Transcript Chapter 14: Bloodborne Pathogens

Chapter 11: Bloodborne
Pathogens
• 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
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
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
• 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
• 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
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
– 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
• 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
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
• Prevention
– 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
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
• 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)
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
• 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
• 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
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
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
• 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
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
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
• Detectable antibodies may appear from 3
month to 1 year following exposure
– Testing should occur at 6 weeks, 3 months, and
1 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
Universal Precautions in Athletic
Environment
• 1991 OSHA (Occupational Safety and
Health Administration) established
standards for employer to follow that
govern occupational exposure to bloodborne 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
• Preparing the Athlete
– Prior to participation, all open wounds and lesions
should be covered with dressing that will not allow
for transmission
– Occlusive dressing lessens chance of crosscontamination
• 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
• 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
• 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
– 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
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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
• 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
• 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
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