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Chapter 14 Infectious Diseases, Bloodborne Pathogens, and Universal Precautions
Chapter 14
Extended Lecture Outline
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Introduction:
o The athletic trainer must ensure that the athletic training room is clean and sterile, take measures
to prevent spread of infectious diseases and take precautions to minimize exposure to blood and
other infectious materials
Infectious Diseases (Table 14-1)
 Infectious diseases are the invasion or infection of a Host (person or animal) by
microorganisms called pathogens
 Pathogens cause disease by either disrupting a vital body process or stimulating the
immune system to mount a defensive reaction
 Most common pathogens are bacteria, viruses, parasites and fungi
 Infectious disease requires an agent and a mode of transmission
 An infectious disease is termed contagious if it is transmitted from one person to another
 Transmission can be direct or indirect
 Three types of direct transmission (contact between body surfaces, droplet spread and
fecal-oral spread)
 Indirect transmission (from one infected person to an uninfected person by
means of inanimate objects – water, food, towels, clothing and eating utensils)
 Indirect transmission through vectors (birds, insects, or animals that carry the
diseases from human to human)
 Indirect airborne transmission of infected particles that have been suspended in
an air source for an extended period of time (riding on an airplane)
 Five stage sequence occurs when pathogen infects a host
 Incubation Stage
 Prodromal Stage
 Acute Stage
 Decline Stage
 Recovery Stage
o The Immune System
 Two lines of defense against invading pathogens
o Mechanical Defenses (separate the internal body from the external
environment – skin, mucous membranes, nasal hairs)
o Cellular Defenses (when mechanical defenses are disrupted the cellular
system or immune system takes over eliminating microorganisms,
foreign proteins or abnormal cells collectively referred to as antigens)
 Immune System
o T-cells and B-cells are found in the bloodstream, lymphatic tissues and
interstitial fluid
o The T and B cells defend the body against specific antigens
o Macrophages activate T-cells to assist in the immune response
o T-cells activate both killer T-cells that assist the macrophages in
destroying the antigen and B-cells which are transformed into plasma
cells capable of producing antibodies
 Immunity
o Acquired immunity can be developed either artificially when the body
is exposed to weakened pathogens through vaccination or
immunization or passively when antibodies are injected to proved
immediate protection until the body can develop natural immunity
 Immunizations
o Immunization has eradicated many infectious diseases
o Epidemiology is used to study infectious disease in a population
o Sporadic outbreak = occasional occurrence
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Chapter 14 Infectious Diseases, Bloodborne Pathogens, and Universal Precautions
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o Endemic = regular cases often occurring in a region
o Epidemic = unusually high number of cases in a region
o Pandemic = global epidemic
o Preventing Spread of Infectious Diseases (Focus Box 14-1)
 Most effective practice to prevent spread of diseases is to wash hands frequently when
treating patients
Bloodborne Pathogens
 Bloodborne pathogens are viruses transmitted through contact with blood or other bodily
fluids
 Virus = submicroscopic parasitic organism that is dependent on the nutrients within cells
 Viruses consist of either DNA or RNA, and a shell of proteins surrounding the genetic
material
 Bloodborne pathogens are pathogenic microorganisms that can potentially cause disease
and are present in human blood and other body fluids (semen, vaginal secretions,
cerebrospinal fluid, synovial fluid and any other fluid contaminated with blood)
 Bloodborne pathogens include Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and
Human immunodeficiency Virus (HIV)
o Hepatitis B Virus
 Attacks the liver, resulting in lifelong infection, cirrhosis, liver cancer, liver failure and
death
 HBV is spread when blood from an infected person enters the body of a person who is
not infected
 Presents with flu-like symptoms, fatigue, weakness, nausea, abdominal pain, headache,
fever, dark urine, and possibly jaundice
 Infected persons blood may test positive for HBV antigen within 2-6 weeks after the
symptoms develop, 85% of those infected recover within 6-8 weeks
 Prevention: Good personal hygiene and avoid high-risk activities
 Management: Vaccination against HBV – given in 3 doses over a six-month period
o Hepatitis C Virus
 Both an acute and chronic form of liver disease
 85% of those infected acutely become chronically infected and 67% develop chronic liver
disease
 Leading indication for liver transplant
 80% of those infected have no signs or symptoms – others will present with jaundice or
have mild abdominal pain in the upper right quadrant, loss of appetite, nausea, fatigue,
muscle/joint pain and/or dark urine
 Prevention: be careful with body piercing, tattoos, and sharing needles, syringes
 Management: No vaccine for preventing HCV
o Human Immunodeficiency Virus
 HIV is a retrovirus – combines with a host cell
 Transmitted by exposure to infected blood, or other body fluids, or by intimate sexual
contact
 Symptoms include fatigue, weight loss, muscle/joint pain, painful swollen glands, night
sweats and fever
 Antibodies can be detected in blood 1 year after exposure
 Management: no vaccine for HIV
 Prevention: Practice safe sex
 Most who test positive for HIV develop acquired immunodeficiency syndrome (AIDS)
 Acquired immunodeficiency syndrome (AIDS)
 AIDS is a collection of signs and symptoms due to effects of infection
 No protection against even the simplest infections – develop variety of illness’s and
opportunistic infections and cancers (Kaposi’s sarcoma and non-Hodgkin’s lymphoma)
 No available treatment to cure AIDS
 Prevention of HIV
 Practicing safe sex is of major importance
 See Focus box 14-2
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Chapter 14 Infectious Diseases, Bloodborne Pathogens, and Universal Precautions
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Additional Hepatitis Viruses
 Hepatitis A Virus (HAV)
 Hepatitis D Virus (HDV)
 Hepatitis E Virus (HEV)
o Bloodborne Pathogens in Athletics
 Chances of transmitting HIV among athletes is low
 Minimal risk of on-field transmission of HIV from one player to another – less
than 1 per 1 million games (No validated reports of HIV transmission in sports)
 High risk sports for transmission due to close contact: martial arts, wrestling and
boxing
 Policy Regulation
 Many organizations have developed policies to help prevent the transmission of
bloodborne pathogens, and have also initiated programs to help educate athletes
 All institutions should take the responsibility for educating their student athletes
about transmission of bloodborne pathogens
 HIV and Athletic Participation
 Americans with Disabilities Act of 1991 states that infected athletes with HIV
cannot be discriminated against and may be excluded from participation only on
a medically sound basis
 Testing for HIV
 Should not be used as a screening tool to determine participation status
 Mandatory testing is not allowed for legal reasons related to the ADA and
HIPAA
 Athlete’s who engage in high-risk activities should be encouraged to seek
voluntary anonymous testing for HIV
Universal Precautions in an Athletic Environment
 In 1991, OSHA established standards for an employer to follow that govern occupational
exposure to bloodborne pathogens – protects the health care provider and the patient
 NATA has established specific guidelines for athletic trainers (see Appendix K)
o Preparing the Athlete
 Cover all open wounds or other skin lesions with occlusive dressing
o When Bleeding Occurs
 Athlete’s with active bleeding must be removed from contest and returned only when
deemed safe by medical staff
 Uniforms containing blood must be evaluated for infectivity
 Uniforms saturated with blood must be removed and changed
o Personal Precautions
 Always use non-latex gloves when dealing with bodily fluids (some individuals may be
allergic to latex)
 Double glove when there is heavy bleeding or using sharp instruments
 Hands and skin that come in contact with blood or other bodily fluids should be washed
immediately with soap and water or other antigermicidal agents
 Wash hands between patients
o Availability of Supplies and Equipment
 Biohazard bags or containers should be used for disposal of potentially infected materials
 All contaminated surfaces (treatment tables, taping tables etc.) should be cleaned with
one part bleach to ten parts water or with a disinfectant approved by the Environmental
Protection Agency, disinfectants should inactivate the HIV virus
 Contaminated laundry should be washed in hot water for 25 minutes, using a detergent
that deactivates the virus.
 Care should be taken when handling and disposing of sharps to minimize risk of
puncturing or cutting the skin
 Never recap needles, or scalpels and disinfect tweezers and scissors after use
 Dispose of sharps in a puncture resistant plastic biohazard container
o Protecting the Athletic Trainer
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Chapter 14 Infectious Diseases, Bloodborne Pathogens, and Universal Precautions
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Institutions must provide the necessary supplies and equipment to carry out OSHA
guidelines for bloodborne pathogens
 In the athletic training setting individuals should not eat, drink, apply cosmetics or lip
balm, handle contact lenses or touch the face before washing hands. Food products
should never be placed in a refrigerator containing contaminated blood
Protecting the Athlete from Exposure
 USOC supports required use of mouthpieces in high-risk sports
 Also recommended all athletes shower immediately after practice or competition
 Athletes should receive the HBV immunization
Postexposure Procedures
 After exposure incident – one should have confidential medical evaluation
 Laws vary from state to state with regards to reporting, notification and confidentiality of
test results
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