Infection Control

1
Infection Control

• Basic Medical Asepsis
• Standard Precautions
• Isolation

• Gerontologic Conciderations
• Management Guidlines
• Critical Thinking

2
Learning Objectives

• Describe draw the six steps in the chain of
  infection
• Explain what is meant by the bodys natural
  defenses
• List and describe conditions that predispose
  client to infection
• Describe what is meant by the term nosocomial
  infection and disscuss one intervention that will
  help to prevent it
• List the major organisms responsible for
  nosocomial infections state the main purpose of
  handwashing
• Define the terms surgical asepsis and medical
  asepsis
• Describe the modes of transmission of HIV
• List precaution principles and explain their main
  purpose
• Describe the difference between the first and
  second tier of precautions

3
Chain of Infection

• For an infection to occur a chain of events must
  take place
• If the chain is broken through the implementation
  of infection control measures, the infection is
  less likely to occur

4
The chain of infection involves six steps

• Infection Agent (Microorganism) whether the
  microroganism is capable of producing an
  infection depends on a number of circumstances
• The virulence and number of organisms present
• The susceptibility of the host
• The existence of a portal of entry and the
  affinity of the host to harbor the microorganism

5
The chain of infection involves six steps-
Reservoir- Portal of Exit

• Reservoir must provide a favorable environment
  for growth and multiplication of the
  microorganism
• These reservoirs include the respiratory,
  gastrointestinal, reproductive and urinary tract
  blood
• Portal of Exit which allows the microorganism to
  move from the reservoir to the host . The portal
  of exit is directly associated with the
  reservoir. For example if the resrvoir is the
  respiratory tract, the portal of exit is through
  sneezing, coughing , breathing or talking. If the
  reservoir is blood, the portal of exit is through
  an open wound, needle puncture, or nonintact skin
  surface.

6
The chain of infection involves six steps- Mode
of Transmission

• Mode of Transmission There are five routes of
  transmission. The three primary routes are
  contact, droplet, and air borne. Too lesser
  routes are common vehicle(transmission by
  contaminated items such as food, water, devices,
  or equipment) and vector borne ( (transmitted by
  vectors such as mosquitoes fleas, rats)
• Contact transmission the most frequent source of
  nosocomial infection, transmitted via two modes
  direct and indirect contact

7
The chain of infection involves six steps Mode of
transmission

• Direct contact involves a direct transmission,
  body to body, and the physical transfer of
  microorganisms from one infected person to
  another e.g. Through sexual contact, kissing,
  touch
• It may occur when a health care worker touches a
  client, gives a client a bath, or performs other
  care activities
• Indirect transmission involves contact with a
  contaminated intermediate object such as a
  needle, instrument, or dressing
• This occurs when contaminated hands are not
  washed and gloves are not changed between clients

8
The chain of infection involves six steps

• Droplet transmission it occurs when droplets
  from the infected source person are projected a
  short distance to the hosts nasal mucosa , mouth
  or conjunctiva
• These droplets are not suspended in the air, so
  it is not considered airborne transmission

9
The chain of infection involves six steps- Mode
of transmission

• Air borne transmision occurs by dissemination
  either small particle nuclei of evaporated
  droplets or dust particles containing the
  infectious agent
• These agent can be dispersed widely by air
  currents as with Legionnaires disease may be
  inhaled by a susceptible host.
• These microorganisms include mycobacterium
  tuberculosis, rubeola and varicella viruses

10
The chain of infection involves six steps- Portal
of Entry

• The most effective barrier to transmission of
  microorganisms is an intact skin
• For an infection to occur it must have a means of
  entering the body
• A disruption in the integrity of the skin
  provides such a port of entry for microorganisms
• Microorganisms also enter the body the same way
  they leave the body. The respiratory system
  provides a vailable portal of both exit and entry

11
The chain of infection involves six steps-
Susceptible Host

• For an infection to occur a susceptible host is
  needed- someone who is at risk this includes
  the clients who are immunesuppressed, fatigue,
  stressed, anemic, not immunized, poorly
  nourished,
• Those who have underlying diseases
• Hospitalized client with wounds, catheters, IVs
  are at high risk for developing infections.
• Clients who require invasive procedures, blood
  specimen collections, surgery are in the high
  risk category

12
Barriers to infection

• An individuals ability to resist infection is
  determined
• by the status of the bodys defense mechanisms
  and
• by the persons general health

13
Factors that contribute to susceptibility to
infection include

• Altered nutritional status
• Fatigue disease
• Drugs
• Metabolic functions
• Age
• Clients with severe underlying diseases are more
  likely to develop nosocomial infections
• The body is protected against infection by
  immunities, by the inflammatory process, and by
  anatomic barriers that include the skin and
  mucous membranes

14
Barriers to infection

• When the integrity of the skin or mucous membrane
  is broken, both resident and transient flora or
  bacteria have a direct route to the internal
  tissue of the body
• To prvent the spread of infection the bodys
  internal defense mechanisms mobilize and begin
  clearing and repairing the damage site
• How quickly a wound heals depends on the degree
  of vascularization in the injured area, the
  location and cleanliness of the wound and the
  degree of tissue damage

15
Barriers to infection

• The second way the body resists infections is
  through immunity , antitoxins, and vaccines
• Natural immunity is inherited. Accquired immunity
  occurs after an individual has been exposed to a
  disease or infection or has been vaccinated

16
Barriers to infection

• The third way the body resist infection is
  through the inflammatory process
• Inflammation involves use of metabolic energy
• , increased blood flow to the inflamed areas, in
  many cases drainage of inflammatory debris to the
  external environment

17
Barriers to infection

• When an area becomes inflamed , cells at the site
  activate the plasmin system, the clotting system,
  the kinin system
• The result of the activation of these system is
  the release of histamine, which creates increase
  vascular permeability around the injured site and
  the release of chemotoxic agents, which summon
  phagocytes into the vascular and tissue spaces
• Phagocytes are W.B.C that combat and prevent
  infection by ingesting harmful microorganism

18
The bodys natural defences

• Almost any organism can be the cause of a
  significant nosocomial infection
• Some of variables that help determine which
  organism emerges as the pathogen are the
  virulence and number of organism
• The exposure and attachment of the organisms to a
  susceptible sitre and the duration of the
  clients exposure to infectious challenge

19
The bodys natural defences

• The following formula illustrates these variables
• Dose x virulence / host resistance infection
• Using this formula , the clients risk factors
  can be evaluated. the inherent health and
  immunologic status of the client are major
  factors in determining whether an infection occur
• Alterations in the skin barrier include any
  physiologic break in the integrity of the skin
• Intentional breaks are caused by the use of
  percutaneous catheter and needles and by surgical
  procedures. Unintentional causes of skin
  breakdown include the development of presure
  ulcers and traumatic wounds

20
Conditions predisposing to infection

• Certain conditions and invasive techniques
  predispose clients to infection because the
  integrity of the skin is broken or the illness
  itself establishes a climate favorable for the
  infection process to occur. Among the most common
  are surgical wounds, changes in the antibacterial
  immune system or alteration in the respiratory
  tract or genitourinary tract
• Implant such as heart valves, prosthetic grafts,
  or vascular grafts can lead to nosocomial
  septicemias
• The extensive use of IV therapy in clients has
  increased infections dramatically

21
Surgical wounds

• It has been documented that the longer a person
  is hospitalized prior to the surgical procedure
  the greater the risk of postsurgical infection
• Other factors that influence infection rates are
  duration of time in the operating room, time
  surgery is done (between midnight and 800 A.M is
  period of greatest risk), whether the client has
  postsurgical drains in place, or if the surgery
  enters a colonized or infected part of the body

22
Surgical wounds

• It is useful for the nurse to be aware of
  conditions that increase the risk of
  postoperative infection
• Risk reduction measures include preoperative
  showering with an antiseptic solution, the use of
  depilatory creams or the clipping of hair in lieu
  of shaving the surgical site and keeping the
  incision site covered with a dry sterile dressing

23
Surgical wounds

• a wet dressing, through osmosis and diffusion ,
  pulls organisms down into the wound from the
  surface. This is particularly important during
  the first 45 hours before the wound becomes
  watertight. Research shows that preoperative
  shaving results in disruption of normal flora on
  the surface of the skin

24
Antibacterial immune mechanism

• Three categories of abnormalities in
  antibacterial immune mehanism
• those affecting inflammatory responses,
• those affecting phagocytic functions and
• those affecting opsonins (humoral immunity)
• Anything that interfers with the migration of
  phagocytic cells to the area of contamination or
  with the physical contact of phagocytes and
  bacteria enhances the development of an infection
  e.g. Deficient blood supplies, the presence of
  ischemia or dead tissue, sutured material,
  foreign bodies, hematomas.

25
Antibacterial immune mechanism

• Vasopressor agents, radiation injury, uremia,
  severe nutritional deficiencies, and steroid
  therapy inhibit the synthesis of antibodies and
  other essential proteins
• Clients with severe thermal injuries and severe
  nutritional deficiencies have abnormalities
  involving the number of neutrophils collected at
  the site of an inflammatory response and defects
  of bacterial chemotoxic capacity

26
Antibacterial immune mechanism

• Client with Hodgkins disease have a specific
  defect in cell-mediated immunity
• Genetic inabilities to synthesize complement
  components or specific antibodies can cause
  abnormalities in opsonins. Burn client may have
  complement inactivated by a circulating substance
  released by the damaged tissue without
  complement, lysis of cells and destruction of
  bacteria cannot take place

27
Respiratory Tract

• Alteration that facilitat infection include
  endotracheal intubation, tracheostomy,
  bronchotracheal suctioning, stasis due to poor
  respiratory excursion for client on bed rest
• Catheter placed directly in the trachea can force
  pathogenic microorganisms into the respiratory
  system
• Catheter may damage the mucous lining of the
  respiratory tract

28
Genitourinary tract

• Instrumentation including catheterization of the
  bladder and complicated obstetric delivery after
  prolonges confinement in bed are two procedures
  that introduce potentially pathogenic bacteria
  into the genitourinary tract
• Acute urinary tract infection and pyelonephritis
  occur after the use of a catheter or cystoscope

29
Invasive devices

• Nosocomial septicemias occur as a result of
  significant alterations in normal host defences
• Primary infection caused by direct introduction
  of microorganisms into the bloodstream
• Secondary arising from an infection at another
  site such as the urinary tract
• The most common site for a nosocomial infection
  is the urinary tract
• The use of IV therapy greatly increases the risk
  of introducing harmful microorganisms

30
Invasive devices

• Septicemia may be caused by introduction of
  microorganisms from contaminated fluids, infected
  venipuncture sites, foci of septic
  thrombophlebitis as complication of using an
  indwelling IV catheter
• Infusion related sepsis is associated with
  contaminated infusion fluid which may be
  contaminated either during manufacturing
  (intrensic contamination) or during hospital use
  (extrensic contamination)

31
Venipuncture Sites

• The wounds made by a percutaneous stick at the
  venipuncture site may become colonized or
  infected
• This opening provides a reservoir for bacteria
  that could move along the catheter into the
  bloodstream
• Site infections can be reduced by several
  methods
• Selecting a catheter appropriate to the size of
  the vein
• Avoiding sites near joints
• The performance of proper site preparation
• Maintaining regimen for site care
• Changing the site every 48-72 hours as well as
  maintaining a closed system of therapy

32
Total Parenteral Nutrition Therapy

• Means acheiving an anabolic state in clients who
  would otherwise be unable to maintain normal
  nitrogen balance
• The hypertonic solution used with these client
  supports the growth of a wide variety of
  organisms especially fungus
• Peripheral inserted central catheter lines may
  not be changed for months
• Meticulous site care must be done at least every
  three days to preserve the site and aseptic
  technique used when changing solution, tubing,
  dressings and filters

33
Implanted prosthetic devices

• Include artificial cardiac valves, synthetic
  vascular grafts, orthopedic prosthetic joints,
  neurosurgical shunts, cerebro spinal fluid
  pressure monitoring devices
• If the infection is not controlled, removal and
  replacement of the prosthesis is indicated

34
Nosocomial infections

• Are infections that are acquired while the client
  is in the hospital
• Infections that were not present or incubating at
  the time of admission
• Handwashing is the single most importan
  intervention to prevent these infections

35
Nosocomial infections

• Three major organisms responsible for the
  majority of nosocomial infections
• Clostridium difficile
• Methicillin-resistant staphylococcus aureus
  (MRSA)
• Vancomycin-resistant enterococcus (VRE)

36
Nosocomial infections

• The most common organisms
• C.difficile is an anaerobic
• Gram-positive
• Spore-formig bacillus associated with infectious
  diarrhea(CDAD)
• 20-40 of hospitalized clients become colonized
  within a few days of entering the hospital,
  because it is often resistant to antimicrobial
  therapy, it is able to proliferate in the
  hospital setting

37
Nosocomial pneumonia

• Affecting 40 of all critically ill or
  immunosuppressed clients cause is gram-positive
  staphylococcus that is methicillin resistant
• Occurs in clients who have invasive procedures
  such as intravenous or respiratory therapy
  treatment or surgical procedures
• Health care personnel easily transmit MRSA to
  clients because it frequently colonizes skin
• Vancomycin, the drug choice to treat MRSA, is
  losing its effectiveness as a treatment

38
Vancomycin-resistant enterococcus (VRE)

• A gram positive bacterium
• Normally found in flora of the gastrintestinal
  tract
• When this bacterium mutated and became resistant
  to common antimicrobial therapies, it became a
  major cause of nosocomial infections in the
  hospital setting
• Zyvox is the drug choics for VRE and MRSA

39
Standard precaution

• 1985, universal precautions were instituted as a
  result of the human immunodeficiency virus (HIV)
• Blood and body fluid precautions were practiced
  on all clients regardless of their potential
  infectious state
• 1987, body substance isolation (BSI)was proposed
• The intent to isolate all moist and potentially
  infectious body
• substances (blood, feces, urine, sputum, saliva,
  wound drainage, other body fluids) from all the
  clients, regardless of their infections status,
  primarily through the use of gloves

40
Standard precaution

• 1994, the CDC drafted new guidlines , contain
  two tiers of precautions
• The first tier, standard precautions, blends the
  major features of universal precautions (blood
  and body fluids precautions)and body substance
  isolation into a single set of precautions to be
  used for the care of all clients in hospitals
  regardless of their diagnosis or presumed
  infection status

41
Standard precaution

• The new standard precautions apply to blood all
  body fluids, secretions, and excretions, whether
  or not they contain visible blood, non intact
  skin, and mucous membranes
• These precautions are designed to reduce the risk
  of transmission of both recognized and
  unrecognized sources of infection in hospitals

42
Standard precaution

• As a result of the new category of standard
  precautions, clients with diseases or conditions
  that previously required category-specific or
  disease specific precautions are now covered
  under this category and do not require additional
  precautions

43
Standard precaution

• The second tier, transmission-based precautions
  is designed only for the care of specified
  clients
• This tier reduces the disease-specific
  precautions into three sets of precautions based
  on routes of transmission
• These categories are designed for clients
  documented or suspected to be infected or
  colonized with highly transmissible or
  epidemiologically important pathogens for which
  additional precautions must be used to interrupt
  transmission to other in the hospital

44
Types of transmission based precautions

• Airborne precautions reduce the risk of airborne
  transmission of infection agents such as measles,
  varicella, and tuberculosis
• Droplet precautions are used to prevent the
  transmission of diseases, such as meningitis,
  scarlet fever, diphtheria, rubella and pertussis
• Contact precaution are used for clients known or
  susbected to have serious illness easily
  transmitted by direct contact such as herpes
  simplex, staphylococcal infections, hepatitis A
  respiratory syncyntial virus, wound or skin
  infection

45
Fundamental principles

• 1. Handwashing
• 2. The use of gloves
• Mask, eye protection and face sheild in which
  splashes or sprays could come in contact with
  eyes and mucous membrane
• Gown, should be worn whenever there is a risk of
  contamination from blood , bloody fluids,
  secretions or excretions
• Linen, transport soiledlinens in a manner that
  prevents skin and mucous membrane exposure,
  contamination of clothing and transfer of
  microorganisms to other clients and environment-
  double-bagging linen before taking it to the
  laundry facility
• 3. The proper placement of clients in the
  hospital to prevent the spread of microorganisms
  to others or to the client
• 4. The appropriate use of isolation equipment to
  prevent the spread of microorganisms to health
  care workers and other clients

46
Occupational health and blood-borne pathogens

• Take precautions to prevent injuries caused by
  needles, scalpels or other sharp instruments or
  devices
• Never recap used needles, purposely bend or break
  needles by hand, remove needles from disposable
  syringes or other handle needles directly
• All such instrument should be placed in
  puncture-resistant containers for disposal
• Mouth pieces, resuscitation bags, or other
  ventilation devices should be used as an
  alternative to mouth to mouth resuscitation

47
Client placement

• Clients who are at risk for contaminating the
  environment or who are unable to maintain
  appropriate hygiene or environmental control
  should be placed in a private room

48
Guidlines should be considered when providing
client care

• Health care workers who have open lesions, upper
  respiratory infections, weeping dermatitis should
  refrain from all direct client contact and from
  handling client care equipment
• Because of the risk of transmission of HIV and
  hepatitis B virus (HBV) frother to fetus,
  pregnant health workers should be especially
  familiar with and strictly adher to precautions
  to minimize risk of these viruses.
• Currently pregnant health care workers are not
  known to be at greater risk of contracting HIV or
  HBV than other workers

49
Health care workers protection

• Statistics from the Centers for Disease Control
  and Prevention (CDC)indicating that more than
  800,000 needle sticks and sharp injuries were
  being reported yearly
• Needles stick injuries caused by hollow-borne
  needles accounted for 86 of all reported
  occupational HIV exposures
• Nurses make up 24 of all the cases of HIV
  infection among health care workers

50
Health care workers protection

• More than 20 pathogens can be transmitted through
  small amounts of blood
• In addition to HIV and hepatitieB, syphilis,
  varicella-zoster, and hepatitis c can be
  transmitted vis this route
• Hepatitis B is the most common infectious
  disease transmitted through work-related exposure
  to blood
• About 5,100 health care workers become infected
  with Hepatitis B each year

51
Required Immunity Syndrome (AIDS)Epidemiology
and Modes of transmission

• The statistics are chilling CDC report from US
  2001 79,3000
• 649,000 are males
• 134,845 are females
• 8,994 are children under 13
• Estimates are that will be 75 million HIV cases
  in the top five industrial nations by 2010
• Aids the second leading killer of young men 24-44
  y
• Aids will be the third most common cause of death
  in the united states

52
Required Immunity Syndrome (AIDS)Epidemiology
and Modes of transmission

• Aids is the most serious epidemic facing the
  modern world, making knowledge about it and
  techniques for caring for the AIDS client
  mandatory learning for all nurses. No one is
  immune to AIDS
• The two major risk groups continue to be
  homosexual or bisexual men an IV drug abusers
  which make up over 2/3 of all AIDS cases
• The incidence of female African American cases
  increased significantly among infected
  heterosexuals (11)

53
DefinitionsAIDS

• Defined by CDCas an HIV infection in a person
  with a CD4 T-lymphocyte count of less than 200
  cells/microliter(? L) of blood or a CD4
  percentage of less than 14
• 26 conditions listed in the category C
• Cytomegalovirus (CMV) retinitis
• Kaposis sarcoma
• Mycobacterium avium complex (MAC) which includes
  the M.avium and M. Intracellulare organisms
• M.Kansasii
• Mycobacterium tuberculosis
• Pnemocytis carinii
• Recurrent pneumonia

54
Health Care WorkersExposure to HIV

• The average risk for HIV-transmission after a
  percutancous exposure to HIV-infected blood is
  approximately 0.3 and after a mucous membrane
  exposure is 0.09
• Risk factors for transmission by skin exposure
  and fluid or tissue exposure has not been
  quantified
• CDC states 600,000-80,000 needle stick injuries
  occur each year with potential risk of HIV
  exposure
• Conciderations that influence the use of
  postexposure prophylaxis (PEP) how soon after
  exposure PEP was begun and the believe that the
  infection can be prevented or improved by the use
  of the antiretroviral drugs

55
Exposure definition

• Percutaneous injury, contact of mucous membrane,
  or nonintact skin, or contact with intact skin
  when the duration of contact is prolonged or
  involves an extensive area, with the blood,
  tissue or other body fluids.
• Body fluids include semen, vaginal secretions, or
  other body fluids contaminated with visible blood
  (cerebrospinal, synovial, pleural, amniotic
  fluids, peritoneal, pericardial)
• There is no evidence that tears, sweat, nonbloody
  urine or feces transmit HIV

56
A recommendations for PEP

• 4-week regimen of two drugs (Zidovudine and
  lamivudine) for most HIV exposures
• An expanded regimen that includes the addition of
  a protease inhibitor (indinavir or nelfinavir) is
  recommended for HIV exposures that pose an
  increased risk of transmission or when there is a
  known or suspected resistance to one or more of
  the antiretroviral agents recommended for PEP

57
Tuberculosis

• Infectious disease caused by the tubercle
  bacillus Mycobacterium tuberculosis
• The main reservoir for the organism is the human
  respiratory tract
• Transmission occurs between individuals through
  respiratory contact
• The tubercle bacillus enters the respiratory
  tract on droplets transmitted through productive
  coughing from the infectd individual
• Symptoms may occur 4-12 weeks after exposure or
  may go unnoticed for many years

58
Tuberculosis

• Active pulmonary tuberculosis has a slow,
  insidious onset
• The progression of the active disease and
  symptoms of cough, weight loss, fever usually
  occur within the first two years after the
  infection
• Latent infections which are asymptomatic are not
  infectious and may last a lifetime
• Without RX tuberculosis progresses to other body
  sites
• Disseminated tuberculosis occurs in many of the
  body areas , not just the lungs
• The incidence of tuberculosis cases has increased
  greatly, due in large part of the AIDS epidemic

59
Tuberculosis

• Immunosuppressed hosts are very vulnerable to the
  bacillus
• In addition to immunosuppressed individuals ,
  other concidered at high risk for infection
  include alcoholics IV drug abusers, individuals
  who share a closed environment with the infected
  individual, residents of instituations such as
  long term care , foreign-born individuals from
  countries with a high prevalence of tuberculosis,
  such as Asia, Latin America, Africa, Mexico, the
  former Soviet Union, low income populations who
  are medically underserved

60
Tuberculosis

• Early recognition and treatment of tuberculosis
  must be intiated prompltly and isolation measures
  instituted to prevent the spread of the disease
• The purified protein derivative (PPD) skintest is
  used to quickly identify the infection in the
  absence of clinical stmptoms
• Sputum specimens for AFB and culture and
  sensitivity and chest x-rays are also orderedto
  rule out TB
• A PPD skin test is read 48-72 hours after the
  injection
• A positive skin test is indicated by an
  induration of 5-10 mm at the site of injection

61
Tuberculosis

• A two step method is now being used, particularly
  with health care workers
• The procedure involves the first PPD to be given
  and read within 48-72 hours
• If the PPD is negative or doubtful the PPD is
  repeated in one week.
• If the client has a positive reaction, he or she
  is started on a prophylaxis regimen
• A client who is known to be HIV positive with a
  5 mm or larger duration at the site of the PPD
  injection should be concidered positive for
  tuberculosis

62
Viral Hepatitis

• There are six forms of hepatitis, each form
  differs in regard to incubation period, route of
  transmission, antigenetic properties and
  progression to chronicity
• All forms of hepatitis produce an inflammatory
  response to the liver which is characterized by
  liver cell necrosis, inflammation and cell
  regeneration
• The three major forms of hepatitis are hepatitis
  A virus (HAV), Hepatitis B Virus (HBV) and
  Hepatitis C virus (HCV).
• Hepatitis D virus (HDV) is not as common and
  Hepatitis E (HEV) is rare
• Hepatitis G Virus (HGV) is a recently isolated
  blood-borne infectious agent transmitted by
  needle-sticks and blood transfusions

63
Viral Hepatitis

• Hepatitis A (HAV) is spread via the fecal-oral
  route and sexual transmission
• Poor sanitation and handwashing is a major source
  of infection
• Approximately 152,000 infections occur in the
  United States each year. 99 of those infected
  recover without any serious problems
• HAVRIX vaccine is available to prevent HAV
• Once exposed to the infection or as a preventive
  therapy, immune serum globulin is administered
  intramuscularly

64
Viral Hepatitis

• HepatitisB (HBV) is spread through infected blood
  or body fluids and through two nonparenteral
  routes, sexual contact and perinatal transmission
• Contaminated needles, syringes, and blood
  products are the most common mode of transmission
• About 30 of the cases are spread through sexual
  contact
• 140,000 individuals are infected yearly in US
• 2-10 of adults become chronically infected with
  HBV following an infection
• HBV is 100 times more infectious than HIV
• HBV vaccine provides active immunity in over 95
  of recipients
• The two common vaccines are Engerix-B and
  Recombivax HB

65
Viral Hepatitis

• Hepatitis B immune globulin provides passive
  immunity to individuals who have contact with
  HBV-contaminated material
• Hepatitis C (HCV) is transmitted primarily by
  contact with contaminated blood and blood
  products
• 85 of those infected with HCV will remain
  chronically infected
• Chronic HCV infection is the main causal factor
  for nearly one third of all liver transplants
• Thre are three types of interferon used to treat
  HCV
• The CDC recommends the use of standard
  precautions with clients known to have hepatitis
• The precautions should be maintained for one week
  after the onset of symptoms

66
Severe Acute Respiratory Syndrome (SARS)

• In 2003, there was a multi-country outbreak of a
  virus suspected to be a mutated form of the
  corona-virus (the common cold)
• The specific SARS pathogen is not known
• There is speculation that this new virus has
  jumped from animal to human, setting up the
  possibility for a world-wide pandemic like 1918
  swine or spanish flu that infected millions of
  people around the world and killed more than 20
  million
• Jumping species from animal to human and being
  able to transmit person to person is the worst
  possible combination of events because it can
  cause havoc in a non- immune population

67
Severe Acute Respiratory Syndrome (SARS)

• Because of this potential for disaster, the world
  Health Organization issued a global alert when
  this corona virus rapidly spread to 26 countries
• The primary symptoms of SARS are malaise, aching
  muscles, a persistent fever lt 38?, dry cough,
  shortness of breath or breath difficulties,
  normal WBC
• People with these sympyoms who have recently
  traveled to or been in the far east, are adviced
  to see a doctor immediately
• There is only supportive RX including oxygen and
  ventilatory assistance when necessary

68
Severe Acute Respiratory Syndrome (SARS

• Total infection control precautions are essential
  to prevent transmission
• These would include goggles or glasses to protect
  mucous membranes of the eyes, N95 mask, gown and
  gloves
• Washing hands carefully is essential

69
What is Biohazard Waste

• Any solid or liquid waste that may present a
  threat of infection
• This could include laboratory waste, blood or
  blood products, body fluids, absorbent material
  saturated with blood or body fluids (either wet
  or dry), discarded sharps, nonabsorbent
  disposable devices (drains, excretions, gloves,
  urine specimen)

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Storage of Biohazard Material

• Must be apprpriately sealed
• May be stored for 30 days
• Time starts when material is placed in the sharps
  container or biohazard bag
• All biohazard waste must be restricted, locked
  up, or placed in a separate storage area
• Must be labeled correctly so that there is a
  tracking method for each bag, container
• Labels should say medical waste and biohazard
  and be dated when the bag was first placed in the
  area

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Human immunodeficiency virus (HIV)

• Is a blood-borne infective retrovirus that
  invades the CD4 T-lymphocyte (immunity cells),
  dublicates itself by means of that cell
• Infection of HIV progresses to AIDS in at least
  35 of those infected
• Once the client has been diagnosed with HIV, the
  usual approach to care includes evaluation of the
  immune system and classification by CDC grouping
  (A) asymptomatic, (B) acute symptomatic, and (C)
  AIDS- indicator conditions

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Human immunodeficiency virus (HIV)

• Identification and RX of infectious and
  neoplastic complications, initiation of approved
  antiretroviral therapy and concideration of
  experimental measures are included in the
  evaluation

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HIV is transmitted through high-risk behaviors or
other contact with the virus including

• Sexual contact with HIV-infected individuals
• Sharing needles with HIV-infected individuals
• Transfusions of blood or blood products from
  infected individuals (not common today, but new
  cases are still reported)
• Babies who become infected from the mother before
  or during birth, or through breast-feeding
• Contact with contaminated needles, blood,
  secretions, or excretions from an HIV infected
  client

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Health Care WorkersExposure to HIV