutrient Broth

ORSA PlateORSA Plate MSA

Plate

CHROM agar

Plates (BBL and Hardy)

Possible staphylococcal colonies

BHI Slant

Catalase(+)

Gram Stain(+)

Coagulase(+)

API Staph

(+)

E Test

Blood Agar SlantAfter

catalase

Primary Plating Media

BBL CHROMagar Hardy CHROMagar

Swatches in Nutrient Broth

• Sock swatches in enrichment broth

Identification using API system

Results

Percentage of Players’ Socks vs Control Socks Positive for

Bacterial Growth, Staphylococcal spp. and S. aureus

Control Socks Positive for Growth Staphylococcal spp.

by Source

Number of Socks Unpackaged#(%)

Packaged#(%)

Cultured 4(100.0) 44(100.0)

Any Growth 4(100.0) 1(2.3)

With Staphylococcal spp.

1(25.0) 0(0.0)

Players’ Socks Positive for Staphylococcal spp. by

SourceNumber of Socks

Unpackaged#(%)

Packaged#(%)

p-value

Cultured 46(100.0) 124(100.0)

Staph spp. positive

32(69.6) 72(58.1) 0.17

Players’ Socks Positive for Staphylococcal spp. By Practice

Conditions

Number of Socks Outdoor(offense/defense &

special teams)

#(%)

Indoor#(%)

p-value

Cultured 134 (100.0) 36 (100.0)

Staph spp. + 80 (59.8) 24 (66.7) 0.45

Players’ Socks Positive for Staphylococcal spp. by

Date

Number of Socks

9/24/07#(%)

10/1/07#(%)

10/15/07#(%)

10/22/07#(%)

p-value

Cultured 46(100.0) 46(100.0) 42(100.0) 36(100.0)

Staph spp. + 32(69.6) 16(34.8) 32(76.2) 24(66.7) 0.0002

Proportion of Positive Samples by Player

Staphylococcal spp. Isolated

• aureus• epidermidis• lugdunensis • sciurii• caprae• warneri

• xylosis• lentus• hominis• saprophyticus• cohnii• haemolyticus

Conclusions

Conclusions

Socks serve as a reservoir for Staphylococci

68% of players always or sometimes shed Staphylococci

A variety of species recovered, including those of medical significance S. aureus, S. epidermidis, and S.

saprophyticus

Preventative Measures

Launder personal items after each use

Shower after practice or competition Educate athletes about hygiene and viability of staphylococci in the environment Disinfect training equipment Do not share personal items

Epidemiological Variables

No association Sock source Practice type Practice conditions

Inconclusive association: date

Unknown association: distribution method

Study Limitations

Use of two sock sources Unpackaged Packaged

Distribution of socks Placement on bench Directly distributed

Future Studies

Repeat the study controlling the distribution variables

Carry out the study in high schools with and without active MRSA outbreaks

Conduct a similar investigation in athletes who participate in other high contact sports ( e.g. wrestling)

Future Studies

Beyond Socks . . . . Other pieces of the uniforms Inanimate surfaces and objects

Training equipment Turf Benches

Acknowledgements

TDSHS Tamara Baldwin Thomas Allen, L.A.T, Athletic trainer

The University of Texas at Austin Dr. Leanne H. Field Nancy Elder, Librarian

Hardy Diagnostic

Thank you to:

The Centers for Disease Control and Prevention

Office of Workforce and Career Development