So, what is the likelihood of transmitting MRSA in pools? It's an ongoing debate.
As a general rule, many schools and public pools now have a policy that individuals with open wounds should not
use whirlpools, hydrotherapy pools,
cold tubs, swimming pools and other
common tubs (sample policy).
This is a common sense nod to the fact that it is possible to transmit MRSA (and other bugs present in an open wound) through improperly disinfected pool water and through sharing items (like towels) or touching common areas (like locker-room floors or benches).
However, unlike cryptosporidium, MRSA is rapidly killed by chlorine, so when a pool is properly disinfected, there appears to be little risk of transmission, especially when there is no open wound or portal. (A recent study showed that MRSA could not survive in swimming pool water which maintained a free chlorine concentration of 2.90 ppm).[1]
To learn more about MRSA transmission in pools, attend the ePro Academy online seminar recorded at the 2009 World Aquatic Health Conference ( Emerging Issues: Methicillin-resistant Staphylococcus aureus (MRSA) infection - Jeffrey C. Hageman, M.H.S.).
FYI: Although there is little evidence to suggest that MRSA transmission can/has occurred in chlorinated swimming pools, there have been several reported instances of MRSA transmission in sports team setting, especially when communal whirlpools were used.
Whirlpool transmission research:
1. Contaminated whirlpool water has been implicated as the route of
transmission of Panton-Valentine leukocidin (PVL)-positive MRSA in the
community in a report of MRSA infection in a college football team (Begier et al., 2004).
In this study of a college football team, of the 100 players questioned, 10 were positive for MRSA, of which three of four players with infection at a covered site (hip or thigh) had shaved the affected area, and these infections were also associated with sharing the whirlpool greater than or equal to two times per week.
2. Furthermore, methicillin-sensitive Staphylococcus aureus (MSSA) was isolated in communal whirlpool water associated with a professional football team in the US (Kazakova et al., 2005), where there was an outbreak of skin abscesses due to MRSA infection.
3. A more recent report of MRSA infection in a professional football
team in St. Louis, Missouri, USA (Kazakova et al., 2005), suggested
that the skipping of showers by players prior to use of communal
whirlpools may have promoted MRSA cross-infection between
players.
Conclusion: There appears to be no single broad policy espoused by the CDC or other agencies on whether to limit pool use when an open wound is not present. In general, the Centers for Disease Control (CDC) suggest the following measures for preventing staphylococcal skin infections, including MRSA:
1. Practice good hand hygiene by washing hands frequently and in a thorough fashion with soap and warm water or using an alcohol-based hand sanitizer.
2. Take a shower with hot water and wash with soap (liquid antibacterial soap, not bar soap) following all activities (e.g. strength & conditioning sessions, practices, and competitions).
3. Avoid sharing towels, equipment, razors, soap (use liquid soap instead of bar soap), etc.
4. Use a barrier (e.g. clothing or a towel) between your skin and shared equipment.
5. Wipe surfaces of equipment before and after use with an approved disinfectant.
6. Clean and properly cover any open wounds such as turf burns, abrasions, lacerations, etc. with an appropriate bandage at all times. Avoid contact with other people’s wounds or bandages.
7. Avoid whirlpools, hydrotherapy pools, cold tubs, swimming pools, and other common tubs if you have an open wound.
8. Maintain clean facilities and equipment.
9. Do
not ignore skin infections, pimples, pustules, abscesses, etc.
Reference
1. Tolba, O., et al., Survival of epidemic strains of healthcare (HA-MRSA) and community-associated (CA-MRSA) meticillin-resistant Staphylococcus aureus (MRSA) in.... Int. J. Hyg. Environ. Health (2007), doi:10.1016/j.ijheh.2007.06.003
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