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
blood-borne 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 WBCs

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 nonimmunized 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