Communicable Diseases Stacey Montelongo ICEMS System 2005

OSHA OSHA published the final regulation on occupational exposure to bloodborne pathogens on December 6, 1991

Ryan White Law Enacted in 1990 Required medical facilities to inform emergency responders when they may have been exposed to a communicable disease

29 CFR Originally issued December 6, 1991 Places responsibility for protection of personnel onto the employer: –Mandatory in-service training –Work practice controls/engineering controls –Incident reporting/treatment protocols –Hepatitis B vaccinations

What are Bloodborne Pathogens? Disease-causing microorganisms that may be present in human blood. They may be transmitted with any exposure to blood or OPIM (Other Potentially Infectious Material)

Modes of Transmission Piercing of the skin barrier Contamination of the mucous membranes

Transmission Blood borne pathogens are transmitted when blood or OPIM come in contact with mucous membranes, non-intact skin, or by handling or touching contaminated items or surfaces Also occurs by injection under the skin by puncture wounds or cuts from contaminated sharps

Modes of Transmission Contact Transmission Direct contact – straight from person to person, exchange of blood or body fluids ex: blood splash into the eyes Indirect contact – person to object; infection can spread by touching surfaces that have been contaminated with the bacteria or virus ex: Loading stretcher into ambulance and not removing contaminated gloves before touching steering wheel of ambulance touching a contaminated needle

Airborne Transmission Results from inhaling aerosolized particles from micro-organisms that are present in the air Small droplet nuclei from sneezing or coughing Dust particles from contaminated clothes, bedding or floor surfaces

Airborne Transmission Poses a risk in EMS/Fire workplace A key to risk reduction lies in the recognition of signs and symptoms and using the appropriate barrier device, i.e. mask for personal protection Ex: Tuberculosis, meningitis, and childhood diseases such as measles, mumps and chickenpox

The Immune System Helps resist disease-causing bacteria, viruses, and other germs or infections 4 components of the immune system: –Physical barriers –Chemical barriers –Inflammatory response –Immune response

Physical barriers Intact skin –Prevents foreign substances from entering the body –First line of defense against most diseases Mucous membranes –Secrete a fluid call mucous that entraps small foreign particles, so they may be swept away and destroyed

Inflammatory Response Tissue reaction to an injury or disease-causing agent Response may include pain, swelling, itching, redness, heat, loss of function, or any combination of symptoms Commonly referred to as an “infected” site

Infectious Disease An infectious disease is a disease that results from invasion of a host by a disease-producing organisms, such as bacteria, viruses, fungi, or parasites.

Communicable Disease A communicable (contagious) disease is a disease that can be transmitted from one person to another.

Not all infectious diseases are communicable. For example, salmonella is a highly infectious disease that is not contagious.

Pathogen Pathogens are microorganisms capable of producing disease, such as bacteria and viruses.

Incubation Period Incubation period is the time between contact with a disease organism and the appearance of the first symptoms.

Hepatitis A Mode of Transmission –Fecal-oral route—not washing your hands (may last on hands as long as four hours) –Sexual contact Is a vaccine available? –Yes (Havrix & Vaqta) Signs and Symptoms –Usually asymptomatic –Usually found only during liver function studies

Hepatitis B Mode of Transmission –Blood, semen, vaginal fluids, & saliva –Transfusion, dialysis, needle sticks, tattoos, IV drug sharing, razors, sexual contact Is a vaccine available? –Yes (Recombivax HB & Engerix B) Signs and Symptoms –Joint pain and mild rash (60-80% are asymptomatic)

Hepatitis C Formerly (Non A & Non B) Mode of Transmission –IV drug use & Sexual contact –Before 1989—blood transfusions Is a vaccine available? –No effective vaccine as of yet Signs and Symptoms –Liver fibrosis—cirrhosis, jaudice, ascites, esophageal varices

Hepatitis D (Formerly Delta Hepatitis) Mode of Transmission –Coexists with HBV Is a vaccine available? –Same as HBV Signs and Symptoms –Not much is known at this time, is rare but mortality rate is high

Hepatitis E Mode of Transmission –Fecal-Oral route –Seems to be associated with contaminated drinking water Is a vaccine available? –None yet Signs and Symptoms –Very rare in the US –More common in 3 rd world countries

AIDS / HIV Mode of Transmission –Blood, blood products & body fluids –Semen, vaginal secretions, breast milk –Tears, amniotic fluid, urine, saliva, & bronchial secretions Is a vaccine available? –No, there are currently only treatments for the symptoms Signs and Symptoms –Fatigue, fever, sore throat, enlarged spleen, rash, and diarrhea—earlier signs –Kaposi’s sarcoma, dementia, psychosis, encephalopathy, and peripheral neurological disorders—all of these are late signs Kaposi’s Sarcoma

Chickenpox Mode of Transmission –Inhalation of airborne droplets, direct contact w/ weeping lesions, tainted linen Is a vaccine available? –Varivax or childhood immunity from actual disease Signs and Symptoms –Respiratory symptoms, malaise, low-grade fever, and rash

Herpes Simplex (Cold Sores) Mode of Transmission –Saliva Is a vaccine available? –no Signs and Symptoms –Cold sore or fever blister in the oral cavity or on the genitals

Varicella Zoster (Shingles) Mode of Transmission –Similar to chicken pox –More common in adults Is a vaccine available? –No, varivax may be helpful Signs and Symptoms –Painful condition that causes skin lesions along the pathway of a peripheral nerve and dermatome bands

Influenza (flu) Mode of Transmission –Types A,B, C –Crowds and droplets known to last for hours on surfaces –autoinfection Is a vaccine available? –Yes—flu vaccine Signs and Symptoms –Fever, chills, malaise, muscle aches, nasal secretions, and cough

Lice: Head, Body, Pubic Mode of Transmission –Direct or close contact Is a vaccine available? –No, but there is shampoo and other treatments Signs and Symptoms Itching particularly behind the ears, and lower occiput region (head) Itching under arms, pubs for body

Measles Mode of Transmission –Inhalation of infected droplets and direct contact Is a vaccine available? –No vaccine, immunity for life is common if contracted in childhood—maternal protection for up to 5 months post partum Signs and Symptoms – Severe cold, fever, conjunctivitis, photophobia, malaise, cough, congestion,rash –Koplik’s Spots-bluish-white spots w/ red halo on oral mucosa Koplik’s Spots

Meningitis (meningococcal) Mode of Transmission –Respiratory droplets –Peak is in midwinter months w/ low temperature and humidity Is a vaccine available? –Yes for bacterial –No for viral Signs and Symptoms –Fever, chills, headache, nuchal rigidity w/ flexion, arthralgia, lethargy, malaise, vomiting, diarrhea, altered LOC and seizures

Brudzinki’s sign-physical exam finding in which flexion of neck causes flexion of the hips Kernig’s signs-inability to fully extend the knees with hips flexed

Mononucleosis Mode of Transmission –Caused by the Epstein-Barr Virus –Exchange of saliva Is a vaccine available? –No vaccine Signs and Symptoms –Fatigue, fever, severe sore throat, oral discharge, swollen glands

Mumps Mode of Transmission –Respiratory droplets & direct contact Is a vaccine available? –Yes-live virus vaccine Signs and Symptoms –Painful enlargement of the salivary glands, earache, difficulty in chewing/swallowing

Scabies Mode of Transmission –Direct or close contact Is a vaccine available? –No, treatments available Signs and Symptoms –Small red bumps/ bites between toes, fingers, beltline—may progress to rest of body without treatment

Whooping Cough (pertussis) Mode of Transmission –Respiratory droplets Is a vaccine available? –DTP Vaccine Signs and Symptoms –Coughing thick secretions, vomiting, increased ICP and intracerebral bleeding, pneumothorax,

Tuberculosis, pulmonary Mode of Transmission –Airborne respiratory droplets (cough, sneeze, speaking, & singing) –10-15 million Americans carry TB Infection—1 in 10 infected person progress to the active disease stage Is a vaccine available? –Isoniazid (INH), rifampin, pyrazinamide, ethambutol, streptomycin –PPD Test annually (or chest x-ray) Signs and Symptoms –Chills, fever, fatigue, productive or non- productive chronic cough and weight loss, night sweats

PPD Test Yearly Mantoux (Purified Protein Derivative) test required If first result is positive, then chest x-ray is mandated Medical attention necessary if chest x-ray positive for TB

Tuberculosis Bacterial infection that enters the body and establishes itself in the alveoli and spreads throughout the body A healthy immune system will prevent TB infection from becoming TB disease TB can cause permanent body damage and death

What is considered a TB exposure? Any exposure with an infected TB patient within an enclosed or confined space If an exposure has occurred you should be tested at baseline and again at 12 weeks The average treatment regimen may last up to 6, 12, or 18 months (depending upon patient presentation)

Multi-Drug Resistant TB Failure of a person to complete the regimen of drug therapy for TB disease Remaining bacteria becomes resistant to the medication If untreated TB and MDRTB have a 50% mortality rate Treatment may last for MDR-TB up to 18 months

Transmission of TB Only persons with active disease in their lungs or larynx can spread TB Persons who are being treated for TB with medication usually become non-infectious People who have TB infection, but do not have active disease are not infectious

Groups at High Risk for TB People who share breathing space with someone who has active TB disease Poor and homeless Persons from foreign countries Nursing home residents and employees Correctional facility personnel Autopsy workers Persons with HIV People with diabetes, cancer, or cardiovascular disease Incarcerated populations

Prevention and early recognition are the answer

Prevention Engineering controls Work practice controls PPE Universal Precautions

Engineering Controls Attempt to design safety into the tools and workspace organization Structural or mechanical devices the company provides

Engineering Controls (cont.) Examples: Handwashing facilities Eye wash stations Sharps containers Biohazard labels

Universal Precautions Concept that all blood and certain body fluids are to be treated as contaminated with blood borne pathogens.

Universal Precautions (cont.) Potentially infectious materials that require Universal Precautions: Blood Semen Vaginal secretions Cerebrospinal Fluid Synovial Fluid Pleural Fluid Any body fluid with visible blood Any unidentifiable body fluid Saliva from dental procedures

Infection Control Precautions – Universal and BSI –Gloves –Protective eyewear and facemask –Do not recap needles –Cleaning/infection control procedures –Wear gowns –Barrier devices –Contaminated clothes –Wash hands

Decontamination Disinfecting the equipment and vehicle is critical. After pt has been turned over to ED staff all contaminated items should be placed in red biohazard bag and disposed of properly. Interior of ambulance should be cleaned with approved antibacterial spray

Decontaminating and Laundering Clothing Uniforms should be washed and dried according to manufacturers recommendations

BLOOD/BODY FLUID SOILED LAUNDRY Linens and clothing contaminated with blood, excessive body fluids or other potentially infectious materials should be handled as little as possible, with minimum agitation, to prevent exposure to personnel and environment. The contaminated laundry should then be placed in the appropriate bag, so that it is easily identifiable, and given to the supervisor.

Handwashing Single most important means of preventing the spread of communicable diseases On-scene hand washing should be performed as soon as patient care is completed and gloves are removed Washing performed with waterless antimicrobial hand cleaner if water not available

HAND WASHING Hand washing is the single most effective way to prevent the spread of infections. –Wash your hands often and thoroughly, paying special attention to the area around and under your fingernails. –Wash Hands: When arriving to work. Before and after eating. After using the restroom. After removing gloves. Before leaving work at the end of the day. –Gloves are not a substitute for routine hand washing - rather an added protection.

Red Bagging Bloodied or contaminated dressings or bandages Soiled gloves Suction catheters or tubing ET tubes, O2 adjuncts Emesis basins *Double bag if there is danger of leakage*

Contaminated sharps Any contaminated object that can penetrate the skin, including, but not limited to, needles, scalpels, broken blood tubes All contaminated sharps must be placed in a sharps container

What is a potential Occupational Exposure Incident? Occurs if you are in a work situation and come in contact with blood or other potentially infectious materials

Determining a true exposure Two questions will determine whether or not an exposure has occurred: 1.Is the fluid I came in contact with blood, semen, vaginal secretions, or any other body fluid containing blood? 2.Did the fluid enter my body by a needlestick, non-intact skin, laceration from a contaminated object, through my eyes, nose, or mouth? Both answers must be yes in order for an exposure to have occurred

Reporting an Incident Report incident to your supervisor immediately Employee then taken to a physician depending on work hours (Occupational Health) during their hours or IMH after hours The supervisor and employee should complete the Communicable Disease Exposure Report

Test time….. Please go out of this presentation and click on the word document labeled: Communicable Disease—please print off a hard copy, take the test and get to the Stacey by 12/15/05