1. Infectious Diseases Bill Edstrom, Epidemiologist Spokane Regional Health District

2. OSHA Bloodborne Pathogen Standard Designed to eliminate or minimize employees’ exposure to human blood and other potentially infectious materials (OPIM) in the workplace

3. Who is Covered? All employees who may reasonably expect to be exposed to blood and OPIM that may contain pathogens Anyone whose job involves handling or possibly being exposed to blood or blood products, or OPIM

4. Germs transmitted from one person to another through contact with blood or OPIM What are pathogens?

5. Caution! You do NOT need to directly contact someone carrying a bloodborne pathogen to be at risk for exposure! Risks also come from: Clinical specimens Biohazardous trash Blood- or body fluid- soaked laundry Needles or sharps

6. Annual Training Required: How diseases are transmitted and their symptoms Protective measures to prevent exposure Procedures to be followed if exposed

7. Exposure Control Plan OSHA requirement Must describe: –Exposure prevention –Engineering and work practice controls –Universal precautions –Personal protective equipment

8. Infectious Disease Transmission Stages of Disease Transmission: 1.Someone has an infection 2.The infectious pathogen leaves the Infected person’s body

9. Infectious Disease Transmission: 3.The infectious pathogen reaches another person and enters his or her body. Transmission: - Bloodborne - Airborne - Vector - Direct or indirect contact 4.The second person develops the infection.

10. Serious Bloodborne Pathogens Hepatitis B virus (HBV) Hepatitis C virus (HCV) Human immunodeficiency virus (HIV)

11. Hepatitis AHepatitis BHepatitis C Transmission Person-to-Person through fecal-oral Exposure to fecally contaminated food/water Blood/Semen OPIM All Body Fluids Contaminated needles Unclean tattoo/piercing tools Sharing contaminated items Signs & Symptoms Fever Fatigue N/V ABD pain Dark Urine Clay-colored stool Joint pain Loss of appetite Jaundice Flu-like symptoms Loss of Appetite Nausea Fatigue Muscle/joint aches Mild fever Stomach pain Jaundice MOST INFECTED PEOPLE DO NOT HAVE SYMPTOMS Fatigue Loss of appetite Nausea Anxiety Weight Loss Alcohol Intolerance Abdominal pain Loss of concentration Jaundice Severity Symptoms last < 2 months, can last up to 6 months Major liver damage Cirrhosis Liver CA Infection for decades No Cure – Prevention is critical Prevention Vaccine No Vaccine

12. Measures Measures you take to prevent HBV, HCV, and HIV also help prevent diseases caused by other bloodborne pathogens

13. Do Exposures Always Cause Infection? Whether pathogens are present in the source blood or body fluid The number of pathogens present The type of injury or exposure Your current health and immunization status NONO The risk of infection after an exposure depends on:

14. HIV and AIDS Acquired immunodeficiency syndrome (AIDS) is caused by the human immunodeficiency virus (HIV) There are almost one million HIV-positive people in the U.S.

15. HIV and AIDS AIDS damages cells essential for immune function People with AIDS are more susceptible to opportunistic infections The disease is eventually fatal

16. HIV and AIDS Transmission Through an infected person’s body fluids Signs & Symptoms One quarter of the HIV-infected persons in the U.S. do not know that they are infected. Loss of appetite Weight Loss Fever Skin rashes Swollen lymph nodes Diarrhea Night sweats Tiredness Inability to fight off infection Severity Life-long Prevention No Vaccine

17. Prevention

18. OSHA Standard Requires employers to use strategies to reduce occupational exposures: Engineering controls Work practice controls Personal protective equipment Universal precautions

19. Engineering Controls Needleless systems Eye wash stations Handwashing facilities Biohazard labels

20. Work Practice Controls Use of personal protective equipment (PPE) Handwashing Decontamination and sterilization of equipment and areas

21. Personal Protective Equipment Gloves Jumpsuits, aprons Eye shields, goggles Face masks, face shields Caps Booties

22. OSHA Standard Requires that your employer: –Provide PPE at no cost –Train you how to use equipment –Must clean, repair, or replace it as needed

23. For Unexpected Exposure If blood or OPIM splashes in your eyes or other mucous membranes, flush area with running water for 20 minutes Wash any exposed area well with soap, using an antibacterial soap –Gently treat any scabs and sores Report the exposure to your supervisor Save any potentially contaminated object for testing purposes Seek medical care

24. Employer Responsibilities Identify and document source of blood or OPIM Obtain consent and arrange to test the source blood Inform you of the test results Arrange for you to have your blood tested Arrange counseling and medical care for you as needed

25. Airborne Pathogens

26. Three Types of Airborne Pathogens Viral Bacterial Fungal

27. Airborne Pathogens Precautions for tuberculosis also lower the risk for other airborne pathogens –Meningitis –Influenza –Pneumonia –Tuberculosis

28. Airborne Pathogens Spread by inhaling the germ Coughing or sneezing tiny droplets of moisture into the air containing pathogens Pathogens can remain airborne for several hours

29. Airborne Transmission Depends On: –How contagious the infectious person is –Where the exposure occurs –How long the exposure lasts –How healthy you are at the time of the exposure

30. Tuberculosis Transmission Inhaling the TB pathogen after an infected person coughs or sneezes Signs & Symptoms Many people with TB infection have no symptoms! Weight loss Fever Night sweats Feeling weak Severity Skin test cannot distinguish between TB infection and TB disease Chest x-ray and phlegm sample needed to determine diagnosis PreventionEngineering Controls

31. H1N1 (“Swine Flu”)

32. H1N1 and EMS EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine respiratory droplet precautions while assessing all patients for suspected cases of swine- origin influenza. Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following: nasal congestion/ rhinorrhea, sore throat, or cough).

33. H1N1 and EMS If no acute febrile respiratory illness, proceed with normal EMS care. If symptoms of acute febrile respiratory illness, then assess all patients for travel to a geographic area with confirmed cases of swine- origin influenza within the last 7 days or close contact with someone with travel to these areas.

34. H1N1 and EMS If travel exposure, don appropriate PPE for suspected case of swine-origin influenza. If no travel exposure, place a standard surgical mask on the patient (if tolerated) and use appropriate PPE for cases of acute febrile respiratory illness without suspicion of swine-origin influenza (as described in PPE section).

35. Questions

36. Contact: Renee Anderson 509-232-8155 1-866-630-4033 andersr@inhs.org andersr@inhs.org Fax: 509-232-8168