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Infection Control Training Communicable Diseases and Protecting Yourself Against Pathogens

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Title: Infection Control Training Communicable Diseases and Protecting Yourself Against Pathogens


1
Infection Control TrainingCommunicable Diseases
and Protecting Yourself Against Pathogens
  • Principles of Disease Transmission
  • Updated November 2004

2
Infectious 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.

3
Organisms
  • 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.

4
How 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

5
How our body fights infection continued
fever
  • Antibodies

6
Some 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

7
Some 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)

8
Spread 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

9
Spread 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

10
Once 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

11
Mode 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)

12
Type 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

13
Type 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.

14
Duration of Contact
  • The longer you are exposed to an infectious
    agent, the more likely you are to get the disease

15
Host 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

16
Host 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.

17
Host 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,

18
Amount 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

19
Amount 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

20
Virulence 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

21
Whether 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.

22
Immediate 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

23
Communicable Diseases
24
Common Childhood Diseases
  • Rubeola (Measles)
  • Rubella (German Measles)
  • Mumps (Infectious parotitis)
  • Chickenpox (Varicella)
  • -Shingles (Herpes Zoster) an adult disease
  • Fifth Disease (Parvovirus B)

25
Some 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)

26
Other Communicable Diseases
  • Meningitis
  • HIV-AIDS
  • Hepatitis A,B,C,D,E
  • Respiratory Infections
  • Staph Aureus
  • Conjuctivitis
  • Acute diarrhea
  • Scabies
  • Syphilis

27
Uncommon 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

28
Bacterial 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.

29
Meningoccal 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

30
Signs 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

31
Bacterial 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

32
Bacterial 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)

33
MRSAMethicillin 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

34
MRSA 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.

35
MRSA 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.

36
Prevention 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.

37
Prevention 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!

38
VRE - 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.

39
VRE - 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)

40
Preventing 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.

41
HIV 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

42
HIV
  • 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

43
HIV 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

44
HIV continued
  • Signs and Symptoms
  • -Fever and night sweats
  • -Swollen lymph glands
  • -Weight loss
  • -Chronic diarrhea

45
HIV 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

46
HIV 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

47
Hepatitis 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)

48
Hepatitis B
  • Incidence of healthcare worker occupational
    exposure is declining due to the introduction of
    needleless systems and vaccination

49
Hepatitis 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)

50
Hepatitis 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

51
Hepatitis 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

52
Hepatitis B Vaccine
  • To be offered to ALL employees with exposure risk
    within 10 days of assignment and before they can
    ride in the ambulance

53
Hepatitis 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

54
Hepatitis B vaccine continued
  • Called Recombivax
  • Attenuated (weakened) Virus
  • -Cant cause disease
  • Not made from blood or blood products

55
Hepatitis 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

56
Hepatitis 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

57
Hepatitis 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

58
Comparing 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

59
Hepatitis C continued
  • Mode of Transmission
  • -Blood
  • -Sexual transmission
  • -Needle stick injury
  • There is no data to support that HCV survives
    outside the body

60
Hepatitis C continued
  • Incubation period
  • -2 weeks to 6 months
  • Prevention
  • -PPE
  • -Hand washing
  • -Proper sharps disposal
  • There is no vaccine against HCV

61
Hepatitis C continued
  • Criteria for exposure
  • -Needle stick injury
  • -Splash to mucous membranes
  • -Non intact skin contact

62
Hepatitis C continued
  • Post Exposure
  • -There is no vaccine or medicine to offer.
    75 of infected people have no symptoms

63
Hepatitis 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)

64
Tuberculosis
  • TB is transmitted through air
  • Signs and symptoms
  • -Weakness
  • -Weight loss
  • -Loss of appetite
  • -Fever
  • -Night sweats
  • -Lethargy

65
Tuberculosis 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

66
SARS
  • Severe Acute Respiratory Syndrome
  • Started in Asia and spread to Toronto and then
    the U.S.
  • No vaccine available as of yet

67
Signs 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

68
Precautions
  • 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

69
How 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

70
Use 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

71
GLOVES
  • 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

72
Needle 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

73
Needle 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.

74
Notes 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

75
Disposal 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)

76
IF 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

77
CMT 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
78
CMT 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.
79
CMT Exposure Paperwork
Left Hand
10/25/04 1400
Joe Doe 2
10/25/04 1400
Big H Hospital
Dr. Feelgood
10/25/04
80
Questions?
81
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