Preventing Disease Transmission

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Preventing Disease Transmission
New Hampshire Wing Civil Air PatrolUnited States
Air Force Auxiliary Paul E Mondoux Lt Col, CAP,
NREMTI, NHEMT/IC
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Bloodborne Pathogens

• This training module is intended as means for the
  completion of the training requirement and serves
  as an update for Civil Air Patrol Members.
• It is designed to provide a basic understanding
  of the risks associated with exposure to
  bloodborne pathogens.

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General Information

• Blood
• Human blood, human blood components and products
  made from human blood.  
• Bloodborne Pathogens
• Pathogenic microorganisms that are present in
  human blood and can cause disease in humans.
  These pathogens include, but are not limited to,
  Hepatitis B Virus (HBV), Hepatitis C Virus (HCV),
  and the Human Immunodeficiency Virus (HIV).

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General Information Continued

• Contamination
• The presence or reasonably anticipated presence
  of blood or other potentially infectious
  materials on an item or surface.
• Contaminated sharps
• Any contaminated object that can penetrate the
  skin including, but not limited to needles,
  scalpels, broken glass, broken capillary tubes,
  and plasticware.

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General Information Continued

• Decontamination
• The use of physical or chemical means to remove,
  inactivate, or destroy bloodborne pathogens on a
  surface or item. As a result, the surface or item
  is no longer capable of transmitting infectious
  particles and the surface is rendered safe for
  handling, use or disposal.
• Engineering Controls
• Mechanical devices that isolate or remove the
  bloodborne pathogens hazard from the workplace.
  Includes sharps containers, shielding, or
  self-sheathing needles.

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General Information Continued

• Other potentially infectious materials (OPIM)
• Means human body fluids, including saliva in
  dental procedures any unfixed tissue or organ
  from a human cell, tissue and organ cultures
  HIV- and HBV- containing culture medium or other
  solutions blood, organs, or other tissues from
  experimental animals infected with HIV or HBV.

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General Information Continued

• Parenteral
• Piercing of mucous membranes or the skin through
  such events as needlesticks, human bites, cuts,
  and abrasions.
• Seroconversion
• The development of detectable specific antibodies
  in the serum as a result of infection or
  immunization.

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General Information Continued

•  Standard Precautions
• An approach to infection control. According to
  the concept of Standard Precautions, all human
  blood and all human body fluids are treated as if
  infectious

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More About Bloodborne Pathogens

• Bloodborne Pathogens include
• Human Immunodeficiency Virus (HIV)
• Hepatitis Viruses
• Meningitis
• Tuberculosis
• As well as agents that cause...
• Malaria
• Relapsing Fever
• Viral Hemorrhagic Fever
• Syphilis

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Transmission of Agents

• Parenteral exposure - The pathogen is introduced
  directly into the body through a break in the
  skin, needlestick, or through a cut with a
  contaminated instrument or glass.
• Mucous membrane exposure - Exposure through
  contact of a mucous membrane in the eye, nose or
  mouth.
• Transmission of HIV and Hepatitis B can also
  occur through sexual contact, and from mother to
  infant through perinatal transmission, or breast
  milk.

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How Diseases Spread

• For a disease to transmitted., all four of the
  following conditions must be met
• A pathogen is present
• There is enough of the pathogen to cause disease
• A person is susceptible to the pathogen
• The pathogen passes through the correct entry
  site

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ContaminationHow Pathogens enter the body
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Diseases that cause concern

• Some diseases, such as the common cold, are
  passed on from one person to another and cause
  some discomfort but are usually short lived and
  rarely cause serious problems.
• Other diseases cause more severe problems and
  these are the ones we have to be concerned with.

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Human Immunodeficiency Virus

• The Human Immunodeficiency Virus causes Acquired
  Immunodeficiency Syndrome (AIDS), a severe life
  threatening illness which suppresses the bodys
  immune system and can impede neurological
  function.
• Symptoms of HIV infection may range from an
  asymptomatic state to severe immunodeficiency,
  opportunistic infections, neoplasms, and other
  conditions. There is no known cure or
  immunization which can prevent seroconversion to
  the virus.

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HIV Transmission

• HIV can be transmitted parenterally and through
  mucous membrane exposures that include
• Sticks with contaminated needles.
• Mucous membrane or non-intact skin exposure to
  infected blood, tissue, blood products and body
  fluids.
• Also, transmission can occur as a result of
• Exchange of infected body fluids during sex.
• Transfusion with infected blood or blood
  products.
• Passage of the virus from mother to infant.

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HIV is not transmitted by casual contact
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HBV

• Hepatitis B Virus (HBV) causes an infection of
  the liver. Symptoms of HBV infection may range
  from none to flu-like symptoms, jaundice and
  serious illness. If symptoms do occur, they may
  not be evident until 2 to 6 months after the
  person is infected.
• Infection with HBV can lead to chronic diseases
  later in life, such as cirrhosis and liver cancer
  and death.

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HBV is much more infectious that HIV

• Hepatitis B is transmitted in many of the same
  ways as HIV through a break in the skin and
  mucous membrane exposures to infected body
  fluids. It can also be spread through sexual
  intercourse.
• The best way to prevent HBV infection is
• Follow Standard Precautions for Body Substance
  Isolation (BSI). (Formerly called Universal
  Precautions)

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Key points to remember

• HBV can survive for up to 7 days outside of the
  host in dried blood.
• 140,000 - 320,000 people become infected with HBV
  every year in the United States.
• Between 6 and 10 of these people become
  carriers.
• 1.25 million people in the United States are
  chronic carriers.

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Hepatitis C (HCV)

• Hepatitis C (HCV) is a virus that, like HBV,
  causes an infection of the liver - potentially
  leading to liver disease, liver cancer, cirrhosis
  and possibly death.

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Symptoms

• Symptoms of HCV are like those of HBV.
• 80 of infections are totally asymptomatic until
  the time of irreversible liver damage.
• It is most commonly transmitted through
  needlestick exposures.

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Center for Disease Control and Prevention
estimates

• 135,000 to 180,000 new cases of HCV each year in
  the United States.
• At least 85 of persons with HCV infection become
  chronically infected.
• 4 million chronic carriers in U.S.
• Approximately 20 of persons who develop a
  chronic infection will develop primary liver
  cancer or cirrhosis.
• 8,000 - 10,000 deaths/year from HCV infections.

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key points

• No vaccination can protect you against Hepatitis
  C.
• Post - exposure treatments are not highly
  effective.
• Standard Precautions are your only protection.

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Herpes

• There are several viruses that can cause herpes
  infections. These viruses cause infection of the
  skin and mucous membranes. They are very easily
  passed on by direct contact.
• The herpes virus stays inactive until stimulated.
  
• Early stages may cause
• Headaches
• Core throat
• Swelling of the lymph glands
• General ill feeling
• Sometimes swelling occurs around the lips and
  mouth commonly called cold sores

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Herpes

• In more serious cases sores to appear around the
  ,Face, Neck and Shoulders
• Another form causes sores in the genital area.
  Antibiotics do not work against the viruses so
  the infection runs its course.
• Herpes becomes inactive and then can flare up
  again.

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Tuberculosis (TB)

• Tuberculosis (TB) is a disease caused by a
  bacterium, Mycobacterium tuberculosis. TB is
  spread primarily by airborne droplets that are
  coughed up from the lungs of persons with active
  disease. Once inhaled, the organisms establish
  infection in the lungs and then disseminate
  throughout the body before the immune response
  brings the primary infection under control. Most
  infected persons have no symptoms of disease.
  Following infection a small percentage of
  individuals will develop symptoms. About ten
  percent of persons who become infected will
  develop an active case of TB during their
  lifetime.

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Risk of (TB)

• The risk of developing active disease is
  enhanced by a number of factors that include
• HIV infection
• Steroids
• underlying medical conditions such as
• diabetes mellitus
• sudden weight loss
• For decades the prevalence of tuberculosis in
  the United States was declining. However, since
  the mid-1980's, the number of tuberculosis cases
  has increased. This increase appears to be fueled
  by the development of the epidemic of HIV
  infection in this country.

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Few Facts

• The risk increases when an uninfected person
  shares space with an infected person for long
  periods of time.
• Employee populations at risk include clinical
  personnel, personnel with outpatient contact and
  laboratory personnel who handle the organism.

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TB Screening

• TB Screening
• Everyone who is at risk of occupational exposure
  to tuberculosis must be screened on an annual
  basis. Persons working in high risk areas should
  be screened twice yearly.
• Screening is done from the local Health
  Department

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Meningitis

• Meningitis is a sever infection of the covering
  of the brain and the spinal cord. It can be
  caused by either viruses or bacteria. It is
  easily transmitted by direct, indirect and
  airborne means

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Meningitis continued

• You can get the viral form from contaminated
  food and water. Bacterial meningitis can be
  transmitted through the mucus in the nose and
  mouth
• The germs might be passed if an effect person
  coughs near your face or if you come in direct
  contact with the persons mucus. You could get
  bacterial meningitis from unprotected rescue
  breathing

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Universal Precautions Body Substance Isolation
(BSI)

• The Center for Disease Control and Prevention
  (CDC) recommend that all patient care workers and
  first responders use universal precautions, Based
  on the assumption that all patients/individuals
  are potential carriers of Bloodborne Pathogens.
• The concept is known as Body Substance Isolation
  (BSI)

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Protection

• Protection takes many forms
• Follow BSI Precautions (also known as Universal
  Precautions) and policies
• Use Personal Protective Equipment Risk is
  controlled with barrier protection such as
  gloves, safety glasses and masks.

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Standard Precautions

• Standard BSI Precautions are minimum infection
  control procedures that are intended to prevent
  the transmission of HIV, hepatitis and other
  bloodborne pathogens in healthcare settings.
• They are based on the principle that all blood,
  body fluids and patients are potentially
  infectious.

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Standard precautions include

• The routine use of protective equipment to
  prevent skin and mucous membrane exposure when
  contact with blood or body fluids is anticipated.
  
• Anyone with lesions or weeping dermatitis should
  refrain from all direct patient care contact and
  from handling patient-care equipment until the
  condition resolves.

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Protective eye wear

• Protective eye wear, or a face shield, is to be
  worn for procedures that may result in the
  generation of droplets, splashing of blood or
  other body fluids, or the generation of bone
  chips

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Gloves

• Wear gloves whenever touching blood and body
  fluids, or when handling items or surfaces soiled
  with blood or body fluids.

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Handwashing

• Hands and other skin surfaces must be washed
  immediately, and thoroughly, if contaminated with
  blood or other body fluids.
• Hands must also be washed immediately after
  gloves are removed.

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Handwashing

• Use soap and water
• Lather 10 - 15 seconds
• Wash all surfaces
• Rinse with warm water
• Towel dry

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Scene Response

• Scene Safety is a most important consideration to
  a first responder.
• Safety considerations need to include your own
  safety and the safety of all the others present
  at the scene.
• An injured responder cannot help those in need,
  and becomes someone who needs help. Close
  attention to safety and BSI can prevent
  unnecessary illness, injuries and even death.

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Emergency Procedures

• For splashes and other potential exposures
• Wash area with water for at least 15 minutes.
• Report exposure to Officer in charge.

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Cleanup of a Blood Spill

• Don personal protective equipment Remove any
  sharp objects carefully
• Circle spill with disinfectant
• Saturate with disinfectant Let stand 15 - 20
  minutes
• Clean and Dispose of Paper Towel
• Re-spray area with disinfectant

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Disposal of waste

• Disposal of waste is an important part of an
  over-all safety strategy.
• The procedures for the disposal of infectious
  wastes are prescribed and regulated by the
  Department of Health and Human Services.
  Regulated waste includes cultures and stocks,
  pathological wastes, human blood, blood products
  and body fluid waste, animal wastes, isolations
  wastes.

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Hazardous waste

• Use RED Hazardous waste Bags for all
  contaminated items that are clearly identifiable
  and distinguishable from general waste.
• ALL disposable gloves are discarded as infectious
  wastes in Hazardous waste bags. These bags are
  RED with the BIOHAZRD symbol on the bag.

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Disposal

• All articles containing Blood or body fluids are
  to be disposed of in the RED Hazardous waste Bags
  
• These bags can be brought to a local Hospital for
  disposal.
• The bags are not to be placed in the normal trash
  containers

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Review

• The Bloodborne Pathogens are microorganisms
  present in blood and other body fluids that can
  cause diseases with significant consequences.
  These diseases include AIDS, Hepatitis B and
  Hepatitis C.

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protect yourself

• To protect yourself from exposure to these
  agents
• Follow all Standard Precautions.
• Treat all human blood, tissue, and body fluids as
  infected.

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If you sustain sharp instrument injury

• Discontinue on contact immediately.
• Wash area with soap and water immediately.
• Report exposure to Officer in Command
  immediately.