Impact of a Quality Improvement Infection Risk Reduction Program on Pathogen Presence in High School and Collegiate Athletic Training Room Facilities

OBJECTIVES: Athletic training rooms have a high prevalence of bacteria, including multidrug resistant organisms, increasing the risk for both local and systematic infections in athletes. There is limited data outlining formal protocols or standardized programs to reduce the bacterial and viral burden in training rooms as a means of decreasing infection rate at the collegiate and high school levels. The purpose of this study is to implement established hygiene principles to high school and collegiate athletic training rooms to reduce bacterial and viral burden using a quality improvement infection control program. The authors hypothesize that implementation of such a program will reduce bacterial and viral counts in athletic training rooms over the course of one academic year. METHODS: Two high school and two college athletic training rooms were studied over the course of one academic year. A three-phase protocol, including introduction of disinfectant products, implementation of posters and checklists, and student-athlete and athletic trainer education was implemented at the four schools. Multiple surfaces in athletic training rooms were swabbed at four time points throughout the investigation, corresponding with each phase of protocol implementation (Image 1). Bacterial and viral burden from swabs were analyzed for overall bacterial aerobic plate count (APC), influenza viral load and the presence of multidrug resistant organisms such methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococcus (VRE). RESULTS: Overall bacterial load, as measured by APC, was reduced by 94.7% (95% CI [72.6, 99.0], p = 0.003) over the course of the investigation following protocol implementation. Image 2 demonstrates the downward trend in bacterial load averaged across all surfaces sampled over the course of the study. MRSA and VRE were found on 24% of surfaces prior to intervention and were reduced to 0% by the end of the study. Influenza was initially detected on 25% of surfaces with no detection following intervention. No cases of athletic training room acquired infections were reported during the study period. CONCLUSION: A uniform infection control protocol implemented in the athletic training room of four secondary schools was effective in reducing bacterial and viral burden, including multidrug resistant organisms, over the course of one academic year. Future investigations will focus on expanding this protocol to a larger number of schools with broader demographics.