© 2007 mcgraw-hill higher education. all rights reserved. chapter 8: bloodborne pathogens,...

© 2007 McGraw-Hill Higher Education. All rights reserved.

Chapter 8: Bloodborne Pathogens, Universal Precautions

and Wound Care


• 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


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


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


– 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– Vaccination against HBV should be provided by employer to those

who may be exposed– Athletic trainers and allied health professionals should be

vaccinated


• Prevention (cont.)– Three dose vaccination over 6 months– Post-exposure vaccination is also available after

coming into contact with blood or fluids


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


• 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


• 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


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


• 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)


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


• 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


• 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

• 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

• 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


• 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 cross-contamination

• 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


• 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 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


– 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 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


• 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


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


• 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

– Incision• Wounds with smooth edges


– 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


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


• 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


• 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


• 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

• 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


• 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

© 2007 mcgraw-hill higher education. all rights reserved. chapter 8: bloodborne pathogens,...

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