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INFECTIOUS DISEASE POLICY
The SCLC adheres to the Virginia High School League Infectious Disease Policy detailed below.
The Virginia High School League Board of Directors has adopted these policies upon the recommendation of the Sports Medicine Advisory Committee to the League. Our goal is to minimize the possibility of transmission of any infectious disease from one athlete to another during practice or competition. The development of this policy is in keeping with the commitment of the VHSL to make athletic participation safer for the athletes in the Commonwealth of Virginia by responding to new information that suggests potential risks.
What are infectious diseases?
Infectious diseases are illnesses that are caused by an organism, usually a virus, bacteria, or fungus. Many of these diseases are contagious, meaning they can be spread from one person to another. For purposes of our athletes, we will consider three types of contagious infectious diseases.
1. Usual viral illnesses like colds, intestinal flu viruses, and influenza are generally spread through airborne transmission of the virus or through direct contact. Hand washing and covering sneezes and coughs are considered reasonable techniques for reducing the spread of these types of illnesses. They are actually more likely to be spread in a closed classroom than an open gym or athletic field except for those sports with close contact like wrestling.
2. Skin lesion such as impetigo (a skin infection), athlete's foot, and non-genital Herpes can also be spread by close contact and should be covered to allow participation. These skin disorders can also be harmful to the individual with the skin lesions by serving as a portal of entry for other kinds of infections. Thus, again, they should be covered or participation should not be allowed.
3. The most serious infectious and contagious diseases in question here are the blood-borne pathogens. These are spread through contact with blood (as well as other bodily fluids such as semen and vaginal fluids) and most notably include Hepatitis B and Human Immunodeficiency Virus (HIV). No reports of transmission from sweat or saliva have been reported with HIV infection. To date, there have been no substantiated reports of these being transmitted through athletic participation and the risk of this happening is very low but theoretically it is NOT ZERO. The rest of this policy is designed with HIV and Hepatitis B in mind. Proper handling of injuries where blood is present can even further reduce the very low risk of transmitting these diseases in the school and playing field arena.
Hepatitis B is a viral infection of the liver that can vary from mild inflammation to a severe life threatening disease. AIDS is a disease of the immune system caused by Human Immunodeficiency Virus. The individual may not develop any symptoms of disease for many years after contracting the virus. Both of these disorders are transmitted through sexual conduct or exposure to infected blood components.
Which sports are most likely to spread AIDS or Hepatitis B?
As stated, neither of these has been reported to be transmitted through sports. The theoretical risk is low but would be greater where there is greater likelihood of blood and close contact. Thus, football, basketball, lacrosse, ice hockey, and wrestling would be most likely to produce this environment. However, any sport could have the potential for blood exposure and thus theoretical risk for exposure.
Should athletes all be tested for these disorders? Mandatory testing has not been advocated by any medial organizations monitoring these disorders. The testing could produce a false sense of security with a negative test during the time between inoculation of an individual and the ability to recognize the presence of the virus. Thus, an individual could be contagious and still have a negative test. The screening tests are not 100% reliable and false positives and negatives have been reported. Additionally, there is concern about infringement of individual rights and the question of what to do if a positive test is obtained. Testing is not a feasible approach to prevention, however, athletes and others involved in interscholastic athletics should have available to them information on where they may obtain private and confidential HIV counseling and testing.
If an athlete is positive, who should be told and should he/she be prevented from participation in sports? The athlete's HIV or Hepatitis 8 status is confidential information between patient and physician. No one else, including school officials can be told without the individual's permission. The athlete with one of these disorders should be encouraged to choose a sport with less contact and opportunity for bleeding than wrestling, for example. The athlete should also be instructed to take proper precautions with skin lesions, bleeding, etc. However, he/she can not be forbidden from participating in whatever sports he/she desires. The decision concerning participation is a personal recommendation could certainly change in the future if any evidence for transmission via sports is documented.
How can we protect our athletes, trainers, and coaches from exposure to one of these blood-borne diseases? There is an effective and safe vaccine available for Hepatitis B. One of the targeted groups to receive this vaccine would be those where the risk of exposure to blood is increased. Thus, any trainer or coach, who frequently deals with an injury with blood, is at potential risk. Strong consideration should be given to having one these individuals receive this immunization.
Blood and other bodily fluids should be handled using "Universal Precautions" as is done in all hospitals and most other health care facilities. This procedure follows. This is the safest approach as one uses techniques that would be preventive in all patients whether they have a disease or not.
Procedures to be followed by coaches, trainers, and officials:
1. A student-athlete should render first aid to himself and cover his own wounds whenever possible. Again, this reduces the risk of transmission from blood-borne pathogen from one person to another.
2. If a bleeding wound occurs, the individual's participation should be interrupted until the bleeding has been stopped and the wound is both cleansed with antiseptic and covered securely or occluded. If bleeding resumes, the practice or contest must be stopped again until bleeding is stopped and contaminated surfaces are cleaned. It is up to the discretion of the official in charge of the competition as to how many times the competition should be stopped due to a student-athlete's bleeding before disqualification occurs.
3. Skin exposed to blood or other body fluids contaminated with blood should be cleaned as promptly as is practical, preferably with soap and warm water. Skin antiseptics (e.g., alcohol) or moist towelettes may be used if sap and water are not available.
4. Even though good hand washing is an adequate precaution, water-impervious gloves should be available for staff to use when handling blood or other body fluids. Gloves are especially important in individuals with not-intact skin. Hands should be washed after glove removal. If gloves are not available, a bulky towel may be used to cover the wound until an off-the field location is reached where gloves can be used during more definitive treatment. Disposable towels should be used in all clean up. Towels, protective gloves, and other materials used in clean up, as well as any cotton used to stem bleeding, should be placed in a container lined with a plastic bag.
5. If blood or blood-contaminated bodily fluids are present on a surface, the object should be cleansed with fresh household bleach solution made for that event by adding one part of bleach to 10 parts of water. Such items as wrestling mats should be cleaned, rinsed, and allowed to dry before resuming action. This solution should be made fresh daily when needed.
6. If any blood gets on an opponent's uniform during competition or on a teammate's uniform during practice, it is necessary to clean the uniform at that point by wiping it with a disinfectant such isopropyl alcohol. This should be done whether or not the opponent or teammate has an open cut or unskilled area on the body, or where or not the blood is on part of the uniform which might come in contact with mucous membranes. If there is substantial saturation of the uniform with blood such that it is dripping, will rub off easily, or drips if squeezed; the uniform must be changed.
7. All soiled linen such as uniforms and towels should be placed in plastic bags and washed in hot soapy water. Any detergent that contains bleach is appropriate.
8. All coaches, officials, and student-athletes should practice good hygiene. Towels, cups and water bottles should not be shared. Also, student athletes should take a shower using a liberal amount of soap and hot water after each practice and competition.
9. It is the responsibility of each team to provide their respective members paper towels, appropriate cleaning solutions, plastic bags, gloves, and any other first aid materials necessary to comply with these regulations.
10. At this time, no cure exists for AIDS, which is a preventable disease. In addition to the aforementioned techniques, education and emphasis on prevention must be an integral part of our athletic programs for all.
According to Dr. David E. Rogers, considered by many to be the foremost expert on the transmission of the HIV Virus, (AIDS), the chances of the virus being transmitted during athletic contests are extremely small. In fact, there is not one documented case of the virus being transmitted in this manner.
The possibility of transmitting AIDS in this manner is much less than the possibility of transmitting other very dangerous blood borne viral infections such as Hepatitis B. However, the chance of transmitting the AIDS virus is not zero. Therefore, precautions- the same as those taken in health care institutions- should be taken to insure that no transmission could occur.
Proper handling of these situations by coaches, officials and competitors will greatly reduce the possibility of any transmission of AIDS, if indeed the athlete who is bleeding is infected by the disease.
These precautions (applicable to wrestling) also can be utilized in other interscholastic activities at any time that a bleeding problem exists:
If an athlete sustains a minor bleeding problem- most result from minor injuries in the nose area- all play should be stopped, the bleeding stemmed, and any blood on the playing surface should be wiped off using bleach in a 10 to 1 solution- 10 parts water and one part bleach. This same solution should be used to wipe any blood off the opponent's skin. It should be noted that there are also many other disinfectants that are very successful in combating the HIV virus (such as isopropyl alcohol).
If any of the blood has gotten on the opponent's uniform, unless the opponent has an open cut or open skin area on his/her body, it is not necessary to clean the uniform at this point. If there is an open cut or an open skin area, then the uniform also should be wiped with the bleach solution.
If an official gets blood on him/her, (s)he should do the same as the competitors (as indicated above).
It is important that any time blood is present, it is treated with respect regarding its ability to transmit infectious disease(s).
Regardless of the activity, if the bleeding problem is severe enough, then the competitor should not be permitted to continue- not only from the standpoint of possible disease transmission, but also for the health and safety of the injured competitor.
ISSUED BY THE VIRGINIA HIGH SCHOOL LEAGUE- JULY 1992
MANDATED BY THE NORTHERN VIRGINIA YOUTH LACROSSE LEAGUE
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