Preventing Disease Transmission

1. Preventing Disease Transmission New Hampshire Wing Civil Air PatrolUnited States Air Force Auxiliary Paul E Mondoux Capt, CAP, NREMTI, NHEMT/IC

2. 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.

3. 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).

4. 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.

5. 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.

6. 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.

7. 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.

8. 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

9. 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

10. 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.

11. 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

12. ContaminationHow Pathogens enter the body

13. 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.

14. Human Immunodeficiency Virus The Human Immunodeficiency Virus causes Acquired Immunodeficiency Syndrome (AIDS), a severe life threatening illness which suppresses the body’s 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.

15. 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.

16. HIV is not transmitted by casual contact

17. 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.

18. 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)

19. 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.

20. 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.

21. 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.

22. 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.

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

24. 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

25. 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.

26. 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.

27. 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.

28. 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.

29. 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

30. 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

31. 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

33. Universal PrecautionsBody 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)

34. 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.

35. 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.

36. 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.

37. 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

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

39. 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.

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

41. 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.

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

43. 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

44. 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.

45. Hazardous waste • Use RED Hazardous wasteBagsfor: 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.

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

47. 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.

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

49. If you sustain sharp instrument injury • Discontinue on contact immediately. • Wash area with soap and water immediately. • Report exposure to Officer in Command immediately.