2.  Healthcare facility must be maintained as clean and sterile to prevent spread of disease and infection  Must take precautions to minimize risk

3. DEFINITION: Pathogenic organisms, present in human blood and other fluids that can potentially cause disease  3 Most significant pathogens are: ◦ Hepatitis B ◦ Hepatitis C ◦ HIV

4. Use the links on moodle to learn more about the 3 most significant bloodborne pathogens.  Fill in the blanks on your guided notes as you read through the websites  Use the heading on the websites to guide your research  For HIV/AIDS Information- you will need to click along the menu on the left side of the screen

5.  Major cause of viral infection, resulting in swelling, soreness, loss of normal liver function  Signs and symptoms ◦ Flu-like symptoms like fatigue, weakness, nausea, abdominal pain, headache, fever, and possibly jaundice ◦ Possible that individual will not exhibit signs and symptoms -- antigen always present ◦ Can be unknowingly transferred

6. ◦ May test positive for antigen w/in 2-6 weeks of symptom development ◦ 85% recover within 6-8 weeks  Prevention ◦ Good personal hygiene and avoiding high risk activities ◦ Proceed with caution as HBV can survive in blood and fluids, in dried blood and on contaminated surfaces for at least 1 week ◦ Vaccination against HBV should be provided by employer to those who may be exposed ◦ Athletic trainers and allied health professionals should be vaccinated

7.  Prevention (cont.) ◦ Three dose vaccination over 6 months ◦ Post-exposure vaccination is also available after coming into contact with blood or fluids

8.  Both an acute and chronic form of liver disease caused by hepatitis C virus (HCV)  Most common chronic bloodborne infection in United States  Leading indication for liver transplant  Signs & Symptoms ◦ 80% of those infected have no S&S ◦ May be jaundice, have mild abdominal pain, loss of appetite, nausea, fatigue, muscle/joint pain, and/or dark urine

9.  Prevention ◦ Occasionally spread through sexual contact ◦ Spread via contact with blood of infected person, sharing needles, or sharing items that may carry blood (razors, toothbrush) ◦ Consider the risks of getting a tattoo or body piercing ◦ ATC should always follow routine barrier precautions

10.  Management ◦ No vaccine for preventing HCV ◦ Multiple tests available to check for HCV  Single positive = infection  Single negative = does not necessarily mean no infection ◦ Interferon and ribavirin are 2 drugs used in combination and appear to be the most effective for treatment ◦ Drinking alcohol can make liver disease worse

11.  A retrovirus that combines with host cell  Virus that has potential to destroy immune system  According to World Health Organization 42 million people were living with HIV/AIDS in 2002

12.  Symptoms and Signs ◦ Transmitted by infected blood or other fluids ◦ Fatigue, weight loss, muscle or joint pain, painful or swollen glands, night sweats and fever ◦ Antibodies can be detected in blood tests within 1 year of exposure ◦ May go for 8-10 years before signs and symptoms develop ◦ Most that acquire HIV will develop acquired immunodeficiency syndrome (AIDS)

13.  Collection of signs and symptoms that are recognized as the effects of an infection  No protection against the simplest infection  Positive test for HIV cannot predict when the individual will show symptoms of AIDS  After contracting AIDS, people generally die w/in 2 years of symptoms developing

14.  Management ◦ No vaccine for HIV, no cure even though drug therapy is available ◦ Research looking for preventive vaccine and effective treatment ◦ Most effective drug combination  Antiviral drug cocktail  Slows replication of virus, improving prospects for survival

15.  Prevention ◦ Greatest risk is through intimate sexual contact with infected partner ◦ Choose non-promiscuous sex partners and use condoms for vaginal or anal intercourse ◦ Latex condom provides barrier against HBV and HIV ◦ Condoms with reservoir tip reduces chance of ejaculate being released from sides ◦ Water-based, greaseless spermicides or lubricants should be avoided ◦ If condom breaks, vaginal spermicide should be used immediately ◦ Condom should be carefully removed and discarded

16.  Chance of transmitting HIV among athletes is low  Minimal risk of on-field transmission  Some sports have potentially higher risk for transmission because of close contact and exposure to bodily fluids ◦ Higher-risk sports:  Martial arts  Wrestling  Boxing

17.  DEFINITION: treat all human blood and certain human body fluids as if they were known to be infectious with a bloodborne pathogen ◦ Wear gloves when touching any body fluid!  OSHA (Occupational Safety and Health Administration) ◦ Organization that develops universal precaution guidelines to protect the healthcare provider and patient

18.  Watch this. Watch this.

19.  Preparing the Athlete for practice/game ◦ Must cover all wounds ◦ Keep the demands of the sport in mind  When Bleeding Occurs ◦ Athlete must be removed from participation and returned when deemed safe ◦ Bloody uniform must be removed or cleaned to remove blood  HYDROGEN PEROXIDE makes a great blood remover!!!

20.  Personal Precautions for Healthcare Workers ◦ One-time use nonlatex gloves should be used in treating the athlete!  Extreme care must be used with glove removal ◦ Other types of protective equipment (in first-aid kit)  Masks  Eye protection  Mouthpieces for CPR ◦ Hands and all skin surfaces that come in contact with blood should be washed immediately  Soap and water OR hand sanitizer!

21.  Availability of Supplies and Equipment  Designated containers for sharps  Needles, razor blades, scalpels  Biohazard warning labels  Labels are fluorescent orange or red  Red bags or containers should be used for potentially infectious material  Disinfectant  Contaminated surfaces should be cleaned immediately with solution of 1:10 ratio approved disinfectant to water  HIV, Hepatitis B and Hepatitis C can live on surfaces for anywhere from hours to days!

22.  Protecting the Athlete From Exposure ◦ Use mouthpieces in high-risk sport ◦ Shower immediately after practice or competition ◦ Athletes exposed should be evaluated and immunized (if applicable)

23.  Skin wounds are extremely common in sports  Numerous mechanical forces can result in trauma ◦ Friction, scraping, pressure, tearing, cutting and penetration

24. ◦ Abrasions  Skin scraped against rough surface  Top layer of skin wears away exposing numerous capillaries  Often involves exposure to dirt and foreign materials = increased risk for infection ◦ Laceration  Sharp or pointed object tears tissues – results in wound with jagged edges  May also result in tissue avulsion

25. ◦ Incision  Wound with smooth edges

26. ◦ Puncture wounds  Can easily occur during activity and can be fatal  Penetration of tissue can result in introduction of tetanus bacillus to bloodstream ◦ Avulsion wounds  Skin is torn from body = major bleeding  Place avulsed tissue in moist gauze (saline), plastic bag and immerse in cold water  Take to hospital for reattachment

27. Types of Wounds  A: Abrasion  B: Laceration  C: Puncture Wound  D. Incision  E. Avulsion

28.  Arterial ◦ Serious, Bright Red, Spurting ◦ Watch this. WARNING- LOTS OF BLOOD! Watch this.  Venous ◦ Dark Red, Steady Flow  Capillary ◦ Slow, Oozing, Higher Risk of infection

29. 1. Direct pressure ◦ Pressure on wound with gauze ◦ Do not remove if blood comes through – add more gauze 2. Elevation ◦ Elevate above heart if possible – slows bleeding ◦ Continue pressure 3. Pressure points ◦ apply pressure to an artery to decrease blood flow to an area ◦ Brachial artery (upper arm) ◦ Femoral artery (top of thigh)

31.  Immediate Care: ◦ Use UNIVERSAL PRECAUTIONS: All wounds should be treated as though they have been contaminated with bloodborne pathogens  First step should ALWAYS be to put on gloves! ◦ To minimize infection clean wound with copious amounts of soap, water and sterile solution

32.  Dressing ◦ Sterile dressing ◦ Antibacterial ointments are effective in limiting bacterial growth and preventing wound from sticking to dressing

33.  Are sutures (stiches) necessary? ◦ Deep lacerations, incisions and occasionally punctures ◦ May be needed if the wound edges cannot be easily pushed back together ◦ Decision should be made by a physician ◦ Sutures should be used within 12 hours ◦ Can use steri-strips if stiches are not required

34.  Signs of Wound Infection ◦ Same as those for inflammation  Pain  Heat  Redness  Swelling  Disordered function ◦ Pus may form due to accumulation of white blood cells ◦ Fever may develop as immune system fights bacterial infection

35.  Infections that start in the skin may spread to cause more serious infections ◦ Tetanus: bacterial infection causing fever and convulsions  Most wound infections can be treated with antibiotics  Staphylococcus aureus has become resistant to some antibiotics ◦ Methicillin-resistant staphylococcus aureus (MRSA) is more difficult and infections can become more severe

36. 1.Make sure all instruments used, such as scissors, tweezers, and swabs are sterilized 2.Wash hands thoroughly and put on nonlatex gloves 3.Clean a skin lesion using soap and water 4.Place a nonmedicated dressing on lesion if the athlete is being sent for medical attention 5.Avoid touching parts of a sterile dressing that will come in contact with the wound 6.Place medication on a pad rather than directly on the skin 7.Secure the dressing with tape or a wrap