Download Chapter 14: Bloodborne Pathogens

Chapter 8: Bloodborne
Pathogens, Universal Precautions
and Wound Care
© 2007 McGraw-Hill Higher Education. All rights reserved.
• 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
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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 Hepatitis B, C
and HIV
• Others that exist are hepatitis A, D, E and
syphilis
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Hepatitis B
• 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
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– 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
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• Prevention (cont.)
– Three dose vaccination over 6 months
– Post-exposure vaccination is also available after
coming into contact with blood or fluids
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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 © 2007 McGraw-Hill Higher Education. All rights reserved.
• 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
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• 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
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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
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• 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)
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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 HIC cannot predict when
the individual will show symptoms of AIDS
• After contracting AIDS, people generally
die w/in 2 years of symptoms developing
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• 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
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• 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
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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
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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
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• 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
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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
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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
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• 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
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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
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• 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
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• 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
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• 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
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– 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
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• Protecting the Caregiver
– 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 and other staff
• Provide necessary supplies and education
– All staff have personal responsibility to follow
guidelines and to enforce them
© 2007 McGraw-Hill Higher Education. All rights reserved.
© 2007 McGraw-Hill Higher Education. All rights reserved.
• 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
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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
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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
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• 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
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– 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
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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
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© 2007 McGraw-Hill Higher Education. All rights reserved.
• 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
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• 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
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• 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
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• Most wound infections can be treated with
antibiotics
• Staphylococcus aureus has become resistant
to some antibiotics
– Methicillin-resistant staphylococcus aureus
(MRSA) is more difficult to treat and infection
is extremely difficult to treat
– If cause of infection is not discovered early and
improper antibiotics are used initially infection
that starts in skin could spread into more
serious infection
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• 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 (HyperTET) immediately
following skin wound
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