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According to Dr. Deverick J. Anderson of the Duke Infection Control Outreach Network, the Tampa Bay Buccaneers are operating a safe environment. Anderson was invited by the Buccaneers to explain the medical side of the latest outbreak in front of the media.
One reason for Anderson's belief that the Bucs have a safe environment is the fact that Lawrence Tynes and Carl Nicks apparently contracted MRSA separately. "We can actually definitively say that the first two cases were really not related to each other," Anderson said. "The probabilities are that because these are different organism, you would not think that there's a single source, what we call a point source outbreak, necessarily. These are more than, as a result, likely related to essentially, in some ways, the day-to-day activities that all of us do. You know, skin-to-skin contact, things like that."
"We know that football players are at higher risk because not only do they have a great deal of skin-to-skin contact just because of their occupation, but they also have a lot of skin breakdown. The reality is that probably all of us get exposed to MRSA pretty regularly, but because we have intact skin we don't run into any problems with it. When you combine MRSA exposure and then subsequent issues with skin, or perhaps as in one of the cases a surgical procedure, then that's where you can get into some trouble."
A safe environment
"I believe that it is a safe environment for players and staff," Anderson said. "Based on my observations, I didn't think there was anything very high risk. I think that football in and of itself is a known risk factor for MRSA and MRSA infection in general. So the fact that a case or even two and now three cases occurred does not necessarily in and of itself mean that this is any higher risk than any other football location in the country."
Anderson speculated that the extra vigilance may have caused the team to identify a case that would otherwise have gone undetected. "MRSA is very common and there are several practices that occur that make you more likely to identify it. If you cultured every single skin infection that happened then you would find MRSA. So I think that to some extent it is related to culturing practices, which is from a clinical perspective a very good thing; you want to know what you're dealing with."
That doesn't mean that the Buccaneers are not going to act to make the facility safer, but drastic steps aren't necessary according to Anderson. "We have some specific what we call 'source control' that we perform on the players themselves using a disinfectant for the skin. But no, I don't think another treatment of the facility is required."
Carl Nicks' treatment
With a recurrence of MRSA in Carl Nicks' case, the question is whether the Bucs were in any way negligent in their response. Anderson was satisfied that the Bucs treated him effectively and did not return him to the field too early. "[His treatment] seemed fairly reasonable. These were very high-powered antibiotics for a very long period of time. We typically do not do major follow-up testing. That is to say you don't have to demonstrate that you've got MRSA eliminated from the skin. Instead you're looking for how do his signs and symptoms improve."
"It is myy understanding from talking to the physician that was caring from him that his foot tremendously improved, and essentially that's the kind of criteria that we would use to say okay, can someone return to work. Not just NFL necessarily, but work in general. There are specific policies say in a hospital setting that we would use to dictate when a person could come back to work after an MRSA infection. He would have met those criteria."
One issue was that MRSA got into the bone with Carl Nicks, Anderson said. "It is not uncommon at all for it to recur. The reality is that oftentimes when MRSA gets into the bone then antibiotic therapy alone is not enough to actually cure it. Typically in that scenario, that is where you've tried antibiotic therapy and it continues to recur, that indicates that you may require a surgical procedure to definitively remove that infection."
Overall, it seems like the Buccaneers have done a good job of dealing with the infection, although it's dubious that they were sluggish in informing everyone else outside their building on these matters. That has greatly improved with this second outbreak, and Anderson made it clear that the Bucs and their players were unlucky to contract MRSA. It should not be a long-term issue for the team and hopefully the players will be able to get through this ordeal swiftly and with their health intact.