Bloodborne Pathogens, Universal Precautions and Wound Care

1. Bloodborne Pathogens, Universal Precautions and Wound Care

2. Bloodborne Pathogens • 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

3. Bloodborne Pathogens • Pathogenic organisms, present in human blood and other fluids • cerebrospinal fluid, semen, vaginal secretion and synovial fluid can potentially cause disease • Most significant pathogens are Hepatitis B, C and HIV • Others that exist are hepatitis A, D, E and syphilis

4. 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

5. Hepatitis B • 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

6. Hepatitis B • Prevention (cont.) • Three dose vaccination over 6 months • Post-exposure vaccination is also available after coming into contact with blood or fluids

7. 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 • 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

8. Hepatitis C • 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

9. Hepatitis C • 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

10. Human Immunodeficiency Virus • A retrovirus that combines with host cell • Virus that has potential to destroy immune system • 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

11. 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 HIV cannot predict when the individual will show symptoms of AIDS • After contracting AIDS, people generally die w/in 2 years of symptoms developing

12. AIDS • 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 • 100% chance of not getting infection is through abstinence

13. 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

14. 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

15. Policy Regulation • 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

16. HIV and Athletic Participation • No definitive answer as to whether asymptomatic HIV carriers should participate in sport • Bodily fluid contact should be avoided • 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

17. 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

18. Testing Athletes for HIV • Detectable antibodies may appear from 3 months 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 trainers should be familiar with state laws and maintain confidentiality and anonymity of testing

19. Universal Precautionsin 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

20. Universal Precautions in Athletic Environment • Preparing the Athlete • Prior to participation, all open wounds and lesions should be covered with a dressing • 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 risk of contamination

21. Universal Precautions in Athletic Environment • 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

22. Universal Precautions in Athletic Environment • Availability of Supplies and Equipment • Must also have chlorine bleach, antiseptics, proper receptacles for soiled equipment and uniforms, wound care equipment, and sharps container • Labels are fluorescent orange or red • Red bags or containers should be used for potentially infectious material

23. Universal Precautions in Athletic Environment • 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) • 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

25. 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

26. Skin Wounds • Types of wounds • Abrasions • Skin scraped against rough surface • Top layer of skin wears away • 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

27. Skin Wounds • 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

28. Laceration Abrasion Avulsion Puncture Incision

29. Immediate Care • All wounds should be treated as though they have been contaminated • To minimize infection clean wound with copious amounts of soap, water and sterile solution • Avoid hydrogen peroxide and bacterial solutions initially

30. 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

31. Are sutures necessary? • Deep lacerations, incisions and occasionally punctures will require some form of manual closure • Sutures should be used within 12 hours preferably a 4 hour window • Physician may decide wound does not require sutures and utilize steri-strips or butterfly bandages

32. 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

33. Signs of Wound 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 could spread into other aspects of the body

34. Signs of Wound 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