What the Experts Say About Managing MRSA: Stage 2
A Single Case
One of the impediments to managing MRSA is reluctance on the part of athletes to report problems. Like Leary, they may be embarrassed or worried that they won't be allowed to play. The key, says Daniel Garza, head team physician for the San Francisco 49ers, is to create a culture of trust, where athletes come to trainers and coaches with potential problems.
At University of California-Berkeley, student athletes sign a form promising to report any injury or illness to the medical staff. "We talk to the athletes about the importance of giving us accurate information, which allows us to give them the best possible care," says Casey Batten, head team physician at Berkeley. "We also try to create a culture that supports the athletes, where they don't feel that they will be separated or excluded from the rest of the team because they report something."
Also, coaches can explain to student athletes that MRSA is a "pay me now or pay me more later" situation. As Jared Muela, youth football coordinator for the 49ers, puts it, "If it's just a rash, it's just a rash. But if I hold you out of a game, there's a reason for it. It may be one game now or a season down the road."
How should high school and university officials decide whether a player should be benched for a MRSA infection? Batten says every case is different. "There are several indications to hold an athlete out of competition for a MRSA infection. If they have a lesion that I can't adequately cover, or if they have systemic symptoms such as fever, chills, malaise - those are instances where I would absolutely hold them out. I've also held out athletes because an incision from a drainage procedure can cause too much pain, and playing would put them at a danger to themselves or others because the pain would take their focus away from the game."
The NCAA mandates that the decision about whether an athlete should be held out of a game should rest with the physician. This approach works because the physician is likely to be unbiased, while the coach or the player may have too much of a vested interest in having the athlete play. "We work under the direction of a physician, who has the final call," says Mike Cembellin, director of sports medicine at Santa Clara University.