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Transcript
Chapter 14 Infectious Diseases, Bloodborne Pathogens, and Universal Precautions Chapter 14 Extended Lecture Outline 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 Prentice, Principles of Athletic Training , 15e LO-14 | 1 Chapter 14 Infectious Diseases, Bloodborne Pathogens, and Universal Precautions 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 Prentice, Principles of Athletic Training , 15e LO-14 | 2 Chapter 14 Infectious Diseases, Bloodborne Pathogens, and Universal Precautions o 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 Prentice, Principles of Athletic Training , 15e LO-14 | 3 Chapter 14 Infectious Diseases, Bloodborne Pathogens, and Universal Precautions o o 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 Prentice, Principles of Athletic Training , 15e LO-14 | 4