1. © 2011 McGraw-Hill Higher Education. All rights reserved.
Chapter 14: Infectious Diseases, Bloodborne Pathogens, and Universal Precautions
© 2011 McGraw-Hill Higher Education. All rights reserved.

2. © 2011 McGraw-Hill Higher Education. All rights reserved.
Bloodborne pathogens are transmitted through contact with blood or other bodily fluids
Hepatitis, especially hepatitis B, human immunodeficiency virus are of serious concern
Healthcare facility must be maintained as clean and sterile to prevent spread of disease and infection
Must take precautions to minimize risk
© 2011 McGraw-Hill Higher Education. All rights reserved.

3. © 2011 McGraw-Hill Higher Education. All rights reserved.
Infectious Disease
Invasion of a host (animal or person) by a microorganism (pathogen)
Causes disease by disrupting vital body processes
Stimulate the immune system to react defensively
Immune response = fever, inflammation, or other damaging symptoms
Most common pathogens = bacteria, viruses, parasites or fungi
© 2011 McGraw-Hill Higher Education. All rights reserved.

4. © 2011 McGraw-Hill Higher Education. All rights reserved.
Microorganism can live in host and be harmless until an agent and mode of transportation allows for transfer of microorganism  pathogen infection
An infectious disease = contagious if transmission occurs from one individual to another
Direct vs. indirect transmission
3 Types of direct transmission
Contact of body surfaces (touching, sexual intercourse)
Droplet spread (inhalation or air droplets)
Fecal-oral spread (feces on hands  contact with mouth
© 2011 McGraw-Hill Higher Education. All rights reserved.

5. © 2011 McGraw-Hill Higher Education. All rights reserved.
Indirect transmission
Travels via inanimate object
Water, food, towels, clothing, utensils
Via vectors
Insects, birds, animals
Airborne transmission
Infected particles suspended in air – infected via sharing air supply
Pathogen entry into body
Through skin, respiratory system, digestive or reproductive system
Ability to generate infection dependent on:
Acquired immunity
Overall health
Health-related behavior
© 2011 McGraw-Hill Higher Education. All rights reserved.

6. © 2011 McGraw-Hill Higher Education. All rights reserved.
Stages of Infection
Incubation stage
From time pathogen enters body to time signs and symptoms of disease appear
Lasting from few hours to months depending on concentration, virulence, level of immune response, presence of other health problems
Prodromal stage
Watery eyes, runny nose, slight fever and malaise may develop briefly
Host can transfer pathogen to other hosts
Host should be isolated to prevent transmission
© 2011 McGraw-Hill Higher Education. All rights reserved.

7. © 2011 McGraw-Hill Higher Education. All rights reserved.
Acute stage
Disease reaches point of greatest development while body resists further damage from pathogen
Decline stage
First signs of recovery
Could relapse if patient becomes overextended
Recovery stage
Overcome invading pathogen
Patient remains susceptible
Body may have built up immunity and will be resistant to future exposure (may not be permanent)
© 2011 McGraw-Hill Higher Education. All rights reserved.

8. © 2011 McGraw-Hill Higher Education. All rights reserved.
The Immune System
Mechanical defenses
Separates the internal body from the external environment
Skin, mucous membranes, nasal hairs, cilia lined airways
Cellular System (Immune system)
Eliminates microorganisms, foreign proteins and antigens
Consists of T-cells and B-cells
Located in bloodstream lymphatic tissues and interstitial fluid
© 2011 McGraw-Hill Higher Education. All rights reserved.

9. © 2011 McGraw-Hill Higher Education. All rights reserved.
Antigens trigger leukocytes and macrophages to locate and destroy antigens
T-cells facilitate macrophages
B-cells transformed into specialized cells (plasma cells) capable of producing antibodies
Antibodies neutralize antigens via lysis and phagocytosis
Memory T-cells are formed to record information regarding antigens and immune response
© 2011 McGraw-Hill Higher Education. All rights reserved.

10. © 2011 McGraw-Hill Higher Education. All rights reserved.
Figure 14-1
© 2011 McGraw-Hill Higher Education. All rights reserved.

11. © 2011 McGraw-Hill Higher Education. All rights reserved.
Immunity
After effectively managing invading antigens the system is primed for future encounters
Acquired immunity
Developed artificially through vaccination/immunizations or passively when antibodies are injected
Both can provide important protection against infectious disease
© 2011 McGraw-Hill Higher Education. All rights reserved.

12. © 2011 McGraw-Hill Higher Education. All rights reserved.
Immunizations
Available and should be provided for all
Possible vaccinations include:
Diphtheria
Pertussis (whooping cough)
Hepatitis B
Haemophilus influenza type B
Tetanus
Rubella (German measles) & measles
Polio, mumps & chickenpox
Helps to minimize incidence of childhood communicable disease
© 2011 McGraw-Hill Higher Education. All rights reserved.

13. © 2011 McGraw-Hill Higher Education. All rights reserved.
Immunizations have eradicated many infectious diseases world wide
Epidemiology is a tool used to study infectious disease in a population
Disease outbreaks
Sporadic (occasional, occurrence)
Endemic (regular cases often occurring in a region)
Epidemic (unusually high number of cases in a region
Pandemic (global epidemic)
© 2011 McGraw-Hill Higher Education. All rights reserved.

14. Preventing Spread of Infectious Disease
Must be diligent in efforts to minimize transmission of disease
Most effective practice = washing hands
Ensure that patient immunizations are up to date
Be sure to educate patients on inability of antibodies to impact viruses, and need to taking antibiotics as directed
Encourage healthy lifestyles in patients
© 2011 McGraw-Hill Higher Education. All rights reserved.

15. © 2011 McGraw-Hill Higher Education. All rights reserved.
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 (HBV) , hepatitis C (HBC) and human immunodeficiency virus (HIV)
© 2011 McGraw-Hill Higher Education. All rights reserved.

16. © 2011 McGraw-Hill Higher Education. All rights reserved.
Virus Reproduction
Submicroscopic parasitic organism is dependent on nutrients of cell
Strand of DNA or RNA dependent on metabolic and reproductive activity of cell
Redirect cell activity to create more viruses
Figure 14-3
© 2011 McGraw-Hill Higher Education. All rights reserved.

17. © 2011 McGraw-Hill Higher Education. All rights reserved.
Hepatitis B
Attacks liver, results in lifelong infection, cirrhosis, liver cancer, liver failure and death
Spread when blood from infected person enters the body of someone who is not infected
Unprotected sex, sharing needles
Individuals who have been vaccinated are at virtually no risk for infection
million people are infected world-wide
8700 healthcare workers contract HBV each year, with 200 of these ending in death
© 2011 McGraw-Hill Higher Education. All rights reserved.

18. © 2011 McGraw-Hill Higher Education. All rights reserved.
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 in these individuals
Can be unknowingly transferred
Chronic active hepatitis may occur because of problem with immune system, preventing complete destruction of virus infected liver cells
© 2011 McGraw-Hill Higher Education. All rights reserved.

19. © 2011 McGraw-Hill Higher Education. All rights reserved.
Signs & Symptoms (continued)
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
© 2011 McGraw-Hill Higher Education. All rights reserved.

20. © 2011 McGraw-Hill Higher Education. All rights reserved.
Management
Vaccination against HBV should be provided by employer to those who may be exposed
Athletic trainers and allied health professionals should be vaccinated
Three dose vaccination over 6 months
After second does 87% of those receiving vaccine will be immune and 96% after the third dose
Post-exposure vaccination is also available after coming into contact with blood or fluids
© 2011 McGraw-Hill Higher Education. All rights reserved.

21. © 2011 McGraw-Hill Higher Education. All rights reserved.
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
© 2011 McGraw-Hill Higher Education. All rights reserved.

22. © 2011 McGraw-Hill Higher Education. All rights reserved.
Prevention
Occasionally spread through sexual contact
Spread via contact with blood of infected person, sharing needles
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
© 2011 McGraw-Hill Higher Education. All rights reserved.

23. Human Immunodeficiency Virus
A retrovirus that combines with host cell
Infects T4 blood cells, B cells and monocytes (macrophages)
Estimated that 11 out of 1000 adults are infected with HIV
4.1 million new HIV infections occurred world-wide in 2005
© 2011 McGraw-Hill Higher Education. All rights reserved.

24. © 2011 McGraw-Hill Higher Education. All rights reserved.
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)
© 2011 McGraw-Hill Higher Education. All rights reserved.

25. 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
© 2011 McGraw-Hill Higher Education. All rights reserved.

26. © 2011 McGraw-Hill Higher Education. All rights reserved.
As of 2007, 1.1 million people in the U.S. were living with HIV infection; 468,000 were living with AIDS
50% develop AIDS w/in 10 years of HIV infection
After contracting AIDS, people generally die w/in 2 years of symptoms developing
© 2011 McGraw-Hill Higher Education. All rights reserved.

27. © 2011 McGraw-Hill Higher Education. All rights reserved.
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
Drug which blocks enzyme action responsible for new virus cell components
Drug which blocks copying of viral agents, disabling synthesis of new viruses
Third drug helps protect T cells, slowing progression of HIV
© 2011 McGraw-Hill Higher Education. All rights reserved.

28. © 2011 McGraw-Hill Higher Education. All rights reserved.
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
© 2011 McGraw-Hill Higher Education. All rights reserved.

29. Additional Hepatitis Viruses
Hepatitis A
Causes inflammation of liver – does not lead to chronic liver disease
Transmitted by fecal or oral routes through close personal contact or contaminated food/water
Transmitted in milk, shellfish, salads, sliced meat
May show no outward signs or symptoms
Adults may exhibit dark urine, light stools, fatigue, jaundice and fever
© 2011 McGraw-Hill Higher Education. All rights reserved.

30. © 2011 McGraw-Hill Higher Education. All rights reserved.
Hepatitis D (HDV) causes inflammation of the liver
Found often in those infected with HBV
Transmitted through contact with infected blood, needles or sexual contact
Symptoms more severe than with HBV
Hepatitis E (HEV)
Causes inflammation of the liver
Rarely found in the United States
Transmitted through fecal and oral routes from contaminated water supplies
© 2011 McGraw-Hill Higher Education. All rights reserved.

31. 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
© 2011 McGraw-Hill Higher Education. All rights reserved.

32. © 2011 McGraw-Hill Higher Education. All rights reserved.
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
© 2011 McGraw-Hill Higher Education. All rights reserved.

33. © 2011 McGraw-Hill Higher Education. All rights reserved.
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
© 2011 McGraw-Hill Higher Education. All rights reserved.

34. 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
© 2011 McGraw-Hill Higher Education. All rights reserved.

35. HIV and Athletic Participation
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
Also must take into consideration risk to patient and other participants and means to reduce risk
© 2011 McGraw-Hill Higher Education. All rights reserved.

36. Testing Athletes for HIV
Should not be used as screening tool
Mandatory testing may not be allowed due to legal reasons (American with Disabilities Act and HIPAA)
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
© 2011 McGraw-Hill Higher Education. All rights reserved.

37. © 2011 McGraw-Hill Higher Education. All rights reserved.
Detectable antibodies may appear from 3 month to 1 year following exposure
Testing should occur at 6 weeks, 3 months, and 1 year
Home test kits are also available which allow you to send blood work to lab for analysis
Home Access test is FDA approved
Lab analyzes dried blood sample and labeled with personal identification number (PIN)
Acquire results and counseling confidentially with PIN
© 2011 McGraw-Hill Higher Education. All rights reserved.

38. © 2011 McGraw-Hill Higher Education. All rights reserved.
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
© 2011 McGraw-Hill Higher Education. All rights reserved.

39. Universal Precautions in Athletic Environment
1991 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
Should include counseling, education, volunteer testing, and management of bodily fluids
© 2011 McGraw-Hill Higher Education. All rights reserved.

40. © 2011 McGraw-Hill Higher Education. All rights reserved.
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
© 2011 McGraw-Hill Higher Education. All rights reserved.

41. © 2011 McGraw-Hill Higher Education. All rights reserved.
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
© 2011 McGraw-Hill Higher Education. All rights reserved.

42. © 2011 McGraw-Hill Higher Education. All rights reserved.
Personal Precautions (continued)
Doubling gloving 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 (germicidal agent)
Hands should be washed between patients
© 2011 McGraw-Hill Higher Education. All rights reserved.

43. © 2011 McGraw-Hill Higher Education. All rights reserved.
Latex Sensitivity and Nonlatex Gloves
Nonlatex glove use is recommended for athletic trainers
May cause allergic reactions if use latex gloves
Contact dermatitis
Systemic reaction
Some become more susceptible due to repeated exposure
Management of acute reaction includes removing irritant, cleansing affected area, monitoring vital signs, seeking additional medical assistance as warranted
© 2011 McGraw-Hill Higher Education. All rights reserved.

44. © 2011 McGraw-Hill Higher Education. All rights reserved.
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
© 2011 McGraw-Hill Higher Education. All rights reserved.

45. © 2011 McGraw-Hill Higher Education. All rights reserved.
Figure 14-4
Figure 14-5
© 2011 McGraw-Hill Higher Education. All rights reserved.

46. © 2011 McGraw-Hill Higher Education. All rights reserved.
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
© 2011 McGraw-Hill Higher Education. All rights reserved.

47. © 2011 McGraw-Hill Higher Education. All rights reserved.
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
Figure 14-6
© 2011 McGraw-Hill Higher Education. All rights reserved.

48. © 2011 McGraw-Hill Higher Education. All rights reserved.
Protecting the Athletic Trainer
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
Provide necessary supplies and education
Athletic trainer has personal responsibility to follow guidelines
Minimize risks by not eating/drinking, applying cosmetics/lip balm, handling contact lenses, and touching face before washing hands
© 2011 McGraw-Hill Higher Education. All rights reserved.

49. © 2011 McGraw-Hill Higher Education. All rights reserved.
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
© 2011 McGraw-Hill Higher Education. All rights reserved.

50. 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
© 2011 McGraw-Hill Higher Education. All rights reserved.