Download What are bloodborne pathogens?

The Lecture Series in
Athletic Training and Sports Medicine
Jim Berry, MEd, ATC, SCAT/NREMT
Director of Sports Medicine
Head Athletic Trainer
Myrtle Beach High School
Myrtle Beach, South Carolina
© 2003
Sports Medicine
Unit 8, Part A
Blood Borne Pathogens
Chapter 8: Bloodborne
Pathogens, Universal Precautions
and Wound Care
• 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
What are bloodborne
pathogens?
• Bloodborne
pathogens are
pathogenic
microorganisms
that can
potentially
cause disease
What are bloodborne
pathogens?
• Bloodborne pathogens may be present in
any of the following…
–
–
–
–
–
–
Human blood
Semen
Vaginal secretions
Cerebrospinal fluid
Synovial fluid
Or any other fluid contaminated by blood
What are bloodborne
pathogens?
• The two most prominent
bloodborne pathogens are the
hepatitis B virus (HBV) and the
human immunodeficiency virus
(HIV)
• There are a number of other
bloodborne diseases that exist as
well, including…
– Hepatitis A, C, and D
– and syphilis
What are bloodborne
pathogens?
• Although HIV has been more widely
addressed in the media, HBV is
spread much more easily in the
population
• HBV is stronger and more durable
than HIV
– It can be spread more easily via sharp
objects, open wounds, or bodily fluids
when compared to HIV
Hepatitis B Virus
• HBV is a major cause of viral
infection that results in swelling,
soreness, and normal function of
the liver
• The number of cases of HBV in the
USA has risen dramatically in the
past 10 years
Signs of HBV
• A person infected with HBV will
exhibit the following signs and
symptoms…
– Flu like symptoms including…
• Fatigue
• Weakness
• Nausea
• Abdominal pain
• Headache
• Fever
• And possible jaundice
Signs of HBV
• It is possible that a person infected
with HBV will show no signs of the
illness
– In these individuals, the virus goes
undetected and is spread unknowingly
to others
• An infected person’s blood may test
positive for HBV within 2-6 weeks
after symptoms develop
• 85% of those infected, recover
within 6-8 weeks
Preventing HBV Infection
• Good personal
hygiene and
avoiding high risk
activities are the
best ways to avoid
HBV
• HBV can survive for
at least a week in
dried blood or on
contaminated
surfaces
Hepatitis C
• 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
• 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
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
Signs & Symptoms of HIV
• Symptoms of HIV include the following…
–
–
–
–
–
–
Fatigue
Weight loss
Muscle and/or joint pain
Painful or swollen glands
Night sweats
Fever
• HIV antibodies can be detected in the blood
within a year following exposure
AIDS
• AIDS is an acronym for Acquired
Immunodeficiency Syndrome
• A syndrome is a collection of
signs/symptoms that are recognized as
the effects of an infection
• A person with AIDS has little or no
protection against infections
– This makes them vulnerable to a host of
diseases and infections that can eventually
kill them
Prevention of HIV & AIDS
• The best means of
prevention is through
education
• ATCs should assist in
educating coaches
and athletes about
HIV, including
practicing safe sex
Dealing with bloodborne
pathogens in athletics
• In general the chance
of transmitting a
bloodborne
pathogen in athletics
is very low
• There is a minimal
risk of transmission
from one player to
another on the field
or court
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
• 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
Dealing with bloodborne
pathogens in athletics
• Studies have shown
that the chances of
transmission from
one player to another
are less than one in
one million games
– In fact, there have
been no documented
cases of transmission
so far in athletics
HIV and Athletic
Participation
• There is no definitive evidence as to whether or not
asymptomatic HIV carriers should participate in
sports
• Obviously bodily fluid contact should be avoided, but
there is no evidence that transmission can occur
through perspiration, etc.
• The ADA of 1991 states that athletes with HIV cannot
be discriminated against and must be allowed to
participate
– They may only be exclude because of legitimate medical
reasons that take into account the risk to the athlete, to other
athletes, and also considers what can be done to reduce those
risks
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
• 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 crosscontamination
• Hydrocolloid 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
• 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
Universal Precautions
• Supplies/Equipment
– In keeping with universal
precautions, the sports
program should have
appropriate
supplies/equipment
available to deal with
blood/body fluid spills
• At a minimum, all institutions
should have household bleach
or some other type of sanitizer
available
Universal Precautions
• Supplies/Equipment
– More appropriately a
training room should
have the following in
addition to bleach or
disinfectants:
• Antiseptics
• Sharps collectors
• Biohazard receptacle
• Wound care supplies
– Biohazard labels should
be affixed to all items
containing infectious
agents
Universal Precautions
• Disinfectants
– All contaminated surfaces, including the field,
court, mats, tables, counters, etc., should be
disinfected with a solution consisting of one part
bleach to ten parts water (1:10) or with a
disinfectant approved by the EPA and shown to
kill bloodborne pathogens
– Towels and other laundry that have been
contaminated should be bagged and washed
separately from other laundry
• Latex gloves should always be worn when placing soiled
laundry into washers
Universal Precautions
• Sharps
– Refers to any sharp object such as a needle, razor
blade, scalpels, etc
– Extreme care should be taken when dealing with
these items and they should be disposed of in a
sharps container when finished using them
– OSHA mandates that all sharps must be disposed
of in a leak proof/puncture proof container, which
must be incinerated when filled
– Needles and other sharps should NEVER be
recapped!!!
Summing up…
• All individuals involved in athletic activities
must be familiar with bloodborne pathogens
• All individuals involved with athletic activities
must be familiar with the established OSHA
guidelines for dealing with exposure to
bloodborne pathogens
• All individuals involved with athletic activities
should always use universal precautions
when dealing with blood or other body fluids
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
• Types of wounds
– 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
– Incision
• Wounds with smooth edges
– Puncture 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
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
• Dressing
– Sterile dressing should be applied to keep
wound clean
– Occlusive dressing 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
• 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