Chapter 14 - Infectious Diseases, Bloodborne Pathogens, and Standard Precautions: Study Notes

Infectious Diseases, Bloodborne Pathogens, and Standard Precautions

Objectives for this Chapter

  • Discuss how infectious diseases are transmitted from person to person.

  • Describe how the immune system neutralizes and eliminates an antigen that invades the body.

  • Explain what bloodborne pathogens are and how they can infect patients and athletic trainers.

  • Describe the transmission, symptoms, signs, and treatment of hepatitis B (HBV).

  • Describe the transmission, symptoms, signs, and treatment of hepatitis C (HCV).

  • Describe the transmission, symptoms, and signs of human immunodeficiency virus (HIV).

  • Explain how human immunodeficiency virus is most often transmitted.

  • List the pros and cons of athletes with HBV, HCV, or HIV participating in sports.

  • Evaluate standard precautions for managing bloodborne and airborne pathogens and their application for the athletic trainer.

Introduction to Infectious Diseases and Public Health

  • Athletic trainers, like other healthcare providers, must be aware of and take standard precautions against the spread of common infectious diseases and bloodborne pathogens.

    • This includes understanding their epidemiology, presenting signs and symptoms, treatment guidelines, and regulations.

  • Maintaining a clean, sterile, and safe environment is crucial to mitigate the spread of infectious diseases.

  • COVID-19 Pandemic:

    • In 20192019, a new coronavirus caused an outbreak in China.

    • Initially sporadic (occasional occurrence), it quickly became endemic (regular cases in a region), then epidemic (unusually high number of cases).

    • By March 20202020, the World Health Organization declared COVID-1919 a global pandemic.

    • This event highlighted the importance of personal responsibility in practicing essential measures to protect oneself and others from infectious diseases and bloodborne pathogens.

    • Failure to do so can lead to life-threatening consequences for individuals with whom one comes into contact.

  • The close physical contact in athletic participation necessitates significant concern for the spread of infectious diseases among athletes and sports medicine personnel.

    • The NATA official statement on "Communicable and infectious diseases in secondary school sports" addresses this concern.

What are Infectious Diseases?

  • Definition: The invasion or infection of a host (person or animal) by microorganisms called pathogens.

  • How Pathogens Cause Disease:

    • Disrupting a vital body process.

    • Stimulating the immune system to mount a defensive reaction.

      • An immune response (e.g., high fever, inflammation) can sometimes be more damaging than the direct harm caused by the pathogen itself.

  • Common Pathogens: Viruses, bacteria, parasites, and fungi.

  • Host Resistance: Microorganisms can live harmlessly in a host (e.g., an animal) without causing infection, leading the host to develop resistance.

    • However, transmission to a new host (e.g., human) may cause the microorganism to become a pathogen.

  • Requirements for Infectious Disease: Requires an agent and a mode of transmission.

    • Example: A mosquito carrying malaria injecting the microorganism into a human, making it a pathogen and infecting the person.

Transmission of Infectious Diseases

  • Contagious Disease: An infectious disease is termed contagious if it is transmitted from one person to another.

  • Modes of Transmission:

    • Direct Transmission (three types):

      1. Contact between body surfaces: Touching, sexual intercourse.

      2. Droplet spread: Inhalation of contaminated droplets (e.g., from a sneeze in close proximity).

      3. Fecal-oral spread: Feces on a host's hands brought into contact with a new host's mouth.

    • Indirect Transmission:

      • Infectious agents travel via inanimate objects (fomites) like water, food, towels, clothing, eating utensils.

      • Vectors: Living things (insects, birds, animals) that carry diseases from human-to-human or animal-to-human.

    • Airborne Transmission: Infected particles suspended in an air source for an extended time (e.g., sharing air in a room with infected people who were there earlier, like on an airplane).

  • Entry Points for Pathogens: Skin, respiratory system, digestive system, reproductive system.

  • Factors Determining Infection: Acquired immunity, overall health, and health-related behavior of the new host.

Stages of Infection Progression

When a pathogen infects a new host, a predictable sequence of five stages occurs:

  1. Incubation Stage:

    • Time from pathogen entry until it multiplies enough for signs and symptoms to appear.

    • Can range from a few hours to years (e.g., herpes, HIV, shingles).

    • Duration depends on organism concentration, virulence, host immune response, and presence of other health problems.

    • Key Point: Host is infected but not infectious during this stage.

  2. Prodromal Stage:

    • Brief development of various non-specific signs and symptoms (e.g., watery eyes, runny nose, slight fever, malaise).

    • Pathogenic agent continues to multiply.

    • Key Point: Host is capable of transferring pathogens to a new host.

    • Recommendation: Person should be isolated to prevent transmission.

  3. Acute Stage:

    • Disease reaches its greatest development.

    • Key Point: Likelihood of transmitting the disease to others is highest.

    • Body resists further damage from the pathogen.

  4. Decline Stage:

    • First signs of recovery appear, indicating the infection is ending.

    • Caution: Patients can relapse if they overextend themselves.

  5. Recovery Stage:

    • Apparent recovery from the invading pathogen.

    • Caution: Overall health may be compromised, making the patient susceptible to other pathogens.

    • Following this stage, subsequent exposure to the same pathogen may not result in infection due to built-up immunity.

    • Important Note: Immunity is not necessarily permanent.

The Immune System

  • Function: Protects the body from invading pathogens.

  • Defense Mechanism: Once a pathogen breaches mechanical defenses (skin, mucous membranes), the immune system mounts a cellular response.

  • Two Branches:

    1. Innate Immune Response

    2. Adaptive Immune Response

Process of Immune Response:

  1. Detection by Neutrophils: Upon infection, neutrophils (innate immune cells) quickly recognize the invasion and remove the infectious agent by releasing antimicrobial molecules.

  2. Activation of Other Innate Cells: More innate immune cells (macrophages, dendritic cells - DCs) are directed to the infection site.

    • Macrophages and DCs engulf and digest pathogens into small protein fragments called antigens.

    • Antigen Presentation: Innate immune cells display antigens on their cell surface, activating adaptive immune cells.

  3. Adaptive Immune Response Activation:

    • Major cell types: B cells and T cells.

    • T cells activate upon recognizing presented antigens and differentiate into specialized effector cell subsets.

    • These subsets direct other immune cells to the infection site and signal them to destroy the pathogen.

  4. T Cell Subsets:

    • CD4+ T helper cells: Direct B cells and other immune cells.

    • CD8+ cytotoxic T cells: Directly kill host cells compromised by infection, stalling progression.

    • Memory T cells: Activate quickly upon second exposure to the same antigen.

  5. B Cell Activation and Antibody Production:

    • T helper cells assist B cells in recognizing foreign antigens.

    • After antigen recognition, B cells differentiate into plasma cells.

    • Plasma cells secrete antibodies.

  6. Antibody Action:

    • Antibodies bind to specific regions on pathogens, decreasing their ability to propagate infection.

    • Antibody-bound pathogens cannot enter host cells, as antibodies neutralize entry mechanisms.

    • Antibody-bound pathogens signal other immune cells (e.g., macrophages) to engulf and destroy them.

  7. Resolution: T cell function decreases as the infection subsides.

  8. Immunological Memory (B cells):

    • B cells also acquire immunological memory (memory B cells).

    • This allows for a fast and efficient response upon secondary exposure to the same antigen.

  • Outcome: A successful immune response primes the body to respond quickly and effectively to re-exposure, leading to natural adapted immunity.

Types of Immunity

  • Natural Adapted Immunity: Developed when the immune system successfully eliminates an invading antigen and is primed for future encounters.

  • Artificial Adapted Immunity: Developed when the body is exposed to weakened pathogens through vaccination or immunization.

  • Passive Immunity: Achieved when antibodies are injected to provide immediate, temporary protection until the body can develop natural immunity.

  • Benefits: Collectively, these forms of immunity provide important protection against infectious disease.

Herd Immunity (Community Immunity)

  • Concept: If a sufficient portion of the population (often 70−8570-85 percent) develops resistance or immunity to a virus or bacteria, the disease will not spread because there are too few susceptible hosts.

  • Outcome: Protects those who, for various reasons, are not immune.

  • Achievement: Can be achieved if a substantial portion of people either recover from the disease or receive a vaccine.

  • Examples: Eradication of polio and smallpox.

Vaccinations

  • Historical Success: Numerous vaccines have successfully (with minimal risks) treated serious infectious diseases:

    • Polio, smallpox, shingles, pertussis (whooping cough), hepatitis B, Haemophilus influenzae type B (flu), tetanus, rubella (German measles), measles (red measles), mumps, and chickenpox.

  • Many of these vaccines have virtually eradicated infectious diseases worldwide and are readily available and recommended for everyone.

  • The development and use of vaccines are recognized as one of the top 1010 public health achievements of the twentieth century.

  • Vaccine Hesitancy Factors: Despite evidence of effectiveness, hesitancy is attributed to:

    • Concerns about vaccine efficacy.

    • Distrust of the medical establishment.

    • Parental ability to opt out of immunizations.

    • Medical and religious exemptions.

    • Concerns about violations of personal liberty due to mandatory vaccinations.

  • COVID-19 Vaccines: Overwhelming science-based evidence supports taking recent vaccines (e.g., for coronavirus) to:

    • Minimize severity of symptoms in infected individuals.

    • Mitigate risks of transmission to others.

Preventing the Spread of Infectious Diseases

  • Role of Athletic Trainer: Must be diligent in minimizing transmission chances.

  • Medical Histories: Review patient medical histories to ensure all potential immunizations are up to date.

  • Healthy Lifestyle Habits: Encourage patients to develop healthy habits:

    • Eating well.

    • Getting enough sleep.

    • Exercising.

    • Avoiding tobacco and substance abuse.

Bloodborne Pathogens (BBP)

  • Definition: Pathogenic microorganisms present in human blood and body fluids that can cause disease in humans.

  • Types: Most common are viruses; several bacterial BBPs also exist.

  • Greatest Risks: Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV).

Hepatitis B Virus (HBV)

  • Target: Attacks the liver, potentially leading to:

    • Mild infection (a few weeks).

    • Lifelong infection.

    • Cirrhosis (scarring) of the liver.

    • Liver cancer.

    • Liver failure.

    • Death.

  • Transmission:

    • NOT spread through food, water, or casual contact.

    • Spread when fluids from an infected person enter the body of an uninfected person.

    • Examples: Unprotected sex, intravenous drug use, percutaneous needlesticks/sharps exposures to infectious fluids (serum, blood) in healthcare providers.

  • Risk of Transmission: 50−10050-100 times higher than HIV.

  • Immunity for Healthcare Personnel: Those vaccinated against HBV and with developed immunity are at virtually no risk of infection.

  • Statistics:

    • In the U.S., 1.591.59 million individuals estimated to be chronically infected.

    • Worldwide, 292292 million may be infected.

  • Symptoms and Signs (Acute Infection):

    • Flu-like symptoms: fever, fatigue, loss of appetite, nausea, vomiting.

    • Jaundice (yellow skin/eyes, dark urine, clay-colored bowel movements).

    • Pain in muscles, joints, and stomach.

    • Asymptomatic Cases: Many infected individuals exhibit no signs or symptoms; virus may go undetected.

      • HBV antigen will always be present, leading to unknowing transmission to others through blood/body fluid exposure or intimate contact.

  • Chronic Active Hepatitis: Can occur if the immune system fails to destroy virus-infected liver cells completely.

    • Serious, can lead to liver damage (cirrhosis), liver cancer, and death.

    • Chronically infected people can spread HBV even if they appear healthy.

  • Diagnosis: Infected person's blood may test positive for HBV antigen within 2−62-6 weeks after symptoms develop.

  • Recovery: Approximately 8585 percent of those infected recover within 6−86-8 weeks.

  • Prevention:

    • Good personal hygiene and avoiding high-risk activities.

    • HBV can survive for at least 11 week in dried blood or on contaminated surfaces.

    • Avoid contact with any blood or other fluid potentially containing a bloodborne pathogen.

  • Management (Vaccination):

    • Infants: Vaccinations soon after birth are most effective for preventing long-term illness.

    • Schedule: Three-dose pattern, complete within 66 months.

    • Children/Adolescents ( <19): Should be vaccinated if not already.

    • Adults: Can also get vaccinated.

    • Immunity Rates: Approximately 8787 percent immune after the second dose; 9696 percent after the third dose.

    • Post-Exposure Vaccination: Available for individuals with direct contact with an infected person's body fluids.

    • Employer Responsibility: Vaccination against HBV must be provided at no cost by employers to any individual at risk of exposure.

    • Recommendation: All athletic trainers and allied healthcare professionals should receive immunization.

Hepatitis C Virus (HCV)

  • Target: Acute and chronic forms of liver disease.

  • Prevalence: Most common chronic bloodborne infection in the United States.

  • Progression:

    • Approximately 55−8555-85 percent of acutely infected individuals become chronically infected.

    • 15−3015-30 percent develop chronic liver disease within 2020 years.

    • Leading indication for liver transplant.

    • 33 percent of those with chronic liver disease die from cirrhosis or liver cancer.

  • Statistics (2020):

    • Estimated 5858 million people worldwide living with HCV.

    • 2.22.2 million Americans living with HCV.

  • Incubation Period: 22 weeks to 66 months.

  • Symptoms and Signs:

    • Majority with chronic HCV have no signs or symptoms for many years.

    • May exhibit chronic fatigue and depression.

    • Symptomatic individuals may have advanced liver disease.

    • Symptoms (when present): Jaundice, mild abdominal pain (especially upper right quadrant), loss of appetite, nausea, fatigue, muscle/joint pain, dark urine.

  • Prevention:

    • NOT spread by sneezing, hugging, coughing, food/water, eating utensils/drinking glasses, or casual contact.

    • Rarely spread through sexual contact.

    • Primary Transmission: Contact with the blood of an infected person.

      • Most commonly: Sharing needles or syringes.

      • Also: Sharing personal care items with blood (razors, toothbrushes).

      • Risks associated with tattoos or body piercings.

    • Athletic Trainers: Should follow routine barrier precautions and safely handle needles and sharp objects.

  • Management:

    • No Vaccine: Currently, no vaccine for preventing HCV transmission.

    • Diagnosis: Several blood tests can detect HCV within 1−21-2 weeks of infection.

      • A single positive test indicates infection; a single negative test does not rule it out (repeat testing if suspected).

    • HCV-positive persons should be evaluated for liver disease.

    • Treatment: Direct-acting antiviral drugs (e.g., Daklinza, Zepatier, Mavyret) interfere with viral growth proteins.

      • Best drug depends on the extent of liver damage.

      • Drinking alcohol can worsen liver disease.

Human Immunodeficiency Virus (HIV)

  • Definition: A retrovirus that combines with a host cell.

  • Target Cells for Entry: Macrophages, dendritic cells, and CD4+ T cells.

  • Replication: Occurs only in CD4+ T cells, leading to their destruction.

  • Immune System Breakdown: Destruction of CD4+ T cells by HIV leads to immune system breakdown.

    • This is why people with HIV die from secondary infections or cancers that normally don't kill non-immunocompromised individuals.

  • Transmission:

    • Exposure to infected blood or other body fluids.

    • Intimate sexual contact.

    • NOT transmissible through: Casual contact with saliva, sweat, tears, respiratory droplets, urine, feces, or inanimate objects (wrestling mats, swimming pools, toilet seats, sinks).

  • Statistics (2019/2020):

    • 1.21.2 million people in the U.S. infected with HIV; 36,80036,800 new infections in 2019.

    • Worldwide (2020): Estimated 37.637.6 million people living with HIV/AIDS.

    • 88 percent of adults aged 15−4915-49 infected with HIV/AIDS-associated illnesses.

    • 1.51.5 million new HIV infections in 20202020 alone.

    • HIV/AIDS-associated illnesses caused approximately 680,000680,000 deaths in 20202020.

  • Symptoms and Signs (Acute Phase):

    • Fatigue, weight loss, muscle/joint pain, painful or swollen glands, night sweats, fever.

    • Antibodies to HIV detectable in blood within one year of exposure.

  • Asymptomatic Chronic Phase:

    • Follows acute phase; individuals may be unaware of infection.

    • Can last 8−108-10 years before signs/symptoms develop.

  • Stage 3 AIDS: Without treatment, AIDS symptoms will likely occur after the acute and chronic phases.

Acquired Immunodeficiency Syndrome (AIDS)

  • Definition: A syndrome (collection of signs and symptoms) recognized as the effects of an HIV infection.

  • Individuals with AIDS have no protection against even simple infections, making them vulnerable to serious illnesses, opportunistic infections, and cancers (e.g., Kaposi's sarcoma, non-Hodgkin's lymphoma) that cannot be stopped.

  • A positive HIV test does not predict if an individual will show AIDS symptoms.

  • Prevention of AIDS Progression: Begin HIV medications (antiretroviral therapy - ART) as soon as possible after diagnosis to suppress viral load.

    • Medication can make the viral load so low it becomes undetectable.

    • This is the most effective way for HIV-infected persons to remain healthy.

  • Progression without Treatment: HIV usually progresses to AIDS in about 1010 years, and AIDS typically leads to death in about 33 years.

Testing for Human Immunodeficiency Virus

  • CDC Recommendation: Everyone aged 13−6413-64 should be tested for HIV at least once as part of routine healthcare.

  • High-Risk Individuals: Those engaging in risky behaviors should get tested as soon as possible.

  • Mandatory Testing: Mandatory testing should be secondary to education for HIV prevention.

    • Neither NCAA nor CDC recommends mandatory HIV testing for athletes.

  • Types of HIV Tests:

    1. Nucleic Acid Test (NAT):

      • Looks for the actual virus and viral load in the blood.

      • Accurate during early infection but very expensive.

      • Used if high-risk exposure and early symptoms.

      • Can detect HIV infection 10−3310-33 days post-exposure.

    2. Antigen/Antibody Test:

      • Performed in a laboratory; looks for specific antigen (p2424) and HIV viral antibody.

      • Results may take several days.

      • Can detect HIV infection 18−4518-45 days post-exposure.

      • Most common lab test currently used.

    3. Rapid Antibody Screening Test:

      • Uses blood (vein or finger prick) or oral fluid swab to identify HIV antibody presence.

      • Venous blood tests detect HIV sooner than finger prick or oral fluid tests.

      • Results generally in 3030 minutes or less.

      • Positive rapid tests require follow-up confirmation.

    4. Home Collection Kits:

      • Antibody screening tests using finger prick blood or oral swab samples sent to a lab.

      • Results available by phone next day.

      • OraQuick In-Home HIV Test is the only FDA-approved at-home HIV test.

  • Post-Testing: Follow-up counseling with a healthcare provider is strongly recommended, regardless of results.

  • Confidentiality: Most states protect confidentiality of HIV-infected persons. Athletic trainers should be familiar with state laws and guard anonymity.

Management of HIV

  • No Vaccine: Currently, no vaccine for HIV.

  • No Cure: No available treatment cures HIV.

  • Treatment Goal: Allow infected individuals to live long and healthy lives and prevent transmission to sexual partners.

  • Antiretroviral (ART) Therapy:

    • Recommendation (2018 WHO): Recommended for all people living with HIV, regardless of health status or infection duration.

    • Mechanism: ART medicines prevent HIV from multiplying, reducing the viral load.

    • Immune system strengthens (increased CD4 cell levels) to fight off infections, even with some HIV remaining.

    • Drug Combinations: Therapy consists of various drug combinations:

      • One drug blocks an enzyme HIV needs for new virus cells.

      • A second drug blocks copying of viral genes (reverse transcription) into host cells.

      • A third drug protects T cells, slowing HIV progression.

  • Exercise: HIV-infected patients are recommended to engage in exercise/training programs to improve muscle and aerobic fitness; fitness programs appear to have no negative effect on immunologic function.

  • Public Health Implications: New treatments have extended healthy life spans, but HIV prevalence continues to increase.

    • Declining AIDS cases (due to treatment) mean more people living with HIV, increasing the need for prevention and treatment services.

Prevention of HIV

  • Education: Best means of prevention.

  • Greatest Risk: Intimate sexual contact with an infected partner.

  • Safe Sex Practices: Major importance.

    • Choose non-promiscuous sex partners.

    • Use latex condoms for vaginal or anal intercourse (barrier against HBV and HIV).

    • Male condoms should have reservoir tips.

    • Prelubricated condoms are less likely to tear.

    • Avoid water-based, greaseless spermicides or lubricants.

    • If condom tears, use a vaginal spermicide immediately.

    • Remove and discard condoms carefully.

Additional Hepatitis Viruses

Three additional viruses (hepatitis A, D, and E) are related to hepatitis but are generally not considered bloodborne pathogens.

Hepatitis A Virus (HAV)

  • Effect: Causes inflammation of the liver but does not lead to chronic liver disease.

  • Transmission:

    • Fecal-oral routes.

    • Close personal contact.

    • Ingestion of contaminated food or water (e.g., by an infected food preparer who doesn't wash hands).

    • Commonly transmitted in milk, shellfish, salad, sliced meat.

  • Symptoms and Signs:

    • May show no outward symptoms.

    • Adults may have dark urine, light stools, fatigue, fever, jaundice.

  • Duration: Persists acutely for up to 2121 days, but effects last longer.

  • Mortality: Death is rare.

Hepatitis D Virus (HDV)

  • Effect: Causes inflammation of the liver; prone to hepatitis and cirrhosis.

  • Transmission:

    • Sexual activity.

    • Injected drugs.

    • Needlesticks in healthcare workers.

  • Key Characteristic: Most likely to infect individuals already infected with HBV.

  • Severity: Symptoms are more severe than with HBV.

  • Mortality Rate: At least 22 percent.

Hepatitis E Virus (HEV)

  • Effect: Causes inflammation of the liver.

  • Transmission:

    • Fecal-oral routes.

    • Waterborne: Contaminated water and food supplies implicated in major outbreaks in foreign countries with poor sanitation.

    • Person-to-person transmission is uncommon.

    • No evidence of sexual transmission or transmission by transfusion.

  • Course: Self-limiting viral infection followed by recovery.

  • Mortality Rate: Between 0.50.5 percent and 4.04.0 percent.

Bloodborne Pathogens in Athletics

  • Transmission Risk: Generally exceedingly rare among athletes.

    • Virtually no risk of on-field transmission from one player to another.

    • No well-documented/validated reports of HIV, HCV, or HDV transmission in sports in professional literature.

  • Infectivity Comparison:

    • HIV has the lowest infectivity.

    • HBV has the highest infectivity because it is highly concentrated in infected individuals, increasing transmission risk.

    • HBV can persist on environmental surfaces for ≥1\geq 1 week.

  • Healthcare Settings: Transmission of HCV and HIV in healthcare settings remains a serious concern, but risk can be significantly mitigated by standard precautionary measures.

Policy and Regulation

  • Organized sports involve procedures and policies regarding bloodborne pathogen transmission.

  • Organizations with Policies: NATA, U.S. Olympic Committee, NCAA, National Federation of State High School Athletic Associations, NBA, NHL, NFL, MLB.

  • Evolution of Policies: Due to lack of evidence of BBP transmission in athletics, more recent policies focus on managing bleeding during competition.

  • Refocused Efforts: These organizations now emphasize educating athletes on lifestyle habits and choices that increase risk of contracting BBPs (e.g., unsafe sexual practices, sharing needles for steroids or tattoos).

  • Education Responsibility:

    • Institutions should educate student-athletes on BBP transmission.

    • For secondary-school athletes, parents should also be educated.

    • Athletes (professional, collegiate, secondary-school) must be aware that the greatest risk of contracting HBV or HIV is through off-the-field activities.

    • Athletic trainers must educate athletic training students about exposure control policies.

Standard Precautions in an Athletic Environment

  • OSHA Universal Precautions (1991): Guidelines for employers to address occupational exposure to bloodborne pathogens, initially focused on blood contact.

  • Evolution to Standard Precautions (2007, CDC): Expanded upon universal precautions to address both bloodborne and airborne pathogens.

    • Recognized risk of airborne transmission (influenza, coronavirus) via aerosolized particles from sneezing, coughing, breathing, talking.

    • Gloves alone are insufficient protection.

    • Stress on Body Isolation: Through Personal Protective Equipment (PPE), including gloves, masks, goggles, and aprons/gowns.

Preparing the Athlete

  • Before practice or competition, all open skin wounds and lesions must be covered.

    • Dressing must be fixed and prevent transmission to/from other athletes.

    • Occlusive dressings (e.g., hydrocolloid dressings) lessen cross-contamination, keeping the wound moist and pliable, reducing re-opening.

When Bleeding Occurs

  • Open wounds and other skin lesions presenting a risk for disease transmission require aggressive treatment.

  • Athletes with active bleeding must be removed from participation immediately.

    • Can return only when deemed safe by medical staff.

  • Uniforms with blood must be evaluated for infectivity.

    • Blood-saturated uniforms must be removed and changed before return to competition.

  • All personnel managing potential infective wound exposure must follow standard precautions.

Hand Washing

  • Hands and all skin surfaces in contact with blood/body fluids should be washed immediately with soap and water or antigermicidal agents.

  • Hands should also be washed between each patient treatment.

  • Soap and water are superior to hand sanitizers.

  • If hand washing is unavailable, use sufficient sanitizer for complete hand coverage.

Personal Protective Equipment (PPE)

  • Healthcare personnel potentially exposed to bloodborne or airborne pathogens must use appropriate PPE.

  • PPE includes:

    • Disposable gloves.

    • Nonabsorbent gowns or aprons.

    • Face masks and shields.

    • Goggles for eye protection.

    • Disposable face shields for CPR.

  • Equipment for dealing with pathogens should be included in sideline emergency kits.

Disposable Gloves

  • Used when handling any potentially infectious material.

  • Double gloving: Suggested for heavy bleeding or when using sharp instruments.

  • Recommended: Nonlatex, latex-free vinyl, or nitrile rubber gloves for athletic trainers due to potential allergic reactions to latex (contact dermatitis to systemic reactions).

Protective Face Masks

  • Surgical Face Mask:

    • One-time-use, disposable, loose-fitting mask covering nose and mouth.

    • Designed for general public and healthcare personnel to block large-particle droplets, splashes, sprays, or splatters.

    • Does NOT filter or block very small, aerosolized particles.

    • May help reduce exposure of wearer's saliva/respiratory secretions to others.

    • Generally NOT considered full PPE alone.

  • N95 Respirator Mask:

    • Respiratory protective device designed to form a tight seal around nose and mouth.

    • Provides efficient filtration of airborne particles.

    • Recommended for healthcare settings with high potential for airborne pathogen transmission.

Biohazard Warnings

  • Biohazard warning labels (fluorescent orange or red) must be affixed to:

    • Containers for regulated wastes.

    • Refrigerators containing blood.

    • Other containers for storing or shipping potentially infectious materials.

  • Red bags or containers should be used for disposal of potentially infected materials.

  • When unsure if a substance is biohazardous, use a biohazard bag for disposal.

Decontamination

  • All contaminated surfaces (treatment tables, taping tables, work areas, floors) must be cleaned immediately.

  • Use an EPA-approved disinfectant, following manufacturer's recommendations for amount, dilution, and contact time.

  • A solution of 11 part bleach to 1010 parts water (1:101:10) is recommended for immediate cleaning after contamination.

Contaminated Laundry

  • Towels and other contaminated linens should be bagged and separated from other laundry.

  • Soiled linen transported in red or orange containers/bags that prevent soaking/leaking and labeled with biohazard warnings.

  • Washed in hot water (71∘C/159.8∘F71^{\circ}C / 159.8^{\circ}F for 2525 minutes) with a virus-deactivating detergent.

  • Laundry done outside the institution should go to an OSHA-compliant facility.

  • Gloves must be worn during bagging and cleaning of contaminated laundry.

Sharps

  • Definition: Sharp objects used in athletic training (needles, razor blades, scalpels).

  • Handling/Disposal: Extreme care to minimize skin punctures/cuts.

  • Athletic trainers rarely use needles but often use scalpels or razor blades.

  • Needles: Should not be recapped, bent, or removed from a syringe.

  • Disposal: Sharps disposed of in leakproof and puncture-resistant containers.

    • Container must be red or orange and labeled as a biohazard.

  • Scissors and Tweezers: Less likely to cause injury but should be sterilized with disinfectant and stored cleanly after use.

Protecting the Athletic Trainer

  • OSHA Guidelines: Intended to protect coaches, athletic trainers, and other employees.

  • Coach Risk: Coaches usually have reduced risk due to less contact with blood/body fluids.

  • Institutional Responsibility: Secondary schools, colleges, professional teams, or clinics must:

    • Ensure safety of athletic trainers as healthcare providers.

    • Institute and annually update policies for education on preventing BBP/airborne pathogen transmission.

    • Provide necessary supplies and equipment to carry out recommendations.

  • Athletic Trainer Personal Responsibility: Adhere to and enforce policies/guidelines in the athletic training clinic.

  • Risk Minimization: Avoid eating, drinking, applying cosmetics/lip balm, handling contact lenses, or touching the face before washing hands.

  • Food products should never be placed in refrigerators containing contaminated blood.

Post-Exposure Follow-Up for the Athlete

  • Mouthpieces: USOC supports required use in high-risk sports.

  • Showering: Recommend immediate showering after practice or competition.

Post-Exposure Procedures for the Athletic Trainer

  • After an exposure incident report, the athletic trainer should have a confidential medical evaluation, including:

    • Documentation of the exposure route.

    • Identification of the source individual.

    • A blood test.

    • Counseling.

    • An evaluation of reported illness.

  • Laws regarding reporting, confidentiality, and test result notification vary by state.