Transcript Chapter 14: Bloodborne Pathogens

Chapter 9: Bloodborne
Pathogens, Universal
Precautions, and Wound Care
McGraw-Hill/Irwin
© 2013 McGraw-Hill Companies. All Rights Reserved.
• Healthcare facility must be maintained
as clean and sterile to prevent spread of
disease and infection
• Must take precautions to minimize risk
and prevent contaminations
• Must be aware of potential dangers
associated with exposure to blood or
other infectious materials
9-2
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 Hepatitis
B, C and HIV
• Others that exist are hepatitis A, D, E and
syphilis
9-3
Hepatitis B (HBV)
• Major cause of viral infection, resulting
in swelling, soreness, loss of normal
liver function
• 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
– Can be unknowingly transferred
9-4
– 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
– Be cautious as HBV can survive in blood and
fluids, in dried blood and on contaminated
surfaces for at least 1 week
9-5
• 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
– Post-exposure vaccination is also available
after coming into contact with blood or
fluids
9-6
Hepatitis C (HCV)
• Acute and chronic form of liver disease
caused by 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
9-7
• Prevention
– Occasionally spread through sexual contact
– Spread via contact with blood of infected
person, sharing needles, or sharing items that
may carry blood (razors, toothbrush)
– Consider the risks of getting a tattoo or body
piercing
– ATC should always follow routine barrier
precautions
9-8
• 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
9-9
Human Immunodeficiency
Virus (HIV)
• A retrovirus that combines with host cell
• Virus has potential to destroy immune
system
• According to World Health Organization
42 million people were living with
HIV/AIDS in 2004
9-10
• 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)
9-11
Acquired Immunodeficiency
Syndrome (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
• After contracting AIDS, people generally
die w/in 2 years of symptoms developing
9-12
• Management
– No vaccine or cure for HIV
– Research looking for preventive vaccine and
effective treatment
– Some antiviral drug combinations help to
slows replication of virus
• Prevention
– Education is critical
– Greatest risk is through intimate sexual
contact with infected partner
– Emphasis safe sexual practices
• Choose non-promiscuous partners
• Use latex condoms to provide HBV & HIV barrier
• Vaginal spermicides
9-13
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
9-14
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
9-15
• Institutions should educate student athletes
– 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 follow universal
precautions and implement policies
concerning bloodborne pathogens
9-16
HIV and Athletic
Participation
• Bodily fluid contact should be avoided
• Avoid exhaustive exercise that may lead to
susceptibility to infection
• According to American with Disabilities Act
infected athletes cannot be discriminated
against and may only be excluded with
medically sound basis
9-17
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
9-18
• Detectable antibodies may appear from 3
months to 1 year following exposure
– Testing should occur at 6 weeks, 3 months,
and 1 year
• 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
9-19
Universal Precautions
• Occupational Safety and Health
Administration (OSHA) 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
– Include counseling, education, volunteer
testing, and management of bodily fluids
9-20
• Preparing the Athlete
– All open wounds and lesions should be
covered with dressing that will not allow for
transmission
– Occlusive dressing lessens chance of crosscontamination
• Hydrocolloid dressing reduces chance that wound
will reopen, maintains moist and pliable wound
• When Bleeding Occurs
– Athletes must be removed from participation
and returned when deemed safe
– Bloody uniform must be removed or cleaned
9-21
• Personal Precautions
– Use appropriate equipment
• 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
• Non-latex gloves can be used when long term exposure to
blood and bodily fluids is not likely
– 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 (anti-germicidal agent)
– Hands should be washed between patients
9-22
• Availability of Supplies and Equipment
– 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
• Shipping containers for infectious material
– Gloves and bandages should be placed in
sealed white bags prior to disposal in regular
trash receptacles
9-23
– Disinfectant
• Contaminated surfaces should be clean with
solution of 1:10 ratio approved disinfectant to
water
• Contaminated towels should be bagged, labeled,
and separated from other soiled laundry, then
transported in biohazard container
– Sharps
• Needles, razorblades, and scalpels
• Do not recap, bend needles
or remove from syringe
• Scissors and tweezers should
be sterilized and disinfected
regularly
9-24
• Protecting the Caregiver
– OSHA guidelines are designed to protect
coaches, athletic trainers and other
employees.
– Responsibility of institution to protect
athletic trainer and other staff
• Provide necessary supplies and education
– All staff have personal responsibility to
follow guidelines and to enforce them
9-25
9-26
• Protecting the Athlete From Exposure
– The USOC suggests use of mouthpieces in
high-risk sports
– Shower immediately after practice or
competition
– Athletes exposed to HIV or HBV should be
evaluated and immunized against HBV
9-27
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
9-28
Caring for Skin Wounds
• Skin wounds are extremely common in
sports
• Soft pliable nature of skin makes it
susceptible to injury
• Numerous mechanical forces can result
in trauma
– Friction, scrapping, pressure, tearing,
cutting and penetration
9-29
• Types of wounds
– Abrasions
• Skin scraped against rough surface
• Top layer of skin wears away exposing
numerous capillaries
• Often involves exposure to dirt and foreign
materials = increased risk for infection
– Laceration
• Blunt force delivered over a sharp bone or a
bone that is poorly padded results in wound
with jagged edges
• May also result in tissue avulsion
9-30
– Puncture wounds
• Can easily occur during activity and can be
fatal
• Penetration of tissue can result in introduction
of tetanus bacillus to bloodstream
• All severe lacerations and puncture wounds
should be referred to a physician
– Avulsion wounds
• Skin is torn from body = major bleeding
• Place avulsed tissue in moist gauze (saline),
plastic bag and immerse in cold water
• Take to hospital for reattachment
– Incision
• Wounds with smooth edges
9-31
Immediate Care
• Should be cared for immediately
• All wounds should be treated as though
they have been contaminated with
microorganisms
• To minimize infection clean wound with
copious amounts of soap, water and
sterile solution
– Avoid hydrogen peroxide and bacterial
solutions initially
9-32
• Dressing
– Sterile dressing should be applied to keep
wound clean
– Occlusive dressing are extremely effective
in minimizing scarring
– Antibacterial ointments are effective in
limiting bacterial growth and preventing
wound from sticking to dressing
– Saline solution is recommended for
repeated cleaning
9-33
• Are sutures necessary?
– Deep lacerations, incisions and
occasionally punctures will require some
form of manual closure
– Decision should be made by a physician
– Sutures should be used within 12 hours
– Area of injury and limitations of blood
supply for healing will determine materials
used for closure
– Physician may decide wound does not
require sutures and utilize steri-strips or
butterfly bandages
9-34
• Signs of Wound Infection
– Same as those for inflammation
•
•
•
•
•
Pain
Heat
Redness
Swelling
Disordered function
– Pus may form due to accumulation of
WBC’s
– Fever may develop as immune system
fights bacterial infection
9-35
• Most wound infections can be treated
with antibiotics
• Staphylococcus aureus has become
resistant to some antibiotics
– Methicillin-resistant staphylococcus aureus
(MRSA) is more difficult to treat
– Infection could spread significantly if cause
is not discovered and improper antibiotics
are used initially
9-36
• Tetanus
– Bacterial infection that may cause fever
and convulsions and possibly tonic skeletal
muscle spasm for non-immunized athletes
– Tetanus bacillus enters wound as spore
and acts on motor end plate of CNS
– Following childhood vaccination, boosters
should be supplied once ever 10 years
– If not immunized, athlete should receive
tetanus immune globulin (Hyper-Tet)
immediately following skin wound
9-37