HIV/AIDS, Bloodborne Pathogens, and Tuberculosis

1. HIV/AIDS, Bloodborne Pathogens, and Tuberculosis

2. Introduction to Bloodborne Pathogens

3. What are bloodborne pathogens? • Infectious microorganisms in human blood that can cause disease in humans. • Include, but are not limited to, hepatitis B (HBV), hepatitis C and human immunodeficiency virus (HIV). Adapted from www.osha.gov

4. Who is at Risk? • Workers in many occupations, including caregivers, housekeeping personnel, nurses and other healthcare personnel may be at risk of exposure to bloodborne pathogens. Adapted from www.osha.gov

5. Exposure Control Plan • Must implement an exposure control plan • Describe how an employer will use a combination of engineering and work practice controls • Ensure the use of personal protective clothing and equipment • Provide training • Medical surveillance • Hepatitis B vaccinations • Signs and labels • Among other provisions… Adapted from www.osha.gov

6. HIV and AIDS

7. What is HIV? • Human immunodeficiency virus. • The virus that can lead to acquired immune deficiency syndrome, or AIDS.

8. What is HIV? • HIV damage a person’s body by destroying specific blood cells, called CD4+ T cells, which are crucial to helping the body fight diseases

9. Symptoms • Within a few weeks of being infected with HIV, some people develop flu-like symptoms that last for a week or two, but others have no symptoms at all. • People living with HIV may appear and feel healthy for several years. • However, even if they feel healthy, HIV is still affecting their bodies. 

10. Symptoms May experience flu-like symptoms 2-6 weeks after becoming infected • Chills • Rash • Night sweats • Muscle aches • Sore throat • Fatigue • Swollen lymph nodes • Ulcers in the mouth

11. Statistics • The CDC estimates that about 56,000 people in the United States contracted HIV in 2006. • Around 34 million people worldwide living with HIV • Over 25 million have died since the first cases were reported in 1981

12. AIDS • AIDS is the late stage of HIV infection • The person’s immune system is severely damaged and has difficulty fighting diseases and certain cancers.

13. Progression to AIDS • Before the development of certain medications, people with HIV could progress to AIDS in just a few years. • Currently, people can live much longer - even decades - with HIV before they develop AIDS. This is because of “highly active” combinations of medications that were introduced in the mid 1990s.

14. HIV complications • Cardiovascular Health • Hepatitis • Opportunistic Infections • Oral Health Issues

15. HIV complications • Cancer • Dementia • Kidney disease • Other complications

16. HIV Transmission

17. Transmission • HIV can be detected in several fluids and tissues of a person living with HIV. • Finding a small amount of HIV in a body fluid or tissue does not mean that HIV is transmitted by that body fluid or tissue. • These specific fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the blood-stream for transmission to occur.

18. Which Body Fluids? These body fluids have been shown to contain high concentrations of HIV: • Blood • Semen • Vaginal fluid • Breast milk • Other body fluids containing blood

19. Which Body Fluids? The following are additional body fluids that may transmit the virus that health care workers may come into contact with: • Fluid surrounding the brain and the spinal cord • Fluid surrounding bone joints • Fluid surrounding an unborn baby

20. Transmission • In the United States, HIV is most commonly transmitted through specific sexual behaviors (anal or vaginal sex) or sharing needles with an infected person. • It is less common for HIV to be transmitted through oral sex or for an HIV-infected woman to pass the virus to her baby before or during childbirth or after birth through breastfeeding or by prechewing food for her infant.

21. Transmission • It is possible to acquire HIV through exposure to infected blood, transfusions of infected blood, blood products, or organ transplantation • This risk is extremely remote due to rigorous testing of the U.S. blood supply and donated organs.

22. Transmission • Some healthcare workers have become infected after being stuck with needles containing HIV-infected blood or, less frequently, when infected blood comes in contact with a worker's open cut or is splashed into a worker's eyes or inside their nose.

23. HIV is NOT spread by • Air or water • Insects, including mosquitoes • Saliva, tears, or sweat • Casual contact like shaking hands or sharing dishes • Closed-mouth or “social” kissing

24. The risk to direct care providers • The risk of direct care provider being exposed to HIV on the job is very low • Especially if they carefully follow standard precautions • Casual, everyday contact with an HIV-infected person does not expose direct care providers or anyone else to HIV.

25. The risk to direct care providers • For direct care providers on the job, the main risk of HIV transmission is through accidental injuries from needles and other sharp instruments that may be contaminated with the virus • Even this risk is small. • The risk of infection from a needle-stick is less than 1%.

26. HIV Screening and Testing

27. Antibody Screening Test • Most common HIV test is the antibody screening test. This test can be performed with blood sample or oral fluid. • This tests the antibodies your body produces to fight against HIV. • Blood tests can detect HIV as soon as 3 weeks after being infected.

28. Follow-up Diagnostic Tests • Follow-up diagnostic test – these tests are performed after someone tests positive on his/her first test. • HIV tests are usually very accurate, but a follow-up test is typically performed to confirm the results of the first test mostly for insurance/health care provider purposes.

29. Treatment and Support

30. Treatments • Many people with HIV, including those who feel healthy, can benefit greatly from current medications used to treat HIV infection. • These medications can limit or slow down the destruction of the immune system, improve the health of people living with HIV, and may reduce their ability to transmit HIV. 

31. Medications • Can be expensive • Can be very effective • Complicated dosing schedules • In some cases, virus develops a resistance to the medication

32. HAART Highly Active Anti-Retroviral Therapy

33. Medications

34. Medications

35. There is No Cure • No one should become complacent about HIV and AIDS. • While current medications can dramatically improve the health of people living with HIV and slow progression from HIV infection to AIDS, existing treatments need to be taken daily for the rest of a person’s life, need to be carefully monitored, and come with costs and potential side effects. • At this time, there is no cure for HIV infection.

36. Treatment and Support

37. Hepatitis B

38. Hepatitis B • Hepatitis B is a contagious liver disease that results from infection with the Hepatitis B virus. • It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness.

39. Hepatitis B Transmission • Hepatitis B is spread when blood, semen, or other body fluid infected with the Hepatitis B virus enters the body of a person who is not infected.

40. Hepatitis B Transmission • From an infected mother to her baby during birth • Sex with an infected partner • Sharing needles, syringes, or other drug-injection equipment • Sharing items such as razors or toothbrushes with an infected person • Direct contact with the blood or open sores of an infected person • Exposure to blood from needlesticks or other sharp instruments 

41. Acute or Chronic Acute Hepatitis B • Short-term illness that occurs within the first 6 months after exposure. • Can—but does not always—lead to chronic infection. • Chronic Hepatitis B • Long-term illness that occurs when the virus remains in a person’s body. • Estimated 800,000 to 1.4 million persons have chronic Hepatitis B virus infection in the U.S.

42. Hepatitis B Vaccine • The Hepatitis B vaccine series is a sequence of shots that stimulate a person’s natural immune system to protect against HBV. • After the vaccine is given, the body makes antibodies that protect a person against the virus. • These antibodies are then stored in the body and will fight off the infection if a person is exposed to the Hepatitis B virus in the future.

43. Hepatitis B Vaccine • Safe and effective • Usually given as 3-4 shots over a 6-month period • Recommended for health care workers (including caregivers) at risk for exposure to blood or blood-contaminated body fluids on the job • Employers must offer at not cost if a job puts you at risk for exposure to blood or blood-contaminated body fluids on the job

44. Hepatitis C

45. Hepatitis C • A contagious liver disease that results from infection with the Hepatitis C virus. • It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness.

46. Can Be Acute or Chronic • Acute Hepatitis C virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis C virus. • For most people, acute infection leads to chronic infection. • Chronic Hepatitis C is a serious disease than can result in long-term health problems, or even death.

47. How is hepatitis C spread? • Spread when blood from a person infected with the Hepatitis C virus enters the body of someone who is not infected. • Today, most people become infected with the Hepatitis C virus by sharing needles or other equipment to inject drugs. • Before 1992, when widespread screening of the blood supply began in the United States, Hepatitis C was also commonly spread through blood transfusions and organ transplants.

48. How is hepatitis C spread? People can become infected with the Hepatitis C virus during such activities as: • Sharing needles, syringes, or other equipment to inject drugs • Needlestick injuries in health care settings • Being born to a mother who has Hepatitis C

49. How is hepatitis C spread? Less commonly, a person can also get Hepatitis C virus infection through: • Sharing personal care items that may have come in contact with another person’s blood, such as razors or toothbrushes • Having sexual contact with a person infected with the Hepatitis C virus

50. Is there a vaccine? • At this time there is not a vaccine for hepatitis C. • Vaccines are available only for Hepatitis A and Hepatitis B. • Research into the development of a vaccine is under way.