Chapter 14: Bloodborne Pathogens

Bloodborne pathogens are transmitted through contact with blood or other bodily fluids Hepatitis, especially hepatitis B, human immunodeficiency virus are of serious concern Healthcare facility must be maintained as clean and sterile to prevent spread of disease and infection Must take precautions to minimize risk

Virus Reproduction Submicroscopic parasitic organism is dependent on nutrients of cell Strand of DNA or RNA dependent on metabolic and reproductive activity of cell Redirect cell activity to create more viruses

Bloodborne Pathogens Pathogenic organisms, present in human blood and other fluids (cerebrospinal fluid, semen, vaginal secretion and synovial fluid) that can potentially cause disease Most significant pathogens are HBV and HIV Others that exist are hepatitis A, D, and E

Hepatitis A –Causes inflammation of liver – does not lead to chronic liver disease –Transmitted by fecal or oral routes through close personal contact or contaminated food/water –May show no outward signs or symptoms –Adults may exhibit dark urine, light stools, fatigue, jaundice and fever

Hepatitis D (HDV) causes inflammation of the liver –Only in individuals that have HBV –Transmitted through contact with infected blood, needles or sexual contact Hepatitis E (HEV) –Causes inflammation of the liver –Rarely found in the United States –Transmitted through fecal and oral routes from contaminated water supplies

Hepatitis B Major cause of viral infection, resulting in swelling, soreness, loss of normal liver function New cases develop at a rate of 300,000/year Signs and symptoms –Flu-like symptoms like fatigue, weakness, nausea, abdominal pain, headache, fever, and possibly jaundice –Possible that individual will not exhibit signs and symptoms -- antigen always present in these individuals –Can be unknowingly transferred

–Chronic active hepatitis may occur because of problem with immune system, preventing complete destruction of virus infected liver cells –May test positive for antigen w/in 2-6 weeks of symptom development –85% recover within 6-8 weeks Prevention –Good personal hygiene and avoiding high risk activities –Proceed with caution as HBV can survive in blood and fluids, in dried blood and on contaminated surfaces for at least 1 week

Management –Vaccination against HBV should be provided by employer to those who may be exposed –Athletic trainers and allied health professionals should be vaccinated –Three dose vaccination over 6 months –After second does 87% of those receiving vaccine will be immune and 96% after the third dose –Post-exposure vaccination is also available after coming into contact with blood or fluids

Hepatitis C Both an acute and chronic form of liver disease caused by hepatitis C virus (HCV) Most common chronic bloodborne infection in United States Leading indication for liver transplant Signs & Symptoms –80% of those infected have no S&S –May be jaundice, have mild abdominal pain, loss of appetite, nausea, fatigue, muscle/joint pain, and/or dark urine

Prevention –Occasionally spread through sexual contact –Spread via contact with blood of infected person, sharing needles Management –No vaccine for preventing HCV –Multiple tests available to check for HCV Single positive = infection Single negative = does not necessarily mean no infection –Interferon and ribavirin are 2 drugs used in combination and appear to be the most effective for treatment –Drinking alcohol can make liver disease worse

Human Immunodeficiency Virus A retrovirus that combines with host cell Infects T 4 blood cells, B cells and monocytes (macrophages) Estimated that 11 out of 1000 adults are infected with HIV 5 million new HIV infections occurred world-wide in 2003

Symptoms and Signs –Transmitted by infected blood or other fluids –Fatigue, weight loss, muscle or joint pain, painful or swollen glands, night sweats and fever –Antibodies can be detected in blood tests within 1 year of exposure –May go for 8-10 years before signs and symptoms develop –Most that acquire HIV will develop acquired immunodeficiency syndrome (AIDS)

AIDS Collection of signs and symptoms that are recognized as the effects of an infection No protection against the simplest infection Positive test for HIV cannot predict when the individual will show symptoms of AIDS 50% develop AIDS w/in 10 years of HIV infection After contracting AIDS, people generally die w/in 2 years of symptoms developing

Management –No vaccine for HIV, no cure even though drug therapy is available –Research looking for preventive vaccine and effective treatment –Most effective drug combination Drug which blocks enzyme action responsible for new virus cell components Drug which blocks copying of viral agents, disabling synthesis of new viruses Third drug helps protect T cells, slowing progression of HIV

Prevention –Greatest risk is through intimate sexual contact with infected partner –Choose non-promiscuous sex partners and use condoms for vaginal or anal intercourse –Latex condom provides barrier against HBV and HIV –Condoms with reservoir tip reduces chance of ejaculate being released from sides –Water-based, greaseless spermicides or lubricants should be avoided –If condom breaks, vaginal spermicide should be used immediately –Condom should be carefully removed and discarded