1. Airborne and other infectious disease

2. Tuberculosis Infectious disease cause by the bacterium, Mycobacterium tuberculosis. Spread by airborne droplets, “droplet nuclei,” which may be generated when a person with TB disease coughs, sneezes, speaks or sings.

3. Occurrence Nearly one-third of the world’s population is infected with TB, which kills almost 3 million people per year.

4. Symptoms of TB a bad cough that lasts 3 weeks or longer pain in the chest coughing up blood or sputum weakness or fatigue weight loss no appetite chills fever sweating at night

5. Why Is TB Increasing? Multiple contributing factors: Homelessness Intravenous drug use Overcrowding in institutional settings HIV infection Drug-resistant strains of TB Reduced TB control and treatment resources Immigration from high TB prevalence areas

6. Where Is TB Found in the Workplace? Healthcare Facilities Correctional Institutions Homeless Shelters Long-term Care Facilities for the Elderly Drug Treatment Centers

7. Feasible and Useful TB Abatement Methods Protocol for the early identification of individuals with active tuberculosis Medical surveillance Case management of infected employees Worker training and education Engineering controls

8. TB and Respiratory Protection The primary means to control occupational exposure is through the use of feasible engineering controls such as enclosures, confinement of operations or ventilation. When these controls are not feasible, or while they are being instituted, appropriate respirators shall be used. (i.e. N95 for responders and/or patient)

9. TB and Respiratory Protection (Continued) Respirator Program Elements Selection Medical evaluation Fit testing Use Maintenance and care Breathing air quality and use Training Program evaluation

10. TB and Respiratory Protection (Continued) NIOSH certifies three categories of non-powered air purifying respirators based on filtering efficiency. All three categories are acceptable for use against TB: Type 100 (99.97% efficient) Type 99 (99% efficient) Type 95 (95% efficient)

11. TB and Respiratory Protection (Continued) The 1994 CDC Guidelines specify the following criteria for respirators for exposure to TB: Ability to filter 1 micron in size in the unloaded state with a filter efficiency greater than 95%. Ability to be qualitatively or quantitatively fit tested in a reliable way to obtain face-seal leakage of less than 10%.

12. TB and Respiratory Protection (Continued) Employees must wear NIOSH certified respirators in the following circumstances: When workers enter rooms housing individuals with suspected or confirmed TB disease; When workers perform high hazard procedures on persons who have suspected or confirmed TB disease; and When emergency response employees or others must transport in a closed vehicle, an individual with suspected or confirmed TB disease.

13. Access to Employee Medical and Exposure Records A record concerning employee exposure to TB is an employee exposure within the meaning of 29 CFR 1910.1020. A record of TB skin test results and medical evaluations and treatments are employee medical records within the meaning of 29 CFR 1910.1020. These records shall be handled according to 29 CFR 1913.10 in order for the CSHO to determine compliance with 29 CFR 1910.1020.

14. Annual TB testing The TB skin test is performed by injecting a small amount of fluid (called tuberculin) into the skin in the lower part of the arm. A person given the tuberculin skin test must return within 48 to 72 hours to have a trained health care worker look for a reaction on the arm. The health care worker will look for a raised, hard area or swelling, and if present

15. Meningitis Meningitis is not common, but 3,000-4,000 people are affected every year. It can be very serious, and sometimes leads to death or permanent disability. Meningitis is an infection which causes inflammation of the lining around the brain and spinal cord.

16. Bacterial Meningitis Acute bacterial meningitis usually occurs when bacteria enter the bloodstream and migrate to the brain and spinal cord. Usual spread only with prolonged close contact

17. Viral Meningitis The most common causes of meningitis are viral infections. Most commonly spread through fecal contamination but can also be respiratory or though secretions. No specific treatments available. Effects persons with weak immune systems the most.

18. Signs of Meningitis Meningitis infection is characterized by a sudden onset of fever, headache, and stiff neck. Can also include: Nausea, vomiting, photophobia (sensitivity to light)and altered mental status Rash may or may not occur

19. Prevention of Meningitis Vaccinations (usually given during school age) helpfully for bacterial causes. Good hand hygiene and universal precautions. May include mask for the patient as some forms are transmitted through droplets from the nose or throat of an infected person.

20. Scabies Scabies is caused by an infestation of the skin by the human itch mite. Mites burrows into the upper layer of the skin where it lives and lays its eggs. Symptoms of scabies include intense itching and a pimple- like skin rash. Is usually is spread by direct, prolonged, skin-to-skin contact with a person who has scabies

21. Lice Lice are parasitic insects that can be found on people's heads, and bodies, including the pubic area. Human lice survive by feeding on human blood. Causes intense itching and visible with naked eye.

22. Prevention of Scabies and Lice Proper PPE Good cleaning of ambulance and washing linens and clothing in HOT water. Medical treatment varies

23. MRSA Methicillin-resistant Staphylococcus aureus (MRSA) is a bacteria that is resistant to many antibiotics. Most MRSA infections are skin infections but in medical facilities, MRSA causes life- threatening bloodstream infections, pneumonia and surgical site infections

24. MRSA Studies show that about one in three (33%) people carry staph in their nose, usually without any illness. Two in 100 people carry MRSA. Infections are currently on the decline, but is still a problem in healthcare setting. Many patients are exposed to MRSA in-hospital. Inter- facility transports can increase exposure to responders. This also increases the risk of pasting MSRA to other patients.

25. MRSA MRSA is usually spread by direct contact with an infected wound or from contaminated hands. Prevention includes good hand hygiene and proper use of PPE (gloves, gowns) to prevent the spread from one patient to another.

26. What to do if exposed Immediately wash effected area with soap and water. Notify supervisor Depending on type of exposure, seek medical treatment. Fill out workers compensation and incident form: Borough.safety.incident.reporting@matsugov.us

27. Post exposure evaluation Documentation of the route(s) of exposure. Identification and documentation of the source individual. Collection and testing of blood for HBV and HIV. Post-exposure prophylaxis and care. Counseling. Evaluation of reported illnesses.

28. Recordkeeping Medical Records Shall be maintained for duration of employment plus 30 years. Are kept CONFIDENTIAL, released only with the prior written consent of the individual. Training Records Shall be maintained for 3 years from the date of training.

29. In Summary Definition and scope. OSHA standards relating to Bloodborne Pathogens Personal Protective Equipment and its use Common bloodborne pathogens, airborne and other communicable disease. Exposure policy

30. References www.osha.gov www.cdc.gov Mat Su Borough Infection Control Policy (Oct1,2009)