Council on
Sports Injuries and Physical Fitness
INTRODUCTION:
The Occupational Safety and Health Administration
recognizes the need for a regulation that prescribes safeguards to protect
workers against the health hazards from exposure to blood and certain body
fluids containing bloodborne pathogens, and to reduce their risk to this
exposure. There is a rapidly increasing
participation and exposure of chiropractors in sports medicine as emergency
responders. The chiropractic sports
practitioner must have the knowledge and the plan in place prior to the risk of
exposure. This document is intended to provide information and guidelines as
they relate to sports chiropractic.
DEFINITIONS:
BLOOD:
Under the OSHA rule, blood means human blood, blood
products, or blood components. Bloodborne pathogens are microorganisms that are
present in blood, blood products, and other potentially infectious materials
(OPIM).
OTHER POTENTIALLY INFECTIOUS MATERIALS (OPIM):
Other potentially infectious materials (OPIM), defined by the Centers for
Disease Control as:
· semen
· vaginal secretions
· cerebrospinal fluid
· pleural fluid
· peritoneal fluid
· pericardial fluid
· amniotic fluid
· synovial fluid
· breast milk (not all authorities agree)
· saliva in dental procedures.
OCCUPATIONAL EXPOSURE:
Occupational exposure means a “reasonably anticipated
skin, eye, mucous membrane, or parenteral contact with blood or other
potentially infectious materials that may result from the performance of
employees’ duties.”
UNIVERSAL
PRECAUTIONS:
Universal precautions is a method of infection control
in which all human blood and certain human body fluids are treated as if known
to be infectious for HIV, HBV, and other bloodborne pathogens. Universal
precautions are to be observed in all situations where there is a potential for
contact with blood or other potentially infectious material. Under
circumstances in which differentiation between body fluid types is difficult or
impossible, all body fluids are to be considered potentially infectious.
PERSONAL PROTECTIVE
EQUIPMENT (PPE):
Personal
protective equipment refers to specialized
clothing or equipment worn for protection from exposure to blood or other
potentially infectious materials. Personal protective equipment will be
considered “appropriate” only if it does not permit blood or other potentially
infectious substances and contaminated materials to pass through to or reach a
provider’s work clothes, street clothes, undergarments, skin, eyes, mouth, or
other mucous membranes under normal conditions of use and for the duration of
time the protective equipment is in use. Hypoallergenic alternatives (e.g.,
hypoallergenic or powderless gloves) must be available to people who have an
allergic sensitivity to protective equipment.
Personal protective equipment consists of, but is not limited to,
gloves, face shields, masks, and eye protection, gowns, aprons, and similar
items.
GUIDELINES
AND PRECAUTIONARY MEASURES:
1. Identify in advance, as much as possible, the type and degree of anticipated exposure that you and other responders are likely to encounter.
2. In work areas where there is a reasonable likelihood of exposure to blood or other potentially infectious materials, one must not engage in activities that can transmit bloodborne pathogens. This includes activities such as, eating, drinking, applying cosmetics or lip balm, smoking, and handling contact lenses.
3. Gloves shall be worn where
it is reasonably anticipated that one will have hand contact with blood, other
potentially infectious materials, non-intact skin, and mucous membrane. Disposable gloves are not to be
washed or decontaminated for re-use and are to be replaced when they become
contaminated or as soon as feasible if they are torn, punctured, or when their
ability to function as a barrier is compromised. Gloves should be made of
latex, nitrile, rubber, or other water impervious materials. If glove material is thin or flimsy, double
gloving can provide an additional layer of protection. Always inspect your
gloves for tears or punctures before putting them on. If a glove is damaged, don’t use it!
4. Masks in combination with eye protection
devices, such as goggles or glasses with solid side shield, or chin length face
shields, are to be worn whenever splashes, spray, splatter, or droplets of
blood or other potentially infectious materials may be generated. They are to be worn when eye, nose, or mouth
contamination can reasonably be anticipated.
5. In instances when gross contamination can reasonably be anticipated, appropriate protective clothing shall be worn. This includes:
·
lab coats
·
gowns
·
aprons
·
clinic jackets
·
caps
·
shoe covers
·
booties
·
similar outer garments
6. All contaminated equipment and
work surfaces will be decontaminated after completion of procedures and
immediately or as soon as feasible after any spill of blood or other
potentially infectious materials.
Decontamination will be accomplished by utilizing bleach solutions or
EPA registered germicides.
7. Make certain that anyone
providing treatment to athletes must check oneself for any cuts, sores, and/or
wounds. These must be covered with a
bandage or dressings with no fluid seepage.
If any open wounds are present, it is best to avoid providing first aid
until the wound is healed.
8. Do not contaminate the first
aid/trauma bag with blood, it is best that someone else hands you the materials
from the bag. Anyone assisting the main
provider must also take proper precautions.
9. Equipment that has been
contaminated with blood or other potentially infectious materials shall be
decontaminated prior to reuse.
10. Handwashing is one of the
most important and easiest practices used to prevent transmission of bloodborne
pathogens. If you are working on the
field, or an area
without access to handwashing facilities, you should
use an antibacterial cleanser in
conjunction with clean cloth/paper towels or
antiseptic towelettes. If these
alternative methods are used, hands should be washed with soap and running
water as soon as feasible.
PROPER CLEAN UP OF A BLOOD
SPILL:
1. Wear gloves.
2. If there is debris, remove
glass and other sharp materials with brush and dust pan, plastic scoop,
etc. Do not use your hands.
3. Be sure to discard all
material into a puncture resistant container that is properly labeled for
biohazardous waste disposal.
4. Use absorbent materials,
such as a paper towel to soak up the spilled materials. Always wipe towards the center of the spill.
5. After removing visual
remainders of the spill, clean the area with disinfectant/detergent active
against bloodborne pathogens. A solution of 5.25% of sodium hypochlorite
(household bleach/Clorox) diluted between 1:10 and 1:100 with water. The standard recommendation is to use at
least a quarter cup of bleach per one
gallon of water.
Allow it to stay in contact with the contaminated area for 20 minutes.
If other bacterial/virucidal agent is used, check the label to make sure that
it meets the requirement and follow manufacturer’s instructions on its proper
use.
6. Wipe the area of the
disinfectant.
7. Apply disinfectant/detergent
a final time, allowing agent to set for 10 minutes to air dry.
8. Place all contaminated items
in a properly labeled biohazard bag. All towels or materials used to clean up
the spill must be properly disposed of, according to state and federal
regulations.
9. Wash your hands.
ASEPTIC TECHNIQUE FOR GLOVE
REMOVAL:
1. Grasp the palm of the glove
with your opposite hand.
2. Slowly pull of the glove, inside out, being
careful not to touch the contaminated areas
of your glove with your ungloved hand.
3. Scrunch the glove into a
ball with your gloved hand.
4. Carefully slide your index
finger inside your remaining glove.
5. Pull off your remaining
glove, inside out, over your scrunched glove.
6. Dispose of the gloves in the
biohazard trash receptacle and wash your hands immediately.
MEDICAL SUPPLY LIST:
Note: This is a basic list. There are certain sports that may require specific equipment and materials. Suit your medical bag to the specific needs of your sports event, in addition to this list.
Latex
or nitrile gloves
Scissors/trauma
shears
Bandages (various sizes and shapes)
Sterile gauze pads (4 x 4)
Abdominal pads
Mass trauma dressing
Adhesive tape
Ziploc bags
Splints, variety of sizes
Pocket mask with oxygen inlet (several)
Household bleach or bacterial/virucidal agent
Bag Valve Mask
Wound cleanser
Antibacterial cream
Portable suction unit
Alcohol swabs
Betadine swabs
BP cuff
Stethoscope
Kling
Normal saline/sterile water
Note pad and pen
Scrub brushes
Pocket mask
Eye protection
Face protection
Liquid proof gowns
Biohazard disposal bags with labels
1. Assessing a Bloodborne Pathogens Program. (Johnson LF; Occup Health Saf, 1998 March).
2. Bloodborne Pathogens Compliance Directive. U.S. Dept. of Labor, Occupational Safety & Health Administration, OSHA Directive CPL 2-2.44D (1999, November)
3. Bloodborne Pathogens Final
Standard: Summary of Key Provisions. OSHA Fact Sheet 92-46.
4. Bloodborne Pathogens. Office
of Occupational Medicine (1998).
Addresses the bloodborne pathogen standard as it applies to dental and
medical offices.
5. Bloodborne Pathogens
Exposure Control Plan. Oklahoma State
University Physical Plant, 1995, June).
6. Bloodborne Pathogens
Reference and Training Manual.
University of Wisconsin-Madison, 1997.
7. Bloodborne Pathogens. Department of Occupational Health and
Safety. University of Delaware, 1997.
8. Bloodborne Pathogens’ Unseen
Dangers. (Johnson LF; Occupational Health & Safety, 1996 September).
9. Bloodborne Pathogens Risk
and Precautions Among Urban Fire-Rescue Workers. (Carrillo L; Journal or
Occupational & Environmental Medicine, 1996 September).
10. Bloodborne Pathogen
Transmission in Health Care Workers.
Risks and Prevention Strategies. (Cardo DM; Infect Dis Clin North Am,
1997 June).
11. Healthcare Workers and
Bloodborne Pathogens: Knowledge, Concerns, & Practices. (Ryan ME; Gastroenterol Nurs, 1996 May-Jun).
12. Infection Control:HIV/AIDS
and Other Bloodborne Pathogens. (Casey KM; Nurs Spectr (Fla), 1998 Jan 12).
13. Infection Control
Recommendations for the Dental Office and the Dental Laboratory. ADA Council on
Scientific Affairs and ADA Council on Dental Practice, 1996.
14. Nitrile gloves. GIWU LLC.
15. New Position Statement. Regulations on Bloodborne Pathogens in the
School Setting. National Asssociation of
School Nurses, Inc. (Nasnewsletter, 1997 May).
16. Occupational Exposure to Bloodborne Pathogens: Precautions for Emergency Responders. OSHA 3130 (1998 (revised)).
17. Occupational Exposure to
Bloodborne Pathogens. OSHA 3127 (1996 (revised)).
18. Occupational Exposure of
Health Care Workers to Bloodborne Pathogens, Proposal for a Systematic
Intervention Approach. (Corser WD; AAOHN, 1998 May).
19. Orthopedic Trauma Surgeons’ Attitudes
and Practices Towards Bloodborne Pathogens. (McCarthy ML; Journal of Orthopedic
Trauma, 1996).
20. Post-exposure Evaluation and
Follow-up Requirements Under OSHA’s Standard for Occupational Exposure to
Bloodborne Pathogens. American Dental Association. (December 1997).
21. Shielding Eyes Against
Bloodborne Pathogens. (Roll D; Occupational Health & Safety, 1997, March).