Kin 188 Bloodborne Pathogens


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Kin 188 Bloodborne Pathogens

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