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Murrieta Fire Bloodborne Pathogen Training 2012

Murrieta Fire Bloodborne Pathogen Training 2012. Art Durbin, Paramedic, RN, MICN, BSHS, MA. At the end of this class the student will be able to:. List the Five Microorganisms CDC and OSHA require you to understand. Verbalize the S/S of hepatitis infection

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Murrieta Fire Bloodborne Pathogen Training 2012

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  1. Murrieta Fire Bloodborne Pathogen Training 2012 Art Durbin, Paramedic, RN, MICN, BSHS, MA

  2. At the end of this class the student will be able to: • List the Five Microorganisms CDC and OSHA require you to understand. • Verbalize the S/S of hepatitis infection • Cite appropriate Measures for personal protection. • Verbalize the chain of disease transmission and how it can be broken

  3. At the end of this class the student will be able to: (Cont.) • Verbalize the procedure to follow if you are exposed. • List the OLD & New antiviral agents • When to use Antiviral agents for HIV or Hepatitis • Discuss Vaccines

  4. COMPLETE the Pre Evaluation Quiz • How much do you remember? 

  5. Chain of Disease Transmission

  6. Chain of Disease Transmission Defined • Organism – Bacteria Versus Virus • Dosage – The number of the organism you receive from the exposure • Virulence – the ability of the organism to survive in the environment

  7. Chain of Disease Transmission Defined (cont.) • Host immune system – Are you healthy • Mode of entry – puncture, eye or mouth splash of blood,

  8. Factors for Evaluating theDegree of exposure • Contaminatedneedle-stick injury. • Blood/OPIM contact with the surface of the eye, or inner surface of the nose or mouth. • Blood/OPIM in contact with open area of the skin. • Cuts with sharp objects covered with blood or OPIM.

  9. Primary BBP fluids • Blood * • Semen • Vaginal secretions * = most concerned with in our everyday job!

  10. Other Potential Infectious Material/fluids • Cerebral Spinal Fluid • Synovial fluid * • Amniotic fluid * • Peritoneal fluid * • Any fluid with gross (visible) blood * = with visible blood

  11. No Risk, HBV, HCV, HIV*reference CDC 1910.1030 • Tears & Sweat * • Sputum & Saliva * • Urine & Stool * • Vomit * • Nasal secretions * *{UNLESSthey contain visible blood}

  12. Airborne Diseases • Contact time/Transport time • Ventilation - • Organism type - • Host resistance – PPE used

  13. Human Immunodeficiency Virus • Transmission > Blood, Semen & Vaginal secretions and OPIM • Portal of exit > Bleeding or OPIM especially if contaminated with blood. • Means of transmission > Sexual both Heterosexual & MSM Contaminated Needle, infected blood in the mouth, eyes.

  14. Human Immunodeficiency Virus (Cont.) • Portal of entry > Percutaneous or Mucous membranes • Susceptible host > everyone depending on the virus load and those with poor immune systems.

  15. HIV Statistics • Review the most current CDC stats

  16. Estimated Incidence of AIDS and Deaths of AIDS Cases* Attributed to Heterosexual Contact, 1985-1999, United States 3500 AIDS 1993 definition implementation Deaths 3000 2500 2000 Number of Cases/Deaths 1500 1000 500 0 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 Quarter-Year of Diagnosis/Death *Adjusted for reporting delays and unreported risk

  17. 160 MSM 140 MSM-IDU IDU 120 Heterosexual contact 100 80 60 40 20 0 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 Estimated AIDS Prevalence* among Men, by Risk Exposure, 1985-1999, United States Number of Cases (thousands) Quarter-Year *Adjusted for reporting delays and unreported risk

  18. Estimated AIDS Prevalence* among Women, by Risk Exposure, 1985 - 1999, United States 160 Heterosexual contact IDU 140 120 100 Number of Cases (thousands) 80 60 40 20 0 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 Quarter-Year *Adjusted for reporting delays and unreported risk

  19. Mother's Exposure Category by Year of Child's Birth for Perinatally Acquired AIDS, 1980-1998, United States 70 Injection drug use 60 50 40 Heterosexual contact Percent of Cases 30 Mother's risk not specified 20 Transfusion 10 0 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 Year of Birth

  20. Children <13 Years of Age Living with HIV Infection* and AIDS, Reported through 1999 15 7 0 1 1 27 13 2 16 7 4 12 27 5 0 5 1 MA 79 803 92 0 2 33 RI 7 CT 97 174 76 3 4 6 4 23 11 65 43 NJ 258 367 7 6 126 17 35 DE 15 27 6 4 3 214 MD 7 5 163 84 73 41 17 13 92 DC 107 52 18 51 38 9 16 9 99 20 3 6 23 32 HIV AIDS 45 29 90 N=1,876 N=3,622 43 24 Confidential HIV Reporting** 279 153 105 54 1 141 Required P.R. V.I. 608 5 Pediatric only 175 3 9 * 34 areas conduct confidential HIV infection surveillance for children <13 years old **HIV cases reported by patient name HIV infection reporting initiated in July 1999

  21. AIDS-Defining Conditions Most Commonly Reported for Children <13 Years of Age, N=8,718, Reported through 1999, United States Condition Number % of Cases* 33 2900 Pneumocystis carinii pneumonitis Lymphoid 2061 24 1794 Recurrent bacterial infections 21 HIV wasting syndrome 18 1564 HIV encephalopathy 1462 17 Candida esophagitis 1372 16 Cytomegalovirus disease 838 10 Mycobacterium avium infection 709 8 Severe herpes simplex infection 422 5 418 5 Cryptosporidiosis Pulmonary candidiasis 326 4 *>1 diagnosis reported for some children

  22. Percent of Perinatally HIV Exposed or Infected Children who Received or whose Mothers Received any ZDV* Born1993-March 1999 in 34 States,‡ United States 100 80 60 Percent Receiving Zidovudine 40 20 0 1996 1993 1994 1995 1997 1998 1999 N=1343 N=1437 N=1371 N=1393 N=1466 N=1389 N=302 Quarter-Year of Birth *Any ZDV=Prenatal, intrapartum, or neonatal receipt of Zidovudine to reduce perinatal HIV transmission Includes 34 areas that conduct pediatric HIV Surveillance; data reported through December 1999

  23. Hepatitis General Signs and Symptoms of Infection • May or may not have jaundice • Dark urine, painful joints • Enlarged tender liver • General weakness & weight loss • Photophobia and headache • N/V, muscle ache • Fever 100 to 104

  24. Hepatitis A • Incubation > 2 to 6 weeks. • Means of transmission >oral-fecal route contaminated food, water & shell fish. • Susceptible host >anyone with risk activity. • Mortality > very rare, 0% carriers state. • Vaccine YES.

  25. Hepatitis B • Incubation > up to 200 days • Means of transmission >percutaneous, sex, blood. • Susceptible host >anyone with risk activity and worsens with age.

  26. Hepatitis B (Cont.) • Mortality > 25% develop liver disease 10% become carriers. • Medical Rx: Documentation, Blood testing, Counseling. • Vaccine (YES).

  27. Recommendations for Post Exposure Treatment of Hepatitis B • If the employee has not had the Hep series then HBIG shot plus start the vaccination program. • No prophylactic medication is recommended by CDC.

  28. Hepatitis C • Incubation > 6 to 7 weeks • Means of transmission >percutaneous, sex, tattooing, blood before 1992 • Medical RX: Documentation, Counseling, Follow up blood work

  29. Hepatitis C (Cont.) • Mortality > 50% develop liver disease 85% become carriers • Prevention – Use of PPE

  30. Hepatitis C treatment • Interferon alfa-2b • Interferon alfa-2b + ribaviron

  31. Syphilis (Treponema palladium) • Mode of Transmission – Sex, Needle Stick, Direct contact with draining lesion • Incubation - 10days to 3 months • Prevention – Gloves, good handwashing • Medical RX: PCN or Tetracycline

  32. West Nile Virus (WNV) • Mode of transmission – Mosquito bite Blood transfusion, Organ donation, Breast milk, Sharps injury

  33. West Nile Virus (WNV) (Cont.) • Signs/symptoms – Mild headache, fever, body aches, skin rash on trunk, Swollen Lymph glands, Eye pain, N/V. Severe – Stiff neck, disorientation, coma, tremors, seizures, paralysis, high fever.

  34. West Nile Virus (WNV) (Cont.) • Incubation – 3 – 14 days • PPE – BSI, Needle Safe devices, DEET, long sleeves • Post exposure TX – NONE

  35. Tuberculosis Pulmonary (TB) • Mode of Transmission – Inhalation of Airborne droplets • Incubation – 4 to 12 weeks • S/S – Persistent cough for 2 – 3 weeks, weight loss, fever/night sweats, coughing up blood or bloody sputum

  36. Tuberculosis Pulmonary (TB) (Cont.) • Medical RX. – INH • Prevention – Mask the patient, exposure follow-up, Annual skin testing.

  37. What Happens if I am Exposed??? • WHO/CDC Recommendations for Post Exposure Treatment for HIV exposure and Review! • Determine if it is an Exposure • Notify your supervisor

  38. What Happens if I am Exposed??? (Cont.) • Supervisor retrieve red MFD exposure packet (follow exposure algorhythm) We will review the contents of the red exposure packet now.

  39. Old & New antiviral agents • AZT – zidovudine (Retrovir) 1987 • ZDV – zidovudine/lamivudine (Combivir) 1996 • 3TC – lamivudine (Epivir) 1995 • IDV - indinavir (Crixivan) 1996 PI • Abacavir (Ziagen) 1998

  40. Old & New antiviral agents (Cont.) • Amprenavir (Agenerase) 1999 PI • Didanosine (Videx EC) 2000 • Lopinavir/ritonavir (Kaletra) 2000 two PIs

  41. Side Effects of AntiVirals and Protease Inhibitors • Hepatitis (chemical) • Liver damage or failure • Kidney damage or failure

  42. Summary • HIV infected patients are living longer • You can be protected from Hepatitis A, B & D by vaccination. • Hepatitis C is on the rise, no vaccine yet and may claim more lives than AIDS by 2010

  43. Complete Your quiz & turn in your Pre Test.

  44. Thank You The END  Questions?

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