Daniel Fells, New York Giants tight end, is the latest professional athlete to have his career end prematurely due to a Methicillin-resistant Staphylococcus aureus (MRSA) infection. Doctors believe that a routine cortisone injection triggered the spread of the the bacteria that almost required them to amputate his foot.

In an industry that makes billions of dollars in revenue, why is it so difficult for them to clean their locker rooms to keep their players’ healthy?

According to Dr. Michael David, an instructor at the Chicago MRSA Research Center, “The scale of potential MRSA infections, implementation to prevent outbreaks, and the increasing resistance of MRSA to antibiotics” are the reasons why MRSA is so challenging to keep out of professional sports.

Spread of Bacteria

Almost 2 million Americans, roughly 1 percent of the population, carry the MRSA bacteria without showing any symptoms. These “carriers” infect roughly 90,000 Americans annually claiming the lives of close to 20,000. Most of these deaths are children.

Once primarily a hospital-acquired bacteria, large scale outbreaks started affecting the public due to the spread of CA-MRSA (community-associated MRSA). These strains are an epidemic that can cause rapidly progressive, fatal diseases including necrotizing pneumonia, severe sepsis and necrotizing fasciitis.

Due to the gene-variability and how MRSA invades a person’s body, athletes who participate in contact sports are particularly susceptible to infections caused by turf burns and abrasions out on the playing field. Additionally, locker rooms become a breeding ground for the festering bacteria due to the large concentration of potential carriers.

Implementation is Key

Back in 2004, the NCAA and NFL studied the bacteria further to prevent future outbreaks.

The inability to recognize MRSA was a major contributor in why 11 of 107 players, or 10 percent, of the 2003 University of Southern California football team were infected. Presenting symptoms in the form of a “spider bite” and a low-grade fever many did not recognize the signs. This combined with an omnipresent “macho” attitude contributed to the spread of the bacteria in the locker rooms.

To combat this, doctors at the University of Southern California start each season by identifying potential MRSA-carriers by taking nasal cultures. The cleaning staff also increased the frequency of spraying disinfectants in the locker rooms, including the use of 3 percent solution of hexachlorophene. Most importantly, the staff athletic trainers increased the emphasis of teaching better hygienic practices to players. Here are some of the preventative measures that were emphasized:

Shower with hot water after practices and workouts.

Use the pump provided for liquid soap dispensers instead of bar soap, which can breed MRSA.

Place soiled laundry and towels in the hampers labeled “soiled.”

Refrain from sharing towels, clothes, and equipment.

Show all pimples, boils, spider bites, lacerations, and abrasions to medical staff immediately.

Have all open or draining wounds covered by staff athletic trainers.

Preventative measures are one thing. Implementation is another.

Many of the above steps can easily be implemented systematically, such as using pump dispensers instead of bar soaps in a gym locker room. But what about showing all pimples, lacerations, and spider bites to the medical staff? Imagine how long it would take every 6’5″, 300-pound offensive lineman to show every single pimple, cut, and abrasion to the medical staff after each practice considering that football is a full-contact sport.

Increasing Resistance to Antibiotics

Once the bacteria starts appearing on the skin in the form of boils and redness, a medical professional can excise the infected skin and clean the area. If the patient waits too long for it to be treated by topical solutions, antibiotic injections can be used.

Vancomycin, is the most effective antibiotic used to fight MRSA infections. However, according to Dr. David, “its effectiveness has decreased notably over the past ten years as the bacteria has evolved.”

It is not difficult to speculate how Daniel Fells became a victim of MRSA. The combination of the cortisone injection, an immunosuppressant, and the widespread bacteria that entered the site were the main culprits that ended his professional football career. For the rest of the National Football League, the spread of the bacteria, the challenges in implementation, and the increasing resistance over time are the main reasons why MRSA is still an issue today.