1. The Lecture Series in Athletic Training and Sports Medicine Jim Berry, MEd, ATC, SCAT/NREMT Director of Sports Medicine Head Athletic Trainer Myrtle Beach High School Myrtle Beach, South Carolina © 2003

2. Sports Medicine Unit 8, Part A Blood Borne Pathogens

3. Chapter 8: Bloodborne Pathogens, Universal Precautions and Wound Care

4. 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

5. What are bloodborne pathogens? Bloodborne pathogens are pathogenic microorganisms that can potentially cause disease

6. What are bloodborne pathogens? Bloodborne pathogens may be present in any of the following… –Human blood –Semen –Vaginal secretions –Cerebrospinal fluid –Synovial fluid –Or any other fluid contaminated by blood

7. What are bloodborne pathogens? The two most prominent bloodborne pathogens are the hepatitis B virus (HBV) and the human immunodeficiency virus (HIV) There are a number of other bloodborne diseases that exist as well, including… –Hepatitis A, C, and D –and syphilis

8. What are bloodborne pathogens? Although HIV has been more widely addressed in the media, HBV is spread much more easily in the population HBV is stronger and more durable than HIV –It can be spread more easily via sharp objects, open wounds, or bodily fluids when compared to HIV

9. Hepatitis B Virus HBV is a major cause of viral infection that results in swelling, soreness, and normal function of the liver The number of cases of HBV in the USA has risen dramatically in the past 10 years

10. Signs of HBV A person infected with HBV will exhibit the following signs and symptoms… –Flu like symptoms including… Fatigue Weakness Nausea Abdominal pain Headache Fever And possible jaundice

11. Signs of HBV It is possible that a person infected with HBV will show no signs of the illness –In these individuals, the virus goes undetected and is spread unknowingly to others An infected person ’ s blood may test positive for HBV within 2-6 weeks after symptoms develop 85% of those infected, recover within 6-8 weeks

12. Preventing HBV Infection Good personal hygiene and avoiding high risk activities are the best ways to avoid HBV HBV can survive for at least a week in dried blood or on contaminated surfaces

13. 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

14. 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

15. 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

16. Signs & Symptoms of HIV Symptoms of HIV include the following… –Fatigue –Weight loss –Muscle and/or joint pain –Painful or swollen glands –Night sweats –Fever HIV antibodies can be detected in the blood within a year following exposure

17. AIDS AIDS is an acronym for Acquired Immunodeficiency Syndrome A syndrome is a collection of signs/symptoms that are recognized as the effects of an infection A person with AIDS has little or no protection against infections –This makes them vulnerable to a host of diseases and infections that can eventually kill them

18. Prevention of HIV & AIDS The best means of prevention is through education ATCs should assist in educating coaches and athletes about HIV, including practicing safe sex

19. Dealing with bloodborne pathogens in athletics In general the chance of transmitting a bloodborne pathogen in athletics is very low There is a minimal risk of transmission from one player to another on the field or court

20. 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

21. 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

22. Dealing with bloodborne pathogens in athletics Studies have shown that the chances of transmission from one player to another are less than one in one million games –In fact, there have been no documented cases of transmission so far in athletics

23. HIV and Athletic Participation There is no definitive evidence as to whether or not asymptomatic HIV carriers should participate in sports Obviously bodily fluid contact should be avoided, but there is no evidence that transmission can occur through perspiration, etc. The ADA of 1991 states that athletes with HIV cannot be discriminated against and must be allowed to participate –They may only be exclude because of legitimate medical reasons that take into account the risk to the athlete, to other athletes, and also considers what can be done to reduce those risks

24. 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

25. 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

26. 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

27. Universal Precautions Supplies/Equipment –In keeping with universal precautions, the sports program should have appropriate supplies/equipment available to deal with blood/body fluid spills At a minimum, all institutions should have household bleach or some other type of sanitizer available

28. Universal Precautions Supplies/Equipment –More appropriately a training room should have the following in addition to bleach or disinfectants: Antiseptics Sharps collectors Biohazard receptacle Wound care supplies –Biohazard labels should be affixed to all items containing infectious agents

29. Universal Precautions Disinfectants –All contaminated surfaces, including the field, court, mats, tables, counters, etc., should be disinfected with a solution consisting of one part bleach to ten parts water (1:10) or with a disinfectant approved by the EPA and shown to kill bloodborne pathogens –Towels and other laundry that have been contaminated should be bagged and washed separately from other laundry Latex gloves should always be worn when placing soiled laundry into washers

30. Universal Precautions Sharps –Refers to any sharp object such as a needle, razor blade, scalpels, etc –Extreme care should be taken when dealing with these items and they should be disposed of in a sharps container when finished using them –OSHA mandates that all sharps must be disposed of in a leak proof/puncture proof container, which must be incinerated when filled –Needles and other sharps should NEVER be recapped!!!

31. Summing up… All individuals involved in athletic activities must be familiar with bloodborne pathogens All individuals involved with athletic activities must be familiar with the established OSHA guidelines for dealing with exposure to bloodborne pathogens All individuals involved with athletic activities should always use universal precautions when dealing with blood or other body fluids

32. 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

33. 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

34. –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

35. 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

37. 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

38. 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