Airborne Pathogens and Respirator Use

1. Airborne Pathogens and Respirator Use

2. Objectives – The Illnesses • Discuss Airborne Diseases and the healthcare provider • How they spread • Who is at risk • Possible causes • Symptoms SAINT BARNABAS HEALTH CARE SYSTEM

3. Objectives – EMS Transport • What you should do to protect yourself • General considerations • Infection control • Waste disposal • Cleaning and Disinfection • Follow-up of EMS personnel SAINT BARNABAS HEALTH CARE SYSTEM

4. Objectives - The N95 Respirator • What is it? Why do I need it? • How do I use it? • Fit testing • What are the limitations? SAINT BARNABAS HEALTH CARE SYSTEM

5. Airborne Pathogens • Tuberculosis • Influenza • Avian Influenza • Smallpox • SARS SAINT BARNABAS HEALTH CARE SYSTEM

6. Tuberculosis Famous people who have had TB Fredric Chopin* Eleanor Roosevelt* Nelson Mandela Ringo Starr Tom Jones Tina Turner *Died of TB

7. What is tuberculosis (TB)? • Disease caused by bacteria called Mycobacterium tuberculosis • Chronic bacterial infection • Was once the leading cause of death in US • The number of cases declined in the 1940’s when drugs were developed to treat TB • TB is still a problem worldwide (NIAID) • 8 million people develop TB yearly • 3 million die SAINT BARNABAS HEALTH CARE SYSTEM

8. How is TB spread? • Through the air from person to person by coughing • Usually attacks lungs • Two stages • Latent TB • asymptomatic and not contagious • can take medication to prevent development of disease • Active TB Disease • May spread to others • May have abnormal chest x-ray • Usually have positive skin test SAINT BARNABAS HEALTH CARE SYSTEM

9. Symptoms of TB • Chills • Fever • Weakness or fatigue • Sweating while sleeping, Night sweats • Cough that lasts longer than 2 weeks • Pain in chest • Coughing up blood or sputum SAINT BARNABAS HEALTH CARE SYSTEM

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11. Risk Factors • Close contact with someone who is infected with TB • Traveling to a country where TB is common • Immune compromised • Foreign-born individuals and minorities have a higher incidence of developing TB • 2002: 50% of US cases were in foreign-born individuals (CDC) • 2002: 80% of all US TB cases were in ethnic and racial minorities (CDC) SAINT BARNABAS HEALTH CARE SYSTEM

12. Multi-drug resistant TB (MDR TB) • Bacteria become resistant to antibiotics • Arose from improper use of antibiotics in the treatment of TB • Treatment of one case can cost up to $1.3 million (CDC) • 45 states and Washington, DC have confirmed cases of MDR TB (CDC) SAINT BARNABAS HEALTH CARE SYSTEM

13. MDR TB continued • Treatment is difficult and costly • Can develop from not taking proper course of antibiotics for TB • MDR TB can be spread by an infected person SAINT BARNABAS HEALTH CARE SYSTEM

14. How to protect yourself • BCG vaccine for TB is given in many countries, but not the US • Not recommended for healthcare workers unless a high percentage of patients are infected with MDR TB (CDC) • PPD test if exposure is suspected • USE proper PPE when in contact with patients who may have TB SAINT BARNABAS HEALTH CARE SYSTEM

15. Tuberculosis Summary • Chronic bacterial infection spread through the air • Fever, chills, sweating while sleeping, persistent cough, coughing up blood or sputum • MDR TB • Use proper PPE and get PPD test if exposed SAINT BARNABAS HEALTH CARE SYSTEM

16. Influenza “I had a little bird, His name was Enza, I opened the window and in flew Enza.” -Children’s nursery rhyme about the flu epidemic of 1918

17. What is influenza (“the flu”)? • Disease caused by a virus • Respiratory • More severe than a cold • 10%-20% of US residents will get the flu each year (CDC) • Can lead to complications for some people • 36,000 people die each year from complications (CDC) SAINT BARNABAS HEALTH CARE SYSTEM

18. Types of influenza virus • Influenza A • Most common and most serious • Can lead to epidemics • Influenza B • Can also cause epidemics • Symptoms are milder • Influenza C • Never connected with large epidemics SAINT BARNABAS HEALTH CARE SYSTEM

19. How is influenza spread? • Flu season is from November to March • Respiratory droplets • Coughing • Sneezing • Droplets on objects • Contagious from 1 day before symptoms start to 7 days after symptoms start (CDC) SAINT BARNABAS HEALTH CARE SYSTEM

20. Symptoms • Cough and congestion • Fever • Headache • Body Aches • General malaise • Sore throat SAINT BARNABAS HEALTH CARE SYSTEM

21. Vaccine- The Flu Shot • Administered yearly • Injection or nasal spray (FluMist) • New vaccine made every year • Can prevent types A and B SAINT BARNABAS HEALTH CARE SYSTEM

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23. Who should get a flu shot? (CDC) • >50 years old • Diabetic • Live or work in a nursing home • Compromised immune system • Chronic heart, lung, or kidney disease • Will be more than 3 months pregnant during flu season SAINT BARNABAS HEALTH CARE SYSTEM

24. Protecting yourself • Get flu shot • Use proper PPE around patients suspected of having the flu • Disinfect surfaces regularly • Keep yourself healthy during the flu season! • Get enough rest • Eat well SAINT BARNABAS HEALTH CARE SYSTEM

25. Influenza Summary • Flu season is from November to March • Use PPE • Disinfect • Get a flu shot SAINT BARNABAS HEALTH CARE SYSTEM

26. Avian Influenza February 2004: 72,000 chickens were slaughtered in Delaware after two cases of Avian Influenza were found at a poultry farm under contract for Perdue Farms, Inc.

27. What is Avian Influenza? • Influenza virus that can infect birds and humans • Type A influenza • 3 Type A viruses and each have 9 subtypes • H5: can be high or low pathogenic; can cause severe illness or death • H7: can be high or low pathogenic; infections are rare and symptoms are mild • H9: low pathogenic; very rare in humans SAINT BARNABAS HEALTH CARE SYSTEM

28. Transmission • Contact with infected poultry or contaminated surfaces • No documented cases of sustained human to human transmission • Have been isolated incidents of human to human transmission • Monitoring is important • Influenza viruses have the ability to change • May gain the ability to spread from person to person SAINT BARNABAS HEALTH CARE SYSTEM

29. Symptoms • Same as typical flu-like symptoms • Conjunctivitis • Pneumonia • Severe respiratory distress SAINT BARNABAS HEALTH CARE SYSTEM

30. Incidents of H5 Avian Influenza • 1997: Hong Kong- First documented transmission of birds to humans • 18 people hospitalized • 6 died • 1.5 million chickens slaughtered to prevent further spread of disease • Person to person transmission was also documented SAINT BARNABAS HEALTH CARE SYSTEM

31. Incidents of H5 Avian Influenza • 2003: China and Hong Kong • 2 people infected after traveling to China • 1 died • Source of infection not identified • 2004: Thailand and Vietnam • WHO reported cases of H5 influenza among bird populations • Ongoing since January 2003 • Human cases found in Thailand and Vietnam (WHO) • 37 reported cases • 26 died • Most recent cases were reported August 12, 2004 SAINT BARNABAS HEALTH CARE SYSTEM

32. Avian Influenza Summary • Can be transmitted from birds to humans • Typical flu-like symptoms plus • Conjunctivitis • Respiratory distress • Pneumonia • Use PPE SAINT BARNABAS HEALTH CARE SYSTEM

33. Questions? SAINT BARNABAS HEALTH CARE SYSTEM

34. Smallpox In 1972, a single case of small pox in Yugoslavia led to the infection of 150 people, 34 deaths, 10,000 people quarantined and 20 million vaccinated. -World Health Organization

35. What is Smallpox? • Variola Virus • Contagious infectious disease • Eliminated in human populations • Laboratory stockpiles exist • Concern that it may be used as an agent of bioterrorism • No treatment • Only prevention is vaccine • Two types • Variola major • Variola minor SAINT BARNABAS HEALTH CARE SYSTEM

36. Variola Major • Most common • Severe • Very high fever • Large rash • 4 types • Ordinary: most frequent • Modified: occurs in people who have been vaccinated; mild • Flat: rare and severe • Hemmorhagic:rare and severe • Fatality rate of 30% (CDC) SAINT BARNABAS HEALTH CARE SYSTEM

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38. Variola Minor • Less common • Less severe symptoms • Fatality rate of <1% SAINT BARNABAS HEALTH CARE SYSTEM

39. From World Health Organization SAINT BARNABAS HEALTH CARE SYSTEM

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42. Transmission • Person to person • Prolonged contact with infected person • Contact with infected body fluids or contaminated objects • Can be spread through the air in enclosed settings, but this is rare SAINT BARNABAS HEALTH CARE SYSTEM

43. Vaccine • Complete protection if given before exposure • If given within 3 days after exposure, will prevent or greatly lessen severity • 4-7 days after exposure: lessens severity of disease • No protection if given after rash appears • Not widely available to the public at this time • Stockpiles are in place in case of an outbreak SAINT BARNABAS HEALTH CARE SYSTEM

44. Vaccine contraindications (CDC) • Vaccinia virus can be spread to others from the injection site of an immunized person • Eczema and other exfoliative skin conditions • May develop eczema vaccinatum • Inadvertent autoinnoculation of affected area • Could develop vaccinia • Immune compromised individuals • Pregnancy • Infants and children • Not given to infants <12 months of age • Only in emergency situations to children <18 years of age • Breastfeeding mothers should not get the vaccine • Heart disease SAINT BARNABAS HEALTH CARE SYSTEM

45. Protecting yourself • Vaccine • Use PPE when in contact with infected patient or contaminated fluids • Watch for signs/symptoms of smallpox if you believe you were exposed • Early vaccination after exposure can prevent or lessen the disease SAINT BARNABAS HEALTH CARE SYSTEM

46. Smallpox Summary • Contagious infectious disease • Transmitted through close contact with infected person • Vaccine SAINT BARNABAS HEALTH CARE SYSTEM

47. SARSSevere Acute Respiratory Syndrome The 2003 global SARS outbreak led to over 8,000 people becoming ill, and 774 deaths. It is estimated the panic caused by the disease cost Canada $1 billion in lost tourism and all of Asia over $28 billion. (BBC News)

48. What is SARS?Center for Disease Control Definition • SARS is a respiratory illness of unknown etiology. It was first identified in February 2003. • SARS was first noticed in Southeast Asia. To date more than 100 cases have been reported in the United States • Public health experts think that SARS is spread by close contact between people SAINT BARNABAS HEALTH CARE SYSTEM

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50. How SARS Spreads • SARS is most likely spread when someone sick from the disease coughs droplets into the air and someone else breathes the virus in • It is possible that SARS may spread more broadly through the air or from touching an object that is contaminated SAINT BARNABAS HEALTH CARE SYSTEM