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Transcript
Chapter 14: Bloodborne Pathogens • 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 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 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 • 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 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 – 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 • 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 Human Immunodeficiency Virus • A retrovirus that combines with host cell • Infects T4 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 • 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) 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 • 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 • 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 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 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 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 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 • 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 Universal Precautions in Athletic Environment • 1991 OSHA (Occupational Safety and Health Administration) established standards for employer to follow that govern occupational exposure to bloodborne 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 • 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 • 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 • 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 – 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 • 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 • 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 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