2.  B/c of the close physical contact that occurs through athletic participation, the potential for spread of infectious diseases among fitness, professionals, coaches, athletes, and sports medicine personnel is of major concern.  Healthcare facility must be maintained as clean and sterile to prevent spread of disease and infection  Must take precautions to minimize risk and prevent contaminations  Must be aware of potential dangers associated with exposure to blood or other infectious materials

3.  Pathogenic organisms, present in human blood and other fluids, that can potentially cause disease  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

4.  You don’t want to get the blood/fluid on you or in any opening (cuts, eyes, nose, mouth, etc)  In the field…latex, vinyl, or other medical grade gloves will be what you need (most of the time…)  The exception would be if blood is flying everywhere. You really need to wear goggles and/or an impervious gown.  An exposure to someone’s blood who is positive with something that you really don’t want can haunt you for the rest of your life.

5.  Preparing the Athlete  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 reduces chance that wound will reopen, maintains moist and pliable wound  When Bleeding Occurs  Athletes must be removed from participation and returned when deemed safe  Bloody uniform must be removed or cleaned  Place all bloody items in a biohazard bag

6.  Personal Precautions  Use appropriate equipment  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  Non-latex gloves can be used when long term exposure to blood and bodily fluids is not likely  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 (anti-germicidal agent)  Hands should be washed between patients

7.  First, carefully pinch the flap on the underside of one of your wrists.  Second, role that glove inside out, off of your hand.  Put the glove in the palm of your other hand.  Role that glove off too.  Put the gloves in the biohazard bag.  Wash hands immediately  http://www.youtube.com/ watch?v=BmomTXux_L4 http://www.youtube.com/ watch?v=BmomTXux_L4

9.  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

10.  Depends on the injury….  BBP (Bloodborne pathogens) prevention supplies  A cleaning agent (saline solution, good old soap and water, or some other antiseptic cleaning substance)  Gauze (or something to help clean up)  Some kind of triple antibiotic, or other topical ointment  Wound Covering (Gauze and Tape, Band-Aids, Steri-strips, and again any other coverings that you might have, such as Tefla Pads)

11.  Should be cared for immediately  All wounds and the surrounding skin/area 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  Clean wound from the inside out

12.  Dressing  Sterile dressing should be applied to keep wound clean  Do not remove gauze if it bleeds through. Removal will open clot. Apply more gauze on top.  Occlusive dressing are extremely effective in minimizing scarring  Antibacterial ointments are effective in limiting bacterial growth and preventing wound from sticking to dressing  Apply ointment to dressing to avoid contaminating the tube or use individual packets  Saline solution is recommended for repeated cleaning

13.  In the event that the wound is bleeding…apply direct pressure or apply pressure to a pressure point.  If it squirts that is probably an artery…call 911  If you cannot stop the bleeding…call 911  If it is huge and you think that something else could be injured (you can see bones)…call 911.  If you think that it could use sutures…cover it and send them to the doctor.  If it is on the face…you might want to send them anyway (sutures can reduce scarring)

14.  How to clean a wound http://www.youtube.com/watch?v=YXbsujadP8Y

15.  Are sutures necessary?  Deep lacerations, incisions and occasionally punctures will require some form of manual closure  A wound that looks severe should be referred and decision should be made by a physician  Recommend for face and high stress areas (knee/elbow) or when underlying tissue (fat, tendon, bone or vessels) are exposed or if bleeding cannot be controlled.  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

16.  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

17.  Contusion- a blow compresses or crushes the skin surface, causing bleeding to occur under the skin

18.  Friction Blister- fluid collects below or within the epidermal layer of skin due to rubbing or friction

19.  There shouldn’t be any fluid with these unless it is popped.  In that case, observe universal precautions  If it is popped, or you choose to pop it, make a small hole in the surface at one of the edges and apply pressure to drain the blister.  Chances are that your athlete will be looking for a little padding so that they can keep playing  A Band-aid and second skin pad work wonders.  Or you can use a thin piece of foam cut into a small donut, put it over the blister, and cover it.

20.  Wounds with smooth edges; sharply cut Care  Control bleeding.  Practice Universal Precautions  Clean the wound. Going from the inside-out.  Pull the edges together and close using Steri-strips or a Band-aid.  Apply Triple antibiotic ointment.  If they are going to play, then it needs to be covered.

22.  Skin has been irregularly torn  Blunt force delivered over a sharp bone or a bone that is poorly padded results in wound with jagged edges  May also result in tissue avulsion Care  Control bleeding; Practice Universal Precautions  Clean the wound  Try to close the edges with gauze, Steri-strips, Band-aids (if possible)  Apply triple antibiotic ointment  Cover the wound for competition

24.  Skin is torn from body; usually results in major bleeding  A lot of avulsions may require more medical attention than you can do in the field Care  If it is controlled and manageable, Practice Universal Precautions, clean the wound, replace the displaced flap with Steri-strips or band-aids, apply a topical ointment, and cover.  For large pieces that can be reattached, place avulsed tissue in moist gauze (saline), plastic bag and immerse in cold water  Take to hospital for reattachment

26.  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 Care  These are easy…no closure needed!  Practice Universal Precautions  Clean, apply a topical, and cover  Your athlete will be back into competition and maybe a little sore.

27.  Direct penetration of tissue by pointed object  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  DO NOT REMOVE OBJECT  Attempt to stabilize the object when wrapping  Small punctures can be taken care of relatively easily, but should still be seen by a doctor.  High risk of infection  Practice Universal Precautions, clean, close if needed, cover, and ship.

28.  http://www.youtube.com/watch?v=WK0z Gx9DmLg http://www.youtube.com/watch?v=WK0z Gx9DmLg

29.  You glove up!  You clean it and apply a topical ointment (all occasions)  You close it (when the situation calls for it)  You cover it (on all)

30. ACTIVITY #1 ACTIVITY #2  Pair up  One person play the patient.  Use makeup pencil to draw a wound on your partners arm/hand. Squeeze a little ketchup over the wound to imitate blood.  Practice cleaning a wound  Switch with your partner and repeat.  Each person will receive a cherry tomato  Your partner will make an incision on the tomato and pack it w/coffee grounds, imitating dirt inside the wound  You must clean the wound from inside out using a water bottle as your cleansing agent and gauze  Once clean, close the wound w/steri strips