Blood borne Pathogens to Avoid

1. Blood borne Pathogens to Avoid Listed below are descriptions and definitions of the various “bad guys” we would like you to avoid. Blood borne Pathogens are defined as pathogenic microorganisms present in human blood that can cause disease in humans, including but is not limited to hepatitis B, C, and HIV/AIDS. • HBV - Hepatitis B is found in human blood, the virus can exist on surfaces for weeks, it is not destroyed by sterilization – these facts were discovered in the 1960’s when Hep B reached close to epidemic proportions. With the realization that sterilization did not kill the virus, we had the advent of disposable needles. Most patients who carry the Hep B virus are unaware they are carriers of this dangerous disease. Those who become infected with Hep B may have a severe life threatening illness or for many a mild illness that goes unnoticed and unreported. Today’s Hep B vaccine provides adequate protection from Hepatitis B; all Health Care Workers are required to have the protection of the vaccine today. In spite of the requirement to have the vaccine, approximately 8,000 health care workers contract HBV annually.

2. Blood borne Pathogens to Avoid Hepatitis C is now recognized as another potential problem for health care workers (in the past this was called non A, non B). It is also a virus which can become chronic, cause liver damage and an increased risk of liver cancer. It too is blood borne, can be transmitted by the use of dirty needles, tattoos with contaminated instruments, and for health care workers exposure to blood from an individual with Hepatitis C. Unfortunately there is presently no vaccine for Hepatitis C. Many individuals with Hep C show no symptoms and thus are unaware they have the disease, risking transmission. Diagnosis is by blood test and liver biopsy. The disease is treated with medication, previously Interferon was the drug of choice but newer and more promising medications offer better outcomes with fewer treatments. Without treatment, 85% of those who contact the disease progress to chronic disease.

3. Blood borne Pathogens to Avoid HIV/AIDS virus is found in human blood and other body fluids, such as – semen, vaginal secretions, pleural fluid, saliva, breast milk, peritoneal fluid (not a complete list). Universal precautions were introduced to protect health care workers from HIV/AIDS. Universal precautions include the assumption that all blood, any fluid with blood and other body fluids are contaminated with pathogens including HIV/AIDS. Today many years after the first cases were diagnosed, there is still a danger and many patients are undiagnosed in our area. There is still no vaccine for HIV/AIDS, however recent advances have been made toward a vaccine although full development and testing is not complete. Treatment options have relegated this illness for some patients to a chronic rather than lethal disease. Universal precautions remain as the best defense against this disease. There have been recent findings that the Virus may have mutated making it less treatable with current medications; all the more reason to be vigilant.

4. Other Pathogens to Avoid Other Pathogens can be found in mucous, droplets from coughing or sneezing, and fecal material – included in this group of happy warriors waiting for a host are: • MRSA - Methicillin Resistant Staphylococcus Aureus – the illness often starts as skin eruption similar to a boil, it can also become systemic which requires aggressive treatment and can be fatal. The main mode of transmission is by hand contact, thus the best way to prevent the spread of this difficult disease is the simple act of hand washing. Since strict hand washing was enforced in all hospital settings the infection rate has decreased. As the name indicates the problem is the disease is resistant to many forms of antibiotics and the fear is that it will become resistant to the few remaining treatments.

5. Other Pathogens Continued Influenza –Approximately 15,000 individuals in US die annually from the “flu”, it is mostly fatal to the very old and the very young. It is usually passed by droplets from infections materials that originate in the respiratory tract and spread to the hands as individuals cough and sneeze – the germs than pass from hand to hand as people meet and interact. Present efforts to have individuals with cold or flu symptoms cover their mouth and nose when they cough or sneeze may be an effective way to limit the spread of the disease. There are various strains of flu, each year the vaccine is made based on the best estimate of the flu that will be around for a particular year. One of the problems is that the virus can very easily mutate, but in most cases if you have some immunity from a flu vaccine it will make the infection less severe even without an exact match. Regardless of the make-up of the virus, the best protection will still be hand washing to prevent spread of the disease – from the respiratory tract of an infected individual to your hand – and then you touch your nose, or mouth or eye – any mucous membrane which is very permeable will allow the virus to enter – thus you have the flu. The annual flu vaccine offers very good protection, even when there is not an exact match for a mutated virus, the vaccine offers the benefit of a milder illness.

6. Other Pathogens Continued • EColi is usually detected in fecal material and is the usual culprit when we are told to avoid tomatoes or peppers due to contamination. • TB still remains a threat, it usually affects the lungs of the infected individual. It is spread through the air from droplets, generally by coughing. Some strains of TB are becoming resistant to standard treatment. All health care workers are required to be screened annually; there are approximately 22,000 cases of TB each year in the US. • Flesh eating bacteria (necrotizing fasciitis) is a very rare disease usually caused by a strep germ, most patients survive, one in five die. This germ usually lives in brackish waters such as ponds, lakes and streams. It is generally not a threat to individuals with intact skin. Individuals with decreased immunity are more susceptible. The organism usually enters the system via a deep cut or gash, prompt medical attention should stop the infection from spreading. Now you’ve met the bad guys – how do we protect ourselves – that is the purpose of this module.