Chapter 8 - Bloodborne Pathogens

Report
Chapter 8: Bloodborne
Pathogens, Universal
Precautions and Wound
Care
© 2010 McGraw-Hill Higher Education. All rights reserved.
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
© 2010 McGraw-Hill Higher Education. All rights reserved.
Hepatitis B
• 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
– May test positive for antigen w/in 2-6 weeks of
symptom development
– 85% recover within 6-8 weeks
© 2010 McGraw-Hill Higher Education. All rights reserved.
Hepatitis B (cont’d.)
• 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
© 2010 McGraw-Hill Higher Education. All rights reserved.
Hepatitis B (cont’d.)
• 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
© 2010 McGraw-Hill Higher Education. All rights reserved.
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
© 2010 McGraw-Hill Higher Education. All rights reserved.
Hepatitis C (cont’d.)
• 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
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Hepatitis C (cont’d.)
• 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
© 2010 McGraw-Hill Higher Education. All rights reserved.
Human Immunodeficiency
Virus
• A retrovirus that combines with host cell
• Virus that has potential to destroy
immune system
• According to World Health Organization
42 million people were living with
HIV/AIDS in 2004
© 2010 McGraw-Hill Higher Education. All rights reserved.
HIV (cont’d.)
• 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)
© 2010 McGraw-Hill Higher Education. All rights reserved.
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
© 2010 McGraw-Hill Higher Education. All rights reserved.
HIV/AIDS (cont’d.)
• 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
• Antiviral drug cocktail
• Slows replication of virus, improving prospects
for survival
© 2010 McGraw-Hill Higher Education. All rights reserved.
HIV/AIDS (cont’d.)
• Prevention
– Greatest risk is through intimate sexual
contact with infected partner
– Choose non-promiscuous sex partners and
use condoms
– Proper use of condoms is imperative for
effective protection
© 2010 McGraw-Hill Higher Education. All rights reserved.
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
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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
© 2010 McGraw-Hill Higher Education. All rights reserved.
Policy Regulation (cont’d.)
• 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 (sexual activity and sharing
needles)
• 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
© 2010 McGraw-Hill Higher Education. All rights reserved.
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
© 2010 McGraw-Hill Higher Education. All rights reserved.
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
© 2010 McGraw-Hill Higher Education. All rights reserved.
HIV Testing (cont’d.)
• Detectable antibodies may appear from
3 month 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
© 2010 McGraw-Hill Higher Education. All rights reserved.
Universal Precautions in
Athletic Environment
• OSHA (Occupational Safety and Health
Administration) 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
© 2010 McGraw-Hill Higher Education. All rights reserved.
Universal Precautions (cont’d.)
• 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
• Hydrocolloid 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
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Universal Precautions (cont’d.)
• Personal Precautions
– Those in direct contact should 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
• 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 (antigermicidal agent)
– Hands should be washed between patients
© 2010 McGraw-Hill Higher Education. All rights reserved.
Universal Precautions (cont’d.)
• 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
– Gloves and bandages should be placed in sealed
white bags prior to disposal in regular trash
receptacles
© 2010 McGraw-Hill Higher Education. All rights reserved.
Universal Precautions (cont’d.)
– Disinfectants
• Contaminated surfaces should be cleaned immediately
with solution of 1:10 ratio approved disinfectant (bleach)
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
•
•
•
•
Includes 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
© 2010 McGraw-Hill Higher Education. All rights reserved.
Universal Precautions (cont’d.)
• Protecting the Caregiver
– OSHA guidelines are designed to protect coaches,
athletic trainers and other employees (not the
athlete)
– Coaches generally do not come into contact with
blood and therefore risk is greatly reduced
– 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
© 2010 McGraw-Hill Higher Education. All rights reserved.
Universal Precautions (cont’d.)
• 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
© 2010 McGraw-Hill Higher Education. All rights reserved.
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
© 2010 McGraw-Hill Higher Education. All rights reserved.
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
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Skin Wounds (cont’d.)
• 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
• Sharp or pointed object tears tissues – results
in wound with jagged edges
• May also result in tissue avulsion
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Skin Wounds (cont’d.)
– 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
© 2010 McGraw-Hill Higher Education. All rights reserved.
© 2010 McGraw-Hill Higher Education. All rights reserved.
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
© 2010 McGraw-Hill Higher Education. All rights reserved.
Caring for Skin Wounds
• 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
– Utilization of hydrogen peroxide can occur
several times daily before reapplication of
ointment
© 2010 McGraw-Hill Higher Education. All rights reserved.
Caring for Skin Wounds
(cont’d.)
• 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
© 2010 McGraw-Hill Higher Education. All rights reserved.
Caring for Skin Wounds
(cont’d.)
• Signs of Wound Infection
– Same as those for inflammation
•
•
•
•
•
Pain (Dolor)
Heat (Calor)
Redness (Rubor)
Swelling (Tumor)
Disordered function (Functio Laesa)
– Pus may form due to accumulation of
WBC’s
– Fever may develop as immune system
fights bacterial infection
© 2010 McGraw-Hill Higher Education. All rights reserved.
Caring for Skin Wounds
(cont’d.)
• 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 and infection is
extremely difficult to treat
– If cause of infection is not discovered early and
improper antibiotics are used initially infection that
starts in skin could spread into more serious
infection
© 2010 McGraw-Hill Higher Education. All rights reserved.
Caring for Skin Wounds
(cont’d.)
• 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 (HyperTET)
immediately following skin wound
© 2010 McGraw-Hill Higher Education. All rights reserved.

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