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B/c of the close physical contact that occurs through athletic participation, the potential for spread of infectious diseases among fitness, professionals, coaches, athletes, and sports medicine personnel is of major concern. Healthcare facility must be maintained as clean and sterile to prevent spread of disease and infection Must take precautions to minimize risk and prevent contaminations Must be aware of potential dangers associated with exposure to blood or other infectious materials Pathogenic organisms, present in human blood and other fluids, that can potentially cause disease 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 You don’t want to get the blood/fluid on you or in any opening (cuts, eyes, nose, mouth, etc) In the field…latex, vinyl, or other medical grade gloves will be what you need (most of the time…) The exception would be if blood is flying everywhere. You really need to wear goggles and/or an impervious gown. An exposure to someone’s blood who is positive with something that you really don’t want can haunt you for the rest of your life. Preparing the Athlete All open wounds and lesions should be covered with dressing that will not allow for transmission Occlusive dressing lessens chance of crosscontamination Hydrocolloid dressing reduces chance that wound will reopen, maintains moist and pliable wound When Bleeding Occurs Athletes must be removed from participation and returned when deemed safe Bloody uniform must be removed or cleaned Place all bloody items in a biohazard bag Personal Precautions Use appropriate equipment 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 Non-latex gloves can be used when long term exposure to blood and bodily fluids is not likely 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 (anti-germicidal agent) Hands should be washed between patients First, carefully pinch the flap on the underside of one of your wrists. Second, role that glove inside out, off of your hand. Put the glove in the palm of your other hand. Role that glove off too. Put the gloves in the biohazard bag. Wash hands immediately http://www.youtube.com/ watch?v=BmomTXux_L4 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 Depends on the injury…. BBP (Bloodborne pathogens) prevention supplies A cleaning agent (saline solution, good old soap and water, or some other antiseptic cleaning substance) Gauze (or something to help clean up) Some kind of triple antibiotic, or other topical ointment Wound Covering (Gauze and Tape, Band-Aids, Steri-strips, and again any other coverings that you might have, such as Tefla Pads) Should be cared for immediately All wounds and the surrounding skin/area 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 Clean wound from the inside out Dressing Sterile dressing should be applied to keep wound clean Do not remove gauze if it bleeds through. Removal will open clot . Apply more gauze on top. Occlusive dressing are extremely effective in minimizing scarring Antibacterial ointments are effective in limiting bacterial growth and preventing wound from sticking to dressing Apply ointment to dressing to avoid contaminating the tube or use individual packets Saline solution is recommended for repeated cleaning In the event that the wound is bleeding…apply direct pressure or apply pressure to a pressure point. If it squirts that is probably an artery…call 911 If you cannot stop the bleeding…call 911 If it is huge and you think that something else could be injured (you can see bones)…call 911. If you think that it could use sutures…cover it and send them to the doctor. If it is on the face…you might want to send them anyway (sutures can reduce scarring) How to clean a wound http://www.youtube.com/watch?v=YXbsujadP8Y Are sutures necessary? Deep lacerations, incisions and occasionally punctures will require some form of manual closure A wound that looks severe should be referred and decision should be made by a physician Recommend for face and high stress areas (knee/elbow) or when underlying tissue (fat, tendon, bone or vessels) are exposed or if bleeding cannot be controlled. 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 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 Most wound infections can be treated with antibiotics Contusion- a blow compresses or crushes the skin surface, causing bleeding to occur under the skin Friction Blister- fluid collects below or within the epidermal layer of skin due to rubbing or friction There shouldn’t be any fluid with these unless it is popped. In that case, observe universal precautions If it is popped, or you choose to pop it, make a small hole in the surface at one of the edges and apply pressure to drain the blister. Chances are that your athlete will be looking for a little padding so that they can keep playing A Band-aid and second skin pad work wonders. Or you can use a thin piece of foam cut into a small donut, put it over the blister, and cover it. Wounds with smooth edges; sharply cut Care Control bleeding. Practice Universal Precautions Clean the wound. Going from the inside-out. Pull the edges together and close using Steri-strips or a Band-aid. Apply Triple antibiotic ointment. If they are going to play, then it needs to be covered. Skin has been irregularly torn Blunt force delivered over a sharp bone or a bone that is poorly padded results in wound with jagged edges May also result in tissue avulsion Care Control bleeding; Practice Universal Precautions Clean the wound Try to close the edges with gauze, Steri-strips, Band-aids (if possible) Apply triple antibiotic ointment Cover the wound for competition Skin is torn from body; usually results in major bleeding A lot of avulsions may require more medical attention than you can do in the field Care If it is controlled and manageable, Practice Universal Precautions, clean the wound, replace the displaced flap with Steri-strips or band-aids, apply a topical ointment, and cover. For large pieces that can be reattached, place avulsed tissue in moist gauze (saline), plastic bag and immerse in cold water Take to hospital for reattachment 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 Care These are easy…no closure needed! Practice Universal Precautions Clean, apply a topical, and cover Your athlete will be back into competition and maybe a little sore. Direct penetration of tissue by pointed object 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 DO NOT REMOVE OBJECT Attempt to stabilize the object when wrapping Small punctures can be taken care of relatively easily, but should still be seen by a doctor. High risk of infection Practice Universal Precautions, clean, close if needed, cover, and ship. http://www.youtube.com/watch?v=WK0z Gx9DmLg You glove up! You clean it and apply a topical ointment (all occasions) You close it (when the situation calls for it) You cover it (on all) ACTIVITY #1 Pair up One person play the patient. Use makeup pencil to draw a wound on your partners arm/hand. Squeeze a little ketchup over the wound to imitate blood. Practice cleaning a wound Switch with your partner and repeat. ACTIVITY #2 Each person will receive a cherry tomato Your partner will make an incision on the tomato and pack it w/coffee grounds, imitating dirt inside the wound You must clean the wound from inside out using a water bottle as your cleansing agent and gauze Once clean, close the wound w/steri strips