BLOOD BORNE PATHOGENS AIDS and other blood-borne pathogens such as Hepatitis B and C are deadly diseases that are present in today s society. All blood-borne pathogens are transmitted in blood and other bodily fluids such as semen, vaginal fluid, and urine. It is not known if these diseases are carried in tears, saliva, sweat, or emesis (vomit). Since the direct modes of transmission are not entirely known, we must treat any bodily fluid like it contains any of these diseases. BLOOD BORNE PATHOGENS ARE SPREAD IN A NUMBER OF WAYS 1. Direct sexual contact such as oral, anal, or vaginal; they can also be spread through small cuts or sores. 2. Direct contact with blood and other bodily fluids 3. Direct contact with open wounds that contain blood or other bodily fluids 4. Sharing needles; such as IV drug users and needles used to puncture blisters or other medical procedures 5. An HIV infected woman can pass the disease to her baby during birth and from breast-feeding. Since we, as Athletic Trainers, deal with many different types of people and conditions, we need to be aware of and institute policies and procedures for the handling of blood-borne pathogens and open wounds. Athletic Trainers are exposed to a number of open wounds and need to be educated on how to protect both themselves and the athletes from contacting any of these diseases. Any person or athlete could be infected with HIV or Hepatitis and we would not know. The same goes for Athletic Trainers. We must treat every open wound on every athlete/person like it carries blood-borne pathogens. Consistency is the key. The following universal precautions should be observed: 1. The use of barrier precautions to prevent skin and mucous membrane exposure when contact with bodily fluids are anticipated a. Gloves are to be worn when treating, or when in contact with any blood, body fluid, or mucous membrane b. Gloves are to be worn when handling items or surfaces that have come in contact with blood or body fluids 2. Hands and all skin surfaces that come into contact with blood or other body fluids should be washed thoroughly. Hands should also be washed after glove removal 3. Precautions should be taken to prevent injuries caused by needles, scalpels, or other sharp instruments. Needles should not be recapped, broken, or bent by hand 4. Surfaces contaminated with blood or body fluids should be cleaned with a solution made to kill bacteria, fungus and viruses- including HIV
5. Although saliva has not been implicated in HIV transmission, to minimize the need for emergency mouth-to-mouth resuscitation; mouthpieces, resuscitation bags, or other ventilation devices should be available for use 6. Health care workers who have exudate or weeping lesions should refrain from all direct patient contact 7. Blood or body fluid soiled linens should be bagged and washed in hot water and detergent GENERAL POLICIES AND PROCEDURES OPEN WOUNDS: Athletes with open wounds should have them treated and covered with dressings. Any dressings that become saturated with blood should be changed and redressed. The old dressing should be placed in the infectious waste biohazard container. PREVENTION THROUGH THE USE OF GLOVES 1. Each training room on our campus should have a supply of gloves on hand. Each field kit should be stocked a well. All staff and student trainers should carry gloves while on duty 2. Gloves should be applied to both hands before initiating treatment of open wounds and before initiating any procedure 3. Gloves should be applied before cleaning any surfaces that have been exposed to blood or body fluids 4. Gloves are to be applied when handling any linens, gauze, or bandages that have been exposed to blood or body fluids 5. Gloves should be worn when evaluating an athlete with an open or weeping wound 6. Gloves should be worn when changing or handling biohazardous material (bags/containers) 7. After gloves are removed, they should be placed in biohazard container 8. After gloves are removed, hands should be washed thoroughly PREVENTION OF THE SPREAD OF DISEASES AND GERMS THROUGH PROPER HANDWASHING TECHNIQUES: Hand washing should be done 1. After contact with body fluid 2. After glove removal 3. After going to the bathroom 4. Before eating or drinking 5. Before handling any sterile or clean equipment 6. Before and after palpating and/or evaluating an athlete s injury
PROPER HANDWASHING TECHNIQUE If commercial alcohol based gels are available, follow directions on the bottle CLEAN TECHNIQUE FOR HAND WASHING 1. Wet hands with warm, running water 2. Apply liquid soap and water 3. Wash hands using a circular motion and friction for 15-30 seconds 4. Rinse hands well under warm, running water 5. Dry hands with paper towels 6. Discard paper towels 7. With another paper towel, turn off the water and discard the towel CLEANSING OF WOUNDS Cleansing and handling of certain types of wounds will be discussed later; this will be a broad spectrum of procedures on how to handle any type of open wounds 1. If it is an emergency situation, glove up as fast as possible. The steps will be generally the same as those listed below 2. If its is a non-emergency situation, obtain all supplies that will be needed and have them close by a. Glove up b. Control any bleeding with gauze and direct pressure c. Have someone else open and pour Hydrogen Peroxide or Betadine over the wound (this will help keep cross contamination down) d. Pat or scrub the wound with gauze e. Dry the wound with gauze f. Apply antibiotic ointment (Triple antibiotic or Neosporin) 1. If using large tubes, have someone else open and dispense the ointment onto a clean tongue depressor/cotton applicator. Do not retouch the applicator to the tube. This can cause cross contamination 2. If using individual packets, open packet, apply, and dispose of packet in biohazard container g. Apply bandage h. Dispose of any soiled gauze or bandages in biohazard container i. Discard gloves in biohazard container j. Glove up k. Clean surfaces with Whizzer cleaning and disinfectant solution l. Place soiled linens in bag to be washed m. Discard gloves in biohazard container n. Wash hands using proper techniques BIOHAZARD CONTAINERS 1. Biohazard containers are for the disposal of items (gloves, gauze, dressings, etc.) that come into contact with body fluids or blood 2. Biohazard containers will be provided for all training rooms
3. Biohazard containers will be provided for all practice area, game sites, or any location as needed 4. Biohazard containers will be lined with red biohazard bags that will be changed when full. Wear gloves when changing containers. 5. Sharp objects (needles, scalpels, etc.) will be placed in the Sharp s containers found in each doctors office on the counter 6. Biohazard containers are not trashcans. Do not put gauze or Band-Aid wrappers in them 7. Biohazard waste will be picked up when containers become full OPEN WOUNDS AND WHIRLPOOLS 1. Any person with an open wound will not be allowed to use the whirlpool. The only exception being using a sterile whirlpool for wound debridement. A staff trainer must oversee this process. 2. All staff and student trainers should visually inspect the wound to be treated and the area that it is to be treated in 3. Open wounds include cuts, abrasions, blisters, cracked skin, sutured areas, etc. 4. For treatment purposes, heat packs or ice bags may be used. DISPOSAL OF BLOOD SOILED LAUNDRY Sometimes a staff trainer, student trainer, or an athlete will grab whatever is close to stop bleeding, such as a towel. 1. Any blood or body fluid soiled laundry will be placed into a biohazard bag by itself. The bag will be sealed with a knot at the top of the bag and placed in the biohazard box in the doctor s office. CARE OF UNIFORMS WITH BLOOD ON THEM DURING CONTESTS OR PRACTICES According to NCAA Guidelines, any uniform, equipment, or padding that becomes soiled with blood must be changed or the blood removed before returning to competition, practice, etc. We must be proactive on this matter, do not wait until an official sends an athlete out of the game. If you see blood on a uniform, take care of it as quickly as possible. Follow these procedures. 1. Glove up 2. Spray area with blood removal solution (Blood Buster/Peroxide) 3. Scrub with gauze 4. Rinse area with water 5. Scrub with gauze again 6. Rinse with water again 7. Discard gloves and gauze in biohazard container 8. Wash hands using proper technique
COVERING OF OPEN WOUNDS DURING GAMES AND PRACTICES Any athlete with an open wound should have that wound covered appropriately before participating in a game or practice. In games, officials will send athletes out to have this done. We should be as concerned with practices as well. Consideration should be taken when covering wounds as the athlete will perspire. Make sure the dressing will stay on the athlete during activity. SPECIFIC POLICIES AND PROCEDURES FOR CERTAIN WOUND TYPES ENCOUNTERED IN THE TRAINING ROOM BLISTER DRAINAGE: 1. Obtain all supplies (gloves, gauze, Betadine, Band-Aids, sterile needle/scalpel, tweezers, applicators, Zinc Oxide, antibiotic ointment, etc.) 3. Apply Betadine to area with gauze 4. Make small hole in the base of the blister with needle/scalpel 5. Allow fluid to flow out and pat dry 6. Apply Zinc Oxide or antibiotic ointment with sterile applicator (do not touch blister with ointment and then touch tube with applicator- you will contaminate the tube) 7. Apply Band-Aid 8. Clean up a. place needle/scalpel in Sharp s container b. place gauze in biohazard container c. place all wrappers in trash can d. clean all instruments and place back in tray e. clean surfaces with Whizzer solution f. remove gloves and place in biohazard container g. wash hands using proper technique SUBUNGIUNAL HEMATOMA DRAINAGE: 1. Obtain all supplies (gloves, gauze, Betadine, nail drill, applicators, antibiotic ointment, Band-Aids, etc.) 3. Apply Betadine to nail and drill 4. Drill nail 5. Soak up blood with gauze 6. Apply antibiotic ointment with applicators 7. Apply Band-Aid 8. Clean up a. place gauze and applicators into biohazard container b. clean surfaces c. remove gloves and place in biohazard container d. wash hands using proper technique
CLEANING OF TURF BURNS, CUTS, AND LACERATIONS: 1. Obtain all supplies needed (gloves, gauze, hydrogen peroxide, antibiotic ointment, applicators, Band-Aids, etc.) 3. Apply (pour/spray) hydrogen peroxide to area 4. Pat dry with gauze 5. Apply antibiotic ointment with applicator 6. Clean up a. place gauze, applicators in biohazard containers b. clean surfaces with Whizzer solution c. wash towels d. remove gloves and place in biohazard container e. wash hands using proper technique NOSEBLEEDS (EPISTAXIS): 1. Obtain supplies (gloves, gauze, nose plugs, skin lube) 2. Let athlete do as much as they can 3. Glove up 4. Control bleeding with gauze and direct pressure. Have athlete lean forward (backward leaning could cause choking) 5. Watch for signs of nausea, vomiting, or shock 6. Apply nasal plug if needed 7. If bleeding has not subsided, you can apply skin lube to a nasal plug or a piece of rolled up gaze and place it in the nose 8. Clean up a. place gauze, nasal plugs, etc. into biohazard container b. clean surfaces with Whizzer solution c. wash towels d. remove gloves and place in biohazard container e. wash hands using proper technique DENTAL INJURIES: 1. Obtain supplies (gloves, gauze) 3. Control any bleeding with gauze and direct pressure 4. If not bleeding, wear gloves anyway for barrier against saliva 5. If tooth is out of socket, gently replace it and contact team dentist immediately. If you are unable to replace it in the socket, have athlete hold it in his/her mouth until transport to team dentist can be arranged 6. If tooth is cracked, contact team dentist 7. If necessary, use a save a tooth kit to keep a lost tooth or large piece of tooth healthy 8. Place soiled items in biohazard container (gloves, towels, etc.) 9. Clean surfaces with Whizzer solution 10. Remove gloves and place in biohazard container 11. Wash hands using proper technique
CLEANING OF LARGE SPILLS OF BLOOD, VOMIT, URINE 1. Obtain supplies (gloves, bleach solution in spray bottle, paper towels, soap and water) 3. Soak up body fluid with paper towels 4. Dispose of paper towels in biohazard container 5. Scrub spill area with soap and water 6. Remove gloves and place in biohazard container 7. Saturate area with Whizzer solution and let stand 8. Glove up 9. Soak up area with paper towels and place in biohazard container 10. Remove gloves and place in biohazard container 11. Wash hands using proper technique CLEANING OF SPILLS AT CONTEST SITES- OUTDOORS: 1. Obtain supplies (gloves, paper towels, water) 3. Soak up spill with paper towels 4. Dispose of paper towels in biohazard container 5. Saturate spill with Whizzer solution 6. Place gloves in biohazard container 7. Wash hands using proper technique CLEANING OF SPILLS AT CONTEST SITES- INDOORS: Refer to cleaning of large spills as listed above. It may not be possible to let Whizzer solution stand. Clean area as fast as possible because it may be impeding the competition. APPLICATION OF STERI-STRIPS: 1. Obtain supplies (gloves, gauze, applicators, hydrogen peroxide, steri-strips, etc.) 3. Dry area with gauze 4. Wash area with hydrogen peroxide 5. Dry area with gauze 6. Apply steri-strips in an anti-gravity fashion. Pull the sides of the wound together. 7. Clean up a. place gauze and applicators in biohazard container b. Clean surfaces with Whizzer solution c. Place towels in laundry d. Remove gloves and place in biohazard container e. Wash hands using proper technique
SUTURING WOUNDS The team physicians will handle the suturing of wounds. They will follow all universal precautions. Every training room will be equipped with suture kits. Every athletic trainer should be familiar with assisting the team physician in dealing with the injury. Have necessary supplies on hand. REMOVAL OF SUTURES A staff athletic trainer under the order of the team physicians will do the removal of sutures. Take the following steps when removing sutures 1. Obtain supplies (gloves, gauze, suture-removal kit, tweezers) 3. Snip ends of suture and remove with tweezers 4. Clean up a. place sutures and gauze in biohazard container b. place any sharps in Sharp s container c. Remove gloves and place in biohazard container Wash hands using proper technique