SWIM. BIKE. RUN.

     Sweat, saliva and nasal secretions are a source of microbes in shared shower/bathroom facilities and workout areas.
      Most athletes do not think much about it but a sneeze into the hand followed by sweating during the workout and the use of equipment or mats can spread literally thousands of microbes in an environment highly hospitable to their growth and replication.1
      Such unconscious behaviors introduce human microbes (some pathogenic) into common use spaces.  When using common use areas, it is important to cough and sneeze into the elbow or shoulder and to refrain from spitting on the ground, building walls, sinks, shower stalls and in the water fountains, not only because of good manners, but because of the incredible number of bacteria that reside in secretions from the nasal passages, mouth and upper respiratory tract.1,2
      Consider that saliva contains up to one billion organisms per fraction of a teaspoon (mere milliliters).  This includes organisms of the Streptococci and Staphylococcus species that can cause human disease.  The nasal passages commonly contribute Stretpococcus pyogenes to the nose/throat secretions that make-up saliva, particularly when one clears the throat before spitting.1,3  These species of bacteria can be pathogenic and contribute to skin boils, amongst other human health issues. Any open boil or abscess of the skin can also be a source of Staphylococcus aureus, some subspecies of which have been found to be highly resistant to antibiotics.1,3
      There has been an alarming increase in various strains of antibiotic resistant microbes that cause massive infection.  Many are familiar with the term “flesh eating bacteria”.  In the United States, a doubling of the number of strains of Streptococcus and Staphylococcus resistant to common antibiotics has occurred in the decade of the 1990s alone.3,4  
      Serious outbreaks of drug resistant skin boils have occurred in athletes and military personnel in the United States.4   It is of particular concern because these groups may share communal workout, shower and toilet facilities and there is a concern that both poor general hygiene and sanitation habits might be contributing to these problems, especially when individuals in those environments might also be using concurrent antibiotic therapy for an infection.  That scenario provides ample opportunity for multiple sources of bacteria associated with the nose/throat and skin abscesses to come in contact with antibiotics in a communal environment, helping give rise to the antibiotic resistant strains of these species.  
      Remember to be hygiene conscious and safe; whenever sports or workouts requiring skin to skin contact, shower afterwards.  Do not share personal toiletry items such as combs and razors.  Use a barrier of t-shirt or towel to sit on shared use spaces such as a sauna bench. Cover any open wounds or skin abscesses with a bandage. Do not spit on the ground, into shower stalls or into public water fountains.  And make sure that high touch areas such as handrails in common use spaces are disinfected on a regular basis.4,5
      Protect both your health and the health of those around you by avoiding contracting and spreading these infections.  See the references below for additional information and visit the CDC website for a quick podcast discussing how to recognize and prevent skin infections for athletes and others who use shared space workout and bathroom facilities.  

References
1. Centers for Disease Control and Prevention, CDC, 2008. About Methicillin-Resistant
 Staphylococcus aureus (MRSA) among Athletes. [Online]. Available from:
  http://www.cdc.gov/mrsa/groups/advice-for-athletes.html, Accessed 2010 Aug. 1.

2. ABC News, 2005. 'Superbug' MRSA Worries Doctors, Athletes, Drug-Resistant Germ
 Found in Locker Rooms; Can Kill Within Days. [Online]. Available from:
 http://abcnews.go.com/Health/Primetime/story?id=410908&page=1, Accessed 2010, Aug. 1.

3. Martinez, J.M., 2009. MRSA Skin Infection in Athletes. [Online]. Available from:
 http://emedicine.medscape.com/article/108972-overview, Accessed 2010, Aug. 1.

4. Morbidity and Mortality Weekly Report, MMWR, 2003. Methicillin-Resistant
Staphylococcus aureus Infections Among Competitive Sports Participants --- Colorado, Indiana, Pennsylvania, and Los Angeles        County,    2000—2003. [Online]. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5233a4.htm, Accessed 2010, Aug. 1.

5. Centers for Disease Control and Prevention, CDC, 2007. Methicillin-resistant
Staphylococcus aureus (MRSA), Podcast. [Online]. Available from: http://www2c.cdc.gov/podcasts/player.asp?f=6936, Accessed 2010,      Aug. 1.

Dr. Zeman received her Ph.D. in Preventive Medicine with emphasis in Environmental and Occupational Health from the University of Iowa and a Masters in Environmental Science from Southern Illinois University. Her background includes degrees in Nursing, Biolog, and Anthropology. She teaches classes in epidemiology, human diseases, environmental health, and environmental and occupational health regulations.  She is an Associate Professor of Environmental Health in the Health Division, School of HPELS and the College of Natural Sciences, at the University of Northern Iowa.