Haunting Danger, Unseen Enemy:
An Introduction To Blood Borne Pathogens For Martial Artists - Part
2
By Len Sclafani, DDS
Infection Control, and the “Universal Precautions”
In
Part
1 we mentioned that there has never been a reported case of any
bloodborne pathogen (BBP) infection that arose from a martial arts dojo,
but we also suggested that the where and when of infection can be very
illusive.
Thus, anyone
practicing martial arts should be concerned with possible exposure to
bloodborne pathogens.
Hepatitis B (HBV) and C (HCV) viruses are the two most common BBP one
is likely to encounter, not only in the dojo but elsewhere. Knowledge
of the prevention of these two will most certainly assure protection
from others as well, including HIV/AIDS. Adherence to infection control
measures will help prevent transmission of all BBP including hepatitis
viruses.
Although HIV is the most talked about, HBC and HCV are also very nasty
critters. They are life threatening, and can have serious repercussions
later on in life (predisposition to liver cancer among other things),
not to mention the immediate impact on your everyday life, family and
more intimate relationships
Well, what do we do about all this fire and brimstone? Let’s always
assume one thing, and this is really important:
ALL BLOOD IS
TREATED AS IF IT WERE INFECTIOUS!!!
This also includes saliva or any
other body
fluid that is contaminated by blood. I don’t care if it’s
your spouse who you accidentally (or not) punched in the nose, that blood
could have any of the microbes discussed in Part 1 of this article series,
just waiting to set up shop in your body. Application of this approach
to infection control is referred to as “Universal Precautions”,
first developed by the Centers for Disease Control and Prevention. All
other infection control and protective measures flow from this basic
principle.
Where Do Martial Arts Schools & Teachers Fit In?
If you are incorporated (and if the owner is an employee of the corporation),
or are legally defined as a business with at least one employee, you
may be required to comply with OSHA regulations including the OSHA Bloodborne
Pathogens Standard (29 CFR 1910.1030)
If you fall under the auspices of this beast, and you would then be
required to have a written “Infection Control Plan” in order
to comply with these government standards.
Sole proprietors (owner/operators) of dojos with no other employees
may be able to skirt the issue. If you have others teaching for you,
say on nights when you are not there, they may be considered employees
and you will need to ensure that you are in compliance.
If you have ten or more employees, even part time you would have reporting
and record keeping responsibilities. But don't panic. There are resources
out there to make compliance manageable for small companies. Check with
OSHA or your attorney, or check out the OSHA
web site.
OSHA regulations, it should be noted, apply only to those relationships
between employer and employees and do not extend protection to students.
But don’t just look at the government regulations. You have yourself
and students to protect. This means, no matter what your legal status
is, that you are ahead of the game if you train your employees in how
to deal with blood spills, injuries (where there is blood), and students
who have been exposed to another’s blood, salvia and/or other body
fluids contaminated with blood.
To protect yourself, your students and employees, and potentially to
protect yourself legally, you should have protective gloves, disinfectants,
plastic disposable bags and other items suggested in this article available
for use by yourself, other school teachers or staff and students.
You should consider testing yourself and other teachers for exposure
to BBP to see if anyone is infected. Secondly, you should consider inoculate
yourself and other teachers against Hepatitis B to minimize any potential
for infection. Unfortunately, there are now currently no inoculations
that can protect you from HIV, Hepatitis C or other forms of Hepatitis.
If You Are A Student
Never knowingly expose yourself to another student’s blood, saliva,
or other body fluids contaminated by blood. Thus, if you see that another
student has a cut, open wound, bloody scrape or leaking sore, bring it
to his or her attention and to the attention of the teacher. That student
should discontinue training until the source of blood is properly bandaged.
If you have been exposed to another person’s blood, saliva or
other body fluids contaminated by blood, be careful to follow the steps
prescribed below. Don’t allow others to persuade you by saying –“Oh,
that isn’t necessary,” or “You don’t need to
do that.” The important thing is to protect yourself.
If another student has been injured and you try to help, don’t
let that person’s blood get on you. If the other student is bleeding
from the mouth or nose and you want to help stop the bleeding, try to
find protective gloves, or barring that, some kind of plastic bag to
put over your hands. Use some kind of absorbent material to mop off blood,
or apply pressure to stop further bleeding. If nothing is available,
give a paper towel or other absorbent material to the injured student
himself. Also be careful of spattered blood, on the floor, or on his
or her uniform or protective equipment.
Try to make your martial arts school aware of the potential dangers
of bloodborne pathogens. Talk to your instructor, school owner, or martial
arts staff members. Show them this article series. Encourage them to
properly equip their school to deal with BBP and train their teachers
and staff members in BBP procedures.
Dealing With Potential Sources of BBP Exposure
1- Direct Inoculation
By Puncture:
If you punch someone in the mouth and get cut (by a tooth)
or are bitten by someone, immediately wash
the area of potential infection. But this is no guarantee. Get
yourself to a hospital or doctor for further treatment including an
HIV and
Hepatitis screening. 2 - Splattered Blood:
Where there is splattered
blood, pour full strength bleach on the spill and leave it standing
for 15-20 minutes.
Then wipe
it clean with paper towels and disposable gloves.
3-
Blood Contaminated Uniforms or Other Garments, Towels,
Canvas or Absorbant floor Mats
Minor
blood stains should be treated with a disinfectant solution such as
hydrogen peroxide. If there is more extensive staining, then the garment
or piece of equipment should be removed, soaked in solution and put
in
a leak proof bag until it can be properly laundered, including use
of bleach. Always wear gloves when handling contaminated clothing or
other
items. 4- Blood Splashed or Transferred to Intact Skin:
The first thing to
do for the person who is bleeding is to locate and treat the wound.
The person splashed needs to wash thoroughly as noted above. If the
area of skin that is exposed is intact and healthy, infection is
unlikely,
but if there is any doubt, follow up with professional medical evaluation. 5- Blood Splashes or Transferred To Broken or Non-Intact Skin:
This can get real tricky
and very inconvenient, but you gotta do what you gotta do. After
thorough washing and control of bleeding, any open wound that has
become contaminated
should be seen and treated in a hospital emergency room. Unless
you know for a fact that your partner is uninfected (which is impossible
since
we assumed at the beginning that all blood spills are infectious)
then it behooves you to be safe rather than sorry. A baseline test
and follow-ups
for all infectious BBP’s is mandatory. 6- Blood Splashes To Mucous Membranes Such As The Eyes Or Mouth:
Thoroughly
wash out your eyes or mouth. Luckily both saliva and tears have anti-microbial
qualities.
If it is your eyes, ideally your martial arts school will have a portable
eye wash kit recommended by OSHA, or a simple eyewash kit found in any
drugstore (with an eye cup). But this might not be available. If not,
immediately use a water faucet or container of water to thoroughly rinse
the contaminated eye. One reader of Part 1 of this series noted that
he was potentially contaminated when his workout partner exhaled forcefully
and accidentally spit in his face and he felt a droplet hit his eye.
If your mouth has been affected, thoroughly rinse your mouth with water.
Then visit your hospital emergency room or doctor for further testing
including a baseline test and follow-ups for all infectious BBP. 7-
Blood Contaminated Makawara, Punching Pads, Punching Bags & Other
Surfaces:
What do we do about the bloody Makawara (punching pad or post), or blood
splattered punching bag? This is where the use of “barriers” can
be very helpful. If you’ve been to your dentist’s office
in the past 10 years or so, you can’t help but notice the numerous
barriers that are utilized in the modern office. Gloves, masks, eye goggles,
and drapes of all kinds on light handles, x-ray machines, suction tips,
etc. are the order of the day. We can very easily and cheaply utilize
the same type of barrier protection techniques to keep the makawara clean
and blood free.
For example, a square of waterproof upholstery material such as “Naughahyde,” or
other non-porous material, can be fitted with adhesive strips of Velcro
and then wrapped around the post. After use, it can be easily removed,
sprayed with the disinfectant of choice, let sit for 15 minutes, then
wiped clean. Easy, cheap, and safe!
If the Naughahyde is already fixed in place, it can still be sprayed
with a disinfectant before use. A bottle of disinfectant can be left
beside the striking surface to be used by students.
Another method is to wear your own barrier, such as bag gloves.
If, however, the makawara is wrapped in rope, or the surface of a punching
bag or other striking surface is absorbent, there is a real problem.
Just a surface cleaning with a disinfectant will not do the trick, since
blood or blood contaminated body fluids (and possible HVB and HCB) are
absorbed and can remain active for some time.
Most surface disinfectants are effective against HBV, HCV and HIV, if
and only if the surfaces are thoroughly cleaned of the blood or body
fluid contaminant. More power to you if you can clean a rope wrapped
around a makawara this well! Even if you could do this and be sure
that the rope is thoroughly clean (lots of luck) then these things need
to be left on the surface for a certain amount of time, which varies
by product and manufacturer. It then needs to be cleaned off and
dried. Technically, in this type situation the only method that
can be totally trusted is nothing short of a gas or autoclave sterilization
(not very practical for the dojo).
I don't know about any of you, but if I saw somebody who I knew had
HBV, or HCV (not to speak of HIV) punching a rope makawara and then left
some blood on it, it would be cold day in hell before I used that baby
myself. I just wouldn’t take the risk. Would you willing to
take that chance on someone you didn't know?
So what can be done? One possible solution for absorbent surfaces is
to wear bag gloves and other protective equipment to create your own
barrier. Another solution for free standing makawara is to make a Naughahyde
(or other non-porous material) slip cover, a sort of bag that can be
put over the striking surface, something that can also that can be removed
and disinfected.
A Note On Hand Washing
This may seem mundane but according to the Association of Professionals
in Infection Control (APIC) Guidelines, the single most effective way
to prevent cross contamination of infectious diseases is hand washing.
If you are going to do this, you may as well do it correctly, and use
the proper cleaners.
Believe it or not, according to APIC a simple one minute immersion or
scrub with isopropyl (rubbing) alcohol is as effective as a 4 to 7 minute
skin preparation with other antiseptics in removing bacteria from the
skin. Alcohol is not good for cleaning the skin if there is some dirt
around, so in this case, one would be better off using any of the anti
microbial soaps or surgical scrubs that are available. Plain soap (Ivory,
Dove,
etc) and water does NOT reduce the numbers of bacteria sufficiently to
prevent an infection if the microorganisms are rubbed in.
Basic Blood Spill Kit For Martial Arts Schools
The following is a list of some of the minimum basic items one should
have on hand in the dojo or martial arts school in case of a blood spill.
The list is not all inclusive but should provide a start. If your martial
arts school has a medical doctor as a student, ask him or her to assist
you in assembling these materials and in the training of teachers and
staff in BBP protocol.
1- One gallon of common household bleach, e.g., Clorox – for
cleaning spills.
2- One gallon of alkaline gluteraldehyde disinfectant, or any of the
other disinfectants listed at the end of this article, which are also
available from your dentist or medical/dental supply house - to clean
contaminated surfaces.
3- Chlorhexidine Gluconate surgical scrub, such as Hibiclens, also available
in drug stores, for thorough hand washing afterwards.
4- Rubbing alcohol, or an alcohol based hand product for cleansing of
the hands.
5- An eye wash kit in case blood, saliva or blood contaminated body
fluid is splattered or transferred into an eye or eyes. Most drug stores
have a simple rinse and eye cup that can be used for this purpose.
Your local pharmacist may be able to order these last items for you.
6 - Protective goggles to be worn during cleanup to protect the eyes
against possible splashing of disinfectants or other liquids.
7- A box of disposable latex or hypoallergenic non-latex gloves (for
those allergic to latex).
8- A roll of disposable paper towels for absorbing spilled blood, disinfectants
and any other liquids.
9- Leak-proof plastic bag for disposal of soiled towels, gloves, etc.
10- Two 1qt. spray bottles; 1 for the Clorox, 1 for the disinfectant
solution.
11- Hydrogen Peroxide
12- A first aid kit which includes band aids, pads,
tape, sterile gaze, cotton balls and other basic ingredients to control
blood, bandage a
cut, scrape, tear, or other wound should be available in sufficient quantity.
A list of these scrubs and disinfectants along with the manufacturers’ phone
numbers is included at the end of this article.
These items can be obtained from local medical or dental dealers, or
if you really want to do it the easy way, make sure you have a “zero
balance” at your dentist’s office and ask him to order it
for you from his supplier. He can probably get you a better price on
it than you could if you were to go it on your own.
These disinfectants should be fast acting, broad spectrum brands that
kill resistant bacteria (even Tuberculosis, which is not a BBP, but is
on the rise in many areas of the world), and resistant non-enveloped
viruses, such as poliovirus, in the presence of “heavy bioburden” (fresh
human whole blood). The scrubs should have rapid antimicrobial activity,
plus residual and cumulative activity.
If gloves, disinfectant solutions, antiseptic soaps and other barriers
and items in standard spill and first aid kits are not available, then
using a plastic grocery bag as a hand barrier (in lieu of a glove) and
regular soap and water will have to suffice.
Summing Up
The theme of this article series is to protect yourself.
Hepatitis C Virus a real bitch. HBV is not a helluva lot better. The
AIDS (HIV) virus is probably not something that you need to worry about
if you've prevented
against these other bugs. The real infectious things are Hepatitis
B and C (not to mention the Tuberculosis bacteria which has not been
discussed in detail here since it is not a bloodborne pathogen, but is
still something
which represents a threat).
If you kill these, any AIDS (HIV) viruses that may have joined
the party would be history at this point. I'm not underestimating
AIDS. It's just much more fragile virus than any of the other organisms
we have discussed.
Be careful.
Surgical Scrubs and Disinfectants and
Sources
Surgical Scrubs
Hibiclens - H. Schein - 800-372-4346
AcuteScrub - Stahmer, Weston Scientific - 800-423-7188
Bactoshield - Steris Corp. - 800-925-2570
CaviScrub - Kerr/Matrix - 800-841-1428
Surgical Scrub by Dial - H. Schein - 800-372-4346
Disinfectants
A. 3%+ Gluteraldehydes
Cidexplus 3.4% - J&J Medical - 800-255-2500
Coecide XL Plus 3.2% - GC America - 800-323-7063
Maxicide Plus 3.4% - H. Schein - 800-372-4346
Protec-top Plus 3.4% - Darby - 800-448-7323
Security 3.4% - Kerr - 800-537-7123
B. 2% +Gluteraldehydes
Banicide 2.5% - Pascal - 800-426-8051
Cidex 2.4% - J&J Medical - 800-255-2500
Coecide XL 2.5% - GC America - 800-323-7036
Maxicide 2.4% - H. Schein - 800-372-4346
Medica 28 2.5% - First Medica - 800-777-7072
Omincide 28 2.4% - Allegiance Health Care - 800-964-5227
ProCide 2.4% - Matrix - 800-841-1428
Protec-top 2.5% - Darby - 800-448-7323
Sterall 2.5% - Colgate - 800-225-3756 Disclaimer:
The medical information provided in this article is of a
general nature. While the author and others who have worked on or contributed
to this
article in some way have done their best to insure the accuracy of
the information given, the author, contributors and FightingArts.com
can not guarantee the complete accuracy of all factual information
given, and also acknowledge that new relevant information is or might
be discovered which could change, add to, or invalidate some information
provided here. If you are interested in developing a bloodborne pathogen
prevention program you should seek advice of professionals trained
in this field.
Acknowledgment:
I want to thank Christopher Caile for
his many suggestions, additions and editing of this article and for
Sterling Smith, who provided
his technical expertise in reviewing what was written.
About The Author:
Lenny Sclafani, DDS is a dentist in private practice since 1979. He
works and lives in Parsippany, NJ with his wife, Monica, and daughters
Katie, age 12, and Jenny, age 10. He has be training in Isshinryu Karate
since 1971 and Matayoshi Kobudo since 1995. He may be reached via email
at: toothaik@optonline.ne |
