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Article Excerpt
Ryan, a 16-year-old male, is on the Junior Varsity Wrestling Team in a central California high school. Ryan is very active in multiple sports, school events, academics, and social events. He is successful as a wrestler, and well regarded by his peers. His home life is positive. His family is supportive of all his events, and he is very active within the community. His sister is very active in sports as well.
On Saturday morning, January 10, Ryan noticed he had "a sore spot" on his left buttock. It felt like a half inch circular bump and was warm to the touch. He applied hydrocortisone cream he found in the family medicine cabinet to the lesion after his morning shower, thinking he had some sort of a bug bite. He continued with his regular weekend social activities.
On Monday, January 12, Ryan noticed that the lesion seemed bigger, now about three quarters of an inch raised, and when he looked in the mirror, he thought he saw a small amount of pus at the center of the lesion. He decided that it was probably an ingrown hair and expressed the pus from the lesion. He went to school that morning, as usual, and to wrestling practice afterward. He did not think to mention the lesion to his coach or teammates. Ryan participated in the wrestling practice matches with his teammates as he usually did. After practice, Ryan helped clean the mats. He grabbed the same mop he used after practice every day, filled the mop-bucket with water, and quickly swabbed down the mats. He noticed that the mop was beginning to smell these days. After this, as was his habit, Ryan did not shower. He was going to be late for the chemistry study group after practice. "Since there is no soap in the school showers, l wouldn't smell any better anyway," he would explain to his friends. He quickly applied some deodorant, changed his clothes, threw his wrestling clothes into his locker, and headed out to his next activity. On his way out the door, a teammate wanted to return the knee and elbow guards he had borrowed from Ryan for practice that day. Since Ryan was in a hurry, he told his teammate to "just give them back tomorrow." The bump was by now more tender than it had been that morning, and he noticed it was painful to sit on it directly. Ryan tried to not think about it, and focused his attention on his study group. The next day, Tuesday, January 14, the lesion was getting painful enough that Ryan was having trouble ignoring it.
Preventive Care
Ryan attended a high school that employed a school nurse who was present in the office of the high school once a week. On a daily basis, there was a health assistant who worked in tandem with the school nurse. If Ryan were to go to the school health office regarding the lesion on his buttock, the school nurse or the health assistant would have to notify the parent/guardian of the student by phone regarding the reason for the visit, since the Centers for Disease Control and Prevention (CDC) advises school health personnel to inform parents/guardians when students present with skin infections. If the school nurse were present, Ryan could have described the lesion to the nurse. The nurse would have physically assessed the wound and seen the infection.
School nurses are educated regarding community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) and various risk factors, and are perfectly situated to implement preventative measures in the school setting. A large component of a school nurse's role is patient education. Once it was known that Ryan had a skin lesion and was participating in athletics, the school nurse would have educated Ryan on several ways he could protect himself and his teammates from contracting and spreading infections, which are based on the CDC recommendations for school athletics. Ryan would have been given the following information:
* Wash hands frequently with soap and water.
* Avoid sharing sports equipment and personal items with others, not just when an infection is present, but as a regular practice.
* Wrestlers are particularly vulnerable to contracting and spreading infectious disease related to prolonged physical contact inherent in the sport (Playe, 2006).
* Shower after all practices and matches using soap.
* Put down a clean towel before sitting on the benches and utilize the provided toilet seat covers in the restrooms.
* Any equipment the team shares should be wiped down with the appropriate cleaning solution before using it again.
* Let parents or guardians and the coach know if any skin infections develop.
* Wash any cuts or open wounds with soap and water every day, and before and after practice. Keep any wound covered by an occlusive dressing.
* Do not participate in any matches with a draining wound.
* Follow CDC recommendation to follow up with a health care provider (CDC, 2007a).
The CDC (2007b) has made several recommendations for school athletic programs to prevent the spread of skin infections in athletic teams. Coaches should know that:
* Showers should be supplied with liquid antibacterial soap, and coaches should encourage this practice.
* Coaches may elect to institute the practice of a full body check to be sure those participating in matches do not have uncovered cuts or draining lesions.
* Athletes with draining lesions should not be allowed to participate in practice or matches.
* Mats should be cleaned after each practice...
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