Awareness, Perception, and Risk Management Practices Related to Disease Control and Prevention in University Club Sport ...

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Title:
Awareness, Perception, and Risk Management Practices Related to Disease Control and Prevention in University Club Sport Programs
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1 online resource (119 p.)
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english
Creator:
Waechter,Mary E
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University of Florida
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Gainesville, Fla.
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Degree:
Master's ( M.S.)
Degree Grantor:
University of Florida
Degree Disciplines:
Sport Management, Tourism, Recreation, and Sport Management
Committee Chair:
Connaughton, Daniel P
Committee Members:
Ko, Yong Jae
Spengler, John O

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Subjects / Keywords:
Tourism, Recreation, and Sport Management -- Dissertations, Academic -- UF
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Sport Management thesis, M.S.
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theses   ( marcgt )
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Abstract:
Disease control and prevention within campus recreation club sport programs is a critical element of a complete risk management plan. Without the proper planning, control, and prevention of communicable disease and bloodborne pathogen exposure in sport, campus recreation employees, participants and programs may be exposed to an increased risk of harm and liability. The purpose of this study was to: (1) examine club sport administrators? knowledge and perception of the risk to their employees and participants of acquiring a communicable disease and/or bloodborne pathogen-related illness or infection, (2) investigate risk management policies and practices pertaining to communicable diseases and bloodborne pathogens, and (3) determine if there is an association between the administrators? knowledge/perceived risk and their related risk management practices. The survey for this study was adopted and redesigned with permission from previous research (Stier, Schneider, Kampf, Haines, and Gaskins 2008). After a review of the literature and test of content validity by a panel of experts, the survey was granted approval from the Institutional Review Board. Current campus recreation club sport administrators in the United States (N = 522) listed in the NIRSA 2011 Recreational Sports Directory were recruited to participate in the online survey. The resultant population was 498 club sport program administrators with valid contact information. A 31.3% response rate was achieved with 156 (n=156) club sport program administrators submitting completed surveys. Of the nine chi square analyses that were performed, and the single bivariate correlation comparing awareness and importance to corresponding policies and procedures, six (60%) were significant (p<0.05). Of the respondents, 57.7% indicated that they did not have a written risk management plan that specifically addressed disease control and prevention, while 53.2% reported that they did not have a written exposure control plan that addressed bloodborne pathogens. Risk management plans in campus recreation club sport programs should address communicable diseases and bloodborne pathogens. Plans should include educating staff members and athletes/participants about the potential risks, as well as steps that can be taken to prevent and reduce such risks.
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In the series University of Florida Digital Collections.
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Includes vita.
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Includes bibliographical references.
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Description based on online resource; title from PDF title page.
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This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Statement of Responsibility:
by Mary E Waechter.
Thesis:
Thesis (M.S.)--University of Florida, 2011.
Local:
Adviser: Connaughton, Daniel P.
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RESTRICTED TO UF STUDENTS, STAFF, FACULTY, AND ON-CAMPUS USE UNTIL 2013-08-31

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lcc - LD1780 2011
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UFE0043429:00001


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1 AWARENESS, PERCEPTION, AND RISK MANAGEMENT PRACTICES RELATED TO DISEASE CONTROL AND PREVENTION IN UNIVERSITY CLUB SPORT PROGRAMS By MARY E. WAECHTER A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE UNIVERSITY OF FLORIDA 2011

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2 2011 Mary E. Waechter

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3 To my family and friends who offered me unconditional love and support throughout the course of this thesis and gr aduate school. To all of you, I extend my deepest appreciation.

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4 ACKNOWLEDGMENTS It is a pleasure to thank the many people who made this thesis possible. I offer my sincerest gratitude to my academic advisor and committee chair, Dr. Dan Connaughton, wh o has supported me, not only in the writing of this thesis with his patience, knowledge, and careful attention to detail, but also in the planning of my coursework, graduate assistant responsibilities, and graduate school pursuits. I attribute the level of my Master s degree to his encouragement and guidance, as well as the extra efforts he dedicated to seeing me through with the successful completion of my thesis writing and defense. One simply could not wish for a better advisor, friend, and mentor. I wou ld also like to acknowledge and thank my committee members, Dr. J.O. Spengler and Dr. Yong Jae Ko for guiding my research, as well as providing significant amounts of their time, effort, and expertise to better my work. Their wealth of experience, technica l support, constructive criticism, and valuable feedback was crucial to the complet ion of this project. Many thanks and appreciation go es to Mr. Eric Ascher, and assis tance, especially with my survey distribution. A very special thank you to my best friend and epidemiologist, Corinne Thompson. Corinne has provided me with endless support and encouragement, a willingness to offer an extra pair of eyes and editing assista nce whenever necessary, and an unwavering faith and confidence in my abilities. My thanks also go out to legendary cyclist, friend, and running coach Will Harding, whose knowledge, wisdom, and sharp s Finally, I thank my par ents for providing me with infinite support throughout all my studies and academic endeavors, not only at the University of Florida, but also during

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5 my undergraduate career at Penn State. Without their love and encouragement none of this would be a reality This thesis is dedicated to them.

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6 TABLE OF CONTENTS page ACKNOWLEDGMENTS ................................ ................................ ................................ .. 4 LIST OF TABLES ................................ ................................ ................................ ............ 8 ABSTRACT ................................ ................................ ................................ ................... 10 CHAPTER 1 INTRODUCTION ................................ ................................ ................................ .... 12 Background ................................ ................................ ................................ ............. 13 Statement of th e Problem and Purpose of the Study ................................ .............. 17 Significance of the Study ................................ ................................ ........................ 17 Research Questions ................................ ................................ ............................... 18 2 LITERATURE REVIEW ................................ ................................ .......................... 19 Risk Management ................................ ................................ ................................ ... 19 Risk Perception ................................ ................................ ................................ ....... 19 Significance of a Risk Management Plan ................................ ................................ 22 Tort Liability ................................ ................................ ................................ ............ 23 Negligence ................................ ................................ ................................ .............. 23 Forseeability ................................ ................................ ................................ ........... 24 Campus Recreation Programs ................................ ................................ ................ 24 Club Sport Programs ................................ ................................ .............................. 25 Bloodborne Pathogens and Communicable Diseases ................................ ............ 26 Bloodborne Pathogen and Communicable Disease Policies in Sport ..................... 31 3 METHOD ................................ ................................ ................................ ................ 37 Participants ................................ ................................ ................................ ............. 37 Instrument ................................ ................................ ................................ ............... 37 Club Sport Pr ogram and Administrator Demographics ................................ ..... 38 Knowledge and Risk Perception Associated with Disease Control and Prevention ................................ ................................ ................................ ..... 38 Risk Manag ement Practices Associated with Disease Control and Prevention ................................ ................................ ................................ ..... 39 Procedures ................................ ................................ ................................ ............. 39 Data Analyses ................................ ................................ ................................ ......... 40 4 RESULTS ................................ ................................ ................................ ............... 41 Descriptive Statistics ................................ ................................ ............................... 41 Club Sport Program Respondent Demographics ................................ ............. 41

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7 Risk Management Policies and Practices Associated with Disease Control and Prevention ................................ ................................ .............................. 42 Knowledge and Risk Perception Associated with Disease Co ntrol and Prevention ................................ ................................ ................................ ..... 45 Chi Square and Correlation Analyses ................................ ................................ ..... 48 5 DISCUSSION ................................ ................................ ................................ ......... 81 General Risk Management in Club Sport Programs ................................ ............... 81 Risk Management Practices and Policies Associated with Disease Control and Prevention in Club Sport Programs ................................ ................................ ..... 83 Perceived Awareness and Importance of Communicable Disease and Bloodborne Pathogen Risks ................................ ................................ ................ 86 Comparisons between Perceived Awareness and Importance of the Risk with Corresponding Risk Management Policies and Practices ................................ ... 88 Risk Management Policies and Procedures Addressing Communicable Disease and Bloodborne Pathogens in Club Sport Programs ................................ ........... 89 Practical Implications for Reducing Communicable Disease and Bloodborne Pathogen Risks Associated with Equipment and Field/Facility Areas in Club Sport Programs ................................ ................................ ................................ ... 91 Consulting Professional Organizations and Health/Medical Professionals Regarding Communicable Disease and Bloodborne Pathogen Risks in Club Sport Programs ................................ ................................ ................................ ... 92 Reducing Liability Associated with Communicable Disease and Bloodborne Pathogens in Sport ................................ ................................ .............................. 95 6 LIMITATIONS AND FUTURE RESEARCH ................................ ............................ 99 Limitations ................................ ................................ ................................ ............... 99 Future Research Suggestions ................................ ................................ .............. 100 APPENDIX A INFORMED CONSENT ................................ ................................ ........................ 103 B SURVEY INSTRUMENT ................................ ................................ ....................... 104 LIST OF REFERENCES ................................ ................................ ............................. 114 BIOGRAPHICAL SKETCH ................................ ................................ .......................... 119

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8 LIST OF TABL ES Table page 4 1 Descriptive statistics of demographic variables ( n = 156) ................................ .. 56 4 2 Descriptive statistics of addressin g general risk management club sport programs ................................ ................................ ................................ ............ 57 4 3 Descriptive statistics of club sport program certification policy and practice ....... 58 4 4 Descriptive statistics of risk management specifically related to bloodborne pathogens and communicable diseases ................................ ............................. 61 4 5 Descriptive statistics related to cancelations or closures du e to bloodborne pathogens and communicable disease incidents ................................ ............... 63 4 6 Descriptive statistics of the perceived importance of education, training, and certifications ................................ ................................ ................................ ........ 64 4 7 Descriptive statistics of perceived awareness of bloodborne pathogens and communicable disease ................................ ................................ ....................... 66 4 8 Descriptive statistics of the perceived importanc e and risk management practices regarding the Hepatitis B vaccination ................................ .................. 67 4 9 Descriptive statistics of the importance of policy for reducing the risk of bloodborne pathogen and communicable di sease transmission ........................ 68 4 10 Practice of having a Risk Management Plan that Addresses Disease Control and Prevention ................................ ................................ ................................ ... 71 4 11 Have policies and procedures addressing disease control and prevention ........ 72 4 12 Have a written exposure control plan addressing bloodborne pathogens .......... 73 4 13 Practice of training employees in universal precautions ................................ ..... 74 4 14 Have policies for contaminated equipment ................................ ......................... 75 4 15 Have policies for contaminated field/facility areas ................................ .............. 76 4 16 Have policies and procedures addressing a bleeding incident ........................... 77 4 17 Have policy of consulting a health/medical professional ................................ ..... 78 4 18 Policies regarding contaminated equipment in heavy protective equipment sports ................................ ................................ ................................ .................. 79

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9 4 19 Correlations ................................ ................................ ................................ ........ 80

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10 Abstract of Thesis P rese nted to the Graduate S chool of the University of F lorida i n Partial Fulfillment of t he Requirements for the Degree of Master of S cienc e AWARENESS, PERCEPTION, AND RISK MANAGEMENT PRACTICES RELATED TO DISEASE CONTROL AND PREVENTION IN UNIVERSITY CLUB SPORT PROGRAMS By Mary E. Waechter August 2011 Chair: Dan iel P. Connaughton Major: Sport Management Disease control and prevention with in campus recreation club sport programs is a critical element of a complete risk management plan. Without the proper planning, control, and prevention of communicable disease and bloodborne pathogen exposure in sport, campus recreation employees, particip ants and programs may be expos ed to an increased risk of harm and liability. The purpose of this study was to: (1) ex amine club knowledge and perception of the risk to their employees and participants of acquiring a communicable disea se and/or bloodborne pathogen related illness or infection, (2) investigate risk management policies and practices pertaining to communicable disease s and bloodborne pathogens, and (3) determine if there is an associa knowle dge/perceived risk and their related risk management practices. The survey for this study was adopted and redesigned with permission from previous research (Stier, Schneid er, Kampf, Haines, and Gaskins 2008) After a review of the literature and test of co ntent validity by a panel of experts, the survey was granted approval from the Institutional Review Board Current campus recreation club sport administrators in the United States ( N = 522) listed in the NIRSA

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11 2011 Recreational Sports Directory were recru ited to participate in the online survey. The resultant population was 498 club sport program administrators with valid contact information. A 3 1.3% response rate was achieved with 156 (n=156) club sport program administrators submitting completed surveys. Of the nine chi square analyses that were performed, and the single bivariate correlation comparing awareness and importance to corres ponding policies and procedures, s ix (6 0%) were significant ( p <0.05). Of the respondents, 57.7% indicated that they did n ot have a written risk management plan that specifically addressed disease control and prevention, while 53.2% reported that they did not have a written exposure control plan that addressed bloodborne pathogens. Risk management plans in campus recreation c lub sport programs should address communicable dis eases and bloodborne pathogens. Plans should include educating staff members and athletes/participants about the potential risks, as well as steps that can be taken to prevent and reduce such risks.

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12 CHAPTE R 1 INTRODUCTION Sport is commonly defined as an organized, competitive and skillful physical activity requiring commitment and fair play (Spengler, Anderson, Connaughton, & Baker 2009). Sport often involves a degree of physical contact or exertion, as we ll as the dedication of time and effort, and is meant to pose a challenge to the particip ants and competitors involved. Due to this nature, sport is an activity that invo lves a certain degree of risk. Injuries, incidents, and harm are no strangers to sport and certai n risks are inherent The risk of physical injury is often unavoidable in sport. It would be impractical, if not impossible, to remove risk enti rely from all sport settings. Eliminating all risk from sport would alter the nature and intensity o f the activity, likely resulting in diminishing participation. With such modification and alteration, sport would be beyond recognition of the original intent and activity (Spengler et al., 2009). Due to the fundamental relationship between sport and risk, it is imperative to reduce the risk of harm through the application and execution of sound risk management p olicies and procedures. Campus recreation programs are found in most colleges and universities today. Many educational institutions spend millions of dollars on such programs which are used to recruit new students, improve health and fitness, reduce stress, as well as foster student leadership, devel opment, and personal wellness. Within campus recreation programs, several sub programs often exist inc luding fitness, aquatics, intramurals, outdoor pursuits, recreation facility operations, informal recreation, and club sports (National Intramural Recreational Spor ts Association (NIRSA), 2010). Many

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13 recreational sports professionals have accepted the resp onsibility of managing risk and reducing lawsuits in their campus recreational sport programs (Cooper, 1997). The NIRSA is the professional association and governing body for campus recreation. It is the leading resource for professional and student devel opment, education, and research in the field. The NIRSA includes nearly 4,000 professional, student and associate members, and serves an estimated 5.5 million students who participate in campus recreational sports programs throughout the United States, Ca nada and other countries (NIRSA, 2010). emphasize its commitment to providing educational and developmental opportunities for its professional and student members. The NIRSA also seeks to foster quality recreational pr ograms, facilities, and services for differing campus recreation populations. The NIRSA demonstrates its commitment to excellence by promoting ethical and healthy lifestyle choices, as well as facilitating progressive research and professional standards wi thin campus recreation (NIRSA, 2010). Background Although studies regarding risk management in campus recreation and club sport programs have recent research has provide d influential results. Stier, Schneider, Kampf, Haines, and Gaskins (2008) surveyed intramural directors to determine common risk management policies, practices, and procedures for intramural act ivities at NIRSA institutions. The survey investigated the following risk management areas: rules and regulations, di rect supervision, sportsmanship rating systems, restrictive policies, safety devices, certified officials, and background, experience and training of respondents. The researchers management efforts, only a small majority of respondents indicated that a professional

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14 staff member had been given responsibility for overall risk management of the total intramur Specifically, the researchers reported that approximately one third (31%) of the respondents indicated that their schools did not have a written risk management plan, 42% did not have a designated employee responsible for risk management oversight, and 74% of the institutions did not have an oversight committee for risk management operations with in the ir campus recreation department (Stier et al., 2008). Only 30% of the respondents indicated that Automated External Defibrillators (AEDs) were required at all intramural activities. Regarding C ardiopulmonary R esuscitation (CPR), 90% of the institutio ns required certification of professional employee s 79% required student employees to be certified and graduate assistants were required to have certification in 75% of the progra ms. First Aid certification was required of professional staff in 79% of the institutions, 68% required student employees to be certified, and graduate assistants were required to have the certif ication in 67% of the schools. Additionally, the study indicated that the Hepatitis B V accination was offered to professional staff in 24 % of the institutions, to student employees in 29% and to graduate ass istants at 24% of the schools. Furthermore, the vast majority (98%) of the intramural programs documented all injuries that occurred in intramural activities. Finally, just 1% of the res pondents indicated that their intramural programs required their participants to have a physical (medical) examination prior to participation, and only 13% of the institutions required proof of medical insurance prior to participation (Stier et al., 2008). environment for intramural and sport activities for college students at NIRSA institutions

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15 In another study, Schneider, Stier, Kampf, G askins, and Haines (2008) investigated risk management policies and procedures of club sport campus recreation programs within NIRSA 4 year institutions. The purpose of their study was to investigate risk management practices within club sport programs wit h an emphasis on: documentation, club sport travel, coaches, supervision, use of off campus facilities, access to athletic trainers, and medical insurance. They found the majority of club sport programs did not require (a) medical examinations (4% required ) prior to participation, (b) professional campus recreation employee supervision of home event activities (12% required), or (c) athletic trainers to be present at home events (35% required). In addition, the majority of club sport programs did not requir e their coaches to have CPR or First Aid certification (32% required CPR, 13% required AED, and 27% required First Aid ). Additionally, only 17% of campus recreation directors reported requiring an AED at all home club sport competition s Finally, the requi rement of having ambulances present at competitions was not highly reported, with the club sport of rugby having the highest requirement at 7% and ice hockey, soccer, and lacrosse following with 4%. Such risk management oversights may expose an organizati on to liability particularly due to a lack of properly trained personnel, supervision, or failure to address emergency and universal precaution response procedures (Schneider et al., 2008). are not requiring medical exams, physical supervision, or medical care at home events. In addition, if club sport programs are not requiring a coach to have appropriate certifications ( First Aid CPR, AED), ambulance presence at home competitions, professi onal supervision at home competitions, and access to athletic trai ners, then there are potential legal

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16 liability problems related to the lack of properly trained personnel, supervision, and accountability to address emergency response proced ures at these e (p. 75) As a result of this study, campus recreation administrators were advised to take a greater specific courses of action for risk management in an effort to reduce injuries, lawsuits, and liability (Schneider et al., 2008). Conatser and Ledingham (2010) suggested important steps to reduce risk and exposure associated with infectious diseases in physical activity and sport environments, especially those that t ak e place in schools Due to the sharing of common items and facilities, and the increased potential for skin to skin or person to person contact, the authors stressed that physical activity in the school environment needs specific attention to help reduce and prevent disease transmission. Influenza A H1N1 (Swine flu), Methicillin R esistant Staphylococcus A ureus (MRSA; commonly referred to as flesh eating bacteria), Pink Eye, and Infectious Mononucleosis are common and serious infectious diseases found not only in the school environment, but also in sport. Because these infectious diseases can be highly contagious, the use of shared sports equipment, direct contact between participants, unsanitary locker room conditions, as well as injuries and exposure to b odily fluids provide possible routes for infection, and should be appropriately addressed (Conatser & Ledingham, 2010). Human Immunodeficiency Virus ( HIV ) and the Hepatitis B Virus (HBV) are two additional infectious diseases that can spread in the sport e nvironment as well. The article emphasized that participants with such diseases should not be completely banned from part icipating in physical activity, however they should not take part in

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17 higher risk activities (based on an increased incidence of person person contact) such as wrestling and boxing. It was further noted that many school districts have designed and implemented well developed guidelines and procedures for disease control and prevention (Conatser & Ledingham, 2010). Statement of the Problem a nd Purpose of the Study P revious studies have addressed many risk management issues in club sport programs There is a need, however, to better understand risk management as it pertains to disease control and prevention Disease control and prevention with in c lub sport programs is a critical element of a complete campus re creation risk management plan. Without the proper planning, control, and prevention of disease and bloodborne pathogen exposure in sport, campus recreation employees, participants and prog rams may be exposed to an increased risk of harm and liability. The purpose of this study was to (1) ex knowledge and their perception of the risk to their employees and participants of acquiring a communicable disease and/o r bloodborne pathogen related illness or infection, (2) investigate risk management policies and practices pertaining to communicable disease s and bloodborne pathogens, and (3) determine if there is an associ ation between the administrator s knowledge/perc eived and their related risk management practices. Significance of the Study Club sport program administrators were surveyed on their knowledge and percepti on of the risk associated with communicable disease s. This study evaluat ed the scope and nature of risk management procedures relevant to preventing or reducing the risk of communicable diseases in campus recreation club sport programs I t is expected that this study will inform clu b sport program administrators of gaps in their risk

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18 management policies and procedures related to communicable disease and bloodborne pathoge n exposure and control T he results of this s tudy may assist club sport program administrators in identifying and correcting weaknesses within their overall risk management plan, with a specific focus on disease control and prevention. Research Questions The following research questions guided this study: 1. Are campus recreation club sport program administrators aware of the risk of communicable diseases to employees and participants? How d o they perceive such risks? 2. What is the scope and nature of risk management practices relevant to preventing or reducing the risk of communicable diseases in campus recreation club sport programs? 3. Is there an association between club sport administrators perceptions of the risk of communicable diseases and the implementation of relevant risk management practices?

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19 CHAPTER 2 LITERATURE REVIEW Risk Management (probability or like lihood) of injury and loss to sport participants, spectators, employees, identified the benefits of risk management in sport which include (1) injury and death preventio n, (2) reducing negligence and legal claims, (3) preventing financial losses, and (4) reducing stress and negative publicity as a result of risk related incidents. With the growing numbers of campus recreation programs and participants, a sound risk manage ment plan is paramount to the overall success of a recreational sports program. Risk Perception From many different standpoints over the past 50 years researchers have been evaluating and studying risk (Bauer, 1960; Celsi, Rose, & Leigh, 1993; Cox, 1967; Fischhoff, Slovic, Lichtenstein, Read, & Combs, 1978; Lepp & Gibson, 2003; Slovic & Weber, 2002). Such specificity in research has le d to th e categorizing of risk into var i ous areas including risk assessment, risk communication, risk management, and risk reduction (Seigrist, Keller, & Kiers, 2005). Aside from such focused areas, risk can also be more broadly divided into both an objective and subjective perspective. The consequences of exposure to most risk factors can be quantified objectively in terms of the frequency of occurrence and the severity of injury or financial loss suffered (Fuller & beings have invented to help them understand and cope with the dangers and uncert (Slovic & Weber, 2002, p. 4). Therefore, risk assessment is not only

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20 concerned with objective or statistical levels of risk (often presented as a percentage value), but also with the subjective or perceived levels of risk, determined by th e individual characteristics of the participants involved (Fuller & Drawer, 2004). Theories of risk perception have been based on several issues, such as an defined perceive based upon an assessment of the possible negative outcomes and the likelihood that those Overall perception of risk is made up of two components: (1) physical perception, which relates to the factual information received through the sensory system, and (2) cognitive perception, which relates to the mental processes that determine how a reaction to the information received is elicited. Physical percepti on of situations is normally rapid and enables individuals to respond to changing circumstance s in sport related activities. However, cognitive perceptions are formed over time and are adjusted with the accumulatio n of knowledge and experience. In sport an d athletic participation, Fuller and Drawer (2004) point ed out that in terms of cognitive equipment or activities to be dangerous if they know (or think they know) that the y are Evaluating the concepts behind the theory of perceived risk is often accomplished through a procedural, step wise method, referred to a stage model. stage model, Stage 1 is defined a s Attraction, where individuals first experience a need for stimulation and autonomy, entering into potential involvement and activity where risk eleme nts exist. Stage 2 is labeled as Cognitive

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21 Appraisal, where a comparison between the ed situation al risk of the activity and their perceived ability to address the particular risk is carried out Her e, the individual must address the two dimensions of task uncertainty which include: (a) the probability of fai lure (i.e., outcome uncertainty ) and (b) the nature of the consequences regarding failure, ranging from potentially minimal harm to potential catastrophic injury situational risk stemming from the ac tivity is great er than their perceived ability to deal with or treat the risk, the individual anticipates a failure outcome, experiencing feelings of threat, fear, or anxiety, ultimately contributing to inhibited participation in the activity. However, in treat the risky element within an activity equals or exceeds their perceived situational risk, the individual anticipates success. Risk with participation is treatable or existent at a manageable level of negative risk consequence, resulting in a greater probability of participation. In Stage 3 (Decision Making), an cognitive evaluation of the risk and their ability to handle the risk lead to either an avoidance of the activity due to too great or unmanageable risk or participation in the activity with manageable or treatable levels of risk. Stage 4, Performance Experiences, eness. In this stage, feelings of control lead to effective performance, successful outcome, and correct task strategy. Comparatively, feelings of fear or anxiety signal poor performance, along with an unsuccessful outcome and a need for adjustment (Robins on, 1992). An individual who experiences a greater feeling regarding their performance effectiveness will likewise experience more satisfaction and probability for future participation in the

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22 as Intuitive Reflective Appraisal. In this stage individuals are information and knowledge seekers, with motivation to understand the factors behind their success and failure outcomes. Individuals examine and appraise their performance, identifying succes sful and unsuccessful elements, as well as revealing the causes of their performance experiences. Such reflection has the capacity to significantly influence the expectancies of future actions and outcomes (Weiner, 1986). Significance of a Risk Management Plan When designing a risk management plan, developing a framework and founda tion for the plan is critical. Initially, recognition and identification of potential risks (harms and hazards) must be performed. This is followed by classifying those potential risks, which is done by analyzing risks by frequency (how often is a risk likely to occur) and severity (if a risk does occur how severe will it be to the organization). Finally, treating the risks must be carried out. This is accomplished by developing a nd executing organized policies and procedures in an effort to eliminate/avoid, transfer, retain, and/or reduce risks (Spengler, Connaughton, & Pittman, 2006). With a well developed risk management plan in place, the consequential results of risk incidents are decreased. The most prominent consequences of inadequate risk management in sport are injuries, fatalities, litigation, and lia bility. When risk is inappropriately managed, either through a lack of proper planning, policy, and/or procedures, an organi zation may be exposed to severe consequences These include but are not limited to injuries, fatalities, financial loss, loss of time and/or organizational resources, stress, negative publicity, and allegations of negligence and subsequent legal claims (Sp engler et al., 2006).

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23 Tort Liability As stated by Garner (2000) which a remedy may be obtained, usually in the form of damages; or a breach of duty that the law imposes on everyone in the same relation to one anothe r as those involved in a given (p. 1210). Injury in the form of physical injury, property damage, or harm to reputation, without intent is defined as an unintentional tort. An example of an unintentional tort could be an injury to a club sport participant that resulted from a club sport employee failing to carry out a reasonable action as they should have (an act of om ission), or performing an act that they should not have (an act of commission) wh ich caused the physical injury (C otten & Woloha n, 2010). Tort claims often involve an injury resulting from participation in a sport or physical activity, with the injured party seeking monetary compensation for the damages they incurred. A sound risk management plan can reduce tort claims, or at the v ery least, reduce the liability associated with such claims (Stier et al., 2008). Negligence A very common allegation in sport r elated lawsuits is negligence. Negligence, is t person would have exercised in a similar situation; or any conduct that falls below the legal standard established to protect others against unreasonable risk of harm, except for conduct that is intentionally, wantonly, or willfully disregardful of other (Garner, 2000, p. 846). U nreasonable conduct occurs when a reasonable person falls short of protecting another from a foreseeable risk of harm (Cotten & Wolohan, 2010). Negligence is comprised of four essential elements including: duty (protecti ng the participant from an unreasonable risk of harm), breach of duty (failure to protect the

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24 participant from unreasonable risk of harm), injury (participant suffers damage to their person, property, or reputation), and finally causation (breach of duty m ust be th e reason the injury occurred). An individual or service provider cannot be found negligent unless all four elements are present. If any one element is not fu lfilled, there is no negligence (Cotten & Wolohan, 2010). Forseeability In some circumsta nces liability becomes a matter of whether the risk of injury was onably With foreseeability, the specific nature of an injury is not necessarily th e primary concern, but rather the act of foreseeing that injury or the possibility of that harm was likely to occur. Foreseeability is grounded in foresight, and how the reasonable, prudent professional must be able to predict and foresee dangers and risks that pose a threat to participants (Cotten & Wolohan, 2010) Garner (2000) states, eseeability, along with actual causation, is an element of proximate ca use in p. 522). Campus Recreation Programs Over the past few decades, campus recreatio n programs have increased dramatically in both numbers and size of programs. As previously mentioned, t oday, the NIRSA includes nearly 4,000 professional, student and associate members throughout the United States, Canada and other countries. Located in bo th public and private colleges and universities, campus recreation programs within NIRSA serve an estimated 5.5 million students (NIRSA, 2010). Typically within campus recreation programs, several programs exist including but not limited to intramurals, aq uatics, outdoor pursuits, fitness, and club sports.

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25 Club Sport Programs Both public and private colleges and universities have experienced increased development and expansion within their club sport programs. Club sport programs typically offer a wide vari ety of sports and activities, and continue to recruit more participants (students, faculty, and community members) each academic year (Stier et al., 2008). Club sport programs, however, present a unique challenge to university and campus recreation adminis trators, especially in regard to managing risk Although club sport organizations fall under university control, they typically operate with a significant level of autonomy. Utilizing the university name, facilities, and equipment, club sports are defined as student run organizations. They often lack direct supervision (more promin ently found in intramural sport programs) and are typically left on their own for a majority of practices, games, and event activities. With such responsibility falling on the st udents themselves, it is imperative that club sport program administrators examine individual clubs to determine s pecific risk management needs. Once this has been accomplished, they should develop and implement risk management policies and procedures, and communicate with and train their participants and staff appropriately in an effort to reduce injuries, and ensure that appropriate measures are taken when injuries do occur (Fawcett, 1998). R isk identification and analysis, and the development of risk man agement policies and procedures, specific to club sport programs, are critical to loss reduction and prevention. Policies and procedures that protect not only the participants (mostly students) but also the institutions, provide additional value and credit ability to club sport programs. Not only do club sports seek to provide an outlet for sport and physical activity on college campuses, but they also aim to protect their participants and

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26 institutions against the risks (injuries) involved in participation, as well as the potential for lawsuits and losses (financial, reputation, etc.; Fawcett 1998 ; Mull Bayless, Ross, & Jamieson, 1997 ). Bloodborne Pathogens and Communicable Diseases As awareness of the benefits of risk management continues to rise in campus recreation programs (Young, Fields, & Powell, 2007), the perception of the risk associated with exposure to bloodborne pathogens and communicable diseases should be evaluated, as well as what risk management policies and practices are utilized in an effor t to reduce exposure to bloodborne pathogens and communicable diseases Injuries and bleeding are not uncommon to sport, and present a favorable environment for bloodborne pathogen expo sure and disease transmission. Bloodborne pathogens are micr oorganisms found in human blood which can cause infection, disease, and even death. Over the past two decades, the focus of bloodborne pathogen exposure and risk in sport has been on the H uman I mmunodeficiency V irus (HIV ) and Hepatitis B Virus (HBV). These viruses ha ve the capability of not only killing the host in which they reside, but also being transmitted through blood or bodily fluid to an unsuspecting athlete (Zeigler, 1997). Although there have been no reported cases of H uman I mmunodeficiency V irus (HIV) trans mission during athletic competition, the exposure to blood in the athletic environment poses the r isk of infection. HIV infects T lymphocyte cells found w ithin the human immune system. T lymphocyte cells are essential to the human immune system As cells a re attacked by the HIV virus, the immune system begins to fail leaving the body extremely vulnerable to numerous seco ndary infections and diseases. It is this secondary infection susceptibility that often leads to fatality in those with HIV. Currently

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27 ther e is no cure for HIV, and in sport, open wound injuries with severe bleeding pose the greatest risk for transmission if not handled with the proper procedures and precautions (Zeigler, 1997). The Hepatitis B Virus (HBV) is an infectious disease that involv es inflammation and damage to the liver. It is one of five different types of hepatitis that have been identified, and can result in chronic liver damage (cirrhosis), liver cancer, and even liver Hepatitis B Virus can be transmitted through very small amounts of blood and bodily fluid and can remain infectious for a week or longer Those who initially become infected with hepatitis may 0% of those infected each year are asymptomatic, showing no signs of infection. Although a strong immune system, as well as the HBV vaccination (licensed in 1981 by the Federal Drug Administration) can successfully defend against HBV, 6 to 10% of individua ls are incapable of beating the virus and become chronic HBV infected individuals and carriers. The reduction of potential HBV transmission in sports can be achieved by practicing risk management and disease control precautions (Zeigler, 1997). Bereket Yuc el (2007) sampled and analyzed the blood and sweat of 70 male Olympic wrestlers (ages 18 30 years) for evid ence of H epatitis B infection. More than one third of the wrestlers reported that they had competed and trained with bleeding or open wounds. Althoug h it was found that none of the wrestlers had an active HBV infection, as evidenced by a lack of antibodies to the virus, the virus was det ected in the blood of nine (13%; Bereket Yucel, 2007). The researcher pointed out that such a finding suggests that t he wrestlers had concealed inf ections. S uch an occurrence was

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28 possible due to the intense training of the wrestlers leading to temporary suppressions in normal immune response. Even more remarkable, was that eight (11%) also had particles of the virus pres ent in their sweat, with levels of the virus found in the blood similarly matching those found in the sweat. Such findings led to the conclusion that sweat, like open wounds and mucous membranes, could be another way of transmitting the infection (Bereket Yucel, 2007). Methic illin R esistant Staphylococcus A has become a prim ary concern in sport settings. Infections and outbreaks have been documented from high school to professional sport settings. MRSA has been la beled as resistant to common antibiotics (Centers for Disease Control and Prevention (CDC), 2008). Although MRSA is treatable, it usually begins on the skin as a small boi l and has the capacity to cause major illness including infected wounds, blood infections, pneumonia, and even death (Menaker & Connaughton, 2009). In 2005, it was estimated that over 95,000 cases of MRSA were reported in the United States, resulting in 18 ,650 deaths (Klevens et al., 2007). Outbreaks of MRSA are caused by direct physical cont act between people, or from unclean equipment, shared or unclean uniforms, discarding of wound dressings inappropriately, untreated whirlpools, as well as improperly di sinfected locker rooms (CDC, 2008). Several organizations have published official/position statements (National Athletic Trainers Association (NATA), 2005, 2007; National Federation of State High School Associations (NFSHSA), 2007) and guidelines (CDC, 200 8; National Collegiate Athletic Association (NCAA), 2008) which include suggestions and

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29 instructions for reducing the ris k of MRSA infections in sport. Su ch published guidelines address but are not limited to: proper wound cleaning procedures, avoiding th e sharing of athletic gear and clothing, proper disinfecting procedures for athletic gear and equipment (mats, weight benches, exercise equipment etc. ), sanitizing facility locker rooms, training coaches and athletic personnel on exposure control procedur es and prevention techniques, and encouraging sport participants to shower immediately after physical activity. In a recent study Ryan et al. (2011) tested 240 samples taken from fitness facilities for the presence of MRSA. Swabs were collected from fitn ess equipment (cardiovascular machines, barbells, benches and weights) housed in three different fitness facilities including a university fitness facility, a community fitness facility and a high school fitness facility. Swab samples were specifically tak en at three different intervals throughout the day and retrieved from places on equipment that were commonly sweated on or touched. Of the 240 swab samples taken, the researchers found no isolates of MRSA in any of the three fitness centers tested. The r es earchers have emphasized that policies and procedures that are already in place in fitness colonization on gym surfaces, it is possible that the disinfectant is in fa ct effective in reducing or eliminating the presence of staphylococci (Ryan et al., 2011, p. 149) Their findings may lead some to believe that MRSA does not pose a significant threat in the sport environment, however, careful consideration of the limitati ons and nature of this particular study are warranted. For instance, the researchers did not use a broth enhancement with their swab cultures which may have been more effective in exposing

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30 the presence of MRSA isolates. Others point out that the sample si ze of 240 cultures may have been too small, and that future studies would be wise to also examine the clothing and other equipment used by the fitness facility patrons, as well as doorknobs, water fountains, and locker room areas for MRS A isolates (Ryan et al., 2011 ) Birdwell abandon current precautions, policies, and procedures i n fitness areas for reducing the A recent infectious disease that has garnered major media attention is the Influenza A HINI virus, or more commonly referred to as Swine Influenza (Swine Flu). The Centers for Disease Control and Prevention has identified Swine Influenza as a respiratory disease of pigs caused by type A influenza. Swine Influenza has become a threat to humans due to constant changes and mutations in the virus strain. In the past, the CDC received reports of approximately one human Swine Influenza virus infection every one to two years in the U.S., but from December 2005 through February 2009, a major increase in the cases of humans infected with Swine Influenza was reported. In 2009, it was classified as a world wide pandemic (Kates, 2010). Swine Influenza is transmitted through person to person contact and can cause mild to severe illness, as well as death in some instances. Although an individual with dry cough, sore throat, runny/stuffy nose) it differs from a cold and usually comes on suddenly. With such c haracteristics, Swine Influenza poses a particular threat to

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31 athletes. The nature of athletic participation is to push the body to its physical capacity, often resulting in dehydration and a depressed immune system. Athletes also share dressing rooms, pers onal equipment, weight rooms and weight equipment as well as footballs, basketballs, volleyballs or soccer balls providing an increased opportunity to pass the virus from person to person (Kates, 2010). The Swine Flu has affected sport events across the U nited States and Mexico. For example, the state of Texas experienced a high incidence of high school athletic event cancellations in May 2009 due to the Swine Influenza outbreak. For example, Swine Influenza forced the suspension of the baseball and softba ll seasons, and eliminated the regional track championships (ESPN, 2009 a ). Similarly, at Tulane University 31 football players and 6 volleyball players contracted the virus in a matter of a few days. Health experts say college a thletes are perfect candidates for the Swine Flu, the virus known as H1N1, has infected more than one million Americans. The strain tends to spread most quickly among yo ung adults who have not built immunity to flu strains. Because the athletes share dorm rooms, cafeterias and p. D3). Bloodborne Pathogen and Communicable Disease Policies in Sport The National Collegiate Athletic Association (NCAA) established a bloo dbo rne pathogen policy in 1988 entitled NCAA Guideline 2H: Bloodborne Pathogens and Intercollegiate Athletics The policy was updated in June of 1994 ( Zeigler, 1997) The NCAA policy states that any player who is bleeding should be removed from an eve nt or co mpetition immediately. Players are not permitted to return until exposure control procedures are properly carried out and the bleeding has stopped. The NCAA does not

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32 restrict players from competing if they are HIV positive; however, individual institutions have created stricter athlete participation policies for those com peting with HIV. Similarly, of Sports Medicine (ACSM) published a joint position statement on bloodborne pathogen s in sport. Their stance significantly emphasizes the importance of education, training, and compliance in disease control and prevention procedures to reduce the transmission of bloodborne infections in sport (Zeigler, 1997). In 2008, the NCAA (2008) in c onjunction with the CDC (2008) published educational posters and brochures on MRSA risk and prevention. These have been distributed to all institutional members and their professional employees in order to further reinforce MRSA risk and preventative polic ies (Menaker & Connaughton, 2009). The Occupational Safety and Health Administration (OSHA), a federal agency of the U.S. Department of Labor, has established standards designed to provide safer working conditions to protect employees. In campus recreation programs, OSHA standards attempt to protect employees from being unnecessarily exposed to potential health hazards in the workplace (Ross & Young, 1995) However, the guidelines do little for the actual participants (students) in club sport programs in te rms of protecting them from disease transmission. Ross and Young (1995) noted that despite the increasing health risks associated with bloodborne diseases, many campus recreational sport departments have not developed disease control programs. Whether gov erned by federal regulations or not it was emphasized that a legal and moral responsibility to reasonably protect employees

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33 exists. Failing or neglecting to act, places not only the employees, but entire campus recreation communities at risk (Ross & Young 1995). In 1991, with input from the CDC, OSHA issued a standard entitled Occupational Exposure to Bloodborn e Pathogens (29 CFR 1910.1030; CDC, 2008). The main purpose of the bloodborne pathogen standard is to eliminate or reduce occupational exposure to blood and other potentially infectious materials in the work environment that could lead to disease or death. This hazard, and the resulting protective standards, effects employees in many types of jobs and are not exclusive to the healthcare or medical in dustry. Almost all employed jurisdiction with only a few exceptions (Spengler et al., 2006). employees by setting, maintaining, and enforcing standards in workplace health and safety Established primarily in regard to the HIV and HBV pathogen standard was enacted to reduce occupational exposure to blood and other potentially infectious materials (OPIM) in the workplace enviro nment. Specifically, the bloodborne pathogen standard applies to all employers whose employees could be blood, as well as OPIM ( Eickhoff Shemek, Herbert, & Connaugh ton 2009). As Eickhoff Shemek, Herbert, & Connaughton with blood or other potentially infectious materials would occur whe n a health/fitness employee, certified in First Aid is performing First Aid procedures (p. 21). In the operation of sport and recreation programs such employees would likely

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34 include, but would not be limited to, those who are respons ible for administering First Aid and CPR lifeguards, physical the rapists, and athletic trainers. The OSHA bloodborne pathogen standard is a type of administrative law. Not only can the failure to comply result in health and safety risks but it can also r esult in fines as well as civil liability ( Eickhoff Shemek, Herbert, & Connaughton 2009). Under the current OSHA Bloodborne Pathogen standard only employees of campus recrea tion programs are covered. Club sport program participants officers and those s tudents who participate in the actual sport s are not directly protected under OSHA standards b ecause they are not employees. The need for disease control and prevention policies and practices is crucial to protect participants, as well as employees, in cam pus recreation programs. Despite club sport programs falling under their respective university jurisdiction, they (as primarily student run organizations) typically operate with a great deal of autonomy. This unique aspect of club sport results in professi onal staff (e.g., supervisors and coordinators) members often taking a secondary role (although they assist the clubs in plannin g, scheduling, and organizing). Therefore, in certain aspects of club management, students hold a significant amount of responsi bility. For example it is the students who are often the first responders when injuries and incidents arise within their respective clubs and not certified athletic trainers, team physicians, or professional staff (campus recreation employees). During clu b sport practices and/or events, an incident or injury may occur that could result in the exposure to communicable diseases for participants. Although such infectious diseases can be transmitted through non athletic populations, the nature of

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35 sport often creates a more susceptible environment for infectious disease transmission. With the proximity of body contact in participation, shared equipment and facility use, as training, sports of ten yield a hearty environment for infectious diseases to thrive (Nessel, 2009). Ross and Young (1995) noted that the HIV and HBV were two diseases that had generated considerable concern in relation to bloodborne pathogen exposure and transmission. Howeve r, in more recent years, communicable diseases such as MRSA and even more recently, Influenza A H1N1 (Swine Flu) have raised additional concerns over the spread of diseases and of the importance of related risk management policies and practices It would be prudent for club sport programs to meet the standards and guidelines disease control and prevention. Club sports programs should also develop risk management polici es and procedures in terms of an exposure control plan, education and training, preventative measures, post exposure follow up and record keeping (Ross & Young, 1995). Ross and Young (1995) surveyed 300 University campus recreation directors in relation to bloodborne pathogen prevention practices. Of the 157 respondents, 28% were not aware of the OSHA standard (Occupational Exposure to Bloodborne Pathogens 29 CFR 1910.1030), while an additional 28% were aware of the OSHA standard but did not provide HBV v accinations to their employees free of charge. In relation to an exposure control plan within their broader risk management plan, 54% did not provide bloodborne pathogen training to employees, and 30% did not require "first responders" to participate in bl oodborne pathogen training. The reasons most often

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36 cited for not providing such training were the amount of staff time r equired and budgetary reasons. Furthermore, 84% did not have a specific budget for bloodborne pathogen training, and 33% did not have an emergency control plan in place. In another study Connaughton, DeMichele, Horodyski, and Dannecker (2002) investigated exposure control plans (ECPs) for bloodborne pathogens in camp us recreation fitness programs. Of the sample (n=53), 71.7% of the respon dents revealed that their campus recreation fitness prog rams did have an ECP in place. An even larger number, 83%, indicated that a specific staff member was responsible for responding and caring for injured participants. Injury response responsibilities w ere also written out and included within the job descriptions and manuals in 84% of the programs. In regards to universal precautions, 75.5% indicated that a specific staff member was trained in universal precaution procedures; however, the majority of res pondents revealed that they did not provide consistent training, either on a semiannual, annu al, or more frequent schedule. Hepatitis B vaccinations for staff members who were designated to respond to injuries were only required in 7.1% of programs, howeve r, they were recommended by 54.8% of these programs whose staff members were identified as first responders (Connaughton et al., 2002). The research suggests there is a need for club sport programs, with initiative taken by club sport program administrator s, to place a more serious emphasis on developing and practicing risk management related to disease control and prevention.

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37 CHAPTER 3 METHOD The purpose of this study was to: (1) e knowledge and perception of the risk to th eir employees and participants of acquiring a communicable disease and/or bloodborne pathogen related illness or infection, (2) investigate risk management policies and practices pertaining to communicable disease s and bloodborne pathogens, and (3) determi ne if there is an associa tion knowledge/perceived risk of communicable disease and bloodborne pathogens and their related risk management practices. The methodology for the current study will be presented in the following four s ections: ( a) participants, (b) instrument (c) p rocedures, and (d) data analyses Participants For this study, the entire population of club sport administrators in the United States was s elected Club sport program administrators at all 4 year colleges an d universiti es in the United States that were institutional members of the NIRSA were included. This included 522 club sport program directors that were listed in the NIRSA 2011 R ecreational S ports D irectory (NIRSA, 2011 ). The population included both publ ic and private colleges/universities, from all six NIRSA regions. Instrument The survey instrument was partially adopted and modified, with permission, from two previous studies conducted by Stier et al. ( 2008 ) and Schneider et al. ( 2008 ) A number of the items were redesigned t o address the specific focus of bloodborne pathogen and communicable disease control policies and practices within club sport programs. The researcher formulated a preliminary questionnaire consisting of three

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38 sections which included : (a) club sport program and administrator demographics, (b) knowledge and risk perception, and (c) risk management practices associated with disease control and prevention. To establish content validity, the preliminary questionnaire was submitted to a pa nel of seven experts for review. The panel of experts included four university professors and three club sport program administrators. Two of the university professors specialize in law and risk management in sport and recreation. The other university prof essors specialize in campus recreation, survey development and data analyses. The club sport program administrators were from large university campus recreation departments. The expert panel was asked to review the survey for clarity, comprehensiveness, fo rmat, and if any questions should be added, deleted or reworded. Following the feedback of the expert panel, the original instrument was slightly modified in areas of item adequacy and word clarity. The final survey instrument and informed consent form was review board (IRB). Club Sport Program and Administrator Demographics For the purpose of this study, various demographic variables were measured, including size of the club sport program, number of ac tive clubs, number of staff, administrator academic background and certification level, gender, and prior club sport communicable disease and bloodborne pathogen incidence s The Club Sport Program and Administrator Demographic items utilized questions with forced responses. Knowledge and Risk Perception Associated with Disease Control and Prevention The knowledge of and the perceived risk of an adverse outcome is considered as an important factor in adoptin g and implementing risk management practices. Resea rch

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39 on infectious diseases and other health related issues has found perceived risk to be a key predictor in taking preventative measures Although no known instrument currently exists to measure perceived risk for communicable disease and bloodborne patho gen transmission in sport, having a means of gauging perceived risk is valuable (van der Pligt 1998). Exploring how and why persons are motivated to adopt and implement preventive behavior, identifying the educational needs of the target population, and e valuating efforts designed to promote and adopt preventive action, are all outcomes of perceiv ed risk analysis (Beach, 2005). In order to measure the knowledge and risk perception related to bl oodborne pathogen and communicable disease transmission within campus recreation club sport programs, a combination of items with forced responses and a 7 point Likert type scale were utilized. Risk Management Practices Associated with Disease Control and Prevention Risk management practices associated with disease c ontrol and prevention have previously been investigated within sport and campus recreation progr ams, but they have not yet been specifically examined within campus recreation club sport programs. Risk management practices regarding communicable disease and bloodborne pathogens were analyzed. The Bloodborne Pathogen and Disease Control items utilized a forced response question format. Procedures Utilizing Qualtrics an online survey software program, a link to the informed consent and survey was sent via e mail to all 5 22 club sport program directors listed in the 2011 NIRSA Recreation Sports Directory (NIRSA, 2011). Only 498, however, had valid contact information and email addresses, and 24 emails were returned (bounced back) due to incorrect email addres ses. Repeated attempts to obtain the correct contact

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40 information subsequently failed. A follow up email was sent to all non responders one week after the initial email. A final email reminder was sent to all non responders, one week after the second email. A total of 156 completed and useful surveys were received for a response rate of 31.3%. Data Analyses To conduct data analyses, data were entered into Version 17.0 of SPSS for Windows (SPSS 2008) Descriptive statistics were calculated for the demogr aphics, knowledge and risk perception items as well as g eneral risk management practice items and those specifically pertaining to bloodborne pathogens and communicable disease Correlations and c hi square analyses between the knowledge and/or risk percep tions and risk management practices were also p erfor med

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41 CHAPTER 4 RESULTS The results of this study are presented in the following four sections: (a) club sport program respondent demographics, (b) risk management policies and practices associated with d isease control and prevention, (c) knowledge and risk perception associated with disease control and prevention, and (d) chi square and correlation analyses performed to determine if there were significant comparisons and evaluate differences between the k nowledge and/or risk perceptions of communicable disease s and bloodborne pathogens and corresponding risk management practices. Descriptive Statistics Club Sport Program Respondent Demographics Demographic variables are presented in Table 4 1. Of the resp ondents, 64.8% were male and 35.2% were female. The institutional student size, from which the campus club sport programs originated, ranged from a minimum of 1,071 students to a maximum of 56,000 students ( M =16,359.4; SD=12,313). For the purpose of data a nalyses the size of the institution, based upon student population, was categorized into small, medium, and large schools. Small schools had less than 7,500 students (29.3%), medium schools had between 7,501 and 20,000 students (37.0%), and large schools h ad student populations of 20,001 or more (33.7%). The number of registered club sport organizations reported by each school, ranged from 1 club to 57 registered clubs. For the purpose of data analyses, small club sport programs were categorized as having 1 to 15 registered clubs (38.4%), medium programs between 16 and 30 registered clubs (33.7%), and large programs had 31 or more registered clubs (27.9%). The number of full time professionals each club sport program employed ranged from 0 to 40. It is

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42 belie ved that the response of 40 full time club sport program employees was a misunderstanding of the specific survey question, and was a significant outlier. The large majority (98.7%) of respondents reported having between one and two full time employees with in their club sport program ( M =1.91; SD=4.19). Club sport program administrators were asked several questions regarding their educational backgrounds and certifications pertaining to risk management. Of 156 respondents, 115 (73.7%) had taken academic cours es, during their educational degree, related to legal issues in sport and recreation. Similarly, 98 (63.2%) of the respondents had taken academic courses related to risk management. Professional club sport administrators were also asked to identify which c ertifications they held. The large majority of respondents reported having CPR certification (91.7%), AED certification (87.2%), and First Aid certification (85.9%). Only 48.7% of the respondents reported having training in bloodborne pathogens. Risk Manag ement Policies and Practices Associated with Disease Control and Prevention Descriptive statistics of policies and practices related to risk management associated with disease control and prevention are presented in Table 4 2. The majority (87.8%) of club sport programs required documentation of all physical injuries that occur within their program. Conversely, physical (medical) examinations were not required for club sport participants in 87.8% of the club sp ort programs. Similarly, 76.3% of club sport pr ograms did not require their participants to complete a health screening/history form prior to participation. First Aid kits were required at all club sport activities in 53.8% of the programs.

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43 Table 4 3 displays the different certifications that campus r ecreation club sport programs required of professional employees, graduate assistants, student employees, coaches, and participants. For professional employees, 74.4% of programs surveyed required CPR certification, while 68.6% required First Aid certifica tion, and 67.3% required AED certification. Bloodborne Pathogen training was required for 35.5% of professionals by their club sport programs. For graduate assistants, 41.7% of the programs required CPR certification, 41.0% required First Aid and 38.5% re quired AED. Bloodborne Pathogen training for graduate assistants was required by 21.8% of the programs. For student employees, CPR certification was required by 64.7% of club sport programs, with First Aid certification (57.7%) and AED certification (56.4% ). Bloodborne Pathogen training was required by 28.8% of club sport programs for student employees. For club sport program coaches, the certification requirements were vastly different. No certifications were required of coaches by 42.3% of club sport prog rams, while CPR certification was required in only 35.9% and First Aid certification in 32.7%. Only 9.0% required b loodborne p athogen training for coaches. For club sport participants, 58.3% of programs did not require any certifications. Of the certificat ions that were required by club sport programs for their participants, CPR certification (16.0%), First Aid certification (12.2%) and AED certification (12.2%) were the most frequently required. Bloodborne pathogen training for participants was only necess ary i n 4.5% of club sport programs. The majority (76.3%) of campus recreation club sport programs reported that they did provide some certification classes/training (i.e., AED, BBP, CPR, First Aid etc.) to employees, coaches, or participants.

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44 Of the r espo ndents, 57.7% reported not having a risk management plan addressing disease control in their respective club sport program. Additionally, 53.2% stated that they did not have a risk management plan that addr essed bloodborne pathogens ( Table 4 4) In terms o f training employees in universal precautions that could be implemented in the handling of any blood or other potentially infectious material (OPIM) 53.3% of the programs reported that they trained employees in such practices, while 42.9% indicated that t hey did not. In regard to having written policies and procedures addressing equipment contaminated with blood or OPIM 62. 8% reported that they did not. Additionally, 48.1% indicated that they did not have written policies and procedures addressing fields/ facility areas contaminated with blood or OPIM A total of 56.1% of club sport programs reported having written policies and procedures that addressed how to handle a bleeding incident, while 40.0% did not. When asked if their club sport program had consul ted a health/medical professional regarding bloodborne pathogen and communicable disease policies and procedures, 54.8% stated they had not, and 55.1% reported not having consulted any professional organizations (i.e., ACSM, NASM, NATA, NCAA, OSHA, environ mental health and safety department, etc.) regarding such policies and procedures. Descriptive statistics related to cancellations or closures due to bloodborne pathogen and communicable disease incidents in club sport programs are displayed in Table 4 5. A large majority of respondents reported never cancelling or postponing an event due to a communicable disease (84.0%), or bloodborne pathogen (86.5%), incident. However, 3.8% of the respondents reported that their club sport program had cancelled or postp oned an event due to a communicable disease incident, and 2.6%

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45 had cancelled or postponed an event for a bloodborne pathogen incident. A large majority (76.3%) of club sport programs reported never having to close a field/facility or portion of a field/fac ility due to a communicable disease incident, while 75.6% had never closed a field/facility due to a bloodborn e pathogen incident. A few (6.4%) programs reported closing a field/facility due to communicable disease incident, and slightly more (7.7%) report ed closures due to a field/facility bloodborne pathogen incident. Knowledge and Risk Perception Associated with Disease Control and Prevention The perceived importance, held by administrators, of taking academic courses related to legal issues and risk man agement in sport and recreation was ranked from moderate to high. For academic courses related to legal issues, 88.4% stated that they considered taking legal issues courses to be somewhat important to extremely important. Results were similarly ranked for the perceived importance, held by administrators, of taking courses in risk management in sport and recreation. Of the respondents, 92.3% thought risk management courses were important Certifications and train ing for professional club sport staff were al so thought to be of moderately high importance. For AED certification, 37.2% thought it was extremely important, while 47.4% indicated CPR training and certification was extremely important, and 43.2% reported likewise for First Aid certification. Bloodbor ne pathogen training was perceived to be of slightly lower importance with 29.0% responding that it was somewhat important, and 33.5% responding that it was very important. In terms of the per ceived importance of club sport programs providing training for the aforementioned certifications to employees, coaches, and participants, a total of 88.4% of respondents found it to be important practice ( Table 4 6).

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46 T he awareness, held by club sport administrators, of bloodborne pathogens and communicable diseases in relation to the risks they pose within a club sport program is described in Table 4 7 When asked how familiar they were with the risks associated with communicable diseases and bloodborne pathogens (MRSA, HIV, HBV, Swine Flu, etc.) in the sport environme nt, 46.8% reported that they were somewhat familiar with the potential risk in the sport environment. Additionally, 52.3% ranked the associated risk of bloodborne pathogens as being somewhat risky. The majority (59.6%) of respondents thought there was an i ncreased risk of transmitting bloodborne pathogens and communicable diseases in heavy contact sports such as rugby, wrestling, and boxing. However, when asked if they thought there was increased risk of transmitting bloodborne pathogens and communicable di seases in sports that require the wearing of significant amounts of protective equipment such as in fencing, lacrosse, and ice hockey the responses were divided among neither agree or disagree (17.9%), somewhat agree (28.2%), and agree (34.6%). Club sport administrators were also questioned on the practice and perceived importance of the Hepatitis B v accination in their club sport programs ( Table 4 8 ) Exposure to Hepatitis B in the workplace is covered under the OSHA bloodborne pathogen standard (29 CFR 19 10.1030 & 29 CFR 1910.1200; CDC, 2008), however, this only covers employees of club sport programs and not the officers and students who participate in the actual sports. Accordingly, club sport programs were questioned as to whether their club sport p rogr am offered the Hepatitis B v accination to professional employees, graduate assistants and student employees. Overall, 27.1% of respondents reported that they offered the Hepat itis B v accination to professional

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47 employees, 16.4% offered it to graduate assist ant employees, and 18.3% of fered it to student employees. When asked if respondents thought it was important that club sport emp loyees receive the Hepatitis B v accination, 53.9% reported it to be important, while 13.0% perceived it to be unimportant. In Ta ble 4 9 the descriptive statistics pertaining to the perceived importance of having policies related to reducing the risk of bloodborne pathogen and communicable disease transmission in campus recreation club sport programs are provided. A majority ( 88.4 %) of the respondents, rated the importance of identifying which athletes/clubs were most at risk for contracting and transmitting communicable diseases and bloodborne pathogens as important. Results were similar in the perceived importance of having written policies and procedures regarding addressing communicable disease s and bloodborne pathogens, with 92.9 % of respondents perceiving such practices as important Comparably, when asked to rate the importance of identifying which athletes/clubs were believed to be most at risk for communicable disease and bloodborne pathogen transmission in club sport programs only 9.6% perceived this to be of extreme importance, however, 20.0% responded that having written policies and procedures addressing communicable disea se and bloodborne pathogens in club sport programs was of extreme importance. When asked to what degree club sport programs perceived the importance of having a written exposure control plan that addressed bloodborne pathogens, 85.8% reported that such pra ctice was important. The vast majority ( 90.4 %) of r espondents reported perceiving the importance of training employees in universal precautions that could be implemented in the handling of any

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48 blood or potentially infectious material should an injury occur during practice or competition as important. Club sport program respondents also perceived having written policies and procedures regarding equipment contaminated with blood or OPIM as somewhat important (37.0%) and very important (32.5%). Respondents be lieved having written policies and procedures regarding fields/facility areas contaminated with blood or OPIM as somewhat important (34.6%) and very important (37.2%) as well. In regard to having specific written policies and procedures addressing a bleedi ng incident, 45.5% of respondents perceived this to be very important, while responses concerning the consulting of a health/medical professional regarding bloodborne pathogen and communicable disease policies and procedures was divided between somewhat im portant (34.5%) and very important (35.7%). Overall, respondents perceived the importance of having a written risk management plan that addressed disease control and prevention as somewhat important (36.5%) to very important (35.3%). Chi Square and Correla tion Analyses Table 4 10 through Table 4 19 display the results of the chi square and correlation analyses which were performed to analyze the differences, associations, and relationships between variables. Specifically, the analyses were performed to dete rmine if there was an association between club sport administrator perceptions of the risk of communicable diseases and bloodborne pathogens and relevant risk management practices. The chi square analyses compared variables measured on the 7 point Likert s cale (importance and awareness), with the practice variables that were measured as forced response variables (yes or no; Thomas, Nelson & Silverman, 2005 ).

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49 Bivariate correlations were utilized to compare awareness against importance. Partial correlations w ere performed to analyze the relationships between summed awareness, importance, and risk management practices related to communicable disease and bloodborne pathogens in club sport programs, while controlling for both the size of the institution (based on student population) and the respective club sport program (based on number of registered clubs; Thomas, Nelson & Silverman, 2005 ). Table 4 10 provides the results of the comparison between the perceived awareness of risk associated with communicable disea se s and bloodborne pathogens, and whether or not club sport programs have written risk management plans that address disease control and prevention. As the p value was >0.05, t here was no statistically significant difference ( p =0.08) in the perceived aware ness of risk between clubs that do and do not have a written management plan that addresses disease control and prevention. Of the respondents 32.9% indicated that they did not have a written risk management plan that addressed disease control and prevent ion, while 76.5% perceived their awareness of the risk associated with communicable disease s and bloodborne pathogens to be fairly high. Of those who responded that their club sport program did indeed have a written risk management plan that addressed dise ase control and prevention (67.1%), a total of 43.4% perceived their awareness of the associated risk to be quite high while a total of 24.9% perceived their aw areness of the risk to be low. A total of 7.8% of club sport programs who did not have a written risk management plan that addressed disease control and prevention perceived their awareness of the associated risk as low.

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50 Table 4 11 displays a similar comparison, however, here the perceived importance of having a written risk management plan that addr esses disease control and prevention is provided A significant difference ( p =0.001 ) exists in the perceived importance of clubs who do and do not have a risk management plan that addresses disease control and prevention. A majority of respondents (67.3%) reported that they did not have a written risk management plan that addressed disease control and prevention, however, of that number, a total of 74.4% still thought it was an important to very important practice. Those who stated they did have a written r isk management plan that addressed disease control and prevention (32.7%), also agreed (10 0%) that having such a plan was important. No respondents who had a written risk management plan that addressed disease control and prevent ion thought it was unimport ant. The chi squa re analyses in Table 4 12 compare perceived importance to whether or not a program actually had a written exposure control plan that addresses bloodborne pathogens. A significant difference ( p =0.001 ) exists in the perceived importance of b loodborne pathogens between programs that do and do not have a written exposure control plan. A moderate majority of respondents (63.9%) reported that they did not have a written exposure control plan that addressed bloodborne pathogens, however, of that n umber, a total of 78.8% still thought it was an important to very important practice. Among those who stated they did have a written exposure control plan that addressed bloodborne pathogens within their club sport program (36.1%), 98.2% agreed that such practice and policy was important. Table 4 13 displays the results of the chi square analyses of the comparison between the perceived importance and actual practice of club sport programs training

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51 employees in universal precautions that can be implemented in the handling of blood or potentially infectious material. As the p value w as less than 0.05, ( p =0.001 ), a significant difference was found For instance, despite 100% of respondents perceiving such practices to be important, 42.9% reported not training employees in universal precautions. Table 4 14 provides the results of the comparison between the perceived importance and actual practice of club sport programs having written policies and procedures regarding how to handle equipment contaminated with b lood or OPIM A strong ( p =0.001) difference in responses was found between those that did and did not have a plan. Of those who stated that they did have policies and practices regarding equipment contaminated with blood or OPIM (28.8%), 100% perceived suc h practices to be important. Of those who did not have a plan regarding contaminated equipment, only 69.9% believed having a plan was important. No club sport program respondents perceived such policies and practices as unimportant. Similarly, the perceiv ed importance of club sport programs having written policies and procedures regarding fields/facility areas contaminated with blood or OPIM was compared to actual practices ( Table 4 15). As shown, there was a significant difference ( p =0.001) in perceive d i mportance between club sport programs that did and did not have a policy regarding contaminated fields/facilities. A total of 11.4% who did not have such policies and practices thought they were unimportant, and 16.1% were indifferent about their importanc e. Of those who did have such policies and procedures for contaminated fields/facility areas (44.2%), a t otal of 95.6% thought it was important

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52 practice, while only 1.4% thought it was unimportant and 2.9% were ind ifferent toward the importance. In Table 4 16, the results of the comparison between perceived importance and actual practice of club sport programs having written policies and procedures addressing a bleeding incident are provided. A strong difference was found ( p =0.001) in perceived importance o f handling a bleeding incident between club sport programs that did and did not have a plan detailing how to manage such an incident. Of the 44.2% c lubs that did not have a plan, 69.5 % perceived it to be important. A total of 55.8% of the respondents indic ated that they did have such written policies and procedures regarding bleeding incidents within their club sport program. Of those, a total of 97.7% thought that such policies and practices were important. Only 2.3% of those who had the policies and proce dures were indifferent about their importance, perceiving it to be neither important nor unimportant. In Table 4 17, the perceived importance of club sport programs consulting a health/medical professional regarding bloodborne pathogens and communicable di sease policies and procedures, was compared to having a written risk management plan. No significant difference was found ( p =0.309) in the perceived importance of contacting a medical professional between clubs that did and did not have a written risk mana gement plan, suggesting that the perception of importance had no impact on whether or not a program consulted a medical professional regarding such policies and practices. Of those who responded that their club sport program did not consult a health/medica l professional regarding practices related to bloodborne pathogens and communicable disease (72.7%), a total of 78.6% still perceived the importance of such

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53 practices to be important to extremely important. Of the 72.7% who indicated that they did not cons ult a health/medical professional regarding bloodborne pathogens and communicable disease practices, a total of 21.1% perceived it to be unimportant, and 15.2% were indifferent, perceiving it to be neither important nor unimportant. Of the 27.2% who did co nsult a health/medical professional regarding bloodborne pathogens and communicable disease practices within their club sport program, a total of 83.3% perceived it to be an important practice. No respondents who stated that they did have such practices in their club sport program thought it was unimportant, however, 16.7% were indifferent toward the importance, perceiving it to be neither important nor unimportant. In Table 4 18 the results of the difference between awareness of an increased risk of transm itting bloodborne pathogens and communicable disease in sports that require the wearing of significant amounts of protective equipment (i.e., fencing, lacrosse, and ice hockey) and the practice of having a plan addressing these issues is provided. No stati stically significant difference was found ( p =0.562) in perceived importance of wearing protective equipment and having a plan suggesting that awareness does not impact club sport programs as to whether they have a written plan in regard to reducing transm ission of communicable disease and bloodborne pathogens in sports requiring significant amounts of protective equipment. Of the 67.3% club sport program respondents who stated that they did not have such practices pertaining to protective equipment within their risk management plan, 66.7% stated they were aware of the risks associated with such protective equipment. However, 16.2% that did have such practices also reported that they were not aware of the associated risks, while 17.1%

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54 w ere neither aware nor unaware. Those that stated that they did indeed have risk management policies and procedures regarding contaminated equipment (32.7%), also reported (74.5%) that they were aware of the associated risks. However, 5.9% who stated that they did have such poli cies and procedures also stated that they were unaware of the possible associated risks, while 19.6% were neither aware nor unaware. In Table 4 19, the results of the correlations performed to further examine the existence and strength of the relationship between the perceived factors of a wareness and importance with corresponding risk management policies and practices of club sport programs are provided The first correlation displayed is a bivariate correlation between the perceived importance of club spo rt programs identifying which athletes/clubs are most at risk for contracting and transmitting communicable disease and bloodborne pathogens, to the awareness of an increased risk of transmitting blood b orne pathogens and communicable disease in heavy conta ct sports (i.e., rugby, wrestling, and boxing). A strong relationship was found ( p =0.001) suggesting that perception has an impact on practice regarding bloodborne pathogen risk in heavy contact sports. Partial correlations are displayed in Table 4 19. Th e partial correlations compare the summed totals of the awareness and importance variables related to communicable disease and bloodborne pathogens, to corresponding summed totals of the risk management practice variables. The strength of the relationship can be analyzed between awareness, importance, and practice, while controlling for size in order to examine whether the size of the institution or campus recreation club sport program has a significant impact on the associations.

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55 The first two partial corr elations control for the size of the institution. The first partial correlation compares the total perceived awareness of bloodborne pathogens and communicable disease to the total risk management practices associated with bloodborne pathogens and communic able disease. This relationship is statistically significant ( p =0.035) after controlling for the size of the institution, suggesting t hat size was not a confounder. The second correlation, comparing the total perceived importance of bloodborne pathogens an d communicable disease to the total risk management practices associated with bloodborne pathogens and communicable disease displayed similar results, as the relationship was also significant ( p =0.001). Additionally, when controlling for the size of the c lub sport program, the relationship between awareness of bloodborne pathogens and practices regarding bloodborne pathog ens was significant ( p =0.030). Finally, the fourth partial correlation, which compared the total perceived importance to the risk managem ent practice related to communicable disease and bloodborne pathogens, was also significant ( p =0.001) while controlling for the size of the club sport program. Overall, the partial correlations performed were all significant, even when controlling for the variables of size (i.e., size of institution and of club sport program), suggesting that size was not a confounder.

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56 Table 4 1. Descriptive statistics of demographic variables ( n = 156) Variable Category N % Size of Institution (number of students) Smal l (<7,500) 45 29.3 Medium (7,501 20,000) 57 37.0 Large (20,001>) 52 33.7 Public or Private Institution Public 110 70.5 Private 46 29.5 Gender of Club Sport Director Male 101 64.8 Female 55 35.2 Number of Full Time Club Sport Program Professionals Minimum 0 0.65 Maximum 40 98.7 Mean 1.91 0.65 Number of Registered Clubs in Club Sport Program Small (1 15) 59 38.4 Medium (16 30) 52 33.7 Large (31>) 43 27.9 Took a Legal Issues Course During Academic Degree Yes 115 73.7 No 4 1 26.3 Took a Risk Management Course During Degree Yes 98 63.2 No 57 36.8 Certifications held by Club Sport Professionals Automatic External Defibrillator (AED) 136 87.2 Bloodborne Pathogen 76 48.7 Cardio Pulmonary Resuscitation (CPR) 143 91.7 First Aid 134 85.9

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57 Table 4 2. Descriptive statistics of addressing general risk management club sport programs Variable Category N % Are physical (medical) examinations required of all club sport participants? Yes 16 10.3 No 137 87.8 Unsure 3 1 .9 Do you require the club sport program participants to complete a health screening/history form prior participation? Yes 33 21.2 No 119 76.3 Unsure 4 2.5 Does your program require a First Aid kit at all club sport activities? Yes 84 53.8 No 68 43.5 Unsure 4 2.7 Does your club sport program document all physical injuries that occur within your program? Yes 137 87.8 No 16 10.3 Unsure 3 1.9

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58 Table 4 3. Descriptive statistics of club sport program certification policy and practice Variable Category N % What certifications do you require of your club sport professional employees? Attend a Departmental Orientation Certification 33 21.2 Automated External Defibrillator (AED) 105 67.3 Bloodborne Pathogen 55 35.3 Cardio Pulmo nary Resuscitation (CPR) 116 74.4 First Aid 107 68.6 No Certification Required 31 19.9 Sport Specific Certification 10 3.2 Other 5 6.4 What certifications do you require of your club sport graduate assistants? Attend a Departmental Orientation C ertification 19 12.2 Automated External Defibrillator (AED) 60 38.5 Bloodborne Pathogen 34 21.8 Cardio Pulmonary Resuscitation (CPR) 65 41.7 First Aid 64 41.0 No Certification Required 23 14.7 Sport Specific Certification 1 0.6 Other 26 16.7

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59 Table 4 3. continued Variable Category N % What certifications do you require of your club sport student employees? Attend a Departmental Orientation Certification 22 14.1 Automated External Defibrillator (AED) 88 56.4 Bloodborne Pathogen 45 28.8 Cardio Pulmonary Resuscitation (CPR) 101 64.7 First Aid 90 57.7 No Certification Required 29 18.6 Sport Specific Certification 11 7.1 Other 2 1.3 What certifications do you require of your club sport coaches? Attend a Departmental Orientation Certification 14 9.0 Automated External Defibrillator (AED) 38 24.4 Bloodborne Pathogen 14 9.0 Cardio Pulmonary Resuscitation (CPR) 56 35.9 First Aid 51 32.7 No Certification Required 66 42.3 Sport Specific Certification 16 10.3 Other 9 5.8

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60 Table 4 3. continued Variable Category N % What certification do you require of your club sport participants? Attend a Departmental Orientation Certification 16 10.3 Automated External Defibrillator (AED) 19 12.2 Bloodborne Pathogen 7 4.5 Cardio Pulmonary Resuscitation (CPR) 25 16.0 First Aid 19 12.2 No Certification Required 91 58.3 Sport Specific Certification 5 3.2 Other 15 9.6 Does your club sport program provide training for the above mentioned to employees, club sport coaches, an d participants? Yes 119 76.3 No 35 22.4 Unsure 2 1.3

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61 Table 4 4. Descriptive statistics of risk management specifically related to bloodborne pathogens and communicable diseases Variable Category N % Does your club sport program have a written risk management plan that addresses disease control and prevention? Yes 52 33.3 No 90 57.7 Unsure 14 9.0 Does your club sport program have a written exposure control plan that addresses bloodborne pathogens? Yes 56 35.9 No 83 53.2 Unsure 17 10.9 Does your club sport program train employees in universal precautions that can be implemented in the handling of any blood or body fluids should an injury occur during practice or competition? Yes 83 53.3 No 67 42.9 Unsure 6 3.8 Does your club sp ort program have written policies and procedures regarding equipment contaminated with blood or infectious material? Yes 45 28.8 No 98 62.8 Unsure 13 8.4 Does your club sport program have written policies and procedures regarding fields/facility ar eas contaminated with blood or infectious material? Yes 69 44.2 No 75 48.1 Unsure 12 7.7 Does your club sport program have written policies and procedures addressing a bleeding incident? Yes 87 56.1 No 62 40.0 Unsure 6 3.9

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62 Table 4 4. continu ed Variable Category N % Has your club sport program consulted a health/medical professional regarding bloodborne pathogen and communicable disease policies and procedures? Yes 47 30.4 No 85 54.8 Unsure 23 14.8 Has your club sport program consulted professional organizations regarding bloodborne pathogen and communicable disease exposure and control? Yes 43 27.6 No 86 55.1 Unsure 27 17.3

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63 Table 4 5. Descriptive statistics related to cancelations or closures due to bloodborne pathogens and com municable disease incidents Variable Category N % Has your club sport program ever canceled or postponed an event due to a communicable disease related incident? Yes 6 3.8 No 131 84.0 Unsure 19 12.2 Has your club sport program ever canceled or pos tponed an event due to a bloodborne pathogen related incident? Yes 4 2.6 No 135 86.5 Unsure 17 10.9 Has your club sport program every closed a facility or portion of a facility due to a communicable disease related incident? Yes 10 6.4 No 119 76 .3 Unsure 27 17.3 Has your club sport program every closed a facility or portion of a facility due to a bloodborne pathogen related incident? Yes 12 7.7 No 118 75.6 Unsure 26 16.7

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64 Table 4 6. Descriptive statistics of the perceived importance o f education, training, and certifications Variable Category N % To what degree do you perceive the importance of taking courses related to legal issues? ( M =5.53; SD=1.262) Not at all Important 1 0.6 Very Unimportant 2 1.3 Somewhat Unimportant 10 6.5 Neither Important or Unimportant 5 3.2 Somewhat Important 46 29.7 Very Important 59 38.1 Extremely Important 32 20.6 To what degree do you perceive the importance of taking courses related to risk management? ( M =5.89; SD=1.081) Not at all Impo rtant 0 0 Very Unimportant 4 2.6 Somewhat Unimportant 2 1.3 Neither Important or Unimportant 6 3.8 Somewhat Important 30 19.3 Very Important 67 42.9 Extremely Important 47 30.1 To what degree do you perceive the importance of professional cl ub sport staff holding current certification in Automatic External Defibrillation? ( M =5.86; SD=1.272) Not at all Important 1 0.6 Very Unimportant 3 1.9 Somewhat Unimportant 7 4.5 Neither Important or Unimportant 9 5.8 Somewhat Important 24 15.4 Very Important 54 34.6 Extremely Important 58 37.2 To what degree do you perceive the importance of professional club sport staff holding current certification in Bloodborne Pathogen Training (BBP)? ( M =5.59; SD=1.155) Not at all Important 1 0.65 Ve ry Unimportant 1 0.65 Somewhat Unimportant 6 3.9 Neither Important or Unimportant 14 9.1 Somewhat Important 45 29.0 Very Important 52 33.5 Extremely Important 36 23.2 To what degree do you perceive the importance of holding current certificat ion in Cardiopulmonary Resuscitation (CPR) ? ( M =6.12; SD=1.244) Not at all Important 1 0.65 Very Unimportant 1 0.65 Somewhat Unimportant 1 0.65 Neither Important or Unimportant 8 5.2 Somewhat Important 15 9.7 Very Important 55 35.75 Extremely I mportant 73 47.4

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65 Table 4 6. continued Variable Category N % To what degree do you perceive the importance of professional club sport staff holding current certification in First Aid ? ( M =6.09; SD=1.095) Not at all Important 1 0.6 Very Unimportant 1 0.6 Somewhat Unimportant 3 1.9 Neither Important or Unimportant 8 5.2 Somewhat Important 19 12.3 Very Important 56 36.2 Extremely Important 67 43.2 To what degree do you perceive the importance of your club sport program providing training for the above mentioned certifications to employees, club sport coaches, and participants? ( M =5.62; SD=1.210) Not at all Important 2 1.3 Very Unimportant 1 0.6 Somewhat Unimportant 4 2.6 Neither Important or Unimportant 11 7.1 Somewhat Important 3 7 23.9 Very Important 69 44.5 Extremely Important 31 20.0

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66 Table 4 7. Descriptive statistics of perceived awareness of bloodborne pathogens and communicable disease Variable Category N % How familiar are you with the risks associated with communica ble diseases and bloodborne pathogens (MRSA, HIV, HBV, Swine Flu, etc.) in the sport environment? ( M =5.12; SD=1.107) Not at all Familiar 0 0 Very Unfamiliar 5 3.2 Somewhat Unfamiliar 14 9.0 Neither Familiar or Unfamiliar 6 3.8 Somewhat Familiar 73 46.8 Very Familiar 49 31.4 Extremely Familiar 9 5.8 How would you rate the risk associated with communicable diseases/bloodborne pathogens within your club sport program? ( M =4.45; SD=1.152) Not at all a Risk 1 0.6 Very Unrisky 14 9.0 Somewhat Unrisky 15 9.7 Neither Risky or Unrisky 28 18.1 Somewhat Risky 81 52.3 Very Risky 14 9.0 Extremely Risky 2 1.3 I feel that there is an increased risk of transmitting bloodborne pathogens and communicable diseases in heavy contact sports such as rugby, wrestling, and boxing? ( M =5.97; SD=0.846) Strongly Disagree 0 0 Disagree 2 1.3 Somewhat Disagree 0 0 Neither Agree or Disagree 6 3.8 Somewhat Agree 20 12.8 Agree 93 59.6 Strongly Agree 35 22.5 I feel that there is an increased risk o f transmitting bloodborne pathogens and communicable diseases in sports that require the wearing of significant amounts of protective equipment such as fencing, lacrosse, and ice hockey? ( M =4.96; SD=1.314) Strongly Disagree 3 1.9 Disagree 6 3.8 Somewh at Disagree 11 7.1 Neither Agree or Disagree 28 17.9 Somewhat Agree 44 28.2 Agree 54 34.6 Strongly Agree 10 6.5

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67 Table 4 8. Descriptive statistics of the perceived importance and risk management practices rega rding the Hepatitis B v accination Variable Category N % Does your club sport program offer the f ollowing employees Hepatitis B v accination? Professional Employees Yes 40 27.1 No 108 72.9 Graduate Assistants Yes 21 16.4 No 107 83.6 Student Employees Yes 25 18.3 No 111 81.7 Do you think it is important that club sport emp loyees receive the Hepatitis B v accination? ( M = 4.63; SD=1.333) Not at all Important 7 4.6 Very Unimportant 2 1.3 Somewhat Unimportant 11 7.1 Neither Important or Unimportant 51 33.1 Somewhat Impor tant 42 27.3 Very Important 32 20.8 Extremely Important 9 5.8

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68 Table 4 9. Descriptive statistics of the importance of policy for reducing the risk of bloodborne pathogen and communicable disease transmission Variable Category N % How would you ra te the importance of identifying which athletes/clubs are most at risk for contracting and transmitting communicable diseases and bloodborne pathogens? ( M =5.41; SD=1.046) Not at all Important 3 1.9 Very Unimportant 0 0 Somewhat Unimportant 3 1.9 Ne ither Important or Unimportant 12 7.8 Somewhat Important 59 37.8 Very Important 64 41.0 Extremely Important 15 9.6 How would you rate the importance of having written policies and procedures regarding addressing communicable diseases/bloodborne pa thogens in your club sport program? ( M =5.72; SD=0.828) Not at all Important 0 0 Very Unimportant 0 0 Somewhat Unimportant 3 1.9 Neither Important or Unimportant 8 5.2 Somewhat Important 50 32.3 Very Important 63 40.6 Extremely Important 31 20. 0 To what degree do you perceive the importance of your club sport program having a written risk management plan that addresses disease control and prevention? ( M =5.35; SD=1.001) Not at all Important 0 0 Very Unimportant 0 0 Somewhat Unimportant 8 5.1 Neither Important or Unimportant 19 12.2 Somewhat Important 57 36.5 Very Important 55 35.3 Extremely Important 17 10.9

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69 Table 4 9. continued Variable Category N % To what degree do you perceive the importance of your club sport progra m having a written exposure control that addresses bloodborne pathogens? ( M =5.41; SD=0.952) Not at all Important 0 0 Very Unimportant 0 0 Somewhat Unimportant 5 3.2 Neither Important or Unimportant 17 11.0 Somewhat Important 61 39.3 Very Import ant 53 34.2 Extremely Important 19 12.3 To what degree do you perceive the importance of your club sport program training employees in universal precautions that can be implemented in the handling of any blood or body fluids should an injury occur dur ing practice or competition? ( M =5.69; SD=0.963) Not at all Important 0 0 Very Unimportant 0 0 Somewhat Unimportant 6 3.8 Neither Important or Unimportant 9 5.8 Somewhat Important 41 26.3 Very Important 72 46.2 Extremely Important 28 17.9 T o what degree do you perceive the importance of your club sport program having written policies and procedures regarding equipment contaminated with blood or infectious material? ( M =5.39; SD=1.044) Not at all Important 0 0 Very Unimportant 0 0 Somewh at Unimportant 9 5.8 Neither Important or Unimportant 16 10.4 Somewhat Important 57 37.0 Very Important 50 32.5 Extremely Important 22 14.3

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70 Table 4 9. continued Variable Category N % To what degree do you perceive the importance of your club sport program having written policies and procedures regarding fields/facility areas contaminated with blood or infectious material? ( M =5.31; SD=1.129) Not at all Important 1 0.6 Very Unimportant 3 1.9 Somewhat Unimportant 7 4.5 Neither Important o r Unimportant 16 10.3 Somewhat Important 54 34.6 Very Important 58 37.2 Extremely Important 17 10.9 To what degree do you perceive the importance of your club sport program having written policies and procedures addressing a bleeding incident? ( M =5.63; SD=1.073) Not at all Important 1 0.6 Very Unimportant 0 0 Somewhat Unimportant 5 3.2 Neither Important or Unimportant 17 10.9 Somewhat Important 33 21.2 Very Important 71 45.5 Extremely Important 29 18.6 To what degree do you perceiv e the importance of your club sport program consulting a heath/medical professional regarding bloodborne pathogen and communicable diseases policies and procedures ( M =5.27; SD=1.115) Not at all Important 2 1.3 Very Unimportant 2 1.3 Somewhat Unimport ant 3 1.9 Neither Important or Unimportant 24 15.6 Somewhat Important 53 34.5 Very Important 55 35.7 Extremely Important 15 9.7

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71 Table 4 10. Practice of having a Risk Management Plan that Addresses Disease Control and Prevention Yes No Perceiv ed Awareness of Risk Number % Number % 1 1 0.96 0 0.0 2 12 11.5 2 3.9 3 13 12.5 2 3.9 4 20 19.2 8 15.7 5 50 35.7 31 60.8 6 8 7.7 6 11.8 7 0 0.0 2 3.9 Total 104 51 X 2 11.293 p value 0.08 As the p value is >0.05 ( p =0.08) there is no statistically significant difference in perceived awareness of the risk of communicable disease/bloodborne pathogens between clubs that do and do not have a written risk management plan that addresses disease control and prevention. Note: chi square an alysis of the perceived awareness of the risk of communicable disease/bloodborne pathogens within club sport programs and whether club sport programs have a written risk management plan that addresses disease control and prevention.

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72 Table 4 11. Have pol icies and procedures addressing disease control and p revention Yes No Perceived I mportance Number % Number % 1 0 0 0 0 2 0 0 0 0 3 0 0 8 7.6 4 0 0 19 18.1 5 10 19.6 47 44.8 6 27 52.9 28 26.7 7 14 27.5 3 2.9 Total 51 105 X 2 44.833 p v alue 0.001*** ***As the p value is smaller than 0.05 (p =0.001 ) there is a statistically significant difference in perceived importance of club sport programs having written policies and procedures regarding having a risk management plan that addresses disease control and prevention between clubs that do and do not have such policies and procedures. Note: chi square analysis of the perceived importance of club sport programs having a written risk management plan that addresses disease control and prev ention on the practice of club sport programs having a risk management plan that addresses disease control and prevention.

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73 Table 4 12. Have a written exposure control plan addressing bloodborne p athogens Yes No Perceived Importance Number % Number % 1 0 0 0 0 2 0 0 0 0 3 0 0 5 5.1 4 1 1.8 16 16.2 5 12 21.4 49 49.5 6 27 48.2 26 26.3 7 16 28.6 3 3.0 Total 56 99 X 2 40.803 p value 0.001*** ***As the p value is smaller than 0.05 (p=0.001 ) there is a statistically significant differ ence in the perceived importance of a club sport program having a written exposure control plan between clubs who did and did not have a written exposure control plan Note: chi square analysis of the perceived importance of club sport programs having a written exposure control plan that addresses bloodborne pathogens on whether club sport programs have a written exposure control plan that addresses bloodborne pathogens.

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74 Table 4 13. Practice of training employees in universal p recautions Yes No Perce ived Importance Number % Number % 1 0 0 0 0 2 0 0 0 0 3 0 0 6 8.1 4 0 0 9 12.2 5 11 13.4 30 40.5 6 47 57.3 25 33.8 7 24 29.3 4 5.4 Total 82 74 X 2 44.520a p value 0.001*** ***As the p value is smaller than 0.05 (p =0.001 ) there is a statistically significant difference in perceived importance of club sport programs training employees in universal precautions that can be implemented in the handling of blood or OPIM between clubs who did and did not have such practice. Note: chi squa re analysis of the perceived importance of club sport programs training employees in universal precautions that can be implemented in the handling of any blood or OPIM should an injury occur, on the practice of club sport programs training employees on uni versal precautions that can be implemented in the handling of any blood or OPIM should an injury occur.

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75 Table 4 14. Have p olicies for contaminated e quipment Yes No Perceived Importance Number % Number % 1 0 0 0 0 2 0 0 0 0 3 0 0 9 8.3 4 0 0 1 6 14.7 5 9 20 48 44.0 6 24 53.3 26 23.9 7 12 26.7 10 9.2 Total 45 109 X 2 30.641 p value 0.001*** *** As the p value is smaller than 0.05 (p=0.001 ) there is a statistically significant difference in the perceived importance of club spor t programs having written policies and procedures regarding equipment contaminated with blood or OPIM between clubs that did and did not have such policies and procedures Note: chi square analysis of the perceived importance of club sport programs having written policies and procedures regarding equipment contaminated with blood or OPIM on the practice of club sport programs having written policies and procedures regarding equipment contaminated with blood or OPIM.

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76 Table 4 15. Have policies for contami nated field/facility a reas Yes No Perceived Importance Number % Number % 1 1 1.4 0 0 2 0 0 3 3.4 3 0 0 7 8.0 4 2 2.9 14 16.1 5 16 23.2 38 43.7 6 39 56.5 19 21.8 7 11 15.9 6 6.9 Total 69 87 X 2 35.729 p value 0.001*** *** As the p value is smaller than 0.05 (p=0.001 ) there is a statistically significant difference in perceived importance of club sport programs having written policies and procedures regarding fields/facility areas contaminated with blood or OPIM between clubs that did and did not have such policies and procedures. Note: chi square analysis of the perceived importance of club sport programs having written policies and procedures regarding fields/facility areas contaminated with blood or OPIM on the practice of club sport programs having written policies and procedures regarding fields/facility areas contaminated with blood or OPIM.

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77 Table 4 16. Have p olicies and procedures addressing a bleeding i ncident Yes No Perceived Importance Number % Number % 1 0 0 1 13 .0 2 0 0 0 0 3 0 0 5 7.2 4 2 2.3 15 21.7 5 14 16.1 19 27.5 6 48 55.2 23 33.3 7 23 26.4 6 8.7 Total 87 69 X 2 33.841 p value 0.001*** ***As the p value is smaller than 0.05 (p=0.001 ) there is a statistically significant difference in perceived the importance of club sport programs having written policies and procedures regarding a bleeding incident between clubs that did and did not have such policies and procedures. Note: chi square analysis of the perceived importance of club sport programs having written policies and procedures addressing a bleeding incident on the practice of club sport programs having written policies and procedures regarding a bleeding incident.

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78 Table 4 17. Have policy of consulting a health/m edical p rofessio nal Yes No Perceived Importance Number % Number % 1 0 0 2 1.8 2 0 0 2 16.7 3 0 0 3 2.7 4 7 16.7 17 15.2 5 10 23.8 43 38.4 6 20 47.6 35 31.3 7 5 11.9 10 8.9 Total 42 112 X 2 7.125 p value 0.309 The p value is greater than 0.01 ( p=0.309 ). Therefore, no statistically significant difference exists in the perceived importance of club sport programs consulting a health/medical professional regarding bloodborne pathogens and communicable disease policies and procedures between clubs th at did and did not consult a health/medical professional regarding bloodborne pathogens and communicable disease policies and procedures. Note: chi square analysis of the perceived importance of club sport programs consulting a health/medical professional regarding bloodborne pathogens and communicable disease policies and procedures on the practice of club sport programs consulting a health/medical professional regarding bloodborne pathogens and communicable disease policies and procedures.

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79 Table 4 18. Policies regarding contaminated equipment in heavy protective equipment s ports Yes No Perceived Awareness Number % Number % 1 0 0 3 2.9 2 1 1.96 5 4.8 3 2 3.9 9 8.6 4 10 19.6 18 17.1 5 14 27.4 30 28.6 6 19 37.2 35 33.3 7 5 9.8 5 4. 8 Total 51 105 X2 4.855a p value 0.562 The p value is greater than 0.01 ( p=0.0562 ). Therefore, there is no statistically significant difference in the perceived awareness of transmitting bloodborne pathogens and communicable disease in sports that r equire the wearing of significant amou nts of protective equipment (e.g ., fencing, lacrosse, and ice hockey) between clubs that did and did not have written policies and procedures regarding equipment contaminated with blood or OPIM Note: chi square anal ysis of the perceived awareness of an increased risk of transmitting bloodborne pathogens and communicable disease in sports that require the wearing of significant amounts of protective equipment (e.g., fencing, lacrosse, and ice hockey) on the practice o f club sport programs having written policies and procedures regarding equipment contaminated with blood or OPIM.

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80 Table 4 19. Correlations Bivariate Correlation Variables r p Perceived Importance of Club Sport Programs identifying which Athletes/Clubs are Most At Risk for Contracting and Transmitting Communicable Disease and Bloodborne Pathogens on the Awareness of an Increased Risk of Transmitting Bloodborne Pathogens and Communicable Dise ase in Heavy Contact Sports (e.g ., Rugby, Wrestling and Boxing ). 0.358 0.001 Partial Correlations Variables Controlling r p Total Perceived Awareness of Bloodborne Pathogens and Communicable Disease compared with the Total Practices Associated with Bloodborne Pathogens and Communicable Disease Size of Inst itution (Total Student Population) 0.172 0.035 Variables Controlling r p Total Perceived Awareness of Bloodborne Pathogens and Communicable Disease compared with the Total Practice Associated with Bloodborne Pathogens and Communicable Disease Size o f Campus Recreation Club Sport Program 0.177 0.030 Variables Controlling r p Total Perceived Importance of Bloodborne Pathogens and Communicable Disease compare with the Total Practice Associated with Bloodborne Pathogens and Communicable Disease Si ze of Institution (Total Student Population) 0.334 0.001 Variables Controlling r p Total Perceived Importance of Bloodborne Pathogens and Communicable Disease compare with the Total Practice Associated with Bloodborne Pathogens and Communicable Dise ase Size of Campus Recreation Club Sport Program 0.343 0.001

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81 CHAPTER 5 DISCUSSION Sport activities within campus recreation and club sport programs will always involve a certain amount of risk. Therefore, it is essential for such organizations to identi fy potential risks within the activities they oversee, and then address those risks in an effort to reduce them. While club sport program administrators are wise to focus on risks that are both known and perceived (based upon frequency and severity), it wo uld also be prudent for them to account for new and emerging areas of risk that may pose a threat and potentially endanger the safety of either their staff or participants ( Fuller & Drawer, 2004; Lee, Farley, & Kwon, 2010; Spengler, Anderson, Connaughton, & Baker, 2009). For example, an area of risk in the sport environment, which has recently received a lot of media attention, is exposure to bloodborne pathogens and communicable diseases. General Risk Management in Club Sport Programs Recent studies have s uggested that campus r ecreation program administrators are indeed aware and concerned with many of the risks present in their programs and are taking action to reduce the occurrence of such risks, increase the safety of their participants, and decrease the chances of litigation in their programs ( Schneider et al., 2008; Stier et al., 2008 ; Young, Fields, & Powell, 2007 ). With many institutions adopting formal risk management plans in their campus recreation programs, several specific areas have been targete d, including but not limited to: the supervision of activities and facilities, inspections, written policies and/or procedures, emergency plans, staff and/or participant certifications and training, use of waivers and/or consent forms, and proper

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82 documenta tion. In the current study, many club sport programs were addressing several such elements of risk management. For example, the data revealed that 100% of club sport program respondents reported requiring some certification(s) for the following: profession al staff, graduate assistants, student employees, and participants. A majority (76.3%) of club sport programs provided certification courses ( i.e., CPR, AED, First Aid ) in house for employees, coaches, and participant s ( Table 4 3) Club sport program profe ssional employees were the most commonly certified group within club sport programs, with 74.4% of them holding CPR certification, 68.6% holding First Aid certification, and 67.3% holding AED certification. Club sport program student employees and graduate assistants were the two next most certified groups. Certification requirements for coaches and participants were not as common, as no certifications were required for 42.3% of coaches and 58.3% of participants. Club sport program participants were reporte d as having the lowest overall numbers of required certifications as only 16.0% of the respondents required CPR certification for participants, 12.2% required First Aid certification, and 12.2% required AED certification. Regardless of who provides certifi cation training, as well as who is certified, (i.e., professional staff, graduate assistants, student employees, coaches, or participants), in terms of reducing risk, it is important that someone who has the relevant up to date certifications is present at sport club activities when physical activity is taking place (Menaker & Connaughton, 2009; Spengler, Connaughton, & Pittman, 2006). A large number (87.8%) of club sport administrators indicated that their risk management plans included documenting all ph ysical injuries that occurred, and 53.8%

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83 reported that a First Aid kit was required at all club sport activities. However, only 10.3% of club sport programs required physical (medical) examinations, and 23.7% required club sport program participants to com plete a health screening/history form prior to participation. While recent studies ( Stier et al., 2008 ; Young, Fields, & Powell, 2007 ) suggest that general risk management plans in campus recreation programs continue to become more comprehensive and preval ent the current study suggests some gaps remain. For example, approximately 10 % of club sport programs were not documenting all physical injuries, and over 43% did not require a First Aid kit at all club sport activities. Additionally, only 21.2% of club sport programs required participants to complete a health screening/history f orm prior to participatio n (Table 4 2) In an effort to reduce liability and to demonstrate that certain procedures were conducted, the documentation of all injuries is important (Spengler, Connaughton, & Pittman, 2006). Greater efforts should be made by club sport programs to document all injuries. Additionally, a First Aid kit should be present at club sport activities when physical activity is taking place (Spengler, Connaughton & Pittman, 2006). Risk Management Practices and Policies Associated with Disease Control and Prevention in Club Sport Programs The results of this study suggest that policies and practices related to disease control and prevention within club sports prog rams may not have been as extensively addressed as other areas of general r isk management. For example, the majority (57.7%) of club sport administrators indicated that they did not have a written risk management plan that specifically addressed disease co ntrol and prevention, while 53.2% also reported that they did not have a written risk management plan that addressed bloodborne pathogens. However, 53.3% of all respondents indicated that

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84 they trained employees in universal precautions that could be implem ented when handling blood or OPIM and 56.1% of all respondents had written policies and procedures addressing handling an incident involving blood. Without the proper management of communicable disease and bloodborne pathogen risk in sport, club sport pr ogram employees, participants, and organizations may be exposed to an increased risk of injury, death, and liability. Injuries and bleeding are not uncommon to sport and present a favorable environment for bloodborne pathogen exposure and disease transmiss ion. Over the past two decades, bloodborne pathogen exposure and risk in sport has primarily focused on the Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV). These viruses have the capability of not only being potentially lethal to the carrie r, but they can also be transmitted through blood or other infectious material to an unsuspecting sport participant (Zeigler, 1997). In addition to HIV and HBV, other serious diseases that have the potential to infect sport participants also exist. Andrew s, Howard Shaugnessy, and Adams ( 20 07) noted an alarming increase in the prevalence of MRSA infections at all levels of sport (including high school, college and professional), as well as provided recommendations to reduce such risk. Among a number of guid elines and recommendations, the authors stated that MRSA in sport, as well as be able to identify and report any suspicious skin sore, l esion, or boil for immediate and proactive treatment (Andrews et al., 2007). Andrews et al., ( 2007 ) stated, "Left undetected, CA MRSA can be a deadly bacterial infection. Educating sport and dance participants on

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85 detecting an infection early and on appropr iate treatment are all integral components to avoiding a CA be implem Aside from the risks associated with bloodborne pathogens such as HIV, HBV, and MRSA i n the sport environment, communicable diseases including the H1N1 virus can also pose a serious threat. In the spring of 2009, the H1N1 virus spread rapidly across the US, resulting in a number of school closures (Conatser & Ledingham, 2010). Although the majority of the respondents in this study reported that they had never canceled or postponed an event due to a communicable disease (84.0%) or bloodborne pathogen related (86.5%) incident, the potential severity of such an incident, warrants a high degree of proactive attention. Similarly, a majority of club sport programs indicated they had never closed a facility due to a communicable disease (76.3%) incident or a bloodborne pathogen related incident (75.6%). However, not all club sport programs were free from such incidences, with 20.5% reporting that they had communicable disease or bloodborne pathogen related closu res or cancelations ( Table 4 5 ) In the wake of the chaos that surfaced from the H1N1 pandemic, the current guidelines (and/or lack thereof) for decision making regarding athlete participation, facility closures, and event cancellations have come into question. Outside of this study, we know that several local and statewide athletic competitions were canceled in an attempt to limit the outbreak and extent of the disease through person to person contact and interactions. Dismissing athletes or participants from activity is a crucial initial step in separating infected individuals from those who are not yet ill (Koester, 2011). Information and gui

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86 people who become seriously ill or die with the goal of minimizing social disrupti on and 29). sport environment (pertaining to communicable disease cancellations, closures, and participant separation), depend upon multiple variables. Additional recommendations have also emphasized that decisions related to bloodborne pathogen and communicable disease cancellations, closures, and participant separation should only be made, and policies and procedures enacted, after consultation with state and/or local public health officials (Koester 2011). However, in this current study, only 30.4% of the respondents reported that they consulted a health/medical professional, while 27.6% of them consulted professional organizations, regarding communicable disease and bloodborne pathogen risk managem ent recommendations ( Table 4 9 ) Risk management policies and procedures associated with disease control and prevention can be somewhat complex, comprehensive, and evolve frequently. Therefore, it is prudent for club sport administrators to consult health/ medical professionals and/or professional organizations when developing or revising such risk management policies and procedures (Ross & Young 1995; Zeigler, 1997). Perceived Awareness and Importance of Communicable Disease and Bloodborne Pathogen Risks R espondents indicated that they were familiar with the risk of communicable disease and bloodborne pathogens (MRSA, HIV, HBV, Swine Flu, etc.) in the sport environment, with 84.0% ( M =5.12; SD=1.107) reporting that they were familiar with the risk. A total o f 62.6% ( M =4.45; SD=1.152) of respondents also rated the risk associated

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87 with communicable disease and bloodborne pathogens within their club sport programs as risky. Furthermore, 94.9% ( M =5.97; SD=0.846) of respondents agreed that there was an increased r isk of transmitting communicable disease and bloodborne pathogens in heavy contact sports such as rugby, wrestling, and boxing, while 69.3% ( M =4.96; SD=1.314) indicated that they agreed that there was an increased risk of transmitting communicable diseases and bloodborne pathogens in sports that require the wearing of significant amounts of protective equipment such as fencing, lacro sse, and ice hockey ( Table 4 7 ). The data suggest the respondent perceived awareness and importance of communicable disease and bloodborne pathogen risk in the club sport environment as both risky and high, respectively, and therefore should warrant the adoption and practice of relevant risk management policies. Exposure to communicable diseases and bloodborne pathogens poses a threat to sport participants a nd staff members. The CDC identified several modes in which bacteria, bloodborne pathogens, and other communicable diseases may be spread. Such methods of transmission in clude, but are not limited to: act, (3) cuts and abrasions, (4) contamination of MRSA is Spread Among Athletes, 2). Some sports, especially where there is clos e person to person contact (e.g. boxin g, rugby, wresting), or the wearing of significant amoun ts of protective equipment (e.g. hockey, football, lacrosse, fencing), have an increased risk of transmitting blood, infection, or OPIM among participants (Menaker & Connaughton, 2009).

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88 As the NATA elevated risk of infectious disease being spread by skin to skin contact and ). The NATA also recently reported that skin infe ctions, in particular, lead to more than half of all outbreaks of all communicable diseases in physical activity and the spor t environment (Kravitz, 2011). It is, therefore, important for club sport administrators to develop a risk management plan that add resses communicable diseases and bloodborne pathogens (Zeigler, 1997). Comparisons between Perceived Awareness and Importance of the Risk with Corresponding Risk Management Policies and Practices In the current study, chi square and correlation analyses we re utilized to compare awareness and importance of communicable disease and bloodborne pathogen risk to relevant risk management p olicies and procedures Table 4 1 0 through Table 4 19 Of the nine chi square analyses that were performed, and the single biv ariate correlation comparing awareness and importance against corresponding policies and procedures (practice), six (6 0%) were significant ( p <0.05). Although the perceived awareness and importance of the risk associated with communicable disease and bloodb orne pathogens in club sport programs may be moderately high based on the results of this study, the corresponding levels of risk management policies and practices associated with disease control and prevention appear to be somewhat lacking. Risk managemen t policies and procedures for reducing communicable disease and bloodborne pathogen risks in club sport programs should include, but not be limited to: (1) staff/participant education; (2) prompt recognition of athletes and participants with infections or exposure to blood and/or OPIM ; (3) First Aid and infection control procedures to prevent

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89 continued exposure to infection or blood; and (4) as well as adherence to general guidelines, recommendations, and hygienic principles not only for staff members and a thletes/participants, but also in regard to athletic clothing, equipment, and facility areas (CDC, 2008) Risk Management Policies and Procedures Addressing Communicable Disease and Bloodborne Pathogens in Club Sport Programs Among the statistically signif icant chi square analyses ( p < 0.05), the majority (57.7%) of club sport program respondents reported that they did not have a risk management plan that addressed disease control and prevention, and only 35.9% indicated that their club sport program had a wr itten exposure control plan that addressed bloodborne pathogens. While the data suggests that the respondents overall are familiar with the risks and perceive the risk to be somewhat risky, only 33.3% of the club sport programs had a risk management plan t hat addressed such issues. educators, sport and fitness program managers, and others involved in physical activity programs should be encouraged to follow published statements and guidel ines in an Club sport program employees and athletes/participants should receive education and training on bloodborne pathogens and OPIM and the measures that can be used to prevent and reduce their risk. It is also recommended for staff members to report all communicable disease outbreaks and known infections, not only to program administrators, but also to local or state health professionals (Menaker & Connaughton, 2009).

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90 All individuals, whether a staff member or athlete/participant, should take special care to avoid contact with any blood or OPIM Before an athlete/participant partakes in practice or competition, all open skin wounds and lesions (cuts, scrapes, etc .) should be covered with a fixed dressing that does not allow for easy transmission to or from another athlete (Zeigler, 1997). Skin to skin, physical contact with individuals who have cuts or wounds, even if bandaged, should be avoided. Athletes with act ive bleeding should be removed from participation as soon as possible and allowed to return only when the bleeding has stopped and the wound properly dressed and bandaged (Romano, Lu, & Holtom, 2006). Protective First Aid equipment, including disposable gl oves and antiseptic agents, should be kept in properly stocked First Aid kits that are readily available for use. Chlorine bleach (one part bleach and 10 parts water), or other approved agents, should be utilized for disinfecting all potentially contaminat ed surfaces and equipment. When wearing disposable gloves, special care should be taken to not contaminate other surfaces, objects, or individuals. Immediately after exposure to blood or other potentially infectious materials, individuals should wash thei r hands and all exposed body surfaces with anti germicidal and disinfecting agents, or soap and warm water (Zeigler, 1997). Additionally, athletes/participants should also be strongly encouraged to shower immediately after physical activity. As aforementio ned, medical professionals should also be notified if an exposure to infectious material occurs, or if a known infection gets worse, leads to fever, or gives any reason for further serious concern (Rogers, 2008). It is emphasized that infected individuals are aware,

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91 pertaining to communicable disease and bloodborne pathogen exposure control and prevention (CDC, 2008). Club sport administrators, staff, coaches, and students/pa rticipants should be aware of the risk management policies and procedures associated with communicable disease and bloodborne pathogens. Those responsible for providing First Aid and/or handling blood or other potentially infectious material should receive relevant training and have knowledge to the relevant risk management policies. In an effort to reduce risks and potential liability, a club sport program and its administrators, staff, coaches, and participants should be aware and trained in this importan t area (Ross & Young, 1995). Practical Implications for Reducing Communicable Disease and Bloodborne Pathogen Risks Associated with Equipment and Field/Facility Areas in Club Sport Programs The comparison of the perceived importance with risk management pr actices related to potentially contaminated equipment (especially in sports that require the wearing of significant amounts of protective equipment such as fencing, lacrosse, and ice hockey) was not statistically significant, suggesting that perception and practice are independent This raises concern, when considering that the perceived awareness ( M =4.96; SD=1.314) and importance ( M =5.39; SD=1.044) of such risk s were moderately high. Respondents from 62.8% of club sport programs reported not having writte n policies and procedures regarding equipment contaminated with blood or OPIM Similarly, 48.1% reported not having written policies and procedures regarding field/facility areas contaminated with blood or OPIM Sport uniforms, equipment, and facility are as (i.e., locker rooms, showers, field areas, aquatic areas, etc.) should be inspected for blood or OPIM and appropriately

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92 cleaned with a proper disinfectant (Menaker & Connaughton, 2009). Facility areas and fitness equipment (mats, weight training benches /machines, cardiovascular machines, barbells, etc.) should be cleaned and sanitized on a regular basis. Fitness mats, especially those u sed in wresting and yoga, are common area s for the presence of MRSA bacteria. Such pieces of equipment, in particular, s hould be cleaned and sanitized after session s practice s or competition s (Menaker & Connaughton, 2009; Rogers, 2008). A uniform or protective athletic equipment that has blood present on it should be removed immediately and bagged separately (Zeigler, 199 7). Athletic clothing and protective gea r, including but not limited to knee pads, facemasks, goalie equipment, helmets, etc., should be cleaned and di sinfected as well The sharing of towels, razors, and athletic gear should be avoided, and disposable tow els should be provided and utilized during games and practices to avoid the opportunity for disease transmission and/or the harboring of OPIM (Romano, Lu, & Holtom, 2006). As previously emphasized, written risk management policies and procedures regarding equipment and field/facility areas contaminated with blood or OPIM are important for decreasing the risk of disease transmission Consulting Professional Organizations and Health/Medical Professionals Regarding Communicable Disease and Bloodborne Pathogen Risks in Club Sport Programs The comparison between the perceived importance of club sport programs consulting a health/medical professional concerning communicable disease and bloodborne pathogen policies and practices was also not significant, raising co ncerns on how to translate the heightened awareness into proper action. Respondents (54.8%) indicated that they did not consult a health/medical professional regarding communicable disease and bloodborne pathogen policies and procedures. Additionally,

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93 55.1 % did not consult professional organizations (i.e., ACSM, NASM, NATA, NCAA, OSHA, environmental health and safety department, etc.) regarding communicable disease and bloodborne pathogens exposure and control within their programs. As previously mentioned 1910.1030 of Title 29) covers all employees who could reasonably anticipate contact & Young, 1995, p. 12). This inclu des club sport program employees who are tasked with handling situations (e.g., providing First Aid ) involving exposure to blood and/or other potentially infectious materials. The bloodborne pathogen standard requires that all eligible employees receive pr oper training and education pertaining to preventing contamination and transmission of bloodborne pathogens and OPIM The standard mandates the implementation of methods regarding control and prevention in the event of a bloodborne pathogen or OPIM inciden exposure including practices such as utilization of protective gloves when responding to a bloodborne pathogen or infectious material incident, and use of CP R microshields or pockets facemasks to prevent direct mouth to mouth contact, as well as (3) developing a written exposure control plan (ECP), identifying and outlining the tasks and procedures that should be carried out when exposure to bloodborne pathogens or OPIM employees to receive the HBV vaccination a nd post exposure follow up. It also includ es extensive documentation and record keeping (Ross & Young, 1995). The OSHA

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94 bloodborne pathogen standard is comprehensive and somewhat complex. It would be prudent for club sport administrators to consult with the ir local/regional OSHA office and/or other health/medical professionals/organizations when developing related risk management policies and practices. The health and fitness industry has been made aware, and strongly e ncouraged, to comply with OSHA standard s for many years. The risk of coming in contact with blood or OPIM has stirred many fitness facilities and sport related programs to adopt OSHA standards and related risk management practices to protect employees and avoid legal transgressions (Fried, 2009 ). However, despite the OSHA bloodborne pathogen standard providing detailed guidelines for the protection of employees, aspects of the OSHA standard do not cover athletes/participants or other non employees (e.g., c lub sport officers, volunteers; Menaker & Connaughton, 2009). Aside from the OSHA bloodborne pathogen standard, athletes/participants and non employees of campus recreation club sport programs should be provided with the appropriate education and training, as well as made aware of the risk manag ement policies and procedures associated with reducing the risk of bloodborne pathogens and OPIM in the sport environment. The National Collegiate Athletic Association (2008), in addition to their NCAA Guideline 2H: Bloodborne Pathogens and Intercollegiat e Athletics has created educational posters detailing information about the risks associated with bloodborne pathogens in sport. Individuals working in physical activity related programs should consider distributing information on communicable disease and bloodborne pathogens in the sport environment to aid in educating and informing others (Zeigler, 1997).

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95 Furthermore, it is collectively recognized by professional organizations, including but not limited to the ACSM, American Medi cal Society for Sports M edicine and NATA, that knowledge and awareness pertaining to the recommended guidelines for preventing ffort to implement the most up to date standards and to meet the highest level of care, it is wise for club sport program administrators to consult with health/medical professionals and/or professional organizations regarding risk management policies and practices pertaining to communicable diseases and bloodborne pathogens (Menaker & Connaughton, 2009). Risk management in campus recreation club sport programs should address communicable disease and bloodborne pathogens, including informing and educating staff members and ath letes/participants about the potential risks that can ensue, as well as steps that can be taken in order to prevent and reduce such risk occurrences (Menaker & Connaughton, 2009). By adhering to such policies and procedures, the risk of communicable diseas e and bloodborne pathogen transmission in sport can be reduced (Ziegler, 1997). Reducing Liability Associated with Communicable Disease and Bloodborne Pathogens in Sport It is important to manage ris ks associated with communicable disease and bloodborne pa thogens as a means of reducing liability. As Menaker and Connaughton pathogens) could be considered a foreseeable risk in an athletic, physical education, or (p. 1). Club sport administrators and their staff should be aware of the various potential risks that could result in a harmful incident, financial loss, and /or an

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96 overall negative image of their department and institu tion (Schneider et al., 2008). The fa ilure to pr operly manage risk in this area could lead to legal action and liability. For example, in 2009, former National Football League (NFL) receiver Joe Jurevicius sued his team (Cleveland Browns) and the NFL for a staph infection (MRSA) he contracte d. Jurevicius underwent knee surgery in January 2008 and contracted the failure to properly clean the team training facility, and that team doctors failed to warn him tha t the therapy equipment was not always properly sanitized. Jurevici us was released as a player from the Browns and as a result of the staph infection. H is (ESPN, 2009b). The U.S. District Judge in the case, Judge Solomon Oliver, Jr., ruled that the following six claims made by Jurevicius were not preempted by the NFL Collective Bargaining Agreement, and sent them to Cuyahoga County Common Pleas Court: negligent failure t o warn players regarding potentially hazardous conditions at the training facility, (2) negligent failure to undertake proper precautions to remove and/or prevent the spread of staph, (3) negligent misrepresentation regarding whether prior incidents of sta ph infection had been contracted at the training facility, (4) fraudulent misrepresentation that proper procedures were in place to prevent staph infection at the training facility, (5) intentional exposure of employees to a dangerous condition about which the employer was aware, and (6) deliberate misrepresentation of the presence of a toxic or hazardous substance as creating a rebuttable presu 2009b)

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97 d Nance, said the terms of the settlement were confidential; however, it was reported that the lawsuit asked for damages totaling more than $25,000, unspecified punitive damages, attorney and expert fees, and relat ed costs. An infectious disease specialist provided an affidavi t, which revealed that Jurevici circumstances alleged in the lawsuit. Following the lawsuit, a NFL physician surveyed 32 clubs and revealed 33 MRSA staph infections occurred league wide from 2006 08. The s urvey also revealed that at least six Browns players had some form of staph infection (ESPN, 2009b). In another case, a former college football player sued Iona College over an antibiotic resistant staph infection that nearly cost him his leg in September 2005. Nick Zaffarese accused team trainers of initially ignoring the severity of his MRSA infection. He alleged that the team's locker room was an unsanitary environment in which players shared towels and equipment. It was reported that the case settled fo r approximately $250,000 Shortly after the settlement, Iona College disinfected their weight room, as well as implemented hygiene education after 10 members of another athletic team were diagnosed with MRSA as well (ESPN, 2007). Additionally, in 2007, th e Minnesota State High School league suspended a high school wrestler who broke out with the herpes viru s for eight days during the season Athletes from 10 different schools within the league developed skin lesions. When the outbreak was eventually contro lled, 40 wrestlers from 16 different schools had been infected (Popke, 2011). More recently, in 2010, administrators and coaches at North Central High School in Indianapolis were accused of failing to properly and thoroughly

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98 sanitize wrestling mats, as wel l as not taking action to restrict a MRSA infected wrestler from participation. As a result, a 17 year old high school wrestler was hospitalized with a severe staph infection and a 104.5 degree fever after skin to skin contact with an infected wrestler. Ph ysicians who treated the 17 year old wrestler stated that they were 99% sure that he had contracted the infection directly from the skin to skin contact with his sparring partner and unclean wrestling mats. Failure to properly manage the risk associated w ith communicable disease and bloodborne pathogens in sport, can lead to severe infections, illness, death, and subsequent legal claims (Menaker & Connaughton, 2009). Therefore, it would be prudent for club sport program administrators to develop and/or rev ise risk management plans aimed at reducing such risks.

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99 CHAPTER 6 LIMITATIONS AND FUTURE RESEARCH Limitations The study current study had several limitations that must be noted An email invitation and link to the survey instrument was sent to the popula tion through the Qualtrics survey database. Email addresses of the intended survey population were entered into the database prior to the survey being launched. The email addresses of 522 club sport program directors were obtai ned from the NIRSA 2011 recr eational sports directory Due to possible employee turnover and typographical errors, not all of the names and email addresses of the intended population may have been current and/or correct. Of the 522 email addresses entered into the Qualtrics survey d atabase for the initial survey distribution, 24 emails were faulty and produced a permanent error, which resulted in unsuccessful survey distribution. This reduced the intended population to 498 club sport program administrators. Of the 498 club sport admi nistrators who received the survey, 156 submitted complete responses, resu l ting in a 31.3% response rate. With current and correct names and email addresses of all club sport program administrators, a higher response rate m a y have obtainable. It was expec ted that club sport administrators would be aware of the general risk management survey questions, and would be able to answer the m with little to no confusion. However, their specific knowledge of communicable disease and bloodborne pathogen exposure and control, as an aspect of risk management, may not have been as refined. Although communicable disease and bloodborne pathogen exposure and control can be somewhat complex in nature, questions in this section of the survey were written for clarity and under standing to limit potential confusion. Definitions for particular

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100 terms and diseases were provided in order to limit participant answering a question. Some respondents, however, may still not have been fully aware of certain terminology procedures. For example, respondents may not have fully understood the differences regarding an exposure control plan versus an overall risk management plan. Another limitation to this study was the possible increase in non respon ders due to the potential concern that legal related information regarding their respective club sport programs may not remain anonymous. Although this was addressed in the emails by stating that all data would kept anony mous, no individual respondent and/or school would be identified, and all results would be reported as group data, it is presumed that some respondents may have still been deterred from participating in the survey due to this factor. Future Research Sugges tions This study was exploratory in nature. Future studies may adopt more advanced analytical procedures such as confirmatory factor analysis and structural equation modeling to further explore theoretical relationships among the research variables (i.e., awareness, perception, behavioral intentions, and risk management practices). This study was limited to administrators of NIRSA club sport programs in the United States. Although similarities exist among programs in the U.S. and/or those that are instituti onal members of the NIRSA, differences may exist in programs outside of the U.S. or within programs that are not institutional members of the NIRSA. Therefore, the generalizability of the findings of this study should be limited to club sport programs in t he U.S. that are institutional members of the NIRSA. Future studies could include club

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101 sport programs that are outside of the U.S. and/or those that are not institutional members of the NIRSA. Despite club sport programs falling under their respective univ they (as primarily student run organizations) typically operate with a great deal of autonomy. This unique aspect of club sport programs often results in professional staff members (e.g., supervisors and coordinators) taking a second ary role (although they assist the clubs in plannin g, scheduling, and organizing) and therefore, a significant amount of responsibility is he ld by the students. I t is the students who are often the first responders when injuries and incidents arise and not certified athletic trainers, team physicians, or professional staff (campus recreation employees). Future research could include studying students (club sport program participants) perceptions and knowledge of the risk associated with communicable diseas e and bloodborne pathogens in the club sport environment. The current study could also be replicated in different program areas of campus recreation (e.g., fitness centers, intramurals, aquatic programs, outdoor pursuits, etc.) Surveying students or part icipants may provide unique results, as participants typically approach club sport programs in a different manner from administrators and staff members. Participants also often carry out many essent ial duties of their respective club s, and usually act as f ir st responders in the event of a medical incident P p erceived awareness and importance of the risks associated with communicable disease and bloodborne pathogens, as well as corresponding risk management policies and procedures, may result in different relationships.

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102 The current study could have also asked additional questions of the club sport administrators. For example, what professional organizations did respondents specifically belong to? Do respondents believe it is important for NIRSA to address disease control and prevention in club sport programs? Additional data would lead to further analyses. Furthermore, fitness centers would also be an interesting area of investigation. Fitness centers often utilize more shared equipment and facil ity areas and may have increased areas of contamination. Fitness centers may also have higher user rate s or a more diverse population, from that examined in the current study.

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103 APPENDIX A INFORMED CONSENT Please read this consent document carefully befo re you decide to participate in this study. Protocol Title: Awareness perception, and risk management practices related to disease control and prevention in university club sport programs Introduction and Instructions: My name is Mary Waechter and I am a sport management graduate student in the department of Tourism, Recreation and Sport Management at the University of Florida. I am working on my master's thesis project under the guidance of Drs. Dan Connaughton and J.O. Spengler, as well as assistance Director, Mr. Eric Ascher. The purpose of this survey focuses on bloodborne pathogen and communicable disease prevention policies, practices, and risk management procedures within campus recreation club sport pr ograms. This is a national study, distributed to all NIRSA club sport directors in the United States. Information gathered from this survey will help to determine the scope and nature of campus recreation club sports programs' risk management practices reg arding disease control and prevention, how campus recreation club sport directors perceive communicable diseases as a risk, and whether there is an association between risk perception and risk management practices. You must be at least 18 years old to com plete this survey and your participation is voluntary. You may withdraw your consent at any time without penalty, and you do not have to answer any questions you do not wish to answer. There is no compensation to you for participating in this study. Partic ipating involves no anticipated risks and your answers will rema in confidential and anonymous. No individual or institution will be identified, and no email or IP addresses will be saved with your responses. Please answer the following items based upon yo ur perceptions, viewpoints, and experiences within your club sport program. Click on the electronic arrow below each question to navigate throughout the survey. When you have completed the survey, please ensure that you have successfully clicked the submit button as prompted on your computer screen. Note that there is no time limit to this survey; however, once you have completed the online survey you will not be able to return to it again. Thank you for taking the time to participate in this important sur vey. By checking this box, you agree to participate in this survey research project.

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104 APPENDIX B SURVEY INSTRUMENT I. CLUB SPORT DEMOGRAPHICS 1. Please indicate your gender: ______ Male ______Female 2. Is your institution: ______ Publi c ______Private 3. What is the approximate number of students enrolled in your institution? (Please indicate a number in the space provided.) ___________ 4. How many full time professionals (including yourself) are employed within the club spo rts program? (Please indicate a number in the space provided.) ____________ 5. How many registered club sports are currently with your program? (Please indicate a number in the space provided.) ____________ 6. Did you take any courses related to lega l issues while earning your academic degree? ________ YES ________ NO 6a. To what degree do you perceive the importance of taking courses related to legal issues? Unimportant Very Important 7. Did you take any courses related to risk management while earning your academic degree? ________ YES ________ NO 1 2 3 4 5 6 7

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105 7a. To what degree do you perceive the importance of taking courses related to risk management? Unimportant Very Important 8. Do you hold current ce rtification in any of the following? (Please check ( ) all that apply.) ________Automatic External Defibrillator (AED) ________Bloodborne Pathogen Training (BBP) ________Cardiopulmonary Resuscitation (CPR) ________ First Aid 8a. To what degree do you perceive the importance of professional club sport staff holding current certification in Automatic External Defibrillation? Unimportant Very Important 8b. To what degree do you perceive the importance of professional club sport staff holding current certification in Bloodborne Pathogen Training (BBP)? Unimportant Very Important 8c. To what degree do you perceive the importance of professional club sport staff holding current certification in Cardiopulmonary Resuscitati on (CPR)? Unimportant Very Important 8d. To what degree do you perceive the importance of professional club sport staff holding current certification in First Aid ? Unimportant Very Important 9. Has your club sports program ever canceled or postponed an event due to a communicable disease related incident? __________ YES _________NO _________Unsure 9a. If yes, how many times has this occurred in the past 24 months? ______ 10. Has your club sports program ever c anceled or postponed an event due to a bloodborne pathogen related incident? __________ YES _________NO _________Unsure 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7

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106 10a. If yes, how many times has this occurred in the past 24 months? ______ 11. Has your club sports program ever closed a facility or portion of a facility due to a communicable disease related incident? __________ YES _________NO _________Unsure 11a. If yes, how many times has this occurred in the past 24 months? ______ 12. Has your club sports program ever clo sed a facility or portion of a facility due to a bloodborne pathogen related incident? __________ YES _________NO _________Unsure 12a. If yes, how many times has this occurred in the past 24 months? ______

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107 II. KNOWLEDGE & RISK PERCEPTION ASSO CIATED WITH DISEASE CONTROL AND PREVENTION 1. How familiar are you with the risks associated with communicable diseases and bloodborne pathogens (MRSA, HIV, HBV, Swine Flu, etc.) in the sport environment? Unfamiliar Very Familiar 2. H ow would you rate the risk associated with communicable diseases/bloodborne pathogens within your club sport program? No Risk Extreme Risk 3. How would you rate the importance of identifying which athletes/clubs are most at risk for contr acting and transmitting communicable diseases and bloodborne pathogens? Unimportant Very Important 4. How would you rate the importance of having written policies and procedures regarding addressing communicable diseases/ bloodborne pathog ens in your club sports program? Unimportant Very Important 5. I feel that there is an increased risk of transmitting bloodborne pathogens and communicable diseases in heavy contact sports such as rugby, wrestling, and boxing? Strongly Strongly Disagree Agree 6. I feel that there is an increased risk of transmitting bloodborne pathogens and communicable diseases in sports that require the wearing of significant amounts of protective equipment such as fencing, lacrosse, a nd ice hockey? Strongly Strongly Disagree Agree 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7

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108 III. RISK MANAGEMENT PRACTICES ASSOCIATED WITH DISEASE CONTROL AND PREVENTION 1. Does your club sports program have a written risk management plan that addresses disease control and prev ention? __________ YES _________NO _________Unsure 1a. To what degree do you perceive the importance of your club sports program having a written risk management plan that addresses disease control and prevention? Unimportant Very Important 2. Does your club sports program have a written exposure control plan that addresses bloodborne pathogens? __________ YES _________NO _________Unsure 2a. To what degree do you perceive the importance of your club sports program having a written exposure control plan that addresses bloodborne pathogens? Unimportant Very Important 3. Are physical (medical) examinations required of all club sports participants? __________ YES _________NO _________Unsure 3a. To what degree do you perceive the importance of your club sports program requiring all club sport participants to have physical (medical) examinations? Unimportant Very Important 4. Do you require the club sports program participants to complet e a health screening/history form prior to participation? __________ YES _________NO _________Unsure 4a. To what degree do you perceive the importance of your club sports program requiring participants to complete a health screening/history form p rior to participation ? Unimportant Very Important 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7

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109 5. What certifications do you require of your club sports professional employees ? (Please check ( ) all that apply.) _________ Attend a Departmental Orientation Certification _________ Automated External Defibrillator ( AED) _________ Bloodborne Pathogen _________ CPR _________ First Aid _________ No certifications required _________ Sport Specific Certification _________ Other, please list _________________________ 6. What certification s do you require of your club sports graduate assistants ? (Please check ( ) all that apply.) _________ Attend a Departmental Orientation Certification _________ Automated External Defibrillator ( AED) _________ Bloodborne Pathogen _________ CPR _________ First Aid _________ No certifications required _________ Sport Specific Certification _________ Other, please list __________________________ 7. What certifications do you require of your club sports student employees ? (Please check ( ) all that apply.) _________ Attend a Departmental Orientation Certification _________ Automated External Defibrillator ( AED) _________ Bloodborne Pathogen _________ CPR _________ First Aid _________ No certifications required _________ Sport Specific Certification ________ Other, please list ________________________ 8. What certifications do you require of your club sports coaches ? (Please check ( ) all that apply.) _________ Attend a Departmental Orientation Certification _________ Automated External Defibrillator ( AE D) _________ Bloodborne Pathogen _________ CPR _________ First Aid _________ No certifications required _________ Sport Specific Certification

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110 _________ Other, please list ________________________ 9. What certifications do you require of your club sports participants? (Please check ( ) all that apply.) _________ Attend a Departmental Orientation Certification _________ Automated External Defibrillator ( AED) _________ Bloodborne Pathogen _________ CPR _________ First Aid _________ No certifications requir ed _________ Sport Specific Certification _________ Other, please list _________________________ 10. Does your club sport program provide training for the above mentioned certifications to employees, club sport coaches, and participants? __________ YES _________NO _________Unsure 10a. To what degree do you perceive the importance of your club sport program providing training for the above mentioned certifications to employees, club sport coaches, and participants? Unimportant Very Important 11. Are all club sports organizations within your program supplied with a First Aid kit? ________ YES ________ NO 11a. To what degree do you perceive the importance of your club sport program supplying all club sport organizations with a First Aid kit? Unimportant Very Important 12. Does your program require a First Aid kit at all club sport activities? __________ YES _________NO _________Unsure 12a. To what degree do you perceive the importance of your cl ub sport program requiring a First Aid kit at all club sport activities? Unimportant Very Important 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7

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111 13. Does your club sports program train employees in universal precautions that can be implemented in the handling of any blood or body fl uids should an injury occur during practice or competition? __________ YES _________NO _________Unsure 13a. To what degree do you perceive the importance of your club sport program training employees in universal precautions that can be implemente d in the handling of any blood or body fluids should an injury occur during practice or competition? Unimportant Very Important 14. Does your club sport program offer the following employees Hepatitis B vaccination? Professional Employ ees ________YES _______NO Graduate Assistants ________ YES _______NO Student Employees ________ YES _______NO 14a. Do you think it is important that club sport program employees receive the Hepatitis B vaccination? Unimportant Very Important 15. Does your club sport program have written policies and procedures regarding equipment contaminated with blood or infectious material? __________ YES _________NO _________Unsure 15a.To what degree do you perceive th e importance of your club sport program having written policies and procedures regarding equipment contaminated with blood or infectious material? Unimportant Very Important 16. Does your club sport program have written policies and proced ures regarding fields/facility areas contaminated with blood or infectious material? __________ YES _________NO _________Unsure 16a. To what degree do you perceive the importance of your club sport program having written policies and procedures re garding fields/facility areas contaminated with blood or infectious material? Unimportant Very Important 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7

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112 17. Does your club sport program have written policies and procedures addressing a bleeding incident? __________ YES _________NO _________Unsure 17a. To what degree do you perceive the importance of your club sport program having written policies and procedures addressing a bleeding incident? Unimportant Very Important 18. Has your club sports program consulte d a health/medical professional regarding bloodborne pathogen and communicable disease policies and procedures? __________ YES _________NO _________Unsure 18a. To what degree do you perceive the importance of your club sport program consulting a h ealth/medical professional regarding bloodborne pathogen and communicable disease policies and procedures? Unimportant Very Important 19. Has your club sports program consulted professional organizations regarding bloodborne pathogen and c ommunicable disease exposure and control? __________ YES _________NO _________Unsure 19a. If yes, please check ( ) which organizations have been consulted for your program. ______ ACSM (American College of Sports Medicine) ______ College/Instit ution Environmental Health and Safety Department ______ NASM (National Academy of Sports Medicine) ______ NCAA (National Collegiate Athletic Association) ______ OSHA (Occupational Safety and Health Administration) ______ Other (Please identify) __________________________________ 1 2 3 4 5 6 7 1 2 3 4 5 6 7

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113 20. Do es your club sport program document all physical injuries that occur within your program? __________ YES _________NO _________Unsure 20a. If yes, how long do you keep this documentation? __________Year _________Months 20b. To what degree do you perceive the importance of your club sport program documenting all physical injuries that occur within your program? Unimportant Very Important 21. My attitude toward the risk management policies, practices, and procedures currently implemented in my club sport program is: Bad Good Unfavorable Favorable Unsatisfactory Satisfactory Negative Positive 22. My future intention of managing risk associated with communicable disease in my club sport program is: 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7

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114 LIST OF REFERENCES Andrews, A.K., Howard Shaugnessy, C., & Adams, J.E. (2007). Combating CA MRSA in physical education, sports, and danc e. Journal of Physical Education, Recreation, and Dance 78 (9), 19 31. Bauer, R. A. (1960). Consumer behavior as risk taking. In D. F. Cox (Ed.), Risk taking and information handling in consumer behavior (pp. 23 33). Cambridge, MA: Harvard University Press. Beach, M.J. (2005). Assessing parents' perception of children's risk for recreational water illnesses. The Free Library Retrieved September 17, 2010 from: http://www.thefreelibrary.com/Assessing parents' perception of children's risk for recreational... a0132228756 Bereket Yucel, S. (2007). Ris k of Hepatitis B infections in O lympic wrestling. British Journal of Sp ort Medicine 41 306 310. Birdwell, A.F. (2011). MRSA may no t be the bully of the gym after all. University of Florida News Retrieved April 14, 2011 from: http://news.ufl.edu/2011/03/03/mrsa Celsi, R.L. Rose, R. L., & Lei gh, T. W. (1993). An exploration of high risk leisure consumption through skydiving. Journal of Consumer Research, 20 (1), 1 23. Centers for Disease Control and Prevention. (2008). Community associated MRSA information for the public Retr ieved January 31, 2010 from: Connaughton, D.P, DeMichele, D., Horodyski, M.B, & Dannecker, E (2002). An analysis of OSHA compliance and selected risk management practices of NIRSA fitness d irectors. Recreational Sports Journal 26 (1), 7 18. Cooper, N. L. (1997). W ill the defendant please rise: H ow effective is your risk management p lan? NIRSA Journal 21 (2), 34 41. Conatser, P., & Ledingham, C (2010). Helpful t ips for disease prevention in physical a ctivity. PELINKS4U: Promoting Active and Healthy Lifesty les Retrieved from: http://www.pelinks4u.org/articles/conatser0210.htm Cotten, D.J., & Wolohan, J.T. (2010). Law for recreation and sport managers (5 th ed.) Dubuque, IA: Kendall Hunt Cox D. F. (1967). Risk taking and information handling in consumer behavior Boston, MA: The Harvard University Graduate School of Business Administration. Cox, D.F., & Rich, S.U. (1964). Perceived risk and consumer decision making. Journal of Marketing Resea rch 1 32 39.

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115 Curtis, N. (2008 January ). NATA offers recommendations for prevention of communicable diseases. Athletic Therapy Today 45 48. Eickhoff Shemek, J., Herbert, D., & Connaughton D.P (2009). Risk Management for Health/Fitness Professionals: Legal Issues and Strategies Baltimore, MD: Lippincott. ESPN. (2007). E x football player sues Iona over staph infection Retrieved October 10, 2010 from: http://sports.espn.go.com/ncf/news/ story?id=3091076 ESPN. (2009 a April 30). Swine flu affects sports world Retrieved May 10, 2010 from: http://sports.espn.go.com/espn/news/story?id=4113351 ESPN. (2009 b June 16). Jurevi ci us sues Browns over staph infection Retrieved October 8, 2010 from: http://sports.espn.go.com/nfl/news/story?id=4290038 Fawcett, P. A. (1998). S port club risk m anagement. NIRSA Journal 22 (3), 18 19. Fischhoff, B., Slovic, P., Lichtenstein, S., Read, S., & Combs, B. (1978). How safe is safe enough? A psychometric study of attitudes towards technological risks and benefits. Policy Sciences, 9 (2), 127 152. Fried, G. (2009). Fitness facilit y safety: how safe are fitness facilities for workers? Journal of Legal Aspects of Sport 35 (19), 35 65. Fuller, C., & Drawer, S. (2004). The a pplication of risk management in sport. Sports Medicine 34 (6), 349 356. Garner, B. A. (Ed.). (2000). Dictionary (7 th ed.). St. Paul, MN: West. Kates, B. (2010). H1N1a (Swine Flu) & Athletics. Retrieved May 10, 2010 from: http://www.sportssafety.org/articles/swine flu and athlet ics/ Klevens, R.M., Morrison, M.A., Nadle, J., Petit, S., Gershman, K. Ray, S., Harrison, L.H., Lynfield, R., Dumyati, G., Townes, J., Craig, A.S., Zell, E.R., Foshiem, G.E., McDowgal, L.K., Carey, R.B., & Fridkin, S.K. (2007). Invasive Methicillin R esist ant Staphylococcus A ureus infections in the United States. Journal of American Medical Association, 298(15), 1763 1771. Koester, M. (2010 January ). Update on H1N1 Virus How it is Affecting Schools. High School Today 28 29. Kravitz, R. (2011 February ). O ne option for keeping your indoor facility clean. SportsTurf 28 29. Lee, S., Farley, L.A., & Kwon, O. (2010). The effectiveness of risk management plans in recreationa l sport programs of division 1 A universities. Recreational Sports Journal 34 58 68.

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116 L epp, A., & Gibson, H. (2003). Tourist roles, perceived risk and international tourism. Annals of Tourism Research, 30 (3), 606 624. Menaker, B., & Connaughton, D.P. (2009). Reducing CA MRSA (staph) infections in sport and physical activity programs. Safety Notebook 14 (1), 1 4. Mowen, J.C. & Minor, M. (1998). Consumer Behavior (5 th ed.) New York: Prentice Hall Mull, R.F., Bayless, K.G., Ross, C M. & Jamieson, L. M. (1997). Recreational Sport Management (3 rd ed.) Champaign, IL: Human Kinetics. National A Official statement from the NATA on community acquired MRSA infections Retrieved January 28, 2010 from: http://www.nata.org/NR031605 n. (2007). Official statement from the NATA on communicable and infectious diseases in secondary school reports Retrieved January 28, 2010 from: http://www.nata.org/NR032107b National Collegiate Athletic Assoc iation. (2008). Skin infection prevention Retrieved January 30, 2010 from: http://www. ncaa.org/wps/portal/ncaahome?WCM_GLOBAL_CONTEXT=/ncaa/NC AA/Academics+and+Athletes/Personal+Welfare/Health+and+Safety/Skin+Infectio n+Prevention National Federation of State High School Associations. (2007). MRSA in sport participation position statement an d guidelines Retrieve d January 30, 2010 from: http://www.fcps.edu/supt/activities/atp/PDF docs/NFHSMRSAStatement.pdf Nessel, E. H. (2009 Winter ). Keeping the athlete healthy. American Medical Athletic Association Journal 9 10. NIRSA. (2010). National Intramural Recreation Sports Association National Center. Re trieved February 2, 2010 from: http://www. nirsa.org/AM/Template.cfm?Section=Welcome NIRSA. (2011). Recreational Sports Directory Campaign, IL: Human Kinetics. Popke, M. (2011, January 18). Wrestler's mother blames school for son's staph infection. Athletic Business Week Retrieved March 3, 2011 from http://athleticbusiness.com/editors/blog/default.aspx?id=378 Rogers, S. D. (2008). A practical approach to preventing CA MRSA infections in the athletic setti ng. Athletic Trai ning Today 13 (4), 37 41. Robinson D. W. ( 1992 ). A descriptive model of enduring risk recreation involvement. Journal of Leisure Research 24 (1), 52 63.

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117 Romano, R., Lu, D., & Holtom, P. (2006). Outbreak of community acquired Methicillin Resistant Staphyloc occus A ureus skin infections among a collegiate football team. Journal of Athletic Training 41 (2), 141 145. Ross, C.M., & Young, S.J. (1995). Understanding the OSHA bloodborne pathogens s tandard and its impact upon recreational s ports. Recreational Sports Journal 19( 2), 12 17. Ryan, K.A., Ifantides, C., Bucciarelli, C ., Saliba, H., & Tuli, S (2011). Are gymnasium equipment surfaces a source of staphylococ cal infections in the community? American Journal of Infection Control 39 148 150. Schneider, R.C., Stier, W.F., Kampf, S., Gaskins, B ., & Haines, S.G. (2008). Club sports legal liability practices at NIRSA i nstitutions. Recreational Sports Journal 32 62 76. Seigri st, M., Keller, K., & Kiers, H.A. L. (2005). A new look at the psychometric paradigm of perception of hazards. Risk Analysis, 25 (1), 211 222. Slovic, P., & Weber, E.U. (2002, April). Perception of risk posed by extreme events Paper presented at the Risk Management Strategies in an Uncertain World Conference, Palisades, NY. Spengler, J.O., Anderson, P.M., Connaughton, D.P., & Baker, T.A. (2009). Introduction to Sport Law Champaign, IL: Human Kinetics. Spengler, J.O., Connaughton, D.P., & Pittman, A.T. (2006). Risk Management in Sport and Recreation Champaign, IL: Human Kinetics. SPSS (20 08). SPSS for Windows, Rel. 17.0 Chicago IL : SPSS Stier, W.F., Schneider, R.C., Kampf, S., Haines, S., & Gaskins, B (2008). Selected risk management policies, practices, and procedures for intramural activities at NIRSA in stitutions. Recreational Spo rts Journal 32 28 44. Thomas, K. (2009, August 28). College seasons begin and swine flu threat enters locker room. The New York Times, D3. Thomas, J.R., Nelson, J.K. Silverman, S.J. (2005 ). Research methods in physical activity (5 th ed.). Champaign, IL : Human Kinetics. van der Pligt, J. (1998). Perceived risk and vulnerability as predictors of precautionary behavior. British Journal of Health Psychology 3 1 14. Weiner, B. (1986). An attributional theory of motivation and emotion New York: Springer Ve rlag.

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118 Young, S.J., Fields, S.K., & Powell, G.M. (2007). Risk perceptions versus legal realities in campus recreational sport p rograms. Recreational Sports Journal 31 131 145. Zeigler, T. (1997). Management of Bloodborne Infections in Sport: A Practical G uide for Sports Health Care Providers and Coaches Champaign, IL: Human Kinetics.

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119 BIOGRAPHICAL SKETCH Mary Waechter is from Camp Hill, Pennsylvania where she was born and raised. She received her Bachelor of Science in Kinesiology from the Pennsylvani a State University in 2009, and moved to Florida to further her education. After interning with the Penn State Club Sport Program for 2 years during her undergraduate career, she pursued a Master of Science degree in Sport Management at the University of F lorida and graduated in 2011. Although a Gator gradu ate, the Nittany Lions are still near and dear to her heart.