Title: Infection Control Training Communicable Diseases and Protecting Yourself Against Pathogens
1Infection Control TrainingCommunicable Diseases
and Protecting Yourself Against Pathogens
- Principles of Disease Transmission
- Updated November 2004
2Infectious vs. Communicable
- Infectious disease results from invasion of a
host by a disease producing organism. - -Viruses, bacteria, fungus, parasites.
- Communicable ( contagious)
disease can be transmitted from one person to
another.
3Organisms
- Viruses and bacteria ( plus fungus and parasites)
are responsible for the spread of disease - VIRUS- cannot multiply outside of a living
cell. Can live on an environmental surface. - BACTERIA- can multiply outside of the body.
Can live on an environmental surface. - Non-disposable BVMs and other
respiratory equipment have been implicated in the
spread of disease. Proper cleaning of non
disposable equipment is essential.
4How our body fights infection
- White blood cells begin infiltrating area where
microorganisms are present - White blood cells surround and destroy each
microorganism, then eventually die - The accumulation of dead white blood cells,
microorganisms and necrotic tissue forms pus
5How our body fights infection continued
fever
6Some Definitions
- Exposure- Coming into contact with, but not
necessarily becoming infected with, the disease
causing agent - Communicable period- Time when the host can
spread the disease to others. - Incubation period- Time from entry of the
infectious agent into the hosts body until the
time when the host develops symptoms of the
disease
7Some Definitions continued
- Carrier- Person who is infected by the infectious
agent and can spread the disease to others but
show no symptoms of the disease ( and may not
know that he/she has the infectious agent and can
spread it)
8Spread of communicable disease
- Infectious (communicable) agents from a SOURCE to
a HOST - -Source is a person, insect, object,
substance which is a carrier or is contaminated
with the infectious agent. - -Host is a susceptible person
9Spread continued
- Exposure does not necessarily mean disease
- -just because a person is exposed to and/or
infected with the infectious agent,s/he does not
necessarily develop the disease - After a host is infected by an infectious
microorganism, the organism can multiply until
symptoms of the disease occur
10Once exposed, what determines if you will become
infected?
- Mode of transmission
- Type and duration of contact
- Host susceptibility/ resistance
- Amount of microorganism present (dosage)
- Virulence of the organism
- Whether or not precautions were taken
11Mode of Transmission
- Bloodborne
- -Spread by direct contact with blood or OPIM
(Other Potentially Infectious Material) of an
infected person - (HCV, HIV, HBV, ect)
- Airborne
- -Spread by droplet of the disease producing
organism being expelled into the air by cough,
sneeze, suctioning, or by direct contact with
infected body secretions - (TB, meningitis, mumps, measles, rubella,
chickenpox)
12Type of Contact/Mode of Entry
- Infectious agents are spread in various ways,
some through direct or indirect contact, some
through droplet, and some are vector borne - For example, with HIV, getting stuck with a blood
contaminated needle is more likely to cause
infection than splashing a drop of blood into the
mouth
13Type of contact-Mode of entry cont.
- Contact
- Direct- touch the patient
- Indirect- touch the contaminated object
- Droplet- expelled by sneezing, coughing,
- coughing and suctioning
- Vector-borne- Bite from a mosquito, flea,
- spider, tick, ect.
- Contact may require several steps (e.g. Touch a
surface containing a rhinovirus (common cold)
then touch your hand to your mouth, nose or eye.
14Duration of Contact
- The longer you are exposed to an infectious
agent, the more likely you are to get the disease
15Host Susceptibility
- Resistance- Ones ability to fight off infection
following exposure to the infectious agent - -The healthier you are, the more resistant you
are to infection - Immunity
- Active- your body has developed antibodies to
the infectious agent through vaccination or
infection - Passive- passive immunity to certain diseases
can be conveyed to an exposed individual by
injection of antibodies (called immune globulin) - e.g Tetanus or Hepatitis B immune globulin
16Host Susceptibility Cont
- CDC on Immunization of Health Care Workers
- Maintenance of immunity is, therefore, an
essential part of prevention and infection
control programs for health care workers.
17Host Susceptibility cont
- ERE Recommended Immunizations
- Strongly Recommended
- Hepatitis B, MMR, Td, Influenza, Varicella
(if no prior immunity to chickenpox) - Not recommended for routine vaccination of
EREs - Hepatitis A, TB, Rabies, Pertussis,
18Amount of Microorganism Present
- The more organisms you are exposed to, the more
apt you are to become infected - Amount of concentration of organisms in the fluid
(known as viral or bacterial load) - e.g. E.Coli- It takes about 6-8 live E.Coli
bacteria in a hamburger to make a small child
sick it would take around 150 to make a healthy
adult sick
19Amount of Microorganisms present cont
- 1 HBV virus in 1 ml of blood may be all that is
needed to spread HBVHIV may need 100,000 viral
particles to cause infection - HIV- Some people with HIV have a higher
concentration of virus per drop of blood than
others - This is referred to as viral load
20Virulence of the Organism
- Strength of Ability of Organism to cause
infection - HIV is a wimpy virus HBV is considered a strong
one - -CDC data shows that only about 1 in 750
parenteral (injection) exposures with
contaminated sharps results in HIV transmission - -HIV and TB organisms die when exposed to
light and air ( dont forget that they are still
contagious due to dose) - -HBV has been shown to survive on
environmental surfaces for up to 10 days and
still be infectious
21Whether or not Precautions were Taken
- Use of barriers (personal protective equipment)
and regular hand washing greatly reduce the risk
of exposure to infectious agents.The introduction
of needless systems and safety devices on
catheters greatly reduces risk.
22Immediate Exposure Measures
- Skin and Parenteral
- - When running water is not available, use
alcohol based waterless hand cleaner - - At the hospital, wash thoroughly with
regular soap and water (Never use bleach on skin) - Mucous membrane
- -Flush with copious amounts of water or saline
solution immediately -
-
23Communicable Diseases
24Common Childhood Diseases
- Rubeola (Measles)
- Rubella (German Measles)
- Mumps (Infectious parotitis)
- Chickenpox (Varicella)
- -Shingles (Herpes Zoster) an adult disease
- Fifth Disease (Parvovirus B)
25Some Contraindications
- If you are pregnant, have chronic hemolytic
anemia, or are immunocompromised you should not
take calls involving fever and rash without
taking protective measures for yourself (gloves
and masks)
26Other Communicable Diseases
- Meningitis
- HIV-AIDS
- Hepatitis A,B,C,D,E
- Respiratory Infections
- Staph Aureus
- Conjuctivitis
- Acute diarrhea
- Scabies
- Syphilis
27Uncommon Communicable Diseases
- OSHAs bloodborne pathogens standard also
mentions inclusion of the following rarer
bloodborne diseases - Malaria
- Babesiosis
- Brucellosis
- Leptospirosis
- Arboviral Infections
- Relapsing Fever
- Viral Hemorrhagic Fever
- Creutzfeldt-Jakob Disease
28Bacterial Meningitis
- Incubation period
- -2-10 days
- - Have only 24 hours for prophylaxis
- Criteria for exposure
- - mouth to mouth
- Suctioning or intubation with spraying of
secretions into - eyes, nose, and/or mouth
- -Just because you helped lift the stretcher
doesnt mean you were not exposed - -You need to wear a mask and gloves with
patients with known or suspected meningitis.
29Meningoccal and Haemophilus Meningitis
- Meningitis Forms
- Bacterial- communicable
- (Meningococcal, Haemophilus, Pneumococcal)
- Viral-infectious-problem for the patient but
not for the healthcare provider - Gram stain identifies bacterial vs. viral in
15 minutes - Mode of Transmission
- - Direct contact with respiratory secretions
- -Not airborne
-
30Signs and symptoms of Meningitis
- Sudden onset with fever
- Intense headache
- Nausea and vomiting
- Stiff neck- cant touch chin to neck
- Petechial rash with pink macules
- Photophobia
- Flu Like Symptoms
31Bacterial Meningitis
- Post exposure follow-up
- -Counseling
- -Rifampin or Cipro
- -Birth Control Pills will be ineffective
while on - Rifampin
- -Urine will be orange for two days
-
32Bacterial Meningitis cont
- Work Restrictions- none if placed on antibiotics
- Confirmed or suspected disease
- -Immediately remove from work until disease is
resolved and cultures are negative (24 hours
after start of antibiotics)
33MRSAMethicillin Resistant Staph Aureus
- Caused by over usage of antibiotics creating a
resistant form staph aureus - Staph bacteria and MRSA can be found on skin,
wounds, rectally, and in nares. - Approximately 25-30 of the population is
colonized in the nose with staph bacteria. - Infection occurs when the staph bacteria cause
disease in the person. - Not any more virulent than normal Staph Aureus
34MRSA cont.
- Staph bacteria can cause skin infections,bone
infections,pneumonia, severe life threatening
blood infections, and others. - MRSA infections usually develop in hospitalized
patients or those in long term care facilities. - Those at risk are elderly, immunocompromised
patients, recent surgery, those receiving broad
spectrum antibiotics, those who have been
hospitalized for prolonged periods, those in burn
units, and patients spending close time with
those with MRSA.
35MRSA cont
- MRSA infections are found in open wounds, bed
sores, nares, urinary or IV catheters, and rarely
in the lungs. - MRSA is spread through close contact with
infected people. MRSA is almost always spread by
direct physical contact, and not through the air.
Spread may also occur with indirect contact by
touching contaminated surfaces. (i.e..
Towels,sheets,wound dressings) - MRSA can survive for days on environmental
surfaces.
36Prevention of MRSA
- PRACTICE GOOD HYGIENE
- GLOVES,GLOVES,GLOVES
- Remove gloves before touching noncontaminated
items and environmental surfaces such as door
handles to hospitals. - Wash hands thoroughly after contact with ALL
patients. - Keep cuts and abrasions clean.
- Avoid contact with patients wounds or material
contaminated with wounds. - Clean all areas in ambulance with lysol and any
non disposable items used on the patient.
37Prevention of MRSA cont
- Wear a mask and eye protection for procedures
that may generate splashes of blood, body fluids,
secretions and excretions. MRSA pneumonia is rare
and if a patient has it , they or the facility
should notify you so you can don appropriate PPE. - Wear a gown to protect clothing if patient care
activities generate soiling as above. MRSA can
survive on clothing for days and you can transmit
it to your next patient!
38VRE - Vancomycin-resistant Enterococci
- Caused by over usage of antibiotics creating a
resistant form Enterococci - Enterococci is commonly found in the intestinal
tract - Infection occurs when the Enterococci bacteria
cause disease in the person.
39VRE - Vancomycin-resistant Enterococci
- VRE infections usually develop in hospitalized
patients or those in long term care facilities. - Those at risk are elderly, immunocompromised
patients, recent surgery, those receiving broad
spectrum antibiotics, those who have been
hospitalized for prolonged periods, those in burn
units, and patients spending close time with
those with VRE. - VRE is spread through close contact with infected
people. VRE is almost always spread by direct
physical contact, and not through the air. Spread
may also occur with indirect contact by touching
contaminated surfaces. (i.e.. Towels,sheets,wound
dressings)
40Preventing The Spread of VRE
- PRACTICE GOOD HYGIENE
- GLOVES,GLOVES,GLOVES
- Remove gloves before touching noncontaminated
items and environmental surfaces such as door
handles to hospitals. - Wash hands thoroughly after contact with ALL
patients. - Keep cuts and abrasions clean.
- Avoid contact with patients wounds or material
contaminated with wounds. - Clean all areas in ambulance with lysol and any
non disposable items used on the patient.
41HIV and AIDS
- HIV- Human Immunodeficiency Virus
- AIDS-Acquired Immune Deficiency Syndrome
- HIV positive
- -Infected with HIV
- -May or may not develop AIDS
- AIDS
- -Disease caused by HIV
- -Many people are HIV positive but do not have
AIDS
42HIV
- Mode of Transmission
- -Blood
- -Sexual Transmission
- -Needle stick injury (80 in healthcare
workers) - -Mother to infant during childbirth
- Incubation
- -2 to 10 years after testing positive for virus
43HIV continued
- Communicability
- -Depends on viral load
- -Wimpy virus
- Window period
- -Exposure to HIV tested in blood
- -1 to 2 weeks
- -If a person tests negative after the window
period, s/he will not develop infection
44HIV continued
- Signs and Symptoms
- -Fever and night sweats
- -Swollen lymph glands
- -Weight loss
- -Chronic diarrhea
45HIV continued
- Prevention
- -Use of PPE-Task specific use
- -No vaccine available
- Criteria for exposure
- -Percutaneous injection through the skin
- -Mucous membranes
- -Non-intact skin exposure
46HIV continued
- Work restriction
- -Exposed-No work restriction needed
- -HIV positive no symptoms
- Reinforce recommended precautions and injury
prevention techniques during procedures that
involve trauma to tissues/mucous membranes - -AIDS- as above unless medically
- contraindicated
47Hepatitis A
- Mode of Transmission
- -NOT blood borne
- -Fecal to oral route
- -Must eat or drink contaminated food/water
- Prevention
- -Good hand washing
- -Use of gloves
- -Vaccine (not recommended for EMS)
48Hepatitis B
- Incidence of healthcare worker occupational
exposure is declining due to the introduction of
needleless systems and vaccination
49Hepatitis B continued
- Mode of Transmission
- -Blood (primary)
- -Sexual transmission
- -Needle stick injury
- With needle contaminated with HBV-chance
6-30 in 100 - sticks
- With needle contaminated with HIV-chance
of 3-5 in 100 sticks - HBV Survives for up to 10 days in dried blood on
environmental surfaces - (Fluids that are still under study
CSF,Pleural,Pericardial,Synovial,Emesis)
50Hepatitis B continued
- Prevention
- -Use of PPE
- -Vaccine
- -Good hand washing and disinfecting of surfaces
- Criteria for exposure
- -Needle stick
- -Splash or splatter to mucous membranes
- -Non intact skin contact
51Hepatitis B continued
- Signs and Symptoms
- -Phase One
- Flu like symptoms, headache, malaise
- Most communicable in this stage
- -Phase Two
- Yellowing of eyes and skin
- Dark colored urine
- Clay colored stool
- -50 of people infected with HBV never go into
phase two
52Hepatitis B Vaccine
- To be offered to ALL employees with exposure risk
within 10 days of assignment and before they can
ride in the ambulance
53Hepatitis B Vaccine
- Vaccine contraindications
- -Allergy to yeast
- -HBV vaccine is safe if pregnant or
breastfeeding - No boosters indicated
- -Immunologic memory- must have a positive titer
54Hepatitis B vaccine continued
- Called Recombivax
- Attenuated (weakened) Virus
- -Cant cause disease
- Not made from blood or blood products
55Hepatitis B Vaccine continued
- CDC recommends that a titer be done in 1 to 2
months following third dose - -If positive titer no further action, if
negative repeat series - of three
- No cost to the employee
- Healthcare providers statement
- Informed consentInformed denial
- -Declination statement
- 10 of people do not respond to vaccine
56Hepatitis B continued
- Post Exposure follow up
- -Documentation
- -Positive immunity- no action needed
- -Vaccinated but unknown immunity
- If patient positive or unknown
- 1.blood testing of employee(start
immediately-dont - wait for patient results)
- 2.If no positive titer HBIG x 1 and
revaccinate
57Hepatitis C
- Less risk of transmission but more risk for long
term consequences for healthcare workers than HBV - 3-10 risk in needle stick injury
- Most common chronic blood borne infectious
disease in U.S - -nearly 4 million infected
- Leading cause of liver transplantation
58Comparing HBV to HCV
- HBV HCV
- 300,000 annually 150,000
annually - Chronic 1.2 million Chronic 3.5
million - 10 will go on to 85 will go
on to develop liver - develop liver cancer cancer or liver
failure - or liver failure
59Hepatitis C continued
- Mode of Transmission
- -Blood
- -Sexual transmission
- -Needle stick injury
- There is no data to support that HCV survives
outside the body
60Hepatitis C continued
- Incubation period
- -2 weeks to 6 months
- Prevention
- -PPE
- -Hand washing
- -Proper sharps disposal
- There is no vaccine against HCV
61Hepatitis C continued
- Criteria for exposure
- -Needle stick injury
- -Splash to mucous membranes
- -Non intact skin contact
62Hepatitis C continued
- Post Exposure
- -There is no vaccine or medicine to offer.
75 of infected people have no symptoms
63Hepatitis C continued
- Signs and Symptoms
- -Same as HBV
- -90 of initial infections are asymptomatic
or mild - -50-80 will develop chronic infection
- -About ½ of those chronically infected will
develop liver disease (cirrhosis or cancer)
64Tuberculosis
- TB is transmitted through air
- Signs and symptoms
- -Weakness
- -Weight loss
- -Loss of appetite
- -Fever
- -Night sweats
- -Lethargy
65Tuberculosis continued
- How TB is spread
- -Airborne droplets
- -Direct indoor contact
- -Saliva
- TB can survive outside the body for several hours
- Prevention is to wear proper PPE including a HEPA
mask - TB testing is called a Mantoux test. If positive
a person needs to get a chest x-ray every 6
months - Once you have a positive Mantoux test you will
test positive for the rest of your life - TB is treated with antibiotic therapy
66SARS
- Severe Acute Respiratory Syndrome
- Started in Asia and spread to Toronto and then
the U.S. - No vaccine available as of yet
67Signs and Symptoms
- Fever greater than 100.4 F
- Chills, headache,malaise, and mild respiratory
symptoms - After 2-7 days, patients may develop a dry, non
productive cough, SOB, rash and muscle stiffness. - Can lead to respiratory arrest
68Precautions
- SARS is spread through the air and contact.
- A N95 mask and gloves must be worn to prevent
transmission. - SARS cases often look like the flu
- Ask about travel history to Asia or Toronto
- For more information go to the Centers for
Disease and Control website
69How to Protect Yourself
- Standard precautions- workers should treat all
blood and body fluids as infectious when exposed.
In addition use respiratory protocols when
suspect/know a patient may be infected with
airborne pathogens
70Use of Personal Protective Equipment
- PPE is required to be worn by all personnel when
there is a potential exposure to blood and/or
body fluids. - -If it is wet and not yours it may be
infectious WEAR GLOVES - -If it could splash in your face USE EYE SHIELD
AND MASK - -If it is airborne MASK THE PATIENT WITH A
SURGICAL MASK AND YOURSELF WITH AN N95 RESPIRATOR - -If it could splash on your clothes WEAR A GOWN
71GLOVES
- Make sure gloves
- -Fit well
- -Do not have any holes or cracks
- Change gloves between handling different
patients - Please remove gloves before driving an ambulance
- ALWAYS use alcohol hand cleaner and wash hands
with soap and water after glove removal
72Needle and Sharp Disposal
- NEVER recap, ,bend, or break needles or
manipulate them in any way (recapping of
narcotics is allowed using one-handed technique) - Place all needles and other sharp objects in
puncture resistant container - -Remove sharp containers when ¾ full
73Needle and Sharp Disposal
- CMT would rather you lose the IV line than stick
yourself or someone else with a contaminated
needle. Your safety and the safety of those
around you takes priority.
74Notes About Needle Sticks
- A hollow needle carries greater risk than a solid
one - The larger the bore the greater the risk
- The more visible blood the greater the risk
- The deeper the puncture the greater the risk
- Gloves greatly reduce expose risk even if stuck
through the material
75Disposal of contaminated items
- Anything that is visibly dripping with or flaking
off of blood needs to be disposed of into a red
biohazard bag. These bags are located in the
ambulance and can be dropped off at receiving
facility. All other wastes may be thrown away
into regular garbage. (NO SHARPS IN REGULAR
GARBAGE)
76IF CONTACT OCCURS
- Wash affected area immediately
- Report the incident
- -Report to ICO
- -Fill out Exposure paperwork
- Notify medical staff at receiving facility so you
can be examined for appropriate
evaluation,treatment and counseling - Follow CMT exposure Control Plan
77CMT Exposure Paperwork
Doe
John
911 EMS Rd Brady, NY 99999
10/25/04 1336
CMT 944
5-88888888
4000
Little H Hospital
Big H Hospital
Hamster Flu type B
78CMT Exposure Paperwork
I was starting an IV when the exposure occurred
IV Needle
Angiocath
Blood
I was disposing of the IV when I accidentally
slipped and stabbed myself in the hand with the
sharp.
79CMT Exposure Paperwork
Left Hand
10/25/04 1400
Joe Doe 2
10/25/04 1400
Big H Hospital
Dr. Feelgood
10/25/04
80Questions?
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