kin 188 bloodborne pathogens
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KIN 188 – Prevention and Care of Athletic Injuries
Bloodborne Pathogens
Introduction
Bloodborne pathogens
Universal precautions (OSHA guidelines)
Control of bleeding
Wound care principles
Bloodborne Pathogens
Microorganisms that can potentially cause disease – present in Blood Semen Vaginal secretions Cerebrospinal fluid Synovial fluid Any other fluid contaminated by blood
Bloodborne Pathogens
Three most significant pathogens Hepatitis B (HBV) Hepatitis C (HCV) Human immunodeficiency virus (HIV)
HIV has generated most attention, but more likely to contract HBV, HCV in health care environment
Hepatitis B (HBV) Signs and symptoms
Flu-like symptoms (fatigue, weakness, nausea, headache, fever), may have jaundice, may be asymptomatic carrier
Prevention Good personal hygiene, avoiding high risk activities HBV can survive for ~1 week in dried blood or on
contaminated surfaces Management
Vaccination against HBV must be made available by employer at no cost to any individual who may be exposed to blood or body fluids and thus at risk of contracting HBV
Vaccine given in 3 doses over 6 months – 96% immune after 3rd dose
Hepatitis C (HCV) Most common chronic bloodborne infection in US –
leading cause of liver transplant Signs and symptoms
80% show no symptoms - those that do may show jaundice, abdominal pain, flu-like symptoms
Prevention Almost exclusively spread through contact with blood of
infected person, sharing needles, syringes, razors, etc. (tattoo, body piercing risk)
Management No vaccination at this time – blood tests determine
infection within 1-2 weeks Must be treated for liver disease, typically advanced meds
Human Immunodeficiency Virus (HIV)
Signs and symptoms Symptoms include fatigue, weight loss, muscle or
joint pain, swollen glands, fever HIV detectable via blood test within 1 year after
exposure – may go 8-10 years post-infection before symptoms present
Most HIV+ individuals develop acquired immunodeficiency syndrome (AIDS)
Individuals with AIDS unable to fight against even simple infections, extremely vulnerable to illness and most die within 2 years after symptoms start
Human Immunodeficiency Virus (HIV)
Prevention Greatest risk is via sexual contact with an infected
partner – safe sex practices is critical to minimizing risk of infection
Management No vaccine – some meds can prolong life but no
cure at this time
Bloodborne Pathogens in Athletics
Minimal risk of on-field transmission of HIV from one player to another in sports
No current validated reports of HIV transmission in sports
Study estimated risk of transmission in professional football was less than 1 per 1 million games
Policy Considerations
All major athletic organizations have developed policies and procedures regarding transmission of bloodborne pathogens
Focus of policies is education about how viruses are transmitted and risky behavior
ADA Act of 1991 states that HIV+ athletes cannot be discriminated against and may be excluded from participation only on a medically sound basis Exclusion must be based on objective medical evidence
and must consider extent of risk of infection to others, potential harm to the athlete and what means can be taken to minimize that risk
Universal Precautions
Occupational Safety and Health Administration (OSHA) established standards for employers to follow that govern occupational exposure to bloodborne pathogens in 1991
Designed to protect health care workers and patients against bloodborne pathogens
OSHA mandates that training programs for dealing with bloodborne pathogens be repeated every year to provide the most current information
OSHA Guidelines Preparing an athlete
Before an athlete participates in activity all open skin wounds must be covered with fixed dressing
Occlusive dressing (hydrocolloid is best) lessens chance of cross-contamination
When bleeding occurs Mandated that open wounds and skin lesions considered a
risk for transmission be treated aggressively Actively bleeding athlete must be removed from
participation as soon as possible and can return only when deemed safe by medical staff
Uniforms saturated with blood/body fluids must be changed before athlete can return to participation
OSHA Guidelines
Personal protection Individual working with blood/body fluids must
make use of appropriate protective equipment Includes disposable non-latex gloves, non-
absorbent gowns/aprons, masks/shields, eye protection and disposable barriers for CPR
Hands and all skin surfaces that come in contact with blood/body fluids should be washed immediately with soap and water and/or antigermicidal agents
OSHA Guidelines
Availability of supplies and equipment Must also have access to chlorine bleach or
approved disinfectant solution, antiseptics, biohazard containers for soiled uniforms or bandages and sharps containers for disposal of needles, scalpels, syringes
Biohazard warning labels should be affixed to all appropriate containers (red)
Contaminated surfaces must be cleaned with 1:10 bleach to water solution or other disinfectant approved by EPA
Control of Bleeding
External bleeding from open wounds controlled via the following procedures in descending order Direct pressure at site of bleeding Elevation of extremity Indirect pressure (pressure points) to closest
proximal pulse point Tourniquet
Only used in life- or limb-saving effort when access to medical care is likely delayed
Wound Care Principles
All open wounds must be cared for immediately and must be considered contaminated by microorganisms
Must adhere to OSHA guidelines when providing wound care
Wounds must be debrided and cleansed followed by the application of an occlusive dressing
Wound Care Principles
Occlusive dressings minimize scab formation, decrease pain perception from exposed nerve endings, are cost and time effective, provide a barrier against bacteria
Secondary protection against infection provided by use of antibiotic ointments
Good wound care minimizes inflammatory response, creates an optimal environment for healing and minimizes scar formation
Wound Care Principles
Rabenberg et al, Journal of Athletic Training (2002)
Studied effectiveness of hydrogen peroxide and Betadine (iodine) solution as anitmicrobial agents and the cytotoxicity of each solution Hydrogen peroxide bactericidal effectiveness is
minimal while it’s cytotoxicity is very high Betadine effective as antimicrobial agent when diluted
to 1:10 solution with sterile saline – extremely cytotoxic if not diluted
Debate about cytotoxicity of Betadine when diluted to the 1:10 solution
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