General strategies for prevention of illness in your team

Transcription

1 General strategies for prevention of illness in your team Nick Webborn Clinical Professor (Sport & Exercise Medicine) Centre for Sport and Exercise Science and Medicine (SESAME) University of Brighton, UK

2 Incidence of Illness Illness proportion (%) Illness rate (/1000 athlete days) Summer Olympics Summer Paralympics Winter Paralympics Winter Olympics Illness proportion (%) 7 15,1 17,4 8 Illness rate (/1000 athlete days) 5,2 13,2 18,7 5

3 Clinically diag osed i fectio s are ge era y reported as the most commo cause of acute i ess, ith i fectio bei g the cause of respiratory tract i ess i about 75% of cases Schwellnus M, Soligard T, Alonso J-M, et al. Br J Sports Med 2016;50:

4 Illness Prevention Key Issues Address Major Risks all athletes URTI Gastrointestinal infection Parasport Urinary Tract Infection Skin breakdown & Infection Residual Limb & Insensate Areas

5 Focus for Discussion Hand Hygiene

6 Hand Hygiene Mid 1800s - First evidence using antiseptic between patient contacts reduces infection transmission better than handwashing with soap and water. 1843: Wendell Holmes - reports spread of puerperal fever by unwashed doctors 1847: Ignaz Semmelweis insisted that students and physicians clean their hands with a chlorine solution between each patient in the clinic. The maternal mortality rate reduced from 18% to almost 1%

7 Infection Control - Prevention Hand hygiene good practices are the mainstay of minimising spread of infection. Hand washing helps but some products have residual activity i.e. the effect lasts for a few hours after application e.g. Alcohol Gels, First Defence hand foam, Byotrol - Active for 8 hours Encourage regular use and make available to athletes and staff

8 Hand Hygiene Availability individual and at locations dining hall, accommodation medical room. Need to be sure that Consider Fomites Inanimate objects that become contaminated with pathogenic microorganisms Pre-prepared wipes - for the cleaning or disinfection of low risk equipment and the near-patient environment. Medics are not Spreading infection in Non-clinical settings

9 Athlete Education Discuss infection prevention strategy and importance of hand hygiene. Discuss need for sports equipment to be cleaned on a regular basis. Discourage sharing towels, athletic gear, water bottles, disposable razors etc. Are athletes with open wounds, scrapes, or scratches banned from whirlpools, ice baths and common tubs? Encourage athletes to report all abrasions, cuts, and skin lesions to and seek attention

10 Athlete Education Sleep - essential to recovery and immune health Diet - diet rich in fruit, vegetables and healthy fats to ensure a plentiful intake of micronutrients. Vitamin D3 and vitamin C supplements may help prevent colds Consider taking zinc supplement while you have a cold Probiotics

11 Prevention - Probiotics May Reduce Infection in Athletes Study of the effects of a probiotic supplement during 4 mo of winter training in men and women engaged in endurancebased physical activities on incidence of upper respiratorytract infections (URTIs) and immune markers The proportion of subjects on placebo who experienced 1 or more weeks with URTI symptoms was 36% higher than those on Probiotics Saliva IgA concentration was higher on probiotics than placebo Gleeson M., et al (2011) Daily probiotic (Lactobacillus casei Shirota) reduces infection incidence in athletes. International Journal of Sport Nutrition & Exercise Metabolism 21: 55-64

12 Probiotics: Effects on URTI and Illness - Meta-analyses Fewer URTIs Shorter Duration Severity Unchanged

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14 Proposed mechanisms for reducing illness in gastrointestinal and respiratory tract Direct interaction with the gut microbiota Promotion of the integrity of the intestinal mucosa Interaction with the mucosal immune system Immune signalling to a variety of organs and systems including the liver, brain and respiratory tract

15 Practical issues for athletes considering the use of probiotic supplementation Published in: David B. Pyne; Nicholas P. West; Amanda J. Cox; Allan W. Cripps; Europea Jour a of Sport Scie ce 2015, 15,

16 Practical issues for athletes considering the use of probiotic supplementation Take a daily dose of probiotic containing Lactobacillus and/or Bifidobacterium species containing at least ~10 10 live bacteria Probably better than multi-strain probiotics as different strains can produce different effects which may oppose each other. Take the probiotic in the morning with breakfast. Probiotics may need to be taken for several weeks before positive health effects can be expected Published in: David B. Pyne; Nicholas P. West; Amanda J. Cox; Allan W. Cripps; Europea Jour a of Sport Scie ce 2015, 15,

17 Infection Risks Environment - Close proximity living Room Apartment Village Dining Transport Sports Venue The other team! limb

18 Infection Control Limitation Monitor good hygiene practices Early detection - encourage reporting of symptoms Consider early use of First Defence nasal spray or zinc lozenges (>75 mg zinc/day) for cold symptoms Team Specific Infection Control Policy document

19 Infection Control Policy Isolate ill athletes Set aside room in village Infection control monitoring RTP protocol Neck check

20 STD Prevention

21 Urinary Tract Infection Commonest cause of disab i g (time loss) infection in SCI athletes Hero to Zero in hours Education Hydration Hand hygiene

22 Urinary Tract Infection

23 Infection Early Detection UTI Athletes susceptible to urinary tract infections will be offered dipstick testing on entry to camp and village and if positive sent for culture. Early intervention with correct antibiotics

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25 Concept of Marginal Gains Can it work in medical care of the athlete? Sir David Brailsford, British Cycling : The whole principle came from the idea that if you broke down everything you could think of that goes into riding a bike, and then improved it by 1%, you will get a significant increase when you put them all together

26 Illness at the London 2012 Paralympic Games and country clusters: Total athletes = X X

27 Illness at the London 2012 Paralympic Games and country clusters: Respiratory illness/1000 athlete days Southern Africa Asia South America Europe North Africa North America GB

28 Thank you for your attention