The categories of potential risk factors for spreading infection are:
- Sharing of equipment, training facilities
- Skin injury
- Close contact – on field of play, accommodation
- Off the field of play – travel, personal activities
- Diverse populations
Infections can be transmitted by person to person contact, by common source exposure or by vector-borne transmission. The primary focus of attention should be on primary prevention by use of hygiene measures, use of immunisation (vaccinations) and use of interventions to prevent secondary spread of infection. Secondary prevention measures include prevention of recurrence and prevention of onward spread of infection from a source patient. Education of players in key aspects of infection is a key element of prevention.
Standard precautions combine the major features of Universal Precautions and Body Substance Isolation. They are based on the principle that all blood, body fluids, secretions except sweat, non-intact skin, and mucous membranes may contain transmissible infectious agents. Standard precautions include a group of infection prevention practices that apply to all individuals regardless of suspected or confirmed infection status.
Key features of standard precautions include:
- Wearing gloves when touching biohazardous material such as open skin, body fluids of mucus membranes.
- Washing hands with soap and hot water after contact with above even if gloves are used.
- Cleaning surfaces thoroughly with diluted bleach (10% solution)
- Placing sharps in a biohazard puncture proof container
- Covering any wound before going to field of play
Disinfection of equipment
Equipment must be handled in a manner to prevent transmission of infectious agents including proper cleaning and sterilisation of reusable equipment. Bacteria and viruses can exist on equipment. Methicillin resistant Staphylococcus aureus (MRSA) has been found on taping, gel and whirlpool facilities in training facilities. Other bacteria especially Pseudomonas spp, have also been linked to infection outbreaks from use of whirlpools. Guidelines for the proper disinfection and maintenance of whirlpools, saunas, ice machines and swimming pools are provided by the Occupational Safety and Health Administration (OSHA), USA. Use diluted bleach 10% solution (one part bleach in 9 parts water) to cleanse training areas and equipment.
Routine cleaning schedules for shared equipment should be established and recommended. Equipment that has had contact with blood and body fluids should be washed with diluted bleach as above. Any towel or other material that is contaminated with blood should be laundered appropriately.
Suggested Cleaning Schedule for a Rugby Club:
Area to be cleaned
Training Equipment eg balls
As required and Monthly
Playing and Training Clothing
After each usage
Sub Jackets and Towels
After each usage
After usage and beginning and end of season
Good personal hygiene helps reduce colonization of bacteria. Regular handwashing is key in preventing spread of infection. Handwashing with soap for 15-30 seconds, 30 seconds rinse with water followed by complete drying with a towel is necessary. The use of rinses and gels with concentrations of 50-95% alcohol take 15 seconds to use and are effective at killing organisms. Chlorhexidine soap has been useful for reducing transmission of MRSA infections.
- Maintain good personal hygiene with regular hand washing
- All personal training and playing clothing must be laundered after each use including towels
- Alert one of the Doctor or Physio team that they have a skin injury
- Adhere to any advice and instructions given by health professional regarding the skin injury
- Ensure that skin injuries are covered during games and training
- Be sensible and take cautious steps with personal and equipment hygiene with Domestic but especially international travel.
Skin and Soft Tissue Injury
Any athlete with a skin injury (abrasion, laceration etc.) should be removed from the field of play until the area of injury can be securely covered with occlusive dressings or bandages to prevent leakage of body fluid and to protect the lesion becoming infected. Careful attention should be paid to the wound care after play to avoid skin infection.
Any skin injury must be assessed by a doctor or Physiotherapist post game;
It must be cleaned with at least 375ml of saline (or clean water if no saline available) with woven gauze or a soft toothbrush to ensure it is visibly clean. If necessary then it must be covered with a non-adhesive dressing and then reviewed 48 – 72 hours later. They will be provided with Hibiscrub to wash with in the shower to reduce the risk of spreading an infection.
If there are signs of infection then the player must be referred to either their GP or the walk in centre for consideration of antibiotics.
If there is an infection confirmed, then the player must be physically well to return to training and playing and the wound covered for each training and playing session until fully healed.
Action Plan for Escalation
If there are more than one incident coming from the same source then the relevant steps must be taken:
- All key personnel informed such as coaches, management, groundsman and full medical team that this action plan has been implemented
- All areas identified in cleaning schedule above must be completed as a one off immediately.
- Consideration into informing the relevant health Authorities such as Public Health England and the RFU Clinical Lead.
- Liaise with players and health professionals to ensure the most appropriate treatment and management is being implemented
- Depending on type of infection then consideration must be adopted for healthy players and other members of the rugby community to ensure the most appropriate actions are taken.