EDUCATIONAL OBJECTIVES
The learner should, at the completion of the chapter, be able to perform the following:
Although Occupational Safety and Health Administration (OSHA) regulations concerning exposure to bloodborne pathogens in the workplace were published in 1992, confusion and myths still exist. Many schools and companies do not understand the regulations and are not in compliance. Unfortunately, the fact that a school or company does not fully understand the standard will not protect it from enforcement penalties should OSHA investigate. Risk of actual infection with a bloodborne disease is still relatively small, however is growing, especially from Hepatitis B. Hepatitis B is a viral infection that affects the liver and can be fatal. Also, it is estimated that there are 2.5 million people infected with the human immunodeficiency virus (HIV), the majority of whom do not have visible symptoms of the disease. Currently, there is no cure or vaccine for this deadly disease. How many new cases of HIV develop each year is unknown, but the total number of known cases has increased. While the OSHA regulations are cumbersome and time consuming to follow, they should be effective in reducing the risk of infection even further and, therefore, will help stop the spread of bloodborne diseases. Some frequently asked questions regarding OSHA standards follow. You can find the Occupational Safety and Health Administration web site at http://www.osha.gov.
What is the OSHA bloodborne pathogens standard? OSHA Regulation 1910.1030, Occupational Exposure to Bloodborne Pathogens, sets forth required procedures for protecting employees of any type of company, organization, or institution against accidental exposure to bloodborne pathogens. This standard was first published in the Federal Register on December 6, 1991 and became effective March 6, 1992. For access to current bloodborne pathogens standard, contact you local health department or access the Center for Disease Control web site at http://www.cdc.gov.
Is my school covered by this standard? If your school has employees who, in the course of the work which has been assigned to them, can reasonably be expected to come into contact with human blood, certain body fluids, or infectious waste, the school must comply with the provisions of OSHA 1910.1030.
In a scholastic setting, who might be at risk of exposure? The most obvious employees are athletic trainers, coaches, and school nurses who are first responders to athletic or other injuries. The basketball or wrestling coach dealing with a bloody nose or split lip is considered to be in the presence of infectious material. The athletic trainer treating a common abrasion makes his or her employer subject to the standard. Less obvious are teachers providing first aid, the custodial personnel required to mop the gym floor or wrestling mat upon which blood has been spilled, and the laundry workers who must handle blood soaked uniforms. All of these employees are covered by the standard, and provided its protection.
Are game officials and referees considered employees? Yes. As soon as a high school hires them to work a game or match, they are technically considered to be employees of the school and the protections spelled out in the standard must be provided to them.
What are the basic provisions of OSHA 1910.1030? The bloodborne pathogens standard involves seven very precisely defined areas. They are:
If my school is in compliance with regulations of its national governing body, is it in compliance with the OSHA Standard? No. Unless the regulations of the organization are at least as comprehensive as OSHA 1910.1030 they would not be a substitute for them.
Can our teams' athletic trainer, manager or coach remove blood from a player’s uniform and be in compliance with the OSHA Standard? There is nothing in the standard, which specifically prohibits the removal of blood from uniforms. However, the standard does stipulate the only approved method of removing blood from a uniform is to put the uniform through a complete wash cycle with a commercial laundry detergent. Even though participants and other associated individuals could conceivably be exposed through an improperly disinfected uniform, OSHA would most likely discourage the practice of removing blood from uniforms with a chemical spot remover.
What about spraying a disinfectant on the blood spot? This method is not approved as an effective means to disinfect a potentially contaminated uniform. Blood on uniforms is absorbed by thousands of threads made of microscopic fibers. The extent to which a disinfectant will kill viruses and tuberculosis bacilli has not been verified. Presently utilized CDC testing methods apply to hard, non-absorbent surfaces only.
BLOODBORNE PATHOGENS
As athletic trainers, our primary concern is the health of our athletes. However, we must also be concerned for our own personal safety. In 1992, OSHA issued new regulations regarding health care workers and the handling of bloodborne pathogens (BBP). The bloodborne pathogens of most concern are HIV and Hepatitis B. These BBP are of special concern to the athletic trainer since it is common for the athletic trainer to come in contact with blood and other body fluids on a daily basis. It is possible the very athletes we are trying to help may infect us. This contamination is potentially lethal. It is foolish for the athletic trainer to assume none of these athletes are contaminated. Therefore, we should know and practice proper preventive measures. Fortunately, OSHA has laid down basic guidelines for the health care professional.
Preventive and Protective Measures in Waste Management
An athletic trainer can be exposed to bloodborne pathogens in a variety of ways. The most obvious is caring for an athlete with some sort of bloody wound. Other situations would include serum fluid in blisters, vomitus with an ill athlete, and saliva in spittle. Given these exposure opportunities, the athletic trainer should take proper precautions. First, wear latex gloves when working on athletes with exposed body fluids. The use of gloves provides a barrier between you and the wound or body fluid you are treating. Gloves should be worn at all times when evaluating an athlete, especially when the possibility of an undiscovered, open wound may exist. When wearing latex gloves, there are some general guidelines an athletic trainer should follow. The protective value of the gloves diminishes after 10-15 minutes of wearing them. If gloves should tear, replace them immediately. When choosing gloves, an athletic trainer should select a size, which fits his or her hands. After use, the gloves and all contaminated materials should be disposed of properly in a biohazard infectious waste container. The next step the athletic trainers should follow is cleaning of the contaminated athletic training room. An effective preparation is 1 part of bleach to 10 parts of water solution.
To prepare the solution, add 1 ounce of bleach to 10 ounces of water in a spray bottle. The bleach should be mixed with cool water. Warm or hot water deactivates the bleach’s basic cleaning agent, "hypochlorite." Label the bottle and store it so it is accessible only to those who are going to use it. This solution mixture is good only one day, so it should be made daily. In using the bleach/water solution to clean up body fluids, the following procedure is recommended.
1. Put on latex gloves.
2. Absorb fluids with paper towels.
3. Saturate the area with bleach solution and allow soaking before
absorbing it with another paper towel.
4. Scrub the area with bleach solution and then soap and water, using
a paper towel.
5. Rinse the area.
6. All soiled materials, including gloves, should be placed in the
biohazard bag/container.
7. Wash hands thoroughly after disposal of materials.
NATIONAL HIGH SCHOOL FEDERATION RULES
In 1994, the National Federation of State High School Associations (NFSHSA) adopted its nine point Communicable Disease Procedures. This document outlines the protocols that should be followed in the handling of bodily fluids. The nine points include:
CLASSIFICATION AND MANAGEMENT OF WOUNDS
Wounds involve a compromise to the integumentary (skin) system. Once the skin is penetrated, various types of wounds could exist. Listed below is a classification of the five types of wounds.
A wound care kit should include these items: disposable gloves, sterile gauge, sterile dressing/bandage, sterile water, and biohazard bag. When treating a wound, always wear protective gloves, follow current OSHA guidelines and refer athlete for medical evaluation. All wounds should be observed for these signs of infection: pain, swelling, redness, heat, and loss of function.
WOUND MANAGEMENT
Abrasions: Outer layers of skin are damaged from being scraped on a hard surface. Infection can occur and bleeding is limited due to the rupture of small veins and capillaries.
Initial Care: Put on disposable latex gloves and follow OSHA guidelines. Using sterile gauze, cleanse affected area with soap and water to scrub particles out of wound. After applying anti-bacterial ointment to affected area, place dressing to affected area and cover with bandage.
Follow-up Care: Change dressing daily and observe for signs of infection. Keep the wound moist with topical ointment so that the wound will heal from the inside out.
Avulsions: A forcible separation or tearing of tissue from the body in which bleeding occurs immediately.
Initial Care: Put on disposable latex gloves and follow OSHA guidelines. Apply direct pressure with a sterile gauze, elevate affected anatomical structure, watch for severe bleeding, and transport the athlete to a physician. Medical referral is required. Wrap the avulsed body part in a sterile gauze pad and place body part in container of sterile water.
Follow-up Care: Follow the physician’s directions in changing dressings and watch for signs of infection.
Incision: A wound with smooth sides/edges caused by a sharp object, such as glass or metal. With potential damage to anatomical structures, severe bleeding can exist.
Initial Care: Put on disposable latex gloves and follow OSHA guidelines. Using sterile gauze, cleanse area with soap and water to scrub particles out of wound. Apply sterile gauze and direct pressure, elevate affected anatomical structure, watch for severe bleeding, and transport the athlete to a physician. Medical referral is recommended.
Follow-up Care: Follow the physician’s directions in changing the dressings and watch for signs of infection.
Laceration: A jagged, irregular tear in the soft tissues.
Initial Care: Put on disposable latex gloves and follow OSHA guidelines. Using sterile gauze, cleanse area with soap and water to scrub particles out of wound. Apply sterile gauze and direct pressure, elevate affected anatomical structure, watch for severe bleeding, and transport the athlete to a physician. Medical referral is recommended.
Follow-up Care: Follow the physician’s directions in changing the dressings and watch for signs of infection.
Puncture: A small hole in the tissues produced by an object (such as a nail) piercing the skin layers. External bleeding is limited, however internal damage to organs may cause bleeding.
Initial Care: Put on disposable latex gloves and follow OSHA guidelines. Using sterile gauze, cleanse area with soap and water to scrub particles out of wound. Medical referral is recommended.
Follow-up Care: Follow the physician’s directions in changing
the dressings and watch for signs of infection.
SUMMARY
As health care providers, we must not only take care of those individuals
assigned to us, but also take care of safeguarding ourselves in that process.
Proper techniques and knowledge of the bloodborne pathogen guidelines will
help to insure that infection and transmission of disease will be kept
to a minimum. OSHA has taken the lead in providing the concepts to insure
the safety of the health care professional, but your institution must make
sure that those precautions are known and followed.
REFERENCES
Center for Disease Control (1995) Guidelines for prevention of transmission of human immunodeficiency virus and Hepatitis B virus to health-care and public workers. Morbidity and Mortality Weekly Report. Atlanta, GA.
National Athletic Trainers' Association Board of Directors (1995) Bloodborne pathogens for athletic trainers. Journal of Athletic Training, 30(3), 203-204.
Occupational Safety and Health Organization (1992) Occupational exposures to bloodborne pathogens. Washington, DC: United States Government Printing Office.
Amercian Medical Society for Sports Medicine and American Academy of Sports Medicine (1995) HIV and other bloodborne pathogens in sports. American Journal of Sports Medicine 23(4), 510-514.
Hunt, B and Pujol, T. (1994) Athletic trainers as HIV/AIDS educators for athletes. Journal of Athletic Training 29 (2), 102-105.
Chapter 4 - Review Questions
Completion:
1. Wounds affect the ______, also known as the integumentary system.
2. In all follow-up wound care, the athletic trainer should look for signs of ______.
3. All soiled material should be placed in a ______ ______.
4. A student athletic trainer should look for signs of ______ each day when changing wound dressings.
5. OSHA guidelines cover bloodborne pathogens such as ______ and ______.
6. The CDC estimates about ______ infections each year of Hepatitis B.
7. A ______ is when the outer layer of skin is scraped or scratched.
8. A sharp object causes an ______ or ______ wound.
Short Answer:
1. List the five types of wounds mentioned in this chapter.
2. What is the difference between a laceration vs. avulsion?
3. What are the bloodborne pathogens that are of most concern in today’s health care?
4. What solution is used to clean a contaminated athletic training room area?
5. How long does the bleach/water solution keep its effectiveness?
6. List the initial care for an avulsion.
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