Artificial Field Turf vs. Natural Grass Safety

MRSA Infection & Heat Stress Risks on Synthetic Turf Football Fields

Sep 28, 2008 Carla Marie Boulianne

Artificial turf sports fields connected to recent MRSA outbreaks and heat strokes on high school and college football teams raise sports safety concerns.

While players on artificial grass may know of an increased risk of turf toe and other muscle and ligament injuries, synthetic surfaces present additional health risks. MRSA infections and temperature-related injuries such as exertional heat illness and heat stroke are serious medical issues of primary interest.

Synthetic Field Turf Versus Natural Grass Infection Risks- MRSA Links

MRSA is a potentially fatal Staphylococcus infection that cannot be treated with conventional antibiotics due to evolved drug resistance. A number of highly publicized methicillin-resistant Staphylococcus aureus (MRSA) infections implicate artificial grass as a risk factor. Investigation of an outbreak of MRSA on a college football team found that there was a seven-fold increase in risk of infection for players who had received abrasions playing on artificial turf [Beiger 2004]. Cosmetic body shaving was an additional risk factor.

While a manufactured product such as synthetic turf may seem sterile compared to natural grass, MRSA is viable on polypropylene fibers for 20 to more than 90 days in a hospital setting [Neely and Maley 2000].

A more direct study by Andrew McNitt examined microbial populations in synthetic turf sand and rubber infill and found prolific bacterial populations living in the fill. Although the sample size was too small to detect the presence or absence of S. aureus, the research demonstrates microbes alive and well on turf. As a result, artificial field turf manufacturers frequently include disinfection in product bids and maintenance contracts.

Artificial Field Turf Versus Natural Grass Fields- Heat Stress Injuries

Artificial turf can reach high surface temperatures in sunny conditions [Williams and Pulley 2002]. During June 2002, the average air temperature was 81.5 degrees Fahrenheit, but the average surface temperature on Brigham Young University synthetic turf fields was more than 117 degrees. The average high on turf was 156-157 degrees Fahrenheit, but researchers measured a turf surface temperature of 200 degrees on a 98-degree day. By comparison, average concrete temperatures were only 94 degrees and natural grass averaged 78 degrees.

Higher turf temperatures not only impact playability, but cause heat stress injuries [Meyers and Barnhill 2004]. Cooling fields with water adds additional installation and maintenance costs. Unfortunately, Williams and Pulley found that a 174-degree field cooled to 85 degrees with sprinklers returned to 120 degrees after only five minutes.

Playing on Artificial Field Turf Sports Surfaces- Precautions Prevent MRSA Infection

While artificial grass sports fields may offer advantages in playability and maintenance, synthetic sports surfaces present a distinct set of injury and health concerns. Sports teams can avoid turf-related MRSA infections by:

• Regularly disinfecting turf surfaces
• Disinfecting even minor abrasions

Turf burn abrasions present opportunities for entry of infectious organisms like MRSA. Regular disinfection of artificial turf and extra care cleansing seemingly minor scrapes can reduce player risks for MRSA and other severe infections.

Playing on Synthetic Grass Sports Surfaces - Avoiding Heat Stress Injury with Proper Planning

High surface temperatures reduce playability, raise water costs, and increase the risks of potentially fatal heat stress injuries. According to a recent survey of heat injury prevention practices [Luke, et al. 2007], football teams can avoid heat stress injuries by:

• Ensuring proper hydration
• Allowing equipment modifications
• Changing practice schedules
• Monitoring turf temperatures
• Cooling turf when necessary

Players on synthetic sporting surfaces need to pay particular attention to hydration issues and allow frequent water breaks. Football teams practicing on artificial turf may need to alter equipment requirements by removing pads or helmets on hot days. Changing practice schedules to early morning can ensure player safety in high temperatures. Field managers safeguard players by properly monitoring turf temperatures and cooling fields when necessary.

References:

Begier, EM et al. “A high-morbidity outbreak of methicillin-resistant Staphylococcus aureus among players on a college football team, facilitated by cosmetic body shaving and turf burns.” Clin infect Dis. Nov 15, 2004; 39(10):1446-53. Epub Oct 26 2004.

Luke AC, Bergeron MF, Roberts WO. “Heat injury prevention practices in high school football.” Clin J Sport Med, Nov 2007;17(6):488-93.

McNitt, AS. “A survey of microbial populations in infilled synthetic turf fields.” Epub available at http://cropsoil.psu.edu/mcnitt/microbial/index.cfm.

Meyers MC, Barnhill BS. “Incidence, causes, and severity of high school football injuries on FieldTurf versus natural grass: a 5 year prospective study.” Am J of Sports Medicine. Oct-Nov 2004; 32(7):1626-38.

Neely AN and Maley MP. “Survival of enterococci and staphylococci on hospital fabrics and plastic.” J Clinical Microbiol Feb 2000; 38(2): 724-726.

Williams CF and Pulley GE. “Synthetic Surface Heat Studies.” Brigham Young University, 2002. Epub available at http://cahe.nmsu.edu/programs/turf/documents/brigham-young-study.pdf.

The copyright of the article Artificial Field Turf vs. Natural Grass Safety in Sports Medicine is owned by Carla Marie Boulianne. Permission to republish Artificial Field Turf vs. Natural Grass Safety in print or online must be granted by the author in writing.

Turf Linked to MRSA Among Athletes

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Sep 29, 2008 5:07 AM

Guest :

While all bio-related infectious disease are, in fact, able to survive in the crumb rubber infill of synthetic turf fields, any study, or report with results, would be incomplete if it were not to include the alternative choices. There are but two methods that will prevent infections, treat the field once every two weeks with an anti-microbial topical liquid, or use Organite infill with the original installation. Organite is the only virtually permanently coated anti-microbial infill. It prevents the existence of infectious disease, such as MRSA and staph, but only on fields where it is the only infill, no crumb rubber, no rubber and sand mix. Details – www.targapro.com

Sep 29, 2008 8:05 AM

Carla Marie Boulianne :

Although your comment includes a promo, I'll allow it because this opens an excellent line of discussion. My professional background is actually in the evolution of infectious diseases.

Microbes are skilled at evolving resistance to antimicrobials. Why do we have drug-resistant strains like MRSA? These strains evolve due to the overuse of antibiotics and antimicrobials. The scary thing from a health safety standpoint is that once these mechanisms of resistance evolve, they often transfer to other microbes and combine with other resistance mechanisms, creating "superbugs."

Unless you can provide peer-reviewed data with excellent study design showing that none of the microbes commonly found in fill can evolve resistance to the antimicrobial in Organite, then there is no way I could recommend such a product. It only adds to the problem of drug-resistant bacteria.

Is the antimicrobial in Organite a Triclosan-like compound? If so, there is already research showing evolution of resistance and transfer to other micro-organisms. In general, anti-microbials and antibiotics should be used sparingly and for as short a time as necessary. Anytime you put an antimicrobial in long-term contact with microbes, you are creating optimal conditions for resistance evolution. Humankind then loses one more weapon in our arsenal against infectious disease.

From a purely scientific standpoint, periodic treatment with a disinfectant is preferable. Short exposures hold lower risk for evolution of resistance. Resistant bacteria often have a reproducive fitness disadvantage. With short term exposure, resistant bacteria still preferentially survive. With periodic application, these resistant strains just don't reach predominence in the bacterial population. Resistant strains lose their reproductive advantage when there is no antimicrobial present and more benign strains dominate. Constant contact with antimicrobials means that resistant strains will always have the reproductive advantage.

The goal should not be a sterile field, it should be a SAFE field.

Sep 29, 2008 3:27 PM

Guest :

Hold on a minute!

This biased report fails to see the truth. In fact, McNitt's report points out that natural grass has 259,500 CFU's while the highest found in turf was 80,000.

McNitt also published a report that stated "New Penn State Study Debunks Staph Bacteria Scare In Synthetic Turf"

More details can be found here: http://aginfo.psu.edu/News/2006/8/Staph.htm

To be blunt, there HAS NEVER been a link between artificial turf and MRSA.

When it comes to player injuries, the Barnhill report (which is cited) contains facts about the REDUCTION of injuries on artificial turf!

Sep 29, 2008 5:06 PM

Carla Marie Boulianne :

The press release for McNitt's work did state that his research debunked the MRSA scare. Numerous sources have criticized the referenced report. It does not reflect his data or that his study design was grossly insufficient to detect the presence (or absence) of S. aureus. The reality is that McNitt's work still hasn't passed the muster of a peer-reviewed journal.

You are accurate in stating that natural turf harbors a greater CFU and diversity of microbes than turf. This article only states that McNitt's work found microbial populations thriving on synthetic surfaces and in no way implies that microbes are not also found in natural turf.

One problem with turf is that abrasive characteristics increase the likelihood that any microbes present will contaminate an injury. The Meyers and Barnhill study did detect a significantly higher rate of turf burn injuries. Using antimicrobials to clean turf also raises the specter that microbes contaminating a wound would have a greater likelihood of being resistant strains. While the antimicrobials used for disinfection are generally not medically important, unfortunately many types of resistance are borne on bacterial plasmids. Selecting for resistance to one antimicrobial can unintentionally increase the prevalence of resistance to medically important drugs.

Contrary to your assertion, turf has been clearly linked to MRSA infections in Beiger's peer-reviewed research.

As for Meyers and Barnhill's work, it is not as simple as you state. The rate of injuries was found to be higher on synthetic turf, but certain severe injuries occurred with less frequency than on grass. Read my article on artificial turf vs natural grass injuries for more detail.

I apologize for any appearance of bias. Unlike the guest selling Organite, I have no vested interest in promoting natural grass over turf or vice versa. There is genuine interest in the links between artificial turf, infections, and heat stress injuries. I'm just reporting the research with as little spin as possible.

My unbiased research of these topics was recently commissioned by a school board. Their decision is irrelevant, as turf is the best choice in certain circumstances while grass is best in others. Rest assured, the board was sufficiently confident that my final report was unbiased.

Discussing issues of concern and solutions (disinfect turf and wounds; stay hydrated and cool fields) needn't be construed as an anti-turf stance.

Sep 29, 2008 5:50 PM

Carla Marie Boulianne :

Quoted from the abstract for the Meyers and Barnhill research:

"Higher incidences of 0-day time loss injuries, noncontact injuries, surface/epidermal injuries, muscle-related trauma, and injuries during higher temperatures were reported on FieldTurf. Higher incidences of 1- to 2-day time loss injuries, 22+ days time loss injuries, head and neural trauma, and ligament injuries were reported on natural grass."

A close reading of the results shows that in all broad injury categories except the most severe, injury incidences were higher on FieldTurf than on natural grass. Multivariate analysis uncovered the statistically significant differences in specific injury types and time loss that are quoted above.

The only injury rates pertinent to this article are surface/epidermal injuries and those related to high temperatures. In both cases, FieldTurf had higher incidences of injury. Only the heat-related injury rates are referenced.

The superior safety of artificial turf as related to head and neural trauma is outside the scope of the stated topics- turf safety as related to MRSA and heat stress. The article does not attempt to address turf safety as related to traumatic sports injuries. Readers will find that information in a separate article.

For those interested, the Meyers and Barnhill abstract can be reviewed at http://ajs.sagepub.com/cgi/content/abstract/32/7/1626.

Sep 30, 2008 4:51 AM

Guest :

http://www.postgazette.com/pg/07292/826788-100.stm

No MRSA found in tests at Mt. Lebanon High stadium

Friday, October 19, 2007
By Mary Niederberger, Pittsburgh Post-Gazette

Tests conducted by the Allegheny County Health Department have shown that there is no staph bacteria in the turf or the field house facilities at Mt. Lebanon High School stadium.

Health Department Spokesman Guillermo Cole said today that all 13 samples taken yesterday came back negative for any type of staph germs, including those that cause the drug resistant MRSA infections that have been confirmed in 10 students at Mt. Lebanon High School, including nine football players.

Mr. Cole said 13 samples were taken in all, with eight coming from the field and five from the indoor facilities, including the locker rooms, weight room and training room.

"The fact that all of the results came back as rapidly as they did is a testament to how clean things are," Mr. Cole said. "They support what we believed all along -- that the field is an unlikely source of staph."

Mr. Cole said the test results should allay the fears that any parents may have had about the turf and support the department's contention that it is safe for the Mt. Lebanon varsity football team to host the Bethel Park team tonight on the turf.

"We had given it a clean bill of health even before this," Mr. Cole said. "We believed all along that the field is an unlikely source of staph."

The infections diagnosed among the football players and another student athlete are methicillin-resistant staphylococcus aureus, or MRSA, infections. They don't respond to the antibiotics that are prescribed for most other types of infections.

Mt. Lebanon is among 17 school districts in the county reporting MRSA infections among students this year.

Bethel Park High School Principal Zeb Jansante this week sent a letter home to football players, cheerleaders and marching band members explaining that Mt. Lebanon's field has been cleared for use and recommending that all players cover any exposed skin since the infections are spread by skin-to-skin contact.

Dr. Jansante's letter said plans call for the Bethel Park team to dress for the game in the Bethel Park facilities and to shower there after the game as well. In addition, he said the Bethel Park district plans to wipe down and sanitize the buses after the game.

Sep 30, 2008 4:59 AM

Guest :

Here is the abtract to the Begier report:

BACKGROUND: Athletics-associated methicillin-resistant Staphylococcus aureus (MRSA) infections have become a high-profile national problem with substantial morbidity. METHODS: To investigate an MRSA outbreak involving a college football team, we conducted a retrospective cohort study of all 100 players. A case was defined as MRSA cellulitis or skin abscess diagnosed during the period of 6 August (the start of football camp) through 1 October 2003. RESULTS: We identified 10 case patients (2 of whom were hospitalized). The 6 available wound isolates had indistinguishable pulsed-field gel electrophoresis patterns (MRSA strain USA300) and carried the Panton-Valentine leukocidin toxin gene, as determined by polymerase chain reaction. On univariate analysis, infection was associated (P<.05) with player position (relative risk [RR], 17.5 and 11.7 for cornerbacks and wide receivers, respectively), abrasions from artificial grass (i.e., "turf burns"; RR, 7.2), and body shaving (RR, 6.1). Cornerbacks and wide receivers were a subpopulation with frequent direct person-to-person contact with each other during scrimmage play and drills. Three of 4 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 > or =2 times per week (RR, 12.2; 95% confidence interval, 1.4-109.2). Whirlpool water was disinfected with dilute povidone-iodine only and remained unchanged between uses. CONCLUSIONS: MRSA was likely spread predominantly during practice play, with skin breaks facilitating infection. Measures to minimize skin breaks among athletes should be considered, including prevention of turf burns and education regarding the risks of cosmetic body shaving. MRSA-contaminated pool water may have contributed to infections at covered sites, but small numbers limit the strength of this conclusion. Nevertheless, appropriate whirlpool disinfection methods should be promoted among athletic trainers.

What is it really saying? Limit turf burns. They report does not say that turf is a breeding ground for staph. OPEN WOUNDS are the problem and they can happen in any sport, on any playing surface!

Sep 30, 2008 5:12 AM

Guest :

Another great link to review when discussing turf safety:
http://www.bhsfieldofdreams.org/pdf/TurfFieldResearch.pdf

In this report, Jay H. Williams, Ph.D. of the Department of Human Nutrition, Foods and Exercise at Virginia Tech compares natural grass to artificial turf.

The conclusion?

Based on the available evidence, it appears that the potential and risk for injury is not increased for athletes
playing on 3rd generation artificial turf fields compared to grass fields. The potential for head or lower limb
injury is low and similar between turf and grass fields. Research indicates that the newer surfaces do not increase
injury risk for football or soccer players. In fact, some studies raise the possibility that the risk of some
types of injury might actually be reduced by using the new FieldTurf type surfaces. Clearly the new surfaces
are softer, provide more “give” than the older AstroTurf fields and may reduce the stress placed on the knee and
ankle.

Sep 30, 2008 7:36 AM

Carla Marie Boulianne :

Thank you for the great links. Here are a few observations:

http://www.postgazette.com/pg/07292/826788-100.stm
This is not a peer-reviewed study, but rather the results from 13 samples from a locker room and field. It appears the health department did this to alleviate parent fears. Eight samples were taken from the field. It says nothing about the sample sizes.

Read http://www.athleticturf.net/athleticturf/article/articleDetail.jsp?id=37240 5&ref=25
for a discussion of the importance of sample size when trying to disprove the presence of an organism. This was a criticism of McNitt's study.

"The study attempts to draw conclusions about which type of bacteria do or do not exist based on a sample of 0.00000000058% of the infill on the field and 2 of 33 billion fibers. This is hardly representative. In fact, a 1% infill sample would have required the analysis of 3,628,720 grams (8,000 lbs) of crumb rubber per field and 330,000,000 fibers per field, not 2.With a sample so insignificant, to declare that MRSA cannot grow on these fields is an improbable conclusion. This method would be the equivalent of determining that no sharks live in the ocean because you looked underwater once and saw fish… but no sharks."

The current research does show that third generation turf reduces some of the most severe injuries. The research also shows compression characteristics changing over time. It will be interesting to see how these fields perform as they age. Spots on 3rd generation outdoor fields can become just as hard as older foam-based fields. See my article on turf injuries for sources.

It is accurate to say that the concern with MRSA is open wounds. Looking for S. aureus on a field and finding none is a distraction from the true concern. Beiger found a 7.2-fold increased risk of MRSA infections in players with abrasions sustained on turf. Players with cosmetic body shaving had a 6.1-fold increase in risk. The point is that abrasions increase risk of infection. Whether the MRSA inoculates the wound sustained on the field while in the locker room, gym, or whirlpool does not change the fact that playing on turf increases risk of infection. The solution is sterilizing and covering wounds immediately and maintaining precautions until healed, thus preventing wound contamination and infection.

Sep 30, 2008 7:42 AM

Carla Marie Boulianne :

It is of interest that the Mt. Lebanon High School samples were taken after a MRSA outbreak involving 9 football players. It would be very odd to not find any S. aureus in a locker room, as it is a common microbe living in most peoples' noses. The fact that no benign strains of S. aureus were found suggests that these samples were taken post-sterilization following the outbreak or that sample sizes were insufficient. S. aureus is easy to find and benign strains should be expected in a public space.

Oct 1, 2008 12:22 PM

Guest :

You go, girl! Thank you Carla, for the great information and research.

Oct 31, 2008 12:59 AM

Guest :

I am not a microbiologist. However, I can read. When I review research from the CDC and other related sites, it is very evident that MRSA and staph in general can and DO survive for significant amounts of time on surfaces from towels to polyester to polyurethane (56 days in one source and over 90 days in another).
I have not conducted specific studies of turf, but I have been told that 3 of 8 samples taken from fields have shown staph. This does not mean it is always found in turf fields, but it does show that the situation does allow this to happen. We have to remember if there is food, moisture, adequate temperature, etc., staph can grow and survive.
Hospitals and medical facilities all preach to society that staph and MRSA can be prevented with proper hygiene, cleanliness of locker rooms, no sharing of personal equipment or clothes, proper use of athletic equipment, proper showering after activity, avoiding use of community whirlpools with open wounds, etc. Do we really think that by washing hands we can adequately prevent passing staph from person to person?
In no way am I saying that synthetic turf is causing the problem we are facing today with staph and MRSA infections. Turf is another source of contact where germs can be passed, and thus transferred to other persons.
The health care community has a responsibility to use products which are effective and used properly to disinfect surfaces. Further, there are products today which can be further utilized to treat surfaces and provide a dynamic antimicrobial protection for months. This technology has been expanded to synthetic turf products, and should assist in the minimization of secondary transfer of microbes.

Nov 1, 2009 10:46 PM

Guest :

I do not recomment Synthetic Turf. They required me to use the services of their trained Distributor, Aaron Hernandez. He proved to me that he could not do the job properly by doing things such as gluing mismatched nap together, and cutting too much away exposing dirt where weeds could grow, not to mention not showing up when he said he would. I sent in photos to Synthetic Turf. They agreed the job was not being done right, but they would do nothing since they said their Agreement was only with him. I feel this is deceptive and I have spent $15000 and they won't make this job right. Because of them I ended up using him. Beware.

Nov 1, 2009 10:46 PM

Guest :

I do not recomment Synthetic Turf. They required me to use the services of their trained Distributor, Aaron Hernandez. He proved to me that he could not do the job properly by doing things such as gluing mismatched nap together, and cutting too much away exposing dirt where weeds could grow, not to mention not showing up when he said he would. I sent in photos to Synthetic Turf. They agreed the job was not being done right, but they would do nothing since they said their Agreement was only with him. I feel this is deceptive and I have spent $15000 and they won't make this job right. Because of them I ended up using him. Beware.

14 Comments