S. aureus is a common strain of bacterium, often found on the skin and in nasal passages that can cause infection if it enters the body

These days, the University of Southern California 's football players might seem more like fussy disciples of the TV detective Monk than scrappy athletes. They use paper towels on the practice field and at games, and they shower before setting foot in the training room.

Their laundry is washed at a constant 140-degree temperature, which is monitored. Portable cold-therapy tubs are drained and cleaned after each use, and the team brings its own soap to away games.

That’s because while racking up wins in the 2003 and 2004 seasons, the players and trainers also were facing down a different type of adversary — a potential killer known as MRSA, methicillin-resistant staphylococcus aureus.

S. aureus is a common strain of bacterium, often found on the skin and in nasal passages that can cause infection if it enters the body through a cut or scrape. Although it easily can be treated with antibiotics, methicillin-resistant strains don't respond as readily to common antibiotics and thus can be difficult to eradicate once infection takes hold.

The strain of MRSA that infected the USC athletes was a community-acquired strain, as opposed to a hospital-acquired strain, which means that it occurred in otherwise healthy people who hadn't been hospitalised. The bacterium, which can lead to disfiguring skin infections, generally is passed along through skin-to-skin contact but can linger in showers, on towels and on exercise equipment.

The Trojans' MRSA battle -- two hospitalisations in 2002, followed by 11 confirmed cases as well as six suspected cases in 2003 -- was highly publicised at the time. By 2004, though, MRSA at USC was a non-story.

Why? Because as USC nears the midpoint of the 2007 season as one of the top 10 most winning Division 1 schools in history, it also is winning the MRSA battle. In the 2004 season through this year, the football team has logged only two cases in total.

USC's response to the MRSA outbreak has been extraordinary, says David Klossner, National Collegiate Athletic Association director of education services. “Their staff recognised the situation, took steps to eradicate spreading of the infection and added monitoring measures on a scale that was not commonly found in the athletics setting.”

The story of what USC did to fight MRSA is a valuable lesson and a cautionary tale not only for people who play team sports but also for anyone who has swapped sweat on a community exercise machine.

The year 2002 was a bad one for CA-MRSA infections. “In 2002, we investigated four outbreaks of community MRSA, which included USC,” says Elizabeth Bancroft, medical epidemiologist with the Los Angeles County Department of Public Health.

Caught off guard by the outbreaks, the Health Department scrambled to get the word out, issuing fact sheets to consumers and medical professionals on how to prevent the spread of the bacterium, documenting the outbreaks in medical newsletters and journals and initiating surveillance programs at county hospitals. The NCAA also stepped up to the plate, developing educational outreach programmes for coaches and trainers involved in team sports.

Following the outbreaks at USC, which occurred at about the same time as outbreaks at a fencing club in Colorado and among high school wrestlers in Indiana, the NCAA launched a series of initiatives. It created a MRSA website to educate players and coaches, updated its sports medicine guidebook, which is available online, and sent prevention posters to its member institutions.

But fitness centres have not exactly rallied to the cause.

If health clubs are doing anything extra to curb MRSA transmissions, they're not talking about it. Officials at Bally Total Fitness, the Sports Club/LA, Gold's Gym and Crunch Fitness either didn't return repeated calls or declined to comment.

Although health officials assume that some cases are transmitted through communal use of equipment and towels, it's nearly impossible to prove that because of the long incubation period of the bug. “People will call us at the Health Department, and say, ‘I know I got this skin infection because I went to this gym,’ but it's almost impossible to know for certain,” Bancroft says. “It could be that they were exposed through their child at school.”

Cedric Bryant, chief science officer for the American Council on Exercise, acknowledges that there's a reasonable danger of contracting something in a gym. “A set of dumbbells can be a hotbed for common bacteria as well as the handrails on the aerobic equipment, bikes and stair climbers.” Nevertheless, he says, “you don't want to be a germaphobe, but following basic hygienic principles should minimise the risk.”

Reducing risk of contracting MRSA at the gym and elsewhere is a simple matter of adopting common sense hygiene routines that can be found on the county's public-health website, says Bancroft. “None of these guidelines are rocket science,” she says. “Wash your hands. Keep things clean. Follow directions. They're things you learned from your grandmother or in kindergarten.”

It's impossible to know just how many people contract MRSA each year because physicians and medical facilities aren't legally required to report it. In addition, CA-MRSA has moved out of those risk areas, and now essentially anyone is at risk, says Dr Paul D. Holtom, hospital epidemiologist for Los Angeles County +USC Medical Centre and associate professor of medicine and orthopedics at USC Keck School of Medicine.

Holtom, who was consulted extensively on USC's MRSA outbreak, has seen CA-MRSA in basketball and volleyball players but not to the extent that he's seen it in football players. “Why football players are vulnerable is not well explained,” he says. “They have more scrapes on the field, but basketball players, for example, have a lot of physical contact too.”

To combat MRSA, USC developed and implemented a plan of attack based on Health Department guidelines that included eliminating towel sharing; using alcohol-based hand sanitisers; using three per cent hexachlorophene (Phisohex) or four per cent chlorhexidine, intermittently, in the shower soap dispenser; eliminating multiuse lotions and gels with pump dispensers; spraying equipment with disinfectant throughout the day; boosting water temperature in the laundry facility and increasing drying temperature of towels to 180-190 degrees; examining all suspicious lesions; and administering antibiotics to players who are colonised with CA-MRSA. This final move is somewhat controversial, as some public health officials fear the use of antibiotics in this context could increase resistance in the CA-MRSA bug.

Football players and other athletes who engage in vigorous exercise for 90 minutes or more, such as cyclists and swimmers in hard training, appear to be at greater risk for contracting CA-MRSA because of the exercise, says David C. Nieman, an exercise immunologist at Appalachian State University in Boone, N.C. “The immune system of a marathon athlete after a race is very similar to what you'd see in an elderly person. But it's transient; it lasts about a day.”

USC’s head athletic trainer, Russ Romano, who spearheaded USC's effort to control MRSA, believes that all of the infection control measures the school undertook were important.

Certainly USC has set the bar higher for everyone else. After a recent talk on MRSA at a conference for athletic trainers, Romano was besieged with questions from coaches, trainers and educators.

“We still have to be very vigilant,” he writes in an email. “The problem is very prevalent in our community as well as all over the country. The battle is not over.”

—Dawn/LAT-WP Service