BLOODBORNE PATHOGENS

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BLOODBORNE PATHOGENS
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Anatomy of the Skin

• The skin is the largest organ of the body.
• Two major layers are the dermis and epidermis.
• Subcutaneous fat helps insulate the body from the
  environment.
• Skin thickness varies regionally thickest skin
  is on the soles of the feet and palms of the
  hands.

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Anatomy of the Skin
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Anatomy of the Skin (cont.)

• Skins functions include
• Protection from environment.
• Maintenance of bodys fluid balance.
• Protection against disease organisms. Temperature
  regulation.
• Housing for sensory nerves.
• Production of vitamin D.

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• BLOODBORNE PATHOGENS
• Are disease-causing microorganisms (viruses,
  bacteria, and parasites) that may be present in
  human blood.
• - Bloodborne pathogens are transmitted when
  blood or OPIMs (other potentially infectious
  materials) come in contact with mucous membranes
  or nonintact skin.
• - Cuts, abrasions, burns, rashes, acne, paper
  cuts, and hangnails.
• - Splashes or sprays, handling or touching
  contaminated items or surfaces, injection under
  the skin by puncture wounds or cuts from
  contaminated sharps.

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• CHAIN OF INFECTION
• Pathogen- Any disease-causing microorganism
• Reservoir Host- The individual in which the
  infectious
• microorganism reside.
• Portal of Exit- The pathogens route of escape
  from the
• reservoir.
• Route of Transmission- The method by which the
• pathogen enters its new host (direct contact,
  air, insects,
• etc.)
• Portal of Entry- The route through which the
  pathogen enters its new host (respiratory,
  gastrointestinal, urinary, and reproductive
  tracts)

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• Susceptible Host- The source, such as a human
  who accepts the pathogen, and depending on degree
  of resistance, supports the pathogens life and
  reproduction (malnourished, suppressed immune
  systems, and others in poor health)
• Sterlization is the complete destruction of all
  forms of
• microbial life
• Aseptic means sterile, preventing infection

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• Staphylococci are bacteria that occur naturally
  on the
• skin and therefore are on your hands. Research
  has
• shown the most effective method to reduce the
  risk of
• industrial illnesses is to use frequent
  handwashing.
• Washing of hands needs to be done
• - First arriving at work
• Before performing each medical procedure on
  patient
• During a procedure if your hands become
  contaminated
• After using restroom
• After removing gloves from your hands
• Before eating

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• Proper Handwashing Technique

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• Sharps Containers
• All needles, scalpel blades, and other sharp
  objects should be disposed of in the proper
  container.
• Never recap, bend, or manually remove a dirty
  needle.
• Always deposit the entire syringe and needle or
  sharp
• object in the container.
• Immediately clean any puncture wound with alcohol
  
• and betadine and cover the wound. Report incident
  to
• your supervisor or instructor.

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• What Is An Acceptable Container
• It must be
• Closable
• Puncture Resistant
• Leakproof on sides and bottom
• Labeled or color coded
• A sharps container may be made of a variety of
  products,
• including cardboard or plastic, as long as the
  four criteria
• are met. Duct tape may secure a lid, but isnt
  acceptable if
• it serves as the lid.

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• Removing Contaminated Gloves
• Cross-contamination
  exercise

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Wounds

• Wound Care
• Primary goals of wound care are
• Control bleeding.
• Prevent infection.
• Primary concern when rendering first aid is
  avoidance of exposure to whole blood that may
  transmit HIV or HBV.
• The majority of wounds in sports are abrasions,
  lacerations, or incisions.
• Turf burn is a form of abrasion associated with
  artificial grass surfaces.

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Wound Treatment Protocol

• 1. Apply direct pressure to control bleeding by
  applying some type of sterile dressing.
• 2. If dressing becomes blood soaked, add more
  dressing on top. Do not remove blood-soaked
  dressings.
• 3. If bleeding is severe and does not respond to
  direct pressure, use elevation in combination
  with direct pressure.

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Wound Treatment Protocol (cont.)

• 4. Increased hemorrhage control can be achieved
  by application of pressure bandage over either
  brachial or femoral arteries, depending on wound
  location.
• Once pressure is applied to these points, it
  should not be removed until athlete is under
  physicians care.
• Tourniquet should be applied only as a last
  resort.
• 5. All materials used to treat the wound should
  be stored for later disposal in a properly
  identified biohazardous material container.

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Wound Care

• At the time of initial injury, a decision must be
  made regarding continued participation.
• Consider health and safety of the athlete as well
  as risk to others.
• Once bleeding has stopped, apply commercially
  made dressing held in place by adhesive bandage.
• Lacerations and incisions, particularly those to
  the scalp and face, merit special attention
  because of potential cosmetic impact.
• General rule Any wound that is below dermal
  layer and more than 1 cm in length should be seen
  by a physician, especially if it is on the face.

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Guidelines for Cleaning Wounds

• Personnel caring for wound should wear latex
  gloves.
• 2. Wash wound with sterile gauze pad saturated
  with soap and water.
• 3. A 3 solution of hydrogen peroxide may be used
  to clear away clotted blood.
• 4. Flush with a lot of water and dry with sterile
  gauze.
• 5. Clean around wound with isopropyl alcohol do
  not apply the alcohol directly to the wound.

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Guidelines for Cleaning Wounds (cont.)

• 6. Apply a sterile, dry dressing and hold in
  place with some type of clean bandage.
• 7. Severe wounds should be treated for control of
  bleeding and referred immediately for medical
  evaluation.

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HIV/HBV and the Athlete

• HIV and HBV are bloodborne infections.
• Anyone who is sexually active is at risk.
• Athletes injecting steroids and sharing needles
  are also at risk.
• Any time a person infected with HIV sustains a
  bleeding wound, the possibility of transmission
  exists.
• The prudent coach should follow basic preventive
  guidelines for HIV and HBV transmission, as
  outlined by OSHA.

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HIV/HBV and the Athlete (cont.)

• Coaches are at risk because they are often
  exposed to bloody towels, water bottles, playing
  surfaces, and blood-soaked bandaging materials.
• Participants in wrestling, tackle football, and
  boxing often sustain wounds.
• Coaches and officials should take precautions and
  remove players from participation when excessive
  bleeding is evident.
• Education of athletes, coaches, and parents about
  HIV and HBV is essential.

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Hepatitis Infection

• HAV and HBV are both serious. HBV is considered
  potentially life threatening.
• HAV is transmitted via feces, which is a problem
  for food handlers who do not wash their hands.
• HBV transmitted through blood and sexual fluids.
• IV drug users can also become infected through
  contaminated needles.
• Incubation for HAV is 15 to 50 days HBV is 45 to
  160 days.

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Hepatitis Infection (cont.)

• Signs and symptoms for both types of infection
  include
• Nausea, abdominal pain, vomiting, fever, and
  malaise.
• If untreated, both types will involve the
  liver resulting in jaundice.
• Liver damage is possible, leading in some cases
  to death.
• Treatment is limited.
• HAV can be treated with immediate inoculation to
  provide passive immunity.
• Athletes with HAV or HBV should be removed from
  participation.

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• Hepatitis can affect anyone. Each year in the
• United States, 140,000 to 320,000 people will
• become infected with the virus.
• CDC studies have shown steady decline in the
• incidence of HBV infection. Decline is
  attributed
• to the use of vaccine (series of 3 shots) and
• implementation of other prevention methods,
• such as engineering and work practice controls,
• personal protective equipment, and universal
• precautions.

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• HIV (Aquired Immune Deficiency Syndrome)
• HIV-1 and HIV-2
• Causes suppression of the immune system and
• can lead to opportunistic infections and unusual
• types of cancer.
• HIV-2 develops more slowly and may be milder.
• Few cases in US and is predominately found in
• Africa.

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• - CDC reports that is 2003 there were an
• estimated 1,039,000 people in the US w/
• HIV/AIDS.
• - Approximately 25 of infected persons are
• undiagnosed and unaware of their infection.
• - Annual rate of infection with HIV is 16.5 cases
• per 100,000 population with no vaccination.
• - The only way to know if you are infected is to
• be tested.
• Incubation period w/ HIV from time of HIV
  infection to the development of AIDS may take
  8-10 years.

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• - Can not rely on symptoms to know whether you
  are infected with HIV since most people will not
  show symptoms for many years.
• AIDS symptoms of AIDS are similar to the symptoms
  of many other infections and might include night
  sweats, weight loss, fever, fatigue, gland pain
  or swelling, and muscle or joint pain.
• - Patients with AIDS by law are not mandated to
  inform health care providers so ALWAYS protect
  yourself!!!

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• TUBERCULOSIS
• Airborne disease
• Since 1985, incidence of TB in the general US
  population has increased approximately 14.
• Mycobacterium tuberculosis is the bacteria
  responsible for causing TB in humans.
• TB may cause disease in any organ of the body,
  most commonly the lung, which accounts for about
  85 of all infection sites.
• - Other sites may include lymph nodes, CNS,
  kidneys, and the skeletal system.

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• TB is a serious and often fatal disease if left
  untreated.
• Symptoms include weight loss, weakness, fever,
  night sweats, coughing, chest pain, and coughing
  up blood.
• Prevalence of infection is much higher in the
  close contacts of TB patients than in the general
  population.

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• TB is spread from person to person in the form
• of droplet nuclei in the air. When a person
  with TB coughs, sings or laughs, the droplet
  nuclei are released into the air. When
  uninfected people breath in the air, they become
  infected with TB
• You must have close contact to a sufficient
  number of air droplet nuclei.
• - A persons health must also be considered for
  contributing to susceptibility of TB disease.

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• - Among the medical risk factors for developing
  TB are diabetes, gastrectomy (removal of stomach)
  long-term corticosteroid use, immunosuppressive
  therapy, cancers and other malignancies, and HIV
  infection
• Symptoms are similar to the flu or cold but
• last longer and must be treated with
  prescription antibiotics.
• - The HIV epidemic is a major contributing
  factor to the recent increase in cases of active
  TB.