Communicable Diseases

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Communicable Diseases

• Stacey Montelongo
• ICEMS System
• 2005

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OSHA

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

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Ryan White Law

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

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29 CFR 1910.1030

• 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

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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)

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Modes of Transmission

• Piercing of the skin barrier
• Contamination of the mucous membranes

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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

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Modes of TransmissionContact 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

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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

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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

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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

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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

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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

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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.

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Communicable Disease

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

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

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

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Incubation Period

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

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Hepatitis A

• Mode of Transmission
• Fecal-oral routenot 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

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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)

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Hepatitis C Formerly (Non A Non B)

• Mode of Transmission
• IV drug use Sexual contact
• Before 1989blood transfusions
• Is a vaccine available?
• No effective vaccine as of yet
• Signs and Symptoms
• Liver fibrosiscirrhosis, jaudice, ascites,
  esophageal varices

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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

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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 3rd world countries

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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 diarrheaearlier signs
• Kaposis sarcoma, dementia, psychosis,
  encephalopathy, and peripheral neurological
  disordersall of these are late signs

Kaposis Sarcoma
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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

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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

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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

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Influenza (flu)

• Mode of Transmission
• Types A,B, C
• Crowds and droplets known to last for hours on
  surfaces
• autoinfection
• Is a vaccine available?
• Yesflu vaccine
• Signs and Symptoms
• Fever, chills, malaise, muscle aches, nasal
  secretions, and cough

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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

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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 childhoodmaternal protection for
  up to 5 months post partum
• Signs and Symptoms
• Severe cold, fever, conjunctivitis, photophobia,
  malaise, cough, congestion,rash
• Kopliks Spots-bluish-white spots w/ red halo on
  oral mucosa

Kopliks Spots
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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

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Brudzinkis sign-physical exam finding in which
flexion of neck causes flexion of the hips
Kernigs signs-inability to fully extend the
knees with hips flexed
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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

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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

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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,
  beltlinemay progress to rest of body without
  treatment

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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,

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Tuberculosis, pulmonary

• Mode of Transmission
• Airborne respiratory droplets (cough, sneeze,
  speaking, singing)
• 10-15 million Americans carry TB Infection1 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

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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

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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

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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)

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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

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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

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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

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Prevention and early recognition are the answer
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Prevention

• Engineering controls
• Work practice controls
• PPE
• Universal Precautions

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Engineering Controls

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

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Engineering Controls (cont.)

• Examples
• Handwashing facilities
• Eye wash stations
• Sharps containers
• Biohazard labels

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Universal Precautions

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

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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

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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

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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

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Decontaminating and LaunderingClothing

• Uniforms should be washed and dried according to
  manufacturers recommendations

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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.

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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

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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.

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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

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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

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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

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Determining a true exposure

• Two questions will determine whether or not an
  exposure has occurred
• Is the fluid I came in contact with blood, semen,
  vaginal secretions, or any other body fluid
  containing blood?
• 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

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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

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Test time..

• Please go out of this presentation and click on
  the word document labeled Communicable
  Diseaseplease print off a hard copy, take the
  test and get to the Stacey by 12/15/05