Download Chapter 14: Bloodborne Pathogens

Chapter 8: Bloodborne
Pathogens, Universal
Precautions and Wound Care
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• 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
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• 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
– 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
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• 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 should 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
• 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 (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
– Gloves and bandages should be placed in
sealed white bags prior to disposal in regular
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trash receptacles
– 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
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© 2010 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
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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
– Incision
• Wounds with smooth edges
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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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© 2010 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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