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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”

Biohazard

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.


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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


To find more articles of interest, search on one of these keywords:

bloodborne pathogens, martial arts and infectious control, infectious control, hepatitis B, Hepatitis C, HIV, TB, martial arts health concerns


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