| VIRUS REPRODUCTION - A virus is a submicroscopic parasitic organism that is dependent on the nutrients within cells. - A virus consists of either deoxyribonucleic acid (DNA) or ribonucleic acid (RNA) BLOODBORNE PATHOGENS - Mode of transmission includes; o Human blood o Semen o Vaginal secretions o Cerebrospinal fluid o Synovial fluid - Bloodborne pathogens include; o Hepatitis B virus (HBV) o Human immunodeficiency virus (HIV) Hepatitis B Virus - Hepatitis B virus is a major cause of viral infection - Swelling, soreness, and loss of normal function in the liver - 1.25 million people in the United States - 300,000 per year - Symptoms and Signs o Fatigue, weakness, nausea, abdominal pain, headache, fever, and possibly jaundice o + Test within 2 to 6 weeks after symptoms develop - Prevention o Good personal hygiene and avoiding high-risk activities - Management o Vaccination (3 does over 6 months / 87 to 96 %) Human Immunodeficiency Virus - HIV is a retrovirus that combines with a host cell. - Retrovirus = A virus that enter a host cell and changes its RNA to a proviral DNA replica. - 1 in 250 people in the United States (1% in adult male age between 20 to 49) - Symptoms and Signs o Fatigue, weight loss, muscle or joint pain, painful or swollen glands, night sweats, and fever. o + Test within one year after exposure o HIV will develop acquired immunodeficiency syndrome (AIDS) Acquired Immunodeficiency Syndrome - Management o No vaccine and no treatment - Prevention o HIV is most often transmitted through intimate sexual contact. o The use of latex condoms can reduce the chances of contracting HIV BLOODBORNE PATHOGENS IN ATHLETICS - In general the chances of transmitting HIV among athletes is low. Policy Regulation - OSHA (Occupational Safety and Health Administration) Human Immunodeficiency Virus Athletic Participation - Bodily fluid contact should be avoided - Participation should avoid engaging in exhaustive exercise that may lead to an increased susceptibility to infection. - HIV cannot be discriminated against and may be excluded from participation only with a medically sound basis, but can by objective medical evidence. - AIDS virus attacks T-helper lymphocytes of body’s immune system leaving individual vulnerable to infection Taking Athletes for Human Immunodeficiency Virus - Testing for HIV should not be used as a screening tool to determine if an athlete can participate in sports. - A blood test analyzes serum using enzyme-linked immunosorbent assay (ELISA). - The ELISA test detects antibodies to HIV proteins. - Western bolt examination is a more sensitive exposure. UNIVERSAL PRECAUTIONS IN AN ATHLETIC ENVIRONMENT - OSHA established standards for employer to follow that govern occupational exposure to blood-borne pathogens. Preparing the Athlete - An occlusive dressing lessens the chances of cross-contamination (hydrocolloid dressing). When Bleeding Occurs - Uniform that is saturated with blood must be removed and changed before athlete can return to competition. Personal Precautions - Latex gloves should be worn whenever the athletic trainer handles blood or bodily fluids. Availability of Supplies and Equipment - Universal precautions minimize the risk of exposure and transmission. Disinfectants - All contaminated surfaces should be cleaned immediately with solution consisting of one part bleach to ten parts water or with a disinfectant approved by a the Environmental Protection Agency. - Contaminated laundry should be washed in hot water (71 C/ 159 F for 25 minutes) using a detergent that deactivates the virus. Sharps - Scalpels - Razor blades - Needles - Sharps should be disposed of in a leakproof and puncture-resistant container. Protecting the Coach and Athletic Trainer - OSHA guidelines for bloodborne pathogens are intended to protect coach, athletic trainer, and other employees, and not athlete. Protecting the Athlete from Exposure - The USOC supports the required use of mouthpiece in high-risk sports. POSTEXPOSURE PROCEDURES - Documentation of the exposure route, identification of the source individual, a blood test, counseling, and an evaluation of reported illness. |
| Bloodborne Pathogens |
| NATA Blood Borne Pathogens Guidelines for Athletic Trainers The NATA recognizes that blood borne pathogens such as HIV, HBV, and HCV present many complex issues for athletic trainers, athletic administrators, and others involved with the physically active, it is important for athletic trainers to be aware of these issues. The NATA therefore offers the following guidelines and information concerning the management of blood borne pathogen-related issues in the context of athletics and settings in which the physically active are involved. It is essential to remember, however, that the medical, legal and professional knowledge, standards and requirements concerning blood borne pathogens are changing and evolving constantly, and vary, in addition, from place to place and from setting to setting. The guidance provided in these guidelines must not, therefore, be taken to represent national standards applicable to members of the NATA. Rather, the guidance here is intended to highlight issues, problems, and potential approaches to (or management of) those problems that NATA members can consider when developing their own policies with respect to management of these issues. ATHLETIC PARTICIPATION Decisions regarding the participation of athletes infected with blood borne pathogens in athletic competitions should be made on an individual basis. Such decisions should be made following the standard or appropriate procedures generally followed with respect to health-related participation questions, and taking into account only those factors that are directly relevant to the health and rights of the athlete, the other participants in the competition, and the other constituencies with interests in the competition; the athletic program, the athletes, and the sponsoring schools and organizations. The following are examples of factors that are appropriate in many settings to the decision-making process; - The current health of the athlete - The nature and intensity of the athlete’s training - The physiological effects of the athletic competition - The potential risks of the infection being transmitted - The desires of the athlete - The administrative and legal needs of the competitive program EDUCATION OF THE PHYSICALLY ACTIVE In a rapidly changing medical, social, and legal environment, educational information concerning blood borne pathogens is of particular importance. The athletic trainer should play a role with respect to the creation and dissemination of educational information that is appropriate to and particularized with respect to that athletic trainer’s position and responsibilities. Athletic trainers who are responsible for developing educational programs with respect to blood borne pathogens should provide appropriate information concerning; - The risk of transmission or infection during competition - The risk of transmission or infection generally - The availability of HIV testing - The availability of HBV testing and vaccinations Athletic trainers who have educational program responsibility should extend educational efforts to include those, such as the athlete’s families and communities, who are directly or indirectly affected by the presence of blood borne pathogens in athletic competitions. All educational activities should, of course, be limited to those within athletic trainers’ scope of practice and competence, be within their job descriptions or other relevant roles, and be undertaken with the cooperation and/or consent of appropriate personnel, such as team physicians, coaches, athletic directors, school or institutional counsel, and school and community leaders THE ATHLETIC TRAINER AND BLOOD BORNE PATHOGENS AT ATHLETIC EVENTS The risk of blood borne pathogen transmission at athletic events is directly associated with contact with blood or other body fluids. Athletic trainers who have responsibility for overseeing events at which such contact is possible should use appropriate preventative measures and be prepared to administer appropriate treatment, consistent with the requirements and restrictions of their job, and local, state, and federal law. In most cases, these measures will include; - Pre-event care and covering of existing wounds, cuts, and abrasions - Provision of the necessary/usual equipment & supplies for compliance with universal precautions, including, latex gloves, biohazard containers, disinfectants, bleach solutions, antiseptics, and sharps containers - Early recognition and control of a bleeding athlete, including measures such as appropriate cleaning and covering procedures, or changing of blood-saturated clothes - Requiring all athletes to report all wounds immediately - Insistence that universal precaution guidelines be followed at all times in management of acute blood exposure - Appropriate cleaning and disposal policies and procedures for contaminated areas or equipment - Appropriate policies with respect to delivery of life-saving techniques in the absence of protective equipment - Post-event management including, as appropriate, re-evaluation, coverage of wounds, cuts, and abrasions - Appropriate policy development, including incorporation, with necessary legal and administrative assistance, of existing OSHA and other legal guidelines and conference or school rules and regulations STUDENT ATHLETIC TRAINER EDUCATION NATA encourages appropriate education of an involvement of the student athletic trainer in educational efforts involving blood borne pathogens. These efforts and programs will vary significantly based on local needs, requirements, resources, and policies. At the secondary school level, educational efforts should include items such as the following; - Education and training in the use of universal precautions and first aid for wounds - Education regarding the risks of transmission/infection from the participants that they care for - Education on the availability of HIV testing - Education on the availability of HBV vaccinations and testing - Education of parents or guardians regarding the students’ risk of infection. At the college or university level, education efforts should include items such as those listed above, and, additionally, as appropriate, the following; - Education in basic and clinical science of blood borne pathogens - Discussions regarding the ethical and social issues related to blood borne pathogens - The importance of prevention programs - Education concerning the signs and symptoms of HBV and HIV, as consistent with the scope of practice of the athletic profession and state and local law UNIVERSAL PRECAUTIONS AND OSHA REGULATIONS Athletic trainers should, consistent with their job descriptions and the time and legal requirements and limitations of their jobs and professions, inform themselves and other affected and interested parties of the relevant legal guidance and requirements affecting the handling and treatment of blood borne pathogens. Athletic trainers cannot be expected to practice law or medicine, and efforts with respect to compliance with these guidelines and requirements must be commensurate with the athletic trainer’s profession and professional requirements. It may be appropriate for athletic trainers to keep copies of the Center for Disease Control regulations and OSHA regulations and guidelines available for their own and others’ use. MEDICAL RECORDS ANDCONFIDENTIALITY The security, record-keeping, and confidentiality requirements and concerns that relate to athletes’ medical records generally apply equally to those portions of athletes’ medical records that concern blood borne pathogens. Since social stigma is sometimes attached to individuals infected with blood borne pathogens, athletic trainers should pay particular care to the security, record-keeping, and confidentiality requirements that govern the medical records for which they have a professional obligation to see, use, keep, interpret, record, update, or otherwise handle. Security, record-keeping, and confidentiality procedures should be maintained with respect to the records of other athletic trainers, employees, student athletic trainers, and athletes, to the extent that the athletic trainer has responsibility for these records. THE INFECTED ATHLETIC TRAINER An athletic trainer infected with a blood borne pathogen should practice the profession of athletic training taking into account all professionally, medically, and legally relevant issues raised by the infection. Depending on individual circumstances, the infected athletic trainer will or may wish to; - Seek medical care and ongoing evaluation - Take reasonable steps to avoid potential &identifiable risks to his own health &health of his or her patients - Inform, as or when appropriate, relevant patients, administrators, or medical personnel HIV AND HBV TESTING Athletic trainers should follow federal, state, local, and institutional laws, regulations, and guidelines concerning HIV and HBV testing. Athletic trainers should, in appropriate practice settings and situations, find it advisable to educate or assist athletes with respect to the availability of testing HBV VACCINATIONS Consistent with professional requirement and restrictions, athletic trainers should encourage HBV vaccinations for all employees at risk, in accordance with OSHA guidelines. WITHHOLDING OF CARE AND DISCRIMINATION NATA’s policies and its Code of Ethics make it unethical to discriminate on the basis of medical conditions. |