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Mat Hygiene

by | Oct 2, 2022 | Hygiene, Mat Funk

Freshly cleaned mats at Paragon in Ventura, CA

Mat Hygiene

Oct 2, 2022 | Hygiene, Mat Funk | 2 comments

Written by Anthony Walls, MD

So far the mat funk series has delved into a couple of the most common skin infections seen in combat sports and with each the recurrent theme has been the importance of prevention. I am frequently asked about best hygiene measures for prevention of gym acquired infections and so the next two articles in the mat funk series will take a look at what medical science says and doesn’t say in regard to this. When approaching infection prevention measures it’s important to understand there are two sides to the proverbial sword. One side is what we can do as individuals to reduce our own personal risk of infection and the other is what a gym can collectively do to help prevent infections in the team as a whole. In the gym setting this practically translates to what we do to take care of ourselves and what rules or policies a gym follows in order to take care of the entire team. This article will focus on the second point, and we will discuss individual prevention next month.

While the published scientific and medical literature on infection prevention in combat sports is not as robust as other topics with more life-threatening outcomes (e.g. prevention of hospital acquired infections), there are some decent studies we can use to guide our gyms’ hygiene practices and policies. Admittedly, this article is a bit more dense than the others have been, so for the high yield summary of recommended gym hygiene practices and how much evidence there is to back them up refer to Figure 1. If you’re strapped on time, this figure should suffice. But if you want to understand more, read on!

Figure 1 Recommended gym hygiene practices organized by their level of scientific evidence.

Figure 1 Summary of recommended interventions and their level of evidence

Continue Reading: 10min Read

Do mats actually transmit infection?

When an inanimate object transmits an infectious agent to someone, that object is termed a fomite. So do mats act as fomites? The short answer is, yes, most likely. I say most likely because believe it or not, the answer to this question has not been definitively proven in a rigorously designed study. Also, the reality is aside from the mat there are many other fomites that exist in a gym setting (bathrooms, weights, ropes, towels, etc). There’s plenty of evidence to show that live microorganisms can exist on mats and the amount of them does go up when used.2,3,4,5 Also, there is excellent evidence that fomites in other environments (e.g. towels in a household or surfaces/devices at a healthcare facility or a prison) can and do transmit infections.6,7,8,9,10 But whether the amount of microorganism from a mat has ever been enough to cause an infection has technically not been shown and thus we in the medical community infer based on the above data that they can and do transmit infectious disease. Additionally, the answer also probably depends on the organism. While the data is a bit more convincing that mat transmission can occur with staph aureus it is a bit weaker for the fungi causing ringworm.3,11 In short, based off the most up-to-date data we have, it does appear mats likely can act as a fomite, but despite receiving most of the attention and blame it’s important to remember they’re not the only source of infection in a gym and that we humans are the more frequently documented source of gym infection outbreaks.12,13

Does cleaning the mats prevent infection?
Again, the answer to this question is yes, most likely. As I have already alluded to, there has not been a study that follows a gym or multiple gyms over time and randomizes them to a control versus various cleaning methods and/or agents and then documents actual clinical infections as the outcome. I have to admit, the scientist inside of me is getting a bit inspired just thinking about the design of such a study, but I digress and so I’ll stop geeking out. What can be said for sure is that disinfecting the mats does decrease microorganism colonies, or load.2 Additionally data from both hospital and nursing home settings show that implementation of cleaning protocols for the fomites in their respective environments do actually reduce rates of infections for their patients. 6,8 Therefore, by strong logical inference, keeping a gym clean and the shared equipment disinfected after use likely will help prevent infections.
Does cleaning frequency matter?
To this I’d answer probably. There was very limited data in answering this question. In fact there was only one study that remotely was close to answering this question and it only involved looking at one infection, ringworm. In this study of eight high school wrestling teams in Pennsylvania over one wrestling season, there was not a significant difference in ringworm infections between teams who cleaned their mats daily and the one team that only cleaned their mats monthly.11 That said, based on what is known about the microbiology of bacteria like staph compared to that of the fungi that cause ringworm, it’s VERY possible the story would be different regarding bacterial infections. In fact this is supported by a study at a 2013 college wrestling tournament that measured the bacterial load on mats after cleaning them just before the start of the tournament and then hourly throughout the tournament. The study definitively proved bacterial load on mats significantly increases with just two hours of use and so it just makes logical sense until proven otherwise that cleaning mats after each use is the best practice to follow.2

What’s the Best Disinfectant?

Before answering this question, it’s important for a gym to not only choose a disinfectant that is good at killing microorganisms, but it should also be good at not harming humans. The safety of disinfectants to humans is beyond the scope of this article, but it behooves me as a physician to point a gym to the MSDS information on disinfectant ingredients to ensure the short and long term safety for the team. Back to the topic at hand, while no study has tested whether disinfecting gym equipment actually decreases rates of human infections there is one study to date that has done some pretty impressive mat work. Linda Young from Ohio Northern University and her group have been the only ones I know of to compare various mat cleaning solutions in actual practice and tournament settings. Figure 2 was adapted from data in their report and shows the differences in amount of bacteria that was able to be grown from mats that were cleaned with different solutions during a 2014 college wrestling tournament, thus the lower the bar in the graph the better the cleaner. It should be noted that their outcome was limited to the amount of bacteria that could be recovered from the mat as well as the wrestlers before and after grappling, and not the amount of actual skin infections that occurred. However, the fact that they reported on commonly used disinfectants known to kill all types of microorganisms in a petri-dish allows us to logically infer which ones may be better than others at preventing infections.1 Therefore it’s safe to say that agents with residual activity (antimicrobial activity lasting for hours after application) are likely better than those without residual activity. Also it’s probably wise not to use rubbing alcohol alone as a mat cleaner. 2,14

Figure 2 Colony counts of bacteria recovered on mats after use when various disinfectants were used. Adapted from Young et al 2017.
Figure 2 Bacterial Count vs Disinfectant Type. Adapted with permission from Young et al 2017.
Does mopping technique make a difference?
Yes, it does. Aside from comparing various disinfectants in a live mat setting, Young and her research group also were able to show that mopping backwards significantly reduces the occurrence of bacteria being collected and cultured off of mats than mopping forwards.2 Another study was able to show that microbial counts were reduced more after the disinfectant was sprayed on and then followed by a flat mop wipe compared to a using a string mop that is dipped into a bucket of the disinfectant and then spread over the mat. That same study also showed that both forms of mopping do not reduce microbial counts in the seams of the mats,15 thus likely an argument in favor for mat tape to be regularly used.
A paragoon showing excellent backward mopping skills!
Aside from the gym, what about cleaning us?
As I’ve alluded to before, mats seemed to have gotten the short end of the blame stick when the more common source of mat funk is us; but to be honest mat funk just sounds better than human funk, right??  Aside from the obvious of not rolling when we are sick, is there anything else we can do collectively to help prevent the spread of infections? You may roll at a gym that has people wash/sanitize their hands prior to stepping on the mat. If so, they’re on to something. Going back to that research group from Ohio, they have very impressive data over multiple wrestling practices and tournaments showing that both mats and wrestlers themselves end up with less bacteria on them after activity if wrestlers sanitize their hands prior to stepping on the mat compared to not doing so as well as compared to doing a foot bath prior. Figure 4 shows the bacterial load on three different mats that were identically cleaned with 10% bleach but one had the wrestlers do nothing, one had them do a 10% bleach foot bath, and the other had them use an ethanol-based hand sanitizer prior to stepping on the mat.2 So in short, having a hand washing/sanitizing policy in place at a gym will significantly reduce infections more than just keeping the mats clean.
Figure 3 Colony counts of bacteria recovered on mats after use when the only difference was what the wrestlers did prior to stepping on the mat. Adapted from Young et al 2017.
Figure 3 Bacterial Count vs Wrestlers’ Sanitizing Methods. Adapted with permission from Young et al 2017.
Other collective team interventions
While I’ve only touched on two infections so far in the mat funk series, one must not forget anything obtained on the mat while rolling can be lumped into this category. That includes organisms such as influenza, hepatitis b, SARS-CoV-2, Streptococcus pneumoniae, Hemophilus influenza to name a few of the many. Before I make my next point, please know that the purpose of these articles are to give you what medical science actually says. And since this article is about what a gym can collectively do as a team to prevent infections, it would be disingenuous if I didn’t mention vaccinations. When making the personal decision about vaccines it is important to know what the science has shown and continues to show. For the vast majority of people, vaccines are safe (in fact exponentially safer than getting the diseases they are protecting against) and effective at preventing serious disease from an infection both on an individual and collective group level.16,17,18,19 In regards to combat sports, one study, albeit small, even showed that an influenza vaccination policy of a college wrestling team in 2014 dropped influenza infection rate in the team from 40% prior to 2014 to 0%.2 Whether you choose to get vaccinated is up to you, but the reality is that they are safe and effective even for crud encountered on the mats.
Does one need to wash gear between each use?
Yes. Flat out yes. And to be fully honest I say that with no data I could find to support my answer. Believe it or not even in the hospital setting the question of whether clothing acts as a fomite is technically unanswered.20 This is just one of those common sense issues and as one of our black belts at Paragon says, part of being an adult. One more piece of advice handed down from the ages: soak your stuff in the wash with at least one cup of white vinegar for an hour or more before actually washing, if you can. Your team will thank you and you’ll probably get more people wanting to roll with you.

Conclusion

Conclusion
If you have stuck it out through this article, you may have some unanswered questions. For instance, is there any difference between lay people cleaning the gym versus a professional cleaning service doing it? What effect, if any, does the cleanliness of other areas in the gym (e.g. bathrooms/showers, locker rooms, etc) have on gym infection rates? Well, to my knowledge and after an extensive search, there are no studies to help answer these questions. More importantly, you may be asking the very valid question at this point of, “ok I understand what the gym and team can do to reduce infections overall, but what can I do personally to help reduce my chance of getting an infection?” If so you are ready to read the next article coming in the mat funk series which will be on best personal hygiene practices for the grappler. So make sure to subscribe to be notified when it drops so you can get answers to some of the questions many have asked me, like do the body wipes that are commercially available make any difference? How about the soaps marketed to grapplers that contain tea-tree oil, are they worth the investment?
More importantly however, this sport is both an individual and a team sport. I hope this article gives you and gyms in general a perspective on how we can care not just for ourselves, but for the health and success of our entire team. Let’s face it, time off the mat for any reason hurts the progress of both you and the team as a whole.

References

  1. Marples, R. R. Local infections – experimental aspects. J. Soc. Cosmet. Chem. Vol 27, No 10, Oct 1976, pp. 449-457. http://lib3.dss.go.th/fulltext/scan_ebook/j.of_society_1976_v27_n10.pdf
  2. Young LM, Motz VA, Markey ER, Young SC, Beaschler RE. Recommendations for Best Disinfectant Practices to Reduce the Spread of Infection via Wrestling Mats. J Athl Train. 2017 Feb;52(2):82-88. doi: 10.4085/1062-6050-52.1.02.
  3. Hedayati MT, Afshar P, Shokohi T, Aghili R. A study on tinea gladiatorum in young wrestlers and dermatophyte contamination of wrestling mats from Sari, Iran. Br J Sports Med. 2007 May;41(5):332-4. doi: 10.1136/bjsm.2006.030718.
  4. Shadzi S, Ataei B, Nokhodian Z, Daneshmand D. Dermatophytes contamination of wrestling mats in sport centers of Isfahan, Iran. Adv Biomed Res. 2014 Nov 29;3:241. doi: 10.4103/2277-9175.145747.
  5. Aghamirian MR, Ghiasian SA. A clinico-epidemiological study on tinea gladiatorum in Iranian wrestlers and mat contamination by dermatophytes. Mycoses. 2011 May;54(3):248-53. doi: 10.1111/j.1439-0507.2009.01809.x.
  6. Donskey CJ. Does improving surface cleaning and disinfection reduce health care-associated infections? Am J Infect Control. 2013 May;41(5 Suppl):S12-9. doi: 10.1016/j.ajic.2012.12.010.
  7. Knox J, Sullivan SB, Urena J, Miller M, Vavagiakis P, Shi Q, Uhlemann AC, Lowy FD. Association of Environmental Contamination in the Home With the Risk for Recurrent Community-Associated, Methicillin-Resistant Staphylococcus aureus Infection. JAMA Intern Med. 2016 Jun 1;176(6):807-15. doi: 10.1001/jamainternmed.2016.1500.
  8. Makris AT, Morgan L, Gaber DJ, Richter A, Rubino JR. Effect of a comprehensive infection control program on the incidence of infections in long-term care facilities. Am J Infect Control. 2000 Feb;28(1):3-7. doi: 10.1016/s0196-6553(00)90004-x.
  9. Miko BA, Herzig CT, Mukherjee DV, Befus M, Apa ZL, Bai RY, Lee CJ, Uhlemann AC, Larson EL, Lowy FD. Is environmental contamination associated with Staphylococcus aureus clinical infection in maximum security prisons? Infect Control Hosp Epidemiol. 2013 May;34(5):540-2. doi: 10.1086/670218.
  10. Mork RL, Hogan PG, Muenks CE, Boyle MG, Thompson RM, Sullivan ML, Morelli JJ, Seigel J, Orscheln RC, Bubeck Wardenburg J, Gehlert SJ, Burnham CD, Rzhetsky A, Fritz SA. Longitudinal, strain-specific Staphylococcus aureus introduction and transmission events in households of children with community-associated meticillin-resistant S aureus skin and soft tissue infection: a prospective cohort study. Lancet Infect Dis. 2020 Feb;20(2):188-198. doi: 10.1016/S1473-3099(19)30570-5.
  11. Kohl TD, Martin DC, Nemeth R, Evans DL. Wrestling mats: are they a source of ringworm infections? J Athl Train. 2000 Oct;35(4):427-30. PMID: 16558657.
  12. Kermani F, Moosazadeh M, Hosseini SA, Bandalizadeh Z, Barzegari S, Shokohi T. Tinea Gladiatorum and Dermatophyte Contamination Among Wrestlers and in Wrestling Halls: A Systematic Review and Meta-analysis. Curr Microbiol. 2020 Apr;77(4):602-611. doi: 10.1007/s00284-019-01816-3.
  13. Williams C, Wells J, Klein R, Sylvester T, Sunenshine R; Centers for Disease Control and Prevention (CDC). Notes from the field: outbreak of skin lesions among high school wrestlers–Arizona, 2014. MMWR Morb Mortal Wkly Rep. 2015 May 29;64(20):559-60. PMID: 26020140.
  14. Young, LM, B Kohls, A Davis, K Krynak, RE Beaschler H Dyer and VAMotz. 2018 Clean hands healthy wrestlers: Efficacy of hand cleaning in reducing bacterial load during wrestling competitions. Health Science Research. 5(2):43-49
  15. Greisberg, Max. Assessment of Disinfection Techniques for Decontaminating Athletic Mats. The Sport Journal, August 7, 2020. https://thesportjournal.org/article/assessment-of-disinfection-techniques-for-decontaminating-athletic-mats/
  16. Orenstein WA, Ahmed R. Simply put: Vaccination saves lives. Proc Natl Acad Sci U S A. 2017 Apr 18;114(16):4031-4033. doi: 10.1073/pnas.1704507114.
  17. Minozzi S, Lytras T, Gianola S, Gonzalez-Lorenzo M, Castellini G, Galli C, Cereda D, Bonovas S, Pariani E, Moja L. Comparative efficacy and safety of vaccines to prevent seasonal influenza: A systematic review and network meta-analysis. EClinicalMedicine. 2022 Mar 25;46:101331. doi: 10.1016/j.eclinm.2022.101331.
  18. Baden LR, et al. Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine. N Engl J Med. 2021 Feb 4;384(5):403-416. doi: 10.1056/NEJMoa2035389.
  19. Ridgway JP, Tideman S, French T, et al. Odds of Hospitalization for COVID-19 After 3 vs 2 Doses of mRNA COVID-19 Vaccine by Time Since Booster Dose. Published online September 23, 2022. doi:10.1001/jama.2022.17811
  20. McQueen, R.H., Ehnes, B.L. (2022). Antimicrobial Textiles and Infection Prevention—Clothes and Inanimate Environment. In: Bearman, G., Morgan, D.J., K. Murthy, R., Hota, S. (eds) Infection Prevention. Springer, Cham. https://doi.org/10.1007/978-3-030-98427-4_13
  21. Figures were created by author, if patients were involved they gave full written consent complying with HIPAA guidelines.

2 Comments

  1. JON SERRANO
    JON SERRANO on October 2, 2022 at 6:09 pm

    It’s interesting how little research there is on this topic despite wrestling being so common in college athletics. Thanks for the info

    Reply
    • Anthony Walls, MD
      Anthony Walls, MD on October 3, 2022 at 12:28 am

      Totally agreed Jon, I thought there would be a bit more. That said, it seems without wrestling’s popularity we wouldn’t have the research we do have as it is, so I guess I’m a bit grateful in that regard.

      Reply

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