Blood-Borne Pathogensin the Context of Sports Participation

Publication Date: March 20, 2019
Last Updated: January 19, 2024

Recommendations

1. Preparation:

Pre-event preparation includes proper care for pre-existing skin injuries or conditions that compromise the integrity of the protective skin barrier such as abrasions, existing or healing wounds, and dermatitis. These conditions may serve as a source of bleeding or as a point of entry for blood-borne pathogens (BBPs) and should be covered, until completely healed, with an occlusive dressing that will withstand the stress of competition to prevent transmission.
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2. Supplies:

Supplies that reduce blood exposures and are compliant with standard precautions should be used for the care of all patients and be available to caregivers. These resources include latex or vinyl gloves, face/eye shields, soap/disinfectant, bleach (freshly prepared in a 1:10 dilution with tap water) or Environmental Protection Agency (EPA)–approved germicide, safer needles (eg, self-sheathing needles, blunted suture needles, needleless connectors, and infusion sets), bandages or dressings, designated receptacles for soiled equipment or uniforms (with separate leak-proof bags or receptacles appropriately marked for uniforms and equipment contaminated with blood), and a puncture-resistant sharp disposal container. It is recommended that participants in sporting events use squeeze-type water containers to avoid direct contact with the mouth as they drink, as there is a potential risk of transmission through bleeding around the mouth.3. Early recognition: During the sporting event, prompt recognition and appropriate response of active bleeding is the responsibility of officials, athletes, and medical personnel. Participants with bleeding should be removed from the event as soon as is practical. Bleeding must be controlled, and exposed mucus membranes should be flushed with water and wounds cleansed with soap and water. Antiseptic products are not recommended, as they do not reduce the risk of BBP transmission and damage or compromise normal tissue repair. The wound must be covered with an occlusive dressing that can withstand the stress of the activity. Once bleeding is controlled and the wounds are properly covered, the player may return safely to competition. Any participant with exposed blood or blood-containing body fluids present should change that uniform and/or cover and control an area of active bleeding before returning to competition.
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3. Early recognition:

During the sporting event, prompt recognition and appropriate response of active bleeding is the responsibility of officials, athletes, and medical personnel. Participants with bleeding should be removed from the event as soon as is practical. Bleeding must be controlled, and exposed mucus membranes should be flushed with water and wounds cleansed with soap and water. Antiseptic products are not recommended, as they do not reduce the risk of BBP transmission and damage or compromise normal tissue repair. The wound must be covered with an occlusive dressing that can withstand the stress of the activity. Once bleeding is controlled and the wounds are properly covered, the player may return safely to competition. Any participant with exposed blood or blood-containing body fluids present should change that uniform and/or cover and control an area of active bleeding before returning to competition.
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4. Reporting:

Participants should be educated that it is their obligation to report all wounds and injuries in a timely manner, including those recognized before the sporting activity, and wear sport-specific appropriate protective equipment at all times (ie, mouth guards).
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5. Precautions:

Standard precautions must be followed for the care of all patients with the practice of hand hygiene before and after every patient contact.Appropriate gloves are required for all interactions when direct contact with blood, body fluids, and other fluids containing blood can be anticipated. Gloves must be changed after treating each individual participant, and hands should be washed with soap and water or antiseptic after glove removal.
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6. Access to protective equipment:

Personal protective equipment (PPE) namely gloves, goggles, masks, and fluid-resistant gowns, as well as airway devices should be readily accessible. The lack of protective equipment should not delay emergency care for life-threatening injuries.
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7. Decontamination:

Any equipment or playing surfaces (eg, wrestling mat) contaminated with blood or potential infectious body fluids should be wiped immediately with paper towels or disposable cloths and disinfected with a daily-prepared 1:10 ratio of bleach to water solution or EPA-approved germicide. The cleaned area should be dry before reuse, and individuals cleaning the equipment or collecting soiled linen should wear appropriate PPE.
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8. Postevent follow-up:

8. Postevent follow-up: Postevent management may include re-evaluation and management of any wounds sustained during the sporting event, including but not limited to covering wounds, cuts and abrasions, debriding dirty wounds, and suturing clean wounds. Participants should be provided with appropriate follow-up with medical personnel for proper medical evaluation, postexposure counseling, and prophylaxis, as indicated. Blood-soiled uniforms and towels should be collected using standard precautions and laundered according to appropriate protocol: in hot water at a temperature of at least 71°C (160°F) for 25-minute cycles. Procedures: Procedures performed in the training room and during practices must be governed by adherence to standard infectious precautions. Medical providers should be equipped with appropriate PPE when coming into contact with potential BBP. Blood, potential infectious body fluids, or other fluids containing blood should be cleaned as previously described. Equipment handlers, laundry personnel, and janitorial staff should adhere to standard precautions and be advised to wear gloves whenever contact with bloody equipment, clothing, or other items may occur. Appropriate containers for the disposal of needles, syringes, or scalpels should be available.
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9. Procedures:

Procedures performed in the training room and during practices must be governed by adherence to standard infectious precautions. Medical providers should be equipped with appropriate PPE when coming into contact with potential BBP. Blood, potential infectious body fluids, or other fluids containing blood should be cleaned as previously described. Equipment handlers, laundry personnel, and janitorial staff should adhere to standard precautions and be advised to wear gloves whenever contact with bloody equipment, clothing, or other items may occur. Appropriate containers for the disposal of needles, syringes, or scalpels should be available.
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10. Universal precautions:

10. Universal precautions: Adherence to blood exposure plans should be consistent. Complacency concerning adherence to standard (universal) precautions has been documented in a major sporting competition. Given anecdotal reports of transmission of HIV and HCV in bloody street fights, sports with rules against fighting (ie, all sports except North American professional hockey) should be emphasized and enforced.
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11. Prophylaxis:

Pre-exposure and post-exposure prophylaxis for HIV, HBV, and HCV should be based on risk of exposure, with the exception of the hepatitis B vaccine. The strategy of vaccinating individual groups considered to be at high risk of contracting HBV has not been successful in reducing the incidence of new infections, and universal vaccination of all individuals is recommended for prevention by the World Health Organization (WHO),CDC, American Academy of Pediatrics (AAP), NFL, and the Federation Internationale de Medicine du Sport (FIMS). Training: All personnel involved with sports should be trained in basic first aid and infection control, including the preventative measures outlined here.
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12. Training

All personnel involved with sports should be trained in basic first aid and infection control, including the preventive measures outlined here.

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Recommendation Grading

Overview

Title

Blood-Borne Pathogensin the Context of Sports Participation

Authoring Organization

American Medical Society for Sports Medicine

Publication Month/Year

March 20, 2019

Last Updated Month/Year

January 29, 2024

Supplemental Implementation Tools

Document Type

Consensus

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Outpatient, School

Intended Users

Epidemiology infection prevention, athletics coaching, nurse, nurse practitioner, physician, physician assistant

Scope

Prevention, Management

Diseases/Conditions (MeSH)

D006678 - HIV, D006526 - Hepatitis C, D003699 - Hepatitis D, D017848 - Blood-Borne Pathogens

Keywords

blood-borne pathogens, sports participation

Source Citation

McGrew, C., MacCallum, D.-S., Narducci, D., Nuti, R., Calabrese, L., Dimeff, R., … McKeag, D. (2019). AMSSM Position Statement Update. Clinical Journal of Sport Medicine, Publish Ahead of Print. doi:10.1097/jsm.00000000000007