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