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Healthcare Safety Infections & Diseases By Tony Soares.

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1 Healthcare Safety Infections & Diseases By Tony Soares

2 Safe Needle Law It is required that hospitals and other institutions, where exposure to blood is likely to occur, use equipment that is designed to limit as much as possible the likelihood of employee exposure to blood. In the case of needles and other sharp devices that could be contaminated (with blood, for example) an employer/employee committee is required to evaluate all the devices on the market that can be used for a particular task and choose a design that provides employees with the greatest protection from being stuck or cut. The BPS also requires employers to document the reason for the choice, based on safety, of one device over others. Many healthcare workers put their lives on the line every time they use a needle. Each year, 600,000 to 1 million workers are accidentally stuck by needles—nearly 3,000 daily. More than 1,000 contract serious bloodborne diseases, such as HIV, Hepatitis B and Hepatitis C. If stuck by a contaminated needle, workers must live through a terrifying six months or longer to find out they're infected. Although the federal Food and Drug Administration has approved more than 250 needles with such features as protective shields or mechanisms that automatically retract the needle after use, only 15 percent of hospitals use them.

3 Safe Needle Law In addition to saving lives, safer needles save money for healthcare facilities. Even where no infection occurs, it costs up to $3,000 to treat an injured healthcare worker with prophylactic drugs when they've had a high-risk exposure. One case of HIV can cost $100,000, and one case of hepatitis C - involving a liver transplant can cost as much as $750,000. (Hepatitis C is the leading cause of liver transplants.) California, the first state to pass safer needle legislation in 1998, estimates it will save more than $100 million a year by using safer needles. As more healthcare facilities use safer needles, manufacturers will be able to reduce the price due to increased production volume.

4 The Chain of Infection The Six Links in the Chain of Infection
Healthcare: it is important to understand two things about infection: 1. The various ways infection can be transmitted 2. The ways the infection chain can be broken The Six Links in the Chain of Infection 1. The Infectious Agent: Any disease-causing microorganism (pathogen) 2. The Reservoir Host: The organism in which the infectious microbes reside (Healthcare workers, Patients, Visitors, Animals, Rodents, Insects, Food, Equipment, Environment). Hosts that do not show any outward signs or symptoms of a disease but are still capable of transmitting the disease are known as carriers. 3. The Portal of Exit: The path by which the infectious organism (agent) leaves the reservoir – Respiratory Tract (coughing, sneezing, talking), Genitourinary Tract (foley catheters, sexually transmitted diseases), Gastrointestinal Tract ( feces, vomitus), Skin/Mucous Membranes (wounds, skin breaks), Transplacental, Blood (needle stick, blood transfusion).

5 The Chain of Infection Surveillance Prevention Control
4. The Route of Transmission: The method by which the infectious agent is transferred from the reservoir to a susceptible host. Direct Contact (person-to-person), Indirect Contact (contaminated surfaces), Airborne (suspended in air for extended periods, may be spread through ventilation systems), Vector-Borne (mechanical transfer of microbes on external appendages, e.g. Feet of flies), Harbored by Vector (e.g. yellow fever virus). 5. The Portal of Entry: The path by which an infectious agent enters the susceptible host - Respiratory Tract, Genitourinary Tract, Gastrointestinal Tract, Skin/Mucous Membranes, Transplacental (fetus – from mother), Parenteral (percutaneous - blood). 6. The Susceptible Host: A person or animal lacking effective resistance to a particular pathogenic agent INFECTION CONTROL Surveillance Prevention Control

6 The Chain of Infection The Six Ways to break the Chain of Infection
1. Pathogen Identification: Identification of infectious agent & the appropriate treatment. 2. Asepsis & Hygiene: Potential Hosts & carriers must practice asepsis & maintain proper personal hygiene. 3. Control Portals of Exit: Healthcare personnel must practice standard precautions (control body secretions & wash hands according to protocol). 4. Prevent a Route of Transmission: Prevent direct or indirect contact by: 1. Proper hand washing, Disinfection & sterilization techniques, Isolation of infected patients, Not working when contagious 5. Protect Portal of Entry: Healthcare professionals must make sure that ports of entry are not subject to pathogens. (nose, mouth, eyes, urinary tract, open wounds, etc.). 6. Recognition of Susceptible Host: Healthcare professionals must recognize & protect high-risk patients (cancer patients, AIDS patients, transplant patients, infant & elderly patients). Breaking the chain of infection is the responsibility of each healthcare professional.

7 Occupational Latex Allergies
Latex gloves have proved effective in preventing transmission of many infectious diseases. But for some workers, exposures to latex may result in allergic reactions. Reports of such reactions have increased in recent years, especially among healthcare workers. What is latex? The term "latex" refers to natural rubber latex, the product manufactured from a milky fluid derived from the rubber tree, Hevea brasiliensis. Several types of synthetic rubber are also referred to as "latex," but these do not release the proteins that cause allergic reactions. What is latex allergy? Latex allergy is a reaction to certain proteins in latex rubber. The amount of latex exposure needed to produce sensitization or an allergic reaction is unknown. Increasing the exposure to latex proteins increases the risk of developing allergic symptoms. In sensitized persons, symptoms usually begin within minutes of exposure; but they can occur hours later and can be quite varied. Mild reactions to latex involve skin redness, rash, hives, or itching. More severe reactions may involve respiratory symptoms such as runny nose, sneezing, itchy eyes, scratchy throat, and asthma (difficult breathing, coughing spells, and wheezing). Rarely, shock may occur; however, a life-threatening reaction is seldom the first sign of latex allergy. Who is at risk of developing latex allergy? Healthcare workers are at risk of developing latex allergy because they use latex gloves frequently. Workers with less glove use (such as housekeepers, hairdressers, and workers in industries that manufacture latex products) are also at risk.

8 Occupational Latex Allergies
Is skin contact the only type of latex exposure? No. Latex proteins become fastened to the lubricant powder used in some gloves. When workers change gloves, the protein/powder particles become airborne and can be inhaled. How is latex allergy treated? Detecting symptoms early, reducing exposure to latex, and obtaining medical advice are important to prevent long-term health effects. Once a worker becomes allergic to latex, special precautions are needed to prevent exposures. Certain medications may reduce the allergy symptoms; but complete latex avoidance, though quite difficult, is the most effective approach. Are there other types of reactions to latex besides latex allergy? Yes. The most common reaction to latex products is irritant contact dermatitis- the development of dry, itchy, irritated areas on the skin, usually the hands. This reaction is caused by irritation from wearing gloves and by exposure to the powders added to them. Irritant contact dermatitis is not a true allergy. Allergic contact dermatitis (sometimes called chemical sensitivity dermatitis) results from the chemicals added to latex during harvesting, processing, or manufacturing. These chemicals can cause a skin rash similar to that of poison ivy. Neither irritant contact dermatitis nor chemical sensitivity dermatitis is a true allergy.

9 Occupational Latex Allergies
How can I protect myself from latex allergy? 1. Use non-latex gloves for activities that are not likely to involve contact with infectious materials (food preparation, routine housekeeping, general maintenance, etc.). Appropriate barrier protection is necessary when handling infectious materials. If you choose latex gloves, use powder-free gloves with reduced protein content. 2. Use appropriate work practices to reduce the chance of reactions to latex. When wearing latex gloves, do not use oil-based hand creams or lotions (which can cause glove deterioration). After removing latex gloves, wash hands with a mild soap and dry thoroughly. Practice good housekeeping: frequently clean areas and equipment contaminated with latex-containing dust. 3. Learn to recognize the symptoms of latex allergy: skin rash; hives; flushing; itching; nasal, eye, or sinus symptoms; asthma; and (rarely) shock. What if I think I have latex allergy? Consult your physician and follow precautions: 1. Avoid contact with latex gloves and products. Avoid areas where you might inhale the powder from latex gloves worn by other workers. 2. Tell your employer and healthcare providers (physicians, nurses, dentists, etc.) that you have latex allergy. 3. Wear a medical alert bracelet.

10 MRO - Multi-Resistant Organisms
Healthcare employees can be exposed to infections from multidrug resistant organisms such as "staph" and "strep" bacteria at work. Employees can become infected or become carriers and spread infection to other healthcare workers and patients. Multidrug-resistant organisms are bacteria and other microorganisms that have developed resistance to anti-microbial drugs. Common examples include:  MRSA - Methicillin/oxacillin-resistant Staphylococcus aureus  VRE Vancomycin-resistant enterococci  ESBLs - Extended-spectrum beta-lactamases (which are resistant to cephalosporins and monobactams)  PRSP - Penicillin-resistant Streptococcus pneumoniae The CDC recommends Standard Precautions for the care of all patients, regardless of their diagnosis or presumed infection status. Standard Precautions includes the use of: hand washing, and appropriate Personal Protective Equipment such as gloves, gowns, masks, whenever touching or exposure to patients' body fluids is anticipated.

11 Tuberculosis TB causes more deaths than any other infectious disease in the world! Radiology staff can be exposed to patients with TB during x-ray procedures. Exposure may also occur from treatment rooms not properly ventilated after being occupied with a patient who has TB. What is tuberculosis? TB is caused by the bacteria Mycobacterium tuberculosis. It is a disease that is spread from person to person through the air. TB usually affects the lungs. The germs are put into the air when a person with TB of the lungs coughs, sneezes, laughs, or sings. TB can also affect other parts of the body, such as the brain, the kidneys, or the spine. What are the symptoms of TB? General symptoms may include feeling weak or sick, weight loss, fever, and/or night sweats. Symptoms of TB of the lungs may include cough, chest pain, and/or coughing up blood. Other symptoms depend on the particular part of the body that is affected. How is TB disease treated? TB disease can almost always be cured with medicine. The mortality rate of untreated congenital TB is 50%. An yearly TB skin test is required of most healthcare workers. A purified protein derivative (PPD) solution that contains TB antigens, but not live bacteria, is used to provoke a hypersensitivity skin reaction (a red raised bump) in those who may have been infected by TB.

12 Legionnaires’ Disease
Hydro-therapy Whirlpool What is Legionnaires' disease? It is a type of pneumonia that is caused by Legionella. This bacterial disease is commonly associated with water-based aerosols and often a result of poorly maintained air conditioning cooling towers and potable water systems. It can occur where water, contaminated with the legionella organism, is aerosolized and then breathed in by healthcare workers or patients. It is not contagious but is of environmental origin. Consequently, only those who are directly exposed to the contaminated aerosolized water source can get the disease. What are the symptoms of Legionnaires' disease? Legionnaires' disease develops within 2 to 10 days after exposure to legionellae. Initial symptoms may include loss of energy, headache, nausea, aching muscles, high fever (often exceeding 104°F), and chest pains. Later, many bodily systems as well as the mind may be affected. The disease eventually will cause death if the body’s high fever and antibodies cannot defeat it. Victims who survive may suffer permanent physical or mental impairment. How is Legionnaires' disease treated? Erythromycin and Azithromycin, antibiotics, have been effective, especially when cases are detected early. Fatality rate is approximately 15%.

13 Smallpox Smallpox is a serious, contagious, and sometimes fatal infectious disease, named for the thousands of puss-filled blisters that show up in the middle of the disease. About 30 percent of those who get the disease die, the blisters permanently scar the majority of survivors, and some are left blind.  The variola virus that emerged in human populations thousands of years ago causes smallpox. Except for laboratory stockpiles, the variola virus has been eliminated. There is no specific treatment for smallpox disease, and the only prevention is vaccination. Smallpox outbreaks have occurred from time to time for thousands of years, but the disease is now eradicated after a successful worldwide vaccination program. The last case of smallpox in the United States was in 1949. Is smallpox something that I need to worry about? There is no naturally occurring smallpox in the world today. The concern is that other nations may have obtained stocks of this virus and may be prepared to use it against the United States in a terrorist action. How is smallpox spread? Smallpox is spread by respiratory droplets with close contact and occasionally can be airborne. Smallpox can also be transmitted through direct contact with secretions or scabs. When are smallpox patients infectious? They are infectious at about the time the rash appears or just shortly before then. The rash first appears on the extremities, face and forearms. Though there is an earlier prodromal illness of several days, which mimics influenza, the patient is not contagious during this time.

14 Smallpox What distinguishes the rash of smallpox from the rash of chickenpox? The rash of varicella (chickenpox )generally begins on the trunk and the lesions progress in a crop-like fashion (that is new lesions appear as old lesions beginning to crust over and dry). Smallpox is a more synchronous rash in that all of the lesions are at the same stage of development on the same part of the body. While chickenpox begins on the trunk, the rash of smallpox usually begins on the face and extremities. The prodromal illness of chickenpox is fairly mild in comparison with smallpox, which mimics severe influenza-like illness. If I see a case that I suspect may be smallpox, what should I do? Immediately place a mask on the patient and confine the patient to an isolation room, preferably one with negative pressure. Healthcare workers should wear an N-95 mask or a Powered Air-Purifying Respirator (PAPR) and use appropriate contact precautions. The hospital’s infection control and infectious disease staff should be notified immediately. Your local health department should be notified immediately. Can I get smallpox from the smallpox vaccine? No, the smallpox vaccine is vaccinia virus, a relative of cowpox virus, and is closely related to smallpox. There is no risk of actually developing smallpox from the vaccine. Smallpox Chickenpox

15 Tony Soares, Safety Director Compensation Solutions, Inc.
Thank You! Be Safe! Tony Soares, Safety Director Compensation Solutions, Inc. Tel: Ext. 192

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