OA 9.15What’s wrong with this picture?

Chapter 11

Infection Control

Primary survey

Establish Unresponsiveness

• Ask the victim “Are you OK?”

• If no response, active EMS

Check ABC’s

• If not breathing, begin CPR

Determine shock or hemorrhage

• Assess head toe for bleeding or trauma

overview

• Bloodborne pathogens are transmitted through contact with blood or other bodily fluids.

• Hepatitis B and the Human Immunodeficiency Virus are of serious concern.

overview

• A heath care facility must be maintained as clean and sterile to prevent the spread of disease and infection.

• Precautions must be made to minimize the risk of transmission.

bloodborne pathogens

• Pathogenic microorganisms that can potentially cause disease

• Transmitted by human blood, semen, vaginal secretions, CSF, & synovial fluid

bloodborne pathogens

• Three main concerns:– HBV, HCV, and HIV– Additional viruses

• HAV, HDV, HEV

• Make host cells ill by reducing cellular activity– Redirect cell activity to

create more viruses

Hepatitis b virus

• Signs and Symptoms– Swelling, soreness, & loss of normal liver

function– Flu-like symptoms, abdominal pain, fever,

headache, jaundice– May test positive 2-6 weeks after symptoms

develop– 85% recover in 6 to 8 weeks

Hepatitis b virus

• Prevention– Good personal hygiene– Avoid high risk activities– Virus may survive 7 days

on contaminated surfaces

• Management– Vaccination – required

for AHC– 3 dose vaccination over

6 months

Hepatitis C virus

• Acute and chronic liver disease• Most common chronic bloodborne

infection in USA• Signs & Symptoms

– ~80% do NOT have signs and symptoms– Jaundiced, abdominal pain, nausea, loss of

appetite, joint/muscle pain, fatigue, dark urine

Hepatitis C virus

• Prevention– Spread through

contact w/ infected blood

• Usually needles or tools with blood on them

• Rarely through sexual contact

• Management– No vaccine; drug

management

Human immunodeficiency virus

• Signs & Symptoms– Fatigue, weight loss, muscle/joint pain,

painful or swollen glands, night sweats, fever

– May not develop symptoms for up to 8-10 years

– Will eventually develop AIDS

Human immunodeficiency virus

• Management– No vaccine, but there

are drugtherapies

• Prevention– Safe-sex choices– Avoid body fluids &

sharing needles

Disease transmission

• Athletics involve skin-to-skin contact– Some can cause breaks in the skin

• Lacerations• Abrasions• Punctures

• Limited risk of on-field transmission of HIV– Est. risk in football <1:1,000,000 games

Disease transmission

• Some sports may have higher risk– Boxing, wrestling, rugby, martial arts– Basketball, football, hockey, soccer– Non-contact sports have lowest risk

But…

• The risk of transmitting a disease exists– Must be aware of surroundings

• Know the chain of infection

Chain of infectionRESERVOIR HOST

• Infected individual

PORTAL OF EXIT• Nose, mouth, eyes,

urinary/reproductive system, open wounds

ROUTE OF TRANSMISSION

• Direct or indirect contact

PORTAL OF ENTRY• Nose, mouth, eyes,

urinary/reproductive system, open wounds

SUSCEPTIBLE HOST

• Very young and elderly are most susceptible

pathogen

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The Infection Cycle• Infection cycle: chain of events allowing

a pathogen to infect a host:– Pathogen is present– Reservoir host – Portal of exit – Route of transmission – Portal of entry – Susceptible host

Breaking the chain

• The spread of disease can be stopped by removing any link in the chain

• Two ways to remove a link1. Kill the bacteria before it enters the host

2. Change the environment the bacteria lives in• Moist dry• Increase temperature

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Help Prevent the Spread of Infection!

• Wash hands frequently• Wear gloves and other protective

clothing – Gowns, goggles, and masks

• Exposure to blood or other body fluids exists

• Working with clients who may be infectious

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Help Prevent the Spread of Infection!

• Keep your immunizations up-to-date– Especially hepatitis vaccinations

Breaking the ChainRESERVOIR HOST

• Infected individual

PORTAL OF EXIT• Nose, mouth, eyes,

urinary/reproductive system, open wounds

ROUTE OF TRANSMISSION

• Direct or indirect contact

PORTAL OF ENTRY• Nose, mouth, eyes,

urinary/reproductive system, open wounds

SUSCEPTIBLE HOST

• Very young and elderly are most susceptible

pathogen

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Medical Asepsis(Clean Technique)

• Practices and procedures designed to ensure a clean environment– Removing or destroying disease-causing

microorganisms

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Handwashing:The Key to Medical Asepsis

• Handwashing is done at the following times:– When first arriving at work– Before performing each procedure on a

client– During a procedure if hands become

contaminated

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Handwashing:The Key to Medical Asepsis

• Handwashing is done at the following times:– Between each client when a procedure is

performed– After using the restroom– After removing gloves from your hands– Before eating

Universal precautions

• Use Personal Precautions– Wash hand & skin surfaces

• Proper Hand Washing

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Using Gloves

• The athletic trainer: – Should always wear gloves whenever

blood or body fluids are present• Even when the potential for such fluids are

present, gloves must be worn

Universal precautions

• Use Personal Precautions– Extreme care must be used with glove

removal– Glove Removal

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Contaminated Sharps

• A serious risk exists when punctured by a needle or other sharp object

• Dispose of all needles, scalpel blades, and other sharp objects in the proper puncture-resistant container

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Reducing the Risk of Puncture Wounds

• Never recap, bend, or manually remove a dirty needle

• Always deposit the entire syringe and needle or sharp object in puncture-resistant container

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Reducing the Risk of Puncture Wounds

• Immediately clean a puncture wound with alcohol and Betadine and cover the wound

• Report this to your supervisor

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Reducing the Risk of Puncture Wounds

• Never carry needles or sharp objects from one location to another with the tips pointing toward other people or yourself

• Point them toward the floor

33

The Risk of Hepatitis• Handwashing is critical for reducing

hepatitis spread– Often transmitted through the fecal-oral

route due to not washing one’s hands after using the bathroom

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AIDS• Incurable (at present) disease

– Great care must be taken to avoid contact with this virus

– Wash hands– Wear protective eyewear, gloves, and a

mask to prevent exposure to splattering blood or other body fluids

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Universal Precautions• Health care workers must be familiar

with these precautions:– Wear gloves when one has contact with

blood, body secretions, or broken skin – Do not reuse gloves

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Universal Precautions• Health care workers must be familiar

with these precautions:– Wear protective eyewear and a mask

during any procedures that may expose you to splattering blood or other body fluids

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Universal Precautions

• Health care workers must be familiar with these precautions:

– Wear disposable gowns if blood or body fluids may splatter

– Thoroughly wash hands and other skin surfaces immediately following contamination

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Universal Precautions

• Health care workers must be completely familiar with these precautions:– Avoid giving direct mouth-to-mouth

resuscitation– Use mouth-to-mask method, resuscitator

bags, and other available equipment

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Universal Precautions

• Health care workers must be completely familiar with these precautions:– Keep an airway nearby when working in a

health care environment– Avoid direct patient contact if you have

open wounds or other skin conditions

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Universal Precautions

• Healthcare workers must be completely familiar with these precautions:– Wash your hands after each patient contact

and after removing gloves– Carefully dispose of all sharp objects in

appropriate puncture-resistant containers

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Body Secretions for which Standard Precautions Are Used

• Urine• Sputum• Fecal material• Wound drainage• Semen• Vaginal secretions

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Body Secretions for which Standard Precautions Are Used

• Tissues• Synovial fluid

– Around a joint• Cerebrospinal fluid

– Around brain and spinal cord

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Body Secretions for which Standard Precautions Are Used

• Pleural fluid – Lung

• Peritoneal fluid– Abdominal cavity

• Pericardial fluid – Around the heart

• Amniotic fluid

Universal precautions

• Protect Coaches & ATs– Policy for OSHA training– Purchase proper supplies

• Protect Athletes– Use mouthpieces in high-risk sports– Shower immediately– Immunizations

• Postexposure Procedures– Confidential medical evaluation

Take home message…

• Minimize risks by not eating/drinking, applying cosmetics/lip balm, handling contact lenses, and touching face before washing hands in athletic training room