1. Chapter 8: Bloodborne Pathogens, Universal Precautions, and Wound Care

2. Healthcare facility must be maintained as clean and sterile to prevent spread of disease and infection
Must take precautions to minimize risk
Coaches must be aware of potential dangers associated with exposure to blood or other infectious materials
Must take whatever measures to prevent contamination

3. Bloodborne Pathogens
Pathogenic organisms, present in human blood and other fluids (cerebrospinal fluid, semen, vaginal secretion, and synovial fluid), can potentially cause disease
Most significant pathogens are HBV and HIV
Others that exist are hepatitis A, C, D, and syphilis

4. Hepatitis B
Major cause of viral infection, resulting in swelling, soreness, loss of normal liver function
Signs and symptoms
Flu-like symptoms include 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

5. 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

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

7. Human Immunodeficiency Virus
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

8. 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)

9. Acquired Immunodeficiency Syndrome (AIDS)
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

10. 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

11. 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

12. Bloodborne Pathogens in Athletics
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
Martial arts, wrestling, boxing

13. Policy Regulation
Athletes are subject to procedures and policies relative to transmission of bloodborne pathogen
A number of sport professional organizations have established policies to prevent transmission
Organizations have also developed educational programs concerning prevention, and medical assistance

14. Institutions should take responsibility to educate student athletes
At high school level, parents should also be educated
Make athletes aware that greatest risk is involved in off-field activities
Athletic trainer should take responsibility of educating and informing student athletic trainers of exposure and control policies
Institutions should implement policies concerning bloodborne pathogens
Follow universal precautions mandated by OSHA

15. HIV and Athletic Participation
No definitive answer as to whether asymptomatic HIV carriers should participate in sport
Bodily fluid contact should be avoided
Avoid exhaustive exercise that may lead to susceptibility to infection
American with Disabilities Act says athletes infected cannot be discriminated against and may only be excluded with medically sound basis
Must be based on objective medical evidence and must take into consideration risk to patient and other participants, and means to reduce risk

16. Testing Athletes for HIV
Should not be used as screening tool
Mandatory testing may not be allowed due to legal reasons
Testing should be secondary to education
Athletes engaged in risky behavior should undergo voluntary anonymous testing for HIV
Multiple tests are available to test for antibodies for HIV proteins

17. Detectable antibodies may appear from 3 month to 1 year following exposure
Testing should occur at 6 weeks, 3 months, and 1 year
Many states have enacted laws that protect confidentiality of HIV infected person
Athletic trainer should be familiar with state laws, and maintain confidentiality and anonymity of testing

18. Universal Precautions in Athletic Environment
OSHA (Occupational Safety and Health Administration) established standards for employer to follow that govern occupational exposure to blood-borne pathogens
Developed to protect healthcare provider and patient
All sports programs should have exposure control plan
Include counseling, education, volunteer testing, and management of bodily fluids

19. Preparing the Athlete When Bleeding Occurs
Prior to participation, all open wounds and lesions should be covered with dressing that will not allow for transmission
Occlusive dressing lessens chance of cross-contamination
Hyrdrocolloid dressing is considered a superior barrier
Reduces chance that wound will reopen, as wound stays moist and pliable
When Bleeding Occurs
Athletes with active bleeding must be removed from participation and returned when deemed safe
Bloody uniform must be removed or cleaned to remove infectivity

20. Personal Precautions
Those in direct contact must use appropriate equipment including
Latex gloves, gowns, aprons, masks and shields, eye protection, disposable mouthpieces for resuscitation
Emergency kits should contain, gloves, resuscitation masks, and towelettes for cleaning skin surfaces
Doubling gloves is suggested with severe bleeding and use of sharp instruments
Extreme care must be used with glove removal
Hands and skin surfaces coming into contact with blood and fluids should be washed immediately with soap and water (antigermicidal agent)
Hands should be washed between patients

21. Availability of Supplies and Equipment
Must also have chlorine bleach, antiseptics, proper receptacles for soiled equipment and uniforms, wound care equipment, and sharps container
Biohazard warning labels should be affixed to containers for regulated waste, refrigerators containing blood and containers used to ship potentially infectious material
Labels are fluorescent orange or red
Red bags or containers should be used for potentially infectious material

22. Disinfectant
Contaminated surfaces should be clean immediately with solution of 1:10 ratio approved disinfectant to water
Should inactivate HIV
Contaminated towels should be bagged, labeled, and separated from other soiled laundry, then transported in biohazard container
Wash in hot water (159.8 degrees F for 25 minutes)
Laundry done outside institution should be OSHA-certified
Sharps
Needles, razorblades, and scalpels
Use extreme care in handling and disposing all sharps
Do not recap, bend needles, or remove from syringe
Scissors and tweezers should be sterilized and disinfected regularly

23. Protecting the Coach and Athletic Trainer
OSHA guidelines are designed to protect coaches, athletic trainers, and other employees.
Coaches generally do not come into contact with blood and therefore risk is greatly reduced
Responsibility of institution to protect athletic trainer
Provide necessary supplies and education
Athletic trainer and coach have personal responsibility to follow guidelines

25. Protecting the Athlete From Exposure
Use mouthpieces in high-risk sports
Shower immediately after practice or competition
Athletes exposed to HIV or HBV should be evaluated and immunized against HBV

26. Post-exposure Procedures
Athletic trainer should have confidential medical evaluation that documents exposure route, identification of source/individual, blood test, counseling and evaluation of reported illness
Laws that pertain to reporting and notification of results relative to confidentiality vary from state to state

27. Caring for Skin Wounds Skin wounds are extremely common in sports
Soft pliable nature of skin makes it susceptible to injury
Numerous mechanical forces can result in trauma
Friction, scrapping, pressure, tearing, cutting and penetration

28. Types of wounds Abrasions Laceration Incision
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
Incision
Wounds with smooth edges

29. Puncture wounds Avulsion wounds
Can easily occur during activity and can be fatal
Penetration of tissue can result in introduction of tetanus bacillus to bloodstream
All severe lacerations and puncture wounds should be referred to a physician
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

30. Immediate Care Should be cared for immediately
All wounds should be treated as though they have been contaminated with microorganisms
To minimize infection, clean wound with copious amounts of soap, water, and sterile solution
Avoid hydrogen peroxide and bacterial solutions initially

31. Dressing Sterile dressing should be applied to keep wound clean
Occlusive dressings are extremely effective in minimizing scarring
Antibacterial ointments are effective in limiting bacterial growth and preventing wound from sticking to dressing
Utilization of hydrogen peroxide can occur several times daily before reapplication of ointment

32. Are sutures necessary?
Deep lacerations, incisions, and occasionally punctures will require some form of manual closure
Decision should be made by a physician
Sutures should be used within 12 hours
Area of injury and limitations of blood supply for healing will determine materials used for closure
Physician may decide wound does not require sutures and utilize steri-strips or butterfly bandages

33. Signs of Wound Infection
Same as those for inflammation
Pain
Heat
Redness
Swelling
Disordered function
Pus may form due to accumulation of WBC’s
Fever may develop as immune system fights bacterial infection

34. Tetanus
Bacterial infection that may cause fever and convulsions and possibly tonic skeletal muscle spasm for non-immunized athletes
Tetanus bacillus enters wound as spore and acts on motor end plate of CNS
Following childhood vaccination, boosters should be supplied once ever 10 years
If not immunized, athlete should receive tetanus immune globulin (Heper-Tet) immediately following skin wound