1. Chapter 11: Bloodborne Pathogens

2. 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

3. 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

4. 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 HBV and HIV
Others that exist are hepatitis A, D, and E

5. 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
May show no outward signs or symptoms
Adults may exhibit dark urine, light stools, fatigue, jaundice and fever

6. Hepatitis D (HDV) causes inflammation of the liver
Only in individuals that have HBV
Transmitted through contact with infected blood, needles or sexual contact
Hepatitis E (HEV)
Causes inflammation of the liver
Rarely found in the United States
Transmitted through fecal and oral routes from contaminated water supplies

7. Hepatitis B
Major cause of viral infection, resulting in swelling, soreness, loss of normal liver function
New cases develop at a rate of 300,000/year
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

8. Chronic active hepatitis may occur because of problem with immune system, preventing complete destruction of virus infected liver cells
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

9. 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

10. 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

11. Prevention Management 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

12. 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
5 million new HIV infections occurred world-wide in 2003

13. 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)

14. 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
50% develop AIDS w/in 10 years of HIV infection
After contracting AIDS, people generally die w/in 2 years of symptoms developing

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. Detectable antibodies may appear from 3 month to 1 year following exposure
Testing should occur at 6 weeks, 3 months, and 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
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

23. 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

24. Preparing the Athlete When Bleeding Occurs
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
Hyrdrocolloid 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

25. 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

26. 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

27. 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

28. Protecting the Coach and 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 in athletic training room

30. 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

31. 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