WASHINGTON - Sometimes the urge comes when he's spreading mulch or after handling an egg. Other times it's a small cut that sends him to the sink; handling raw meat gets him every time.
Brandon Noble, 40, works the lather and scrubs his skin, up to his elbows sometimes, and eventually he shuts off the water. He invariably returns, the water running again, some perceived stain on his arms or hands but definitely one in his mind, some days standing there 10 or 15 times.
"I feel like I need to wash my hands," said Noble, a former Washington Redskins defensive tackle. "I need to do it."
Ten years ago, Noble completed his sixth NFL season, starting seven games under Coach Joe Gibbs. Then in May 2005 he underwent offseason arthroscopic knee surgery, and at some point afterward, contracted methicillin-resistant Staphylococcus aureus, a bacterium commonly referred to as MRSA.
His was among the first high-profile cases in the NFL of a player contracting the persistent and potentially fatal skin infection. And while it remains unclear where Noble contracted the infection, he believes it ended his playing career.
Mysterious problem: Nearly a decade later NFL teams are still battling the mysterious problem. When MRSA breached the Redskins' locker room, beginning at the end of the 2004 season, Noble was one of between six and eight players to contract the infection in about two years, team physician Anthony Casolaro said.
Outbreaks in Washington and later in Cleveland raised alarm bells across the league, leading some teams - among them the Redskins - to launch full-on assaults against staph infections. Others weren't so aggressive, with league-wide prevention and response protocols not yet in place. Last season the Tampa Bay Buccaneers became the latest franchise to battle a persistent and resilient problem.
"The fear is another issue," Casolaro said, "but the bug itself is a tough bug."
Around this time last year, Noble read a familiar kind of story: The Bucs were scrambling to contain skin infections, including one confirmed case of MRSA. Kicker Lawrence Tynes was placed on the non-football injury list, preventing him from collecting service time and several benefits, and two more players were eventually had infections diagnosed.
Casolaro said the Redskins questioned Bucs officials before an Aug. 29 preseason game between the two teams at Raymond James Stadium, and six weeks later an Oct. 13 Tampa Bay game against the Philadelphia Eagles was considered for postponement. After the Bucs visited the Georgia Dome to play the Atlanta Falcons, photographs circulated of a cleaning crew in full hazmat suits, disinfecting the visitors' locker room.
Unreasonable worry: Matthew Matava, the St. Louis Rams' team physician and president of the NFL Physicians Society, said in a telephone interview that hype and unreasonable worry are primary symptoms of skin infections, particularly when they involve NFL teams.
Matava had a close view in 2003 when the Rams had their own outbreak. He said the team brought in representatives from the Centers for Disease Control to analyze surfaces, review antibiotic records and examine susceptibility for St. Louis players. The locker room and other facilities were fumigated, Matava said, and posters were hung to show players what an infection looks like. For more than a decade, he said, the Rams have been infection-free.
"The media's reaction and the public's relation is, you have to do something," said Matava, who, in an interview arranged by the NFL league office, reiterated several times that MRSA is not the widespread threat, particularly in today's NFL locker room, it is often made out to be.
When Noble and several other Redskins players contracted MRSA during the 2005 season, one of the first reactions was mystery.
Even now, Noble said he has no idea whether he became infected at Redskins Park, the Charlotte, N.C., hospital where he had undergone offseason knee surgery, or at some point in between. Casolaro said it is "assumed" Noble contracted the infection from outside team property. "The most frustrating thing is, everybody just points the finger at everybody else," Noble said.
He said a quarter-sized hot spot appeared near his incision the morning after stitches were removed in the Redskins' training room, and from there the infection spread. He said he spent seven days in the hospital, and after that leg was free from infection, a few months later the other leg became infected. He retired from the NFL after the 2005 season, not long after the second bout with MRSA.
Never again: Once Washington's outbreak was behind it, the team's response was simple: Never again.
Casolaro said all surfaces where players congregate at Redskins Park were replaced with those that won't hold onto germs: the locker room, training room, training tables. "When I came back in," Noble said of his return to the team facility after the first infection, "I had people with Lysol chasing me around."
Next the locker room's community benches were removed; in front of each locker was a player's own stool. The facilities were sprayed with anti-staph material, Casolaro said, and showers and ultraviolet lights were installed next to therapy tubs. Players were reminded to take showers after practices and workouts. An intern was assigned to prevent players from using the same towel during games, scooping up the cloths after someone else wiped his face or arms with them.
Now, Casolaro said, "you can't walk 10 feet" without finding a dispenser for disinfecting solution, and each player, coach, trainer and staff member is checked before the season. "We know we're starting training camp with a clean slate," he said, adding that the team is similarly vigilant about the cleanliness of its training camp facilities in Richmond.
Maybe the Redskins overreacted, too, but Noble said that given his own experience, it at least showed a commitment. "He basically said: 'Hey, fix this,' " Noble said, referring to team owner Daniel Snyder.
It's largely unknown how Tampa Bay responded to last year's ordeal. A Bucs spokesman pointed only toward changes in the front office and coaching staff, along with the team bringing in representatives from Duke University's Infection Control Outreach Network to discuss policies and suggest new protocols. He didn't respond to a request for additional information.
Moving on: Two of the three players who contracted infections last year have moved on from the team - and perhaps their own NFL careers. Tynes, who missed the 2013 season with a skin infection and has said he believes he contracted it at the Bucs' team facility, was released in March and is not currently on a NFL roster. Carl Nicks, a Pro Bowl guard, parted ways with the team last month and was awarded an injury settlement worth a reported $3 million. A statement announcing Nicks's release quoted him as saying he would "step away from the game." Johnthan Banks, a cornerback, is still with the team.
A grievance filed against the Bucs on behalf of Tynes by the NFL Players Association remains outstanding, and questions lingered through the offseason about how quickly former Bucs Coach Greg Schiano responded to the first infection, along with the lack of consistency on how teams handle infectious diseases.
"The union was sufficiently concerned about the varying standards across different teams and the incidents not just in Tampa Bay but other teams in recent years," said George Atallah, the union's assistant executive director of external affairs. "To the league's credit, they have been working with us."
Through that recent collaboration, this season will include a new Infectious Disease Prevention Program, a partnership with the Duke network, which will standardize how NFL teams educate players and their families on hygiene and potential diseases, along with installing league-wide cleaning protocols and a unified response plan toward preventing infections, including MRSA.
As for Noble, he said he regrets that his NFL career ended as it did, though he has moved on. He has worked in coaching and is now a scout for a recruiting service. Mostly, though, he works in his yard outside Philadelphia, prepares meals for his daughter and two sons, and never wanders too far from the antibacterial soap and disinfectant - something one of his sons even jokes about.
"He thinks I'm crazy," Noble said. "But I've got the scars."