Durham, North Carolina - Keeping any team healthy is an important and daunting challenge, but the task is amplified in the National Football League when a bug that spreads rapidly through locker rooms and training facilities can impact an entire season.

“A lot of different microbes can cause problems when you have a large number of people in close contact and in close quarters,” said Deverick Anderson, M.D., an infectious disease specialist and director of the Duke Infection Control Outreach Network (DICON) Program for Infection Prevention in the NFL. “In a place like a school classroom, flu and other bugs spread easily, but when you also have the kind of physical contact inherent in football, infections can be even more contagious.”

Anderson also points out that professional football players have the additional hazard of frequent cuts and scrapes to their skin, providing ready entry for pathogens either through direct, person-to-person contact or via a contaminated environment.  

To help teams keep infections to a minimum and players at their best, DICON has worked with the NFL and the NFL Players Association to develop a comprehensive reference manual for infection prevention, taking into account the highly contagious dynamics within a professional football team environment. 

The manual has been distributed to all 32 NFL teams in advance of the upcoming season, and members of the DICON team are currently meeting with team doctors and trainers to talk through optimal implementation of its content. 

"The health and safety of our players is paramount,” said Jeff Miller, NFL senior vice president of health and safety policy. “We rely on the leading experts and protocols to provide our players the best possible care. DICON offers that in infectious disease prevention and protection.”

As an educational tool, the manual outlines best practices and recommendations to prevent the outbreak and spread of influenza, fungal infections, stomach bugs, methicillin-resistant Staphylococcus aureus (MRSA) and other illnesses that can sideline even the heartiest of players. 

“At its core, the foundation for this manual is based on the approach that athletic training facilities are med¬ical facilities,” Anderson said. “Many of the same infection prevention practices and recommendations related to medical care in hospitals and outpatient clinics are applicable guides for infection prevention in athletic training facilities.”

DICON has nearly two decades of experience providing infection control information and technologies, primarily in the health care sector, but also to sports teams and leagues. Formed in 1997, the Duke-based network was established to provide community hospitals and ambulatory surgical centers access to sophisticated data analysis and metrics, convenient and prompt access to experts in infection control, and the tools to share successful infection control programs and processes. DICON’s goal is to improve patient care by reducing rates of hospital-acquired infections and by minimizing the costs associated with hospital- and community-acquired infections.

"The NFL Players Association understands the critical role of controlling infections in our players,” said Thom Mayer, M.D., medical director of the NFL Players Association. “At a time when emerging infections are increasing in importance, we are fortunate to have the resources from the Duke Infection Control Outreach Network to prospectively lead our efforts to minimize their impact in the NFL.”

The manual targets players, team trainers and doctors for training to increase awareness and knowledge about infection control. It also outlines dozens of strategies that could be used to decrease the risk of infection, such as:

• Encouraging frequent hand washing and providing ample wash or hand disinfectant gel stations; 
• Mandating post-practice showers to reduce player-to-player bacterial transmission;
• Discouraging cosmetic body shaving, which creates a ready environment for infection;
• Adhering to skin preparation and antibiotic guidelines to prevent surgical site infections;
• Developing policies that promote and make available flu and other vaccinations, and identifying and treating contagious illnesses early and aggressively;
• Establishing strong wound care and healing protocols, including in showers and hydrotherapy pools;
• Using tiered contingency plans for single cases or clusters of illnesses and infections, including MRSA;
• Increasing education, infection prevention policies and infection control procedures when MRSA and diarrheal infections are identified.

“These are best practices and recommendations, but it’s up to the teams to implement,” Duke’s Anderson said. “They are really intended to educate teams about improving and increasing the quality of care across the board.”

Anderson said he and other key members of DICON are involved in the site visits to the 32 teams, and many teams are already implementing the manual.

“The Colts organization takes pride in maintaining a sanitary facility and it continues to be one of our top priorities,” said Dave Hammer, head athletic trainer for the Indianapolis Colts. “DICON helped us identify areas to improve in our strong infection control plan to make it even more robust. We’re always committed to learning best practices and DICON was instrumental in raising the standard we had already set here to keep our team healthy. It is great to have independent science at our disposal to properly address infection issues.”