1. Chapter 14: Bloodborne Pathogens

2. Bloodborne pathogens are transmitted through contact with blood or other bodily fluids Hepatitis, especially hepatitis B, human immunodeficiency virus are of serious concern Healthcare facility must be maintained as clean and sterile to prevent spread of disease and infection Must take precautions to minimize risk

3. Virus Reproduction Submicroscopic parasitic organism is dependent on nutrients of cell Strand of DNA or RNA dependent on metabolic and reproductive activity of cell Redirect cell activity to create more viruses

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

5. Hepatitis A –Common in children and results from poor hygiene (food preparers that don’t wash hands) –Transmitted through unprotected sex Hep B, C, D are most common in adults and require contact with bodily fluids Hepatitis C is relatively rare and similar to hepatitis B Hepatitis D occurs due to complications with B Liver damage is more severe with B and C than with A and D

6. Hepatitis B Major cause of viral infection, resulting in swelling, soreness, loss of normal liver function New cases develop at a rate of 300,000/year 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

7. –Chronic active hepatitis may occur because of problem with immune system, preventing complete destruction of virus infected liver cells –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

8. Management –Vaccination against HBV should be provided by employer to those who may be exposed –Athletic trainers and allied health professionals should be vaccinated –Three dose vaccination over 6 months –After second does 87% will be vaccinated and 96% after the third dose –Post-exposure vaccination is also available after coming into contact with blood or fluids

9. Human Immunodeficiency Virus A retrovirus that combines with host cell Infects T 4 blood cells, B cells and monocytes (macrophages) Estimated that 1 out of 250 people are infected with HIV 40,000-50,000 new cases each year 10 to 12 million adults carry the virus

10. 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)

11. AIDS Collection of signs and symptoms that are recognized as the effects of an infection No protection against the simplest infection Positive test for HIC cannot predict when the individual will show symptoms of AIDS 50% develop AIDS w/in 10 years of HIV infection After contracting AIDS, people generally die w/in 2 years of symptoms developing

12. 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 Drug which blocks enzyme action responsible for new virus cell components Drug which blocks copying of viral agents, disabling synthesis of new viruses Third drug helps protect T cells, slowing progression of HIV

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. Detectable antibodies may appear from 3 month to 1 year following exposure –Testing should occur at 6 weeks, 3 months, and 1 year –Home test kits are also available which allow you to send blood work to lab for analysis Home Access test is FDA approved Lab analyzes dried blood sample and labeled with personal identification number(PIN) Acquire results and counseling confidentially with PIN –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

20. Universal Precautions in Athletic Environment 1991 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

21. Preparing the Athlete –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

22. 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

23. 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 e 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

24. –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

25. 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 has personal responsibility to follow guidelines Minimize risks by not eating/drinking, applying cosmetics/lip balm, handling contact lenses, and touching face before washing hands in athletic training room

27. 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

28. 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