Wrestling Coach Skin Protection Guidelines By John Stawinski, MA, ATC

Wrestling With Skin Issues

John Stawinski, MA, ATC

Basic skin lesion prevention methods for the Wrestling Coach:

In 2014 Vermont had the most reported cases of Herpes Gladiatorum(26), per wrestler, than has ever been reported in in any state across the USA. Naive, until last year, we considered our wrestlers relatively “safe” from serious skin issues. Now we must aggressively move forward to protect our athletes as best as we can and prevent any serious outbreaks in the future. After much research, including direct communication with some of the foremost experts of skin lesions in the wrestling community, this recommendation was developed.

The following is a comprehensive guide designed to decrease the risk of contracting or spreading of skin lesions. Not all skin issues will be prevented, even when following this guide, however significant science and common sense show that these guidelines will be effective in decreasing the prevalence of skin lesions.

A school’s sports medicine staff is responsible for educating everyone involved regarding infection-control policies and procedures. This includes coaches, athletes, parents, custodial staff and doctors as needed. Outlines are provided individually for: Coaches, Athlete/Parents, ATC’s, and MD’s.

Wrestler Hygiene

Shower immediately after every practice.
Use Nizoral shampoo 1-2x/week. (Slows or stops the spread of Ringworm, doesn’t cure it)
Do not share towels, bar soap, razors, nail clippers, athletic gear or water bottles.
Athletes should refrain from body shaving.
Nails should be kept trimmed to avoid scratching teammates which creates an avenue for infection.
Any clothing that a wrestler’s unwashed body comes in contact with must be considered “dirty”.

Clothing and Gear

All clothing and wrestling gear is “dirty” after each practice

Soiled “dirty” clothing, including practice gear, undergarments, outerwear, and uniforms, must be laundered on a daily basis.
If you choose not to shower at school, wash all clothes you wear home immediately after arriving home.
Store practice clothes in a plastic bag after changing, do not let them come in direct contact with your gym bag or backpack. Anything coming in contact with your practice clothes, gear or your unwashed body must also be washed.
Equipment, including head gear, knee sleeves, ankle braces wrestling shoes, etc, should be disinfected daily in the manufacturer’s recommended manner.

*If clean athletic gear is dumped into a dirty laundry bag or gym bag, the gear immediately becomes “dirty” and should be cleaned properly.

Practice Room Hygiene

Clean mats and walls prior to each practice with a disinfectant approved by the EPA. Follow this link for a complete list of approved agents: www.epa.gov/oppad001/list_h_mrsa_vre.pdf.
Put wrestling shoes on in the practice room, this will eliminate one of the leading means of fungus entering the wrestling room. Grit brought in from outside the practice room is a contributor to abrasions and the transport of fungus.

–Do not leave the practice room with your wrestling shoes on, removing shoes or using booties (skins) is recommended. Having a few sizes available for when an athlete has to go to the bathroom will work.

-Another option if there will be traffic in and out of the room is to use a towel as a floor mat, soaked with cleaning solution, to wipe off shoes upon entry.

Also have water on hand in the room to decrease the frequency of needing to leave the room.

Meet/Tournament Mat Hygiene

Mats should be disinfected prior to each event, practice or competition, with a disinfectant approved by the EPA. Follow this link for a complete list of approved agents: www.epa.gov/oppad001/list_h_mrsa_vre.pdf.
Re-clean the mats after warm-ups on tournament days.
Re-clean the mats during each tournament break.
Require wrestlers to cover or remove shoes when leaving matside.
Each team should produce skin lesion forms PRIOR to weigh-ins. No coach shall produce this form after weigh-ins or matside, this is too late.

*Wrestling programs should invest in equipment made to clean mats quickly so events are not delayed by the cleaning process.

Skin Checks/Protocol

Remind athletes of protocol regularly
Each team’s coach should perform skin checks daily.
ATC’s should perform skin checks weekly and/or day prior to competition.
Any athlete with a suspicious lesion should be kept OUT of the wrestling room until seen and cleared by a medical professional.
Keep a bottle of hand sanitizer readily available to use after contact with wrestlers at events.

*Infected athletes practicing without a partner, in the wrestling room, during practice may spread infectious germs to the mat, which can subsequently infect another wrestler.

Skin Checks at Competitive Events

The number one emphasis in this year’s NFHS wrestling rules meeting was clarifying the skin check rule for referees and coaches.”The referee shall perform the skin checks or verify that the designated, on-site meet appropriate health-care professional has performed the skin checks.”

-For rule:

http://www.nfhs.org/sports-resource-content/wrestling-rules-changes-2015-16/

-To see a fuller elaboration of the skin check rule: http://www.nfhs.org/sports-resource-content/wrestling-points-of-emphasis-2015-16/

Skin checks should be performed by a medical professional, trained in recognizing skin lesions, during weigh-ins at every event.
Skin lesion form should be collected by the meet/tournament director prior to weigh-ins.
The current (2015) skin form should be used, signed by MD and given to ATC prior to weigh-in.

–https://www.vpaonline.org/cms/lib/VT08001199/Centricity/Domain/13/2015-16%20%20NFHS%20Wrestling%20Skin%20Lesion%20Form.pdf

Skin checks should be performed on each day of competition, including each day of multi-day tournaments.
If weigh-ins are prior to the day of competition, skin checks should still occur on each day of competition.

*Alternate model worth noting: Wisconsin requires MD’s to perform skin checks 3 days prior to every competition.

Reporting lesions to medical staff

Bacteria, virus and fungus occur on the skin naturally. It is when there is a disruption of the skin that they typically propagate and cause an infection. Any disruption of the skin is an avenue to infection.

Athletes should report all abrasions, cuts, and skin lesions to an ATC for proper cleansing, treatment, and dressing. All acute, uninfected wounds (eg, abrasions, blisters, lacerations) should be covered with a semi-occlusive or occlusive dressing (eg, film, foam, hydrogel, or hydrocolloid) until healing is complete to prevent contamination from infected lesions, items, or surfaces.

Medical Requirements/Considerations

Each team should have a go-to medical clinic and/or dermatologist who is specifically trained in skin issues of wrestlers
If a wrestler goes to another physician, a handout accompanying the athlete with a recommended protocol for testing of skin diseases should be followed in addition to the NFHS form.
The current (2015) skin form should reviewed and completed by the athlete’s doctor when referring an athlete for evaluation and treatment- http://www.nfhs.org/media/882323/2015-16-nfhs-wrestling-skin-lesion-form-april-2015-final.pdf
All completed skin lesion forms must be given to ATC prior to weigh-ins
Athletes with a history of herpes outbreaks should be put on suppressive therapy during the wrestling season. Protocol is 800mg of acyclovir daily.
Athletes should also consider prophylactic treatment if they seem susceptible to recurrences of ringworm.
Proper treatment of ringworm- multiple lesions or lesions on the scalp require oral antibiotics. Singular lesions, not on scalp may be treated with ointment.
Diagnoses of MRSA warrants culture of all wrestlers in contact with the infected wrestler. Skin and nose cultures recommended *Many skin infections develop a secondary infection of another type. This was how the VT herpes outbreak spread so easily. Most lesions were initially diagnosed as ringworm, later, after treatment was ineffective, herpes was tested for and confirmed.
It is critical that a herpes culture be performed with any suspicious lesion.
Virtually every skin lesion should improve by the third day of treatment. If no improvement occurs within 2-3 days, return to your doctor for a re-eval.
Don’t blow-off “minor” types of skin injuries because these breaks in the skin open the pathway for all types of infection.

*Remind athletes of protocol regularly

Outbreaks of a skin lesion

In instances of an outbreak of herpes in any wrestler, the recommended course of action is to keep ALL wrestlers from direct contact with ANY OTHER wrestler for eight days. This time period will allow for 90% of incubating cases to erupt and be identified, thereby preventing the disease from being spread to other wrestlers.
If multiple outbreaks occur on multiple teams, the state organization should require cancellation of practices and competition for eight days statewide.

Resources for further reading: