The Staph & Turf Brief - What’s the Connection?, by Guive Mirfendereski, www.synturf.org, Newton, Mass. November 12, 2007.
THIS brief explores the relationship between Staph infections and artificial turf. An infection caused by the bacterium methicillin-resistant Staphylococcus aureus -- for short, Staph, MRSA – pronounced mer-sa, or superbug -- can kill. It can also lead to other health complications, some of which can linger long after the infection has been treated or brought under control.
The appropriate inquiry about the relationship between Staph infection and turf is not one of causality but the risk of contacting Staph infection through “turf burn,” the scrapes and abrasions suffered on an artificial turf surface. The Staph bacterium, if present on the turf surface may enter the compromised skin on the spot. More likely, however, the Staph bacterium may set in when the abrasion or scrape comes into contact with a non-turf surface that is contaminated with the Staph bacterium, such as a towel, mat, pad, equipment, razor, another’s skin, and even an athlete’s own skin.
Preface. A number of reports in 2003-2005 pointed to a growing concern about MRSA infections among athletes and the role that artifcial turf systems may have played as a source of the contamination..
In Novemebr 2005, Professor Brad Fresenburg, the turfgrass expert at University of Missouri’s Department of Horticulture, suggested that artificial turf was a source of bacterial infections. According to him, the warmth and trapped moisture in the synthetic turf field provided a hospitable environment for bacteria to thrive, whereas natural grass had a microbial system and was self-cleaning. The sweat, vomit, spit and blood did not biodegrade on artificial turf as they would on natural grass and, therefore, he advised that disinfectants be sprayed as needed if there is a known infection risk. According to Rex Sharp, University of Missouri’s head athletic trainer at the time, who believed synthetic turf was as safe as grass, nonetheless, the players should report immediately any "turf-burns," which must be immediately washed with soap and water to prevent infection. Often young athletes, according to Sharp, are inclined to ignore seemingly minor injuries so it is up to the coaches and parents to ensure the cleaning and treating of turf burns on the spot.
The comments such the ones attributed to Fresenburg were ready fodder for opponents of artificial turf, allowing them to declare ‘artificial turf causes Staph infections’ or ‘an artificial turf field is a hospitable environment for microbial activity and bacterial growth.’ Of course, only the Staph bacterium causes Staph infection. And, apparently, the turf itself is no more hospitable to the Staph bacteria than natural grass surfaces.
The view contrary to Fresenburg’s was expressed in August 2006 by Professor Andrew McNitt of Pennsylvania State University’s College of Agricultural Sciences, who stated the infilled turf systems was not a hospitable environment for microbial activity; the field tended to be dry and exposed to outdoor temperatures, which fluctuated rapidly. The infill media itself (ground-up tires), was said, contains zinc and sulfur, both of which inhibit microbial growth. However, he did acknowledge, "Some other studies indicate that a player playing on synthetic turf may acquire more skin abrasions due to the abrasiveness of the surface, thus, they have more entry points for the staph, but they're not getting it from the field -- they're picking it up in the locker room or somewhere else.”
Private Pains. In April 2005, Brandon Noble, a Washington Redskins defensive tackle, went in for a routine knee operation. Soon after, the pain in his knee was accompanied by a feeling of flu-like symptoms. Lucky for him, he quickly got to the hospital, which may have saved his leg, but the MRSA infection and its ongoing resultant complications claimed Noble’s career anyway. In a poignant essay about his ordeal, Noble wrote: “I have 2 boys … it will be a lifetime of cuts and bruises. I will keep a close eye on each because I am incredibly paranoid about them getting MRSA. Any small red bump on any of my kids and I am pestering my wife to keep an eye on it, ready to go to the doctors at the drop of a hat.” What is a personal agony for him, however, is the fear of infecting his kids. “The thing that scares me the most is” he wrote, “I could be a carrier of this bug and have to worry about my wife and kids getting it.”
Ricky Lannetti did not survive his quick and fatal bout with MRSA. At the time of his passing, he was at the prime of life. A 21-year old senior at Lycoming College, in Pennsylvania, he was a record-setting Warrior football player. All his ox-like strength and deer-like quickness and graceful running were no match for MRSA. After a week of flu-like symptoms, he ended up at the intensive care unit of Williamsport Hospital, hooked up to a ventilator and on 5 different antibiotics, breathing erratically and feeling cold. In the evening of December 6, 2003, when he was supposed to be playing in the game of his life, he quietly slipped to the other side.
In October 2007, Ashton Bonds, a 17-year old senior at Staunton River High School, in Moneta (Bedford County), Virginia, became yet another fatal casualty of MRSA. Ashton first complained on October 4th of pain in his side; the doctors at Bedford Memorial Hospital ruled out appendicitis and sent him home. Three days later he was back at the hospital and later was transported to Carilion Roanoke Memorial Hospital. Three days after that doctors diagnosed his MRSA infection, which by now had spread to his lungs, kidneys, liver and the muscles around his heart. He was put on a ventilator, but an inoperable blood clot near his heart put a halt to plans to drain his lungs with surgery. This former football player at Staunton River High School passed away on Monday, October 15, 2007.
The next day, on Tuesday, a crew of 30 people began a 12-hour work detail cleaning Staunton River High from the inside out. Large filtration systems blocked the doorways while pumps fogged the building with disinfectants. Although the cleaning solutions used were supposed to be safe, the crew at times required haz-mat suits to protect themselves from the strength of the solutions. Even so, on Wednesday, the attendance was down to 88%, as students stayed away. The news of Bonds’ demise and his school’s scrub down prompted 21 public schools in Bedford County to shut down on Wednesday, October 17, for sanitization. The Virginia Department of Education disseminated precautionary advice to the public schools about MRSA. Many schools passed the information along to parents.
The precautionary advice by health and education authorities and experts insisted on regular hygiene; immediate tending to wounds, scrapes and cuts; abstaining from sharing personal items like razors, towels, and equipment; and disinfecting the areas and surfaces suspected of contamination.
Public Health Scare. The MRSA news story from Virginia echoed in other parts of the country. The cascading effect of the Bonds story suddenly made October 2007 the time when Staph infection entered America’s collective public consciousness. One story after another, from different parts of the country, warned this was no longer a hospital-based phenomenon. In October, MRSA became a grave community-based epidemiological concern: it was attacking the young in daycare centers, schools, and colleges. On its website, the U.S. Centers for Disease Control & Prevention (CDC), gave MRSA marquee billing as a public health feature.
What may have fanned the consternation about this latest awareness about Staph was the publication in JAMA on October 17, 2007, of a report by CDC on invasive MRSA infection in the United States in 2005. The report found that MRSA affected some 95,000 people, resulting in 19,000 fatalities. The study did not go into Staph infections among athletes, but it did state that community outbreaks of MRSA in sports teams, among other diverse populations, usually involved skin disease, but could cause severe, sometime fatal invasive disease. The JAMA’s editorial characterized the pervasive nature of MRSA as “astounding.” Some of the news stories that surrounded the publication of the CDC study also stated that MRSA “could soon kill as many people in the U.S. as AIDS,” and MRSA “enters the blood stream or turns into the so-called flesh-eating disease.”
By October 22, 2007, the NewsHour program on PBS, too, was deep into the subject. It featured Dr. Richard Shannon of University of Pennsylvania School of Medicine, who explained the risks of the sometimes-deadly MSRA bacterium that, according to him, about 25 percent of the population carries on their skin normally.
On October 28, 2007, Senator Charles E. Schumer, Democrat of New York, stated he would file legislation to create a nationwide reporting system for MRSA.
Calming the Waters? On November 11, 2007, the CBS television news magazine 60 Minutes had a segment on MRSA. The background: This year, in Pennsylvania, 13 members of Mt. Lebanon High School Blue Devils football team had come down with MRSA. At the top of the segment, one of the players, Glenn Isralsky, told Leslie Stahl that the first sign of the infection was on his elbow after a game in which he'd cut himself on the school’s artificial turf. "It starts, it looks nothing more than a pimple. And in a day or two, it can become a huge growth on your skin," Glenn explained to Stahl. “In contact sports people get abraded. They get dragged across a surface. They get banged up. They get cut. They get abrasions… They touch somebody else. They touch an article of personal hygiene, a towel or something else that somebody else has used. And they get infected," Dr. Bruce Dixon, director of the public health department for Allegheny County, told Stahl. Dr. Robert Daum, an infectious disease pediatrician at the University of Chicago Medical Center, told Stahl "[e]veryone agrees that this an epidemic. And not only is it an epidemic. But, it's an epidemic of our times. It's here in huge numbers." When asked, “What were some of the myths that the parents came to you with?,” Dr. Dixon replied, "Perhaps the biggest one is that they thought that the field was contaminated. There were people that wanted the field replaced. There were people who wanted the field somehow sterilized." Dixon tested the field twice, taking samples of the turf and found a few bacteria but no MRSA bacteria. When asked if the MRSA Staph bacterium lives in artificial turf, Dixon replied, “We can say unequivocally that MRSA staph does not live in [artificial turf].” According to Dixon, "It's the kids themselves. It's not any inanimate thing that they're touching. It's not the field. It's not the cafeteria. It's people." However, Daum sated, "To think we control community MRSA epidemics by asking people to wash their hands is foolish. I'm not gonna sit here and say washing your hands is bad. Because it's wonderful. But, it's not going to control the community MRSA epidemic….We need more research. And we need to understand why this is happening. And how is it spreading? And what are the new high risk groups?" 
The 60 Minutes segment left this writer pondering if Dr. Dixon was playing the role of a scientist or an officer of the peace when he stated that artificial turf does not harbor Staph bacteria. Not even Professor McNitt would make that claim. If Staph bacteria were placed on turf, if would show up. One must also questions the validity of Dixon’s statement that Staph does not transfer from inanimate objects. If it is not an inanimate object that transfers the Staph bacterium into a compromised skin, then why all this talk by the CDC and public health officials about making sure that athletes do not share towels, razors, soap bars, mats and pads, and equipment? According to the statements that aired on 60 Minutes, one must assume that Dixon clearly is fixated on direct skin-to-skin, direct person-to-person contact as the sole mode of transmission of Staph; the clinical evidence seems to weigh against his assertion.
Risk to Athletes. It is pretty much established that “some artificial turf fields can create ‘rug burns’ and may be a potential infestation area for staph.” Fox Sports, “NFL teams working hard to stop staph,” available at http://msn.foxsports.com/nfl/story/7149542. The study of the relationship between Staph infection and athletes is nothing new. The following is a review of a few studies and their conclusions.
The CDC report (August 2003) summarized several reported clusters of skin and soft tissue infections associated with MRSA among participants in competitive sports in Colorado, Indiana, Pennsylvania, and Los Angeles County for the years 2000-2003. It identified possible risk factors for infection, for example, physical contact, skin damage, and sharing of equipment or clothing. “The findings underscore[d] 1) the potential for MRSA infections among sports participants; 2) the need for health-care providers to be aware that skin and soft tissue infections occurring in these settings might be caused by MRSA; and 3) the importance of implementing prevention measures by players, coaches, parents, and school and team administrators.”
The Begier Study (October 2004) identified turf burns and body shaving as facilitating Staph infections. It looked at 100 college football payers at a Connecticut college that had reported occurrence of Staph infections to the Connecticut public health department. Among the players, the study identified 10 case patients. It found that player position at cornerback and receiver showed the highest risk of infection, followed by players with abrasions gained from artificial turf burns, followed by infections due to cuts and scrapes associated with body shaving. The study concluded, “MRSA was likely spread predominantly during practice play, with skin breaks facilitating infection. Measures to minimize skin breaks among athletes should be considered, including prevention of turf burns and education regarding the risks of cosmetic body shaving.” “Players who'd had turf burns were seven times more likely to get an MRSA infection,” the study found.
The definitive study about the connection of turf burn and Staph infection, however, remains the CDC-Rams Study (2005). In 2003 an outbreak of MRSA among the players on the St. Louis Rams football team prompted the team to ask the CDC to examine the outbreak. In an article published in New England Journal of Medicine in February 2005, The principal researcher of the CDC study, Sophia V. Kazakova, placed the blame for the spread of the infection on turf burns “or areas of skin rendered raw by a run-in with artificial turf as both the source and means of spreading the fast-spreading bacteria that invade the body via cuts in the skin.” While the infections were likely to have spread on as well as off the field through rough play and shared towels, whirlpools, and weights, “[t]hese abrasions were usually left uncovered, and when combined with frequent skin-to-skin contact throughout the football season, probably constituted both the source and the vehicle for transmission," according to Kazakova. Kazakova found “the infections occurred at the site of a turf burn and rapidly progressed to large abscesses 5 to 7 centimeters in diameter that required surgery to drain.” Kazakova also found “linemen were 10 times more likely to develop the infection than a heavily guarded quarterback or other backfielder; the heavier the linebacker, the greater the risk.”
In a story appearing in Science News on February 5, 2005, Nathan Seppa reported on the results of the CDC-Rams study. He wrote: “Athletes who play most of their games on artificial turf might be more prone to infection than those who play mainly on grass fields because they experience more skin abrasions similar to rug burns. Researchers now report that serious infections may arise from such abrasions.” However, the story quoted Elliot J. Pellman, a physician and medical liaison for the National Football League, as sayings one “could not judge whether artificial turf causes more abrasions than do grass fields, which sometimes freeze solid in December and January.” But physician John M. Dorman of Stanford University School of Medicine applauded the CDC-Rams Study as “another argument for not using [artificial] turf." Staph infections "are communicable by contact. On turf, players on both sides are getting abrasions," Dorman told Seppa. “While added body protection might limit abrasions, Pellman cautions that covering players from head to toe during hot months would increase the risk of heat exhaustion.”
The Houston Dermatology Study (June 2005) examined the clinical features of community-acquired MRSA (CAMRSA ) skin infection that occurred in university student athletes, evaluated the potential mechanisms for the transmission of MRSA infection of the skin in participants of athletic activities, and reviewed the measures for preventing the spread of cutaneous CAMRSA infection in athletes. The study concluded “Direct skin-to-skin physical contact with infectious lesions or drainage, skin damage that facilitates the entry of bacteria, and sharing of infected equipment, clothing, or personal items may result in the acquisition and transmission of MRSA infection in participants of athletic activities [such as weight lifting, basketball, fencing, football, rugby, volleyball, and wrestling].” Moreover, “[e]arlier detection and topical treatment of the athletes’ skin wounds by their coaches, avoidance of contact with other participants' cutaneous lesions and their drainage, and good personal hygiene are measures that can potentially prevent the spread of cutaneous MRSA infection in participants of athletic activities,” the study concluded.
Precautionary Protocols. There are four parts to any complete precautionary regime for the athletes playing on artificial turf. The most commonly prescribed principle is proper hygiene, which includes not sharing personal items. Second is to get quick treatment of cuts and abrasions. Third protocol, but least practical, is to cut down on the risk of players getting cuts and abrasions due to turf burn. For example, in many soccer leagues around the country slide tackles are prohibited. While this is intended to cut down on ankle and other injuries from getting clipped from the side or behind, the unintended result is that a soccer player also is spared the agony of scrapes and abrasions, particularly to the outer-thigh and lower legs, which can become infected. The fourth protocol is to wipe down the surfaces and sanitize the medium that are contaminated or suspected of contamination, such as pads, mats, equipment, whirlpools, benches and alike. The extension of this last protocol is the sanitization of the turf surface itself.
The suppliers of antibacterial and antimicrobial products and sanitization systems look at an artificial turf field and see a cesspool of germs. This leads to an interesting body of literature that capitalizes on private pains and public consternation about Staph and other infections. The marketing literature of two such suppliers, TurfAide and AstroShield are discussed on this site at IndustryNotes (Item No. 3: Disinfecting the fields).
Perennial Precautions. In recent years, toward the end of summer and throughout the autumn coaches and trainers keep in mind that Staph too is an adversary. For example, in July 2006 the high school football coaches in several communities in Georgia were not about to see a repeat of the previous year’s Staph infections among their players. They ordered antibacterial products by the gallons, to disinfect the facilities and equioment, while sending the detergent variety of the product home with h playyers to be used in laudering the uniforms and towels.
In a recent survey of 364 certified U.S. athletic trainers, 53% of them had treated MRSA in the athletes under their care: Of the infections treated: 86 percent were in males and 35 percent were in females; 65 percent were in football players; 21 percent in basketball players; and 20 percent were in wrestlers. Of the infections treated: 86 percent were in males and 35 percent were in females; 65 percent were in football players; 21 percent in basketball players; and 20 percent were in wrestlers. The infections typically occurred in: the lower leg (38 percent); forearm (31 percent); and the knee (29 percent). The survey was presented at the annual scientific session of the Society for Healthcare Epidemiology of America in Baltimore in April 14, 2007. Conclusion. The ultimate question is whether artificial turf contributes to Staph infections. In the theory, at least, the answer is in the affirmative, because turf burn is caused by contact of unprotected skin with artificial turf, and Staph bacterium can enter the body through the burn (scrapes and abrasions). In practical terms, the CDC-Rams study notwithstanding, however, there is maybe a need for a larger study that compiles and correlates turf burn with onset of Staph or other infection.
There is mounting anecdotal evidence and practice that suggest many take seriously the connection between turf burn and Staph infection, even if from a purely precautionary standpoint. Dr. Philip J. Landrigan is a professor of pediatrics and the chairman of preventive medicine at the Mount Sinai School of Medicine in New York. In a recent news story, Landrigan cautioned against the health risks that artificial turf surfaces pose to children. He stated, “several medical journals have reported that athletes who fall on synthetic turf are more likely to sustain skin burns that put them at risk of staph infections.”
It is therefore essential that sports-related data on Staph infections that are collected under local, state and federal programs also note (a) the type of surface on which scrapes and abrasions (burn) occur, and (b) the point of contact or entry of the Staph bacterium.
The public health discussion about the spread of Staph infections among athletes is not helped by self-serving obfuscations published in turf industry media. One such example is the article entitled “Staph infections associated with artificial turf?” International Sports Turf News, “Staph infections associated with artificial turf?,” September 1, 2006, available athttp://hcs.osu.edu/sportsturf/international/detail.lasso?id=1093. The article begins with the sexy teaser, “As high school and college athletes prepare for a new football season, sports trainers and coaches are concerned about outbreaks of an antibiotic-resistant staph bacterium that some people have associated with synthetic turf fields.” “But,” it sates in the same breath, “a study by researchers in Penn State's College of Agricultural Sciences [McNitt Study] should help put those concerns to rest.” Neither the McNitt study nor the article mentions a word about the likelihood of Staph infection through contact with skin compromised by turf burn. The bottom-line: The burden should be on the proponents of artificial turf to show that scrapes and abrasions received from artificial turf does not contribute to Staph infection. If there were not an inkling that artificial turf contributes to Staph infection, then one would be hard pressed to explain why “There is also an artificial turf that is treated to reduce the risk of exposure,” or for Cleveland Browns quarterback Derek Anderson receiving “a crash-course on staph while playing collegiately on an artificial surface at Oregon State.” Or for that matter, why would the Cleveland Browns follow the example of the Washington Redskins and pay a private company to “sterilize everything inside team headquarters, including the gym, training room and artificial turf practice field.”
 In the community (as opposed to hospital settings), most MRSA infections are skin infections that may appear as pustules or boils that often are red, swollen, painful, or have pus or other drainage. These skin infections commonly occur at sites of visible skin trauma, such as cuts and abrasions, and areas of the body covered by hair, such as back of neck, groin, buttock, armpit, and beard area of men. Almost all MRSA skin infections can be effectively treated by drainage of pus with or without antibiotics. More serious infections, such as pneumonia, bloodstream infections, or bone infections, are very rare in healthy people who get MRSA skin infections.http://www.cdc.gov/Features/MRSAinSchools/#q1.
The McNitt’s group at Penn State is engaged in a long-term study of artificial turf surfaces. The group disclosed their findings from the first two years of the study in 2007 (Penn State Study). Andrew S. McNitt and Dianne Petrunak, “Evaluation of Playing Surface Characteristics of Various In-Filled Systems,” available at http://cropsoil.psu.edu/mcnitt/infill9.cfm. The section of the study regarding microbial/bacterial populations in turf is available at http://cropsoil.psu.edu/mcnitt/microbial/index.cfm.
Derry, New Hampshire: “Skin Infections Reported Among Pinkerton Athletes,” September 27, 2007, at http://www.thebostonchannel.com/news/14221297/detail.html (Eight football players reported with Staph infections at Nashua North High School; 1 case at Nashua South High School; 15 football players having skin infections at Pinkerton Academy in Derry, where everything was taken out of the locker room, taken home and sanitized, while a cleaning crew came into the field house and totally sanitized the situation; the infections at the three schools all involved students in contact sports, but state officials said it's unlikely that the different teams spread it to each other, it usually spreads by shared equipment and gear; the Pinkerton teams will be using much more hand sanitizer in the wake of the infections, and the locker room will be emptied and sanitized every week and the equipment taken home for cleaning). Concord/Salisbury, New Hampshire: “Child Dies Of Complications From Staph Infection,” October 15, 2007, at http://www.thebostonchannel.com/health/14345832/detail.html (A family mourns losing a child to illness related to a Staph infection. According to Dr. Jose Montero, state epidemiologist: the same strain that killed the child Friday (October 12) caused infections in area football locker rooms this fall; Staph typically spreads in locker rooms where dirty equipment is shared; it enters the body through scrapes and cuts; and the only real protection is good hygiene). Also at “'Superbug' Reports Spread Through Country,” October 18, 2007, at http://www.thebostonchannel.com/health/14367924/detail.htmlBoscawen Elementary School waited a month before notifying parents that a student had contracted a MRSA infection; officials said they were following the advice and protocol of the Department of Public Health). Boston, Massachusetts: “’Superbug’ Reports on Rise at Local Schools,” October 19, 2007, at http://www.thebostonchannel.com/news/14375260/detail.html (Five local school systems in Salem, Winthrop, Wrentham, Dartmouth and Adams sent letters home to parents reporting cases of MRSA at the schools). White Plains, New York: “'Superbug' Cases Hit N.Y. College,” October 19, 2007, at http://www.thebostonchannel.com/health/14382351/detail.html (Nine athletes and a coach at Iona College, in New Rochelle, contracted MRSA; cases were caught early and were mild; school athletes appear particularly susceptible because of cuts and scrapes, bodily contact and the sharing of equipment). Richmond, Indiana: “'Superbug' Scare Strikes High School,” October 18, 2007, at http://www.thebostonchannel.com/health/14366967/detail.html (More than 100 students were sent home on October 17 after they found out that one of their fellow classmates, a football player, might have the Staph infection; the school contacted the Centers for Disease Control and Prevention and was told to clean every classroom and hallway).
Nashville, Tennessee: “'Superbug' Reports Spread Through Country,” October 18, 2007, at http://www.thebostonchannel.com/health/14367924/detail.html (Television station WSMV reported that a simple scrape on the knee landed a 5-year-old girl in the hospital in critical condition. That injury on Tuesday (October 16) put Julianna Clemmons in the hospital by Friday (October 19) and under care and dialysis, ventilator and plasma exchange.
Winston-Salem, North Carolina: “'Superbug' Reports Spread Through Country,” October 18, 2007, at http://www.thebostonchannel.com/health/14367924/detail.html (Television station WXII reported that in September 2007 six high school football players at Winston-Salem East Forsyth High School had MRSA infections; the school is cleaning and sanitizing wrestling mats, locker rooms and football pads; school administrators sent a letter to parents that contained information about the outbreak and methods for dealing with infection). Omaha, Nebraska: “Council Bluffs School Has 1 Confirmed Staph Infection,” October 19, 2007, at http://www.kcci.com/news/14378767/detail.html?rss=des&psp=news (Council Bluffs Thomas Jefferson High School has two football players sick, and at least one has a confirmed staph infection. Crews have cleaned the school and will be doing more thorough cleaning over the weekend. All football players were asked to take everything out of their locker and clean. Three students in the Papillion La-Vista School District at three different schools were infected with methicillin-resistant Staphylococcus aureus over the [October 13-14] weekend. Seven students were diagnosed with staph infections at Millard schools).
second case of staph infection was confirmed at Clark Middle School in Frisco on Wednesday. A few weeks earlier, a seventh-grade football player was diagnosed with the first case at Clark. There had been other cases among athletes at Frisco high schools. Sources inside the district said they were told not to say anything for fear parents would panic. Student-athletes were told to take their clothes home to be washed in hot water. The district also said they took additional steps to decontaminate the locker rooms. The school officials in Southlake and Lewisville have also had confirmed cases of staph infection since the school year began).
Lake County, [Northern] California: Elizabeth Larson, “Health officer: Drug-resistant staph nothing new in county,” October 29, 2007, http://lakeconews.com/content/view/2247/702/(MRSA is everywhere, literally in every county across the state. There have been as many as 100 cases over the last two years in Lake County and those are just the ones that are reported to the County’s public health authorities, because MRSA is not a disease that must be reported to local health officials).
CT-NJ-NY Tri-State Area: “Superbug MRSA spreads across Tri-State,” ABC Report, October 19, 2007, http://www.abclocal.go.com/wabc/story?section=health&id=5715757 (October 18: several communities in Connecticut were put on alert. October 19: in New Jersey, Point Pleasant Borough High School has reopened after buildings there were disinfected because a student having been diagnosed with MRSA infection. Long Island: the Vernon Township public schools sent a letter to parents saying two students have tested positive for a staph infection. In Westchester, nine football players and a coach at Iona College in New Rochelle have contracted it).
 National Football League does not keep statistics on Staph infections, as this record keeping is a team matter. Yet, the outbreak of Staph in NFL teams in recent years – notably in Cleveland, Washington, Miami, San Diego, San Francisco and St. Louis – serves as a reminder that no team is really immune to the Staph. Fox Sports, “NFL teams working hard to stop staph,” available at http://msn.foxsports.com/nfl/story/7149542.
 Ibid. According to Miami Dolphins trainer Kevin O'Neill, “[a]n anti-staph ‘coating’ doesn't necessarily provide protection if the infection is brought into a team facility by a player who contracted bacteria from an outside source or even the practice field.” Ibid.