Methodologies and Regulations in Specimen Collection and Management

1. Methodologies and Regulations in Specimen Collection and Management Module 9: Myths and Facts: TB, Hepatitis, HIV/AIDS, STIs

2. Objectives After this module you will be able to: • Discuss universal precautions, standards, and protocol as applied specifically to: TB, Hepatitis B and C, HIV/AIDS • Differentiate between myths and facts of disease transmission for: • TB , Hepatitis B & C, HIV/AIDS, STIs • Discuss PEP acronym and importance of following protocol within your hospital or clinic

3. Today’s Agenda • Discuss standard (universal) precautions, standards, and protocol as applied to TB, Hepatitis B and C, HIV/AIDS • Differentiate between myths and facts of disease transmission for: • TB • Hepatitis B & C • HIV/AIDS • STIs • Discuss PEP acronym and importance of following protocol within your hospital or clinic

4. Standard Precautions • Standard precaution refers to practice of avoiding contact with patients' bodily fluids, by means of wearing of nonporous articles such as medical gloves, goggles, face shields, good hygiene, use of aseptic techniques • 1996, Universal precautions replaced by the latest term “Standard Precautions”

5. Standard Precautions • Interpretation: All patients considered to be possible carriers of blood-borne pathogens • Blood Borne Pathogens: bacteria and viruses capable of causing disease that are transmitted through contact with blood / bodily fluids from infected people

6. Blood Borne Pathogens:Hepatitis B & C, and HIV Hepatitis B e antigen Envelope Glycoproteins Core DNA Polymerase Viral RNA Hepatitis B Surface antigen (HBsAg) Hepatitis B Core antigen (HBcAg) Envelope Approximately 60 nm Structure of Hepatitis C Virus Partially double-stranded DNA gp 120 Backing Glycoprotein Lipid Membrane gp 41 TransmembraneCytoprotein Reverse Transcriptase

7. Transfer of HIV Virus From Semen to Blood Seminal Fluid CD4 White Blood Cell (Infected with HIV) Sperm HIV Viral Particle Blood Plasma HIV CD4 Semen Cell (Infected with HIV) Red Blood Cells (do not carry HIV) It is not understood how HIV passes between blood and semen.

8. Blood Borne Pathogens:Worldwide Distribution Hep C Hep B

9. Standards • Provide immunizations for HBV • Establish a daily work surface disinfection protocol (Bleach 1:10 or Biosite or JIK) • Provide medical follow ups • Regular training sessions for all employees/health care workers

10. Protocol for Exposure to Blood Borne Pathogens • Notify supervisor immediately • Check source for disease status / check person with injury for current disease status • Evaluate risk factors for transmission of diseases • Begin treatment with drug or other as mandated by your health facility • Document exposure and care in personnel chart • Maintain healthy lifestyle • Have follow-up visit at designated times post exposure (3,6, 12 month post injury)

11. How to Break the Chain of Infection • Decontamination • Immunization • Insect Control • Sterilization • Employee Screening • Antibiotics • Healthy Life Style Infectious Agent Susceptible Host Reservoir Chain of Infection Portal of Entry Portal of Exit Mode of Transmission

12. Any questions?

13. Knowledge Check List the 3 main routes of entry into the body: • Non-intact skin • Intact skin provides a good barrier • Mucous membrane exposure • Eyes, nose, mouth • Percutaneous injury or through the skin • Needlestick, cut, and puncture

14. Transmission of Tuberculosis • Caused by an infection with the bacteria Mycobacterium tuberculosis • Tuberculosis is an airborne disease • Bacteria is spread by droplets from coughing, sneezing, speaking, or laughing • Recipient inhales droplets and becomes infected

15. Factors That Increase the Risk of Transmission • Inadequate ventilation • Recirculation of air containing bacteria • Exposure in enclosed spaces • Inadequate disinfection of equipment • Improper specimen handling procedures

16. Symptoms of Tuberculosis • Cough that lasts for over two weeks • Weight loss • Night sweats • Fever • Chills • Coughing up blood • Weakness or fatigue • Loss of appetite

17. Knowledge Check • What is the difference between having a latent and active form of a tuberculosis infection?

18. Personal Protective Equipment • The following equipment should be used before entering a room of a patient with suspected tuberculosis infection: • Fluid resistant gown • N95 respirator mask • Shoe covers • Head cover • Face shield • Gloves

19. N95 Respirator Mask • Has a filter on it that is 95% effective in preventing infectious agents from entering • A disposable mask that prevents the spread of infections • Only use once if patient is on Airborne or Contact precautions plus standard precautions (SARS, small pox, measles, TB, varicella) • N means the mask is NOT RESISTENT to oil; 95 means the mask will filter out 95% of the infectious particles/bacteria 0.3 microns or larger from entering

20. Any questions?

21. Today’s Agenda • Discuss universal precautions, standards, and protocol as applied to TB, Hepatitis B and C, HIV/AIDS • Differentiate between myths and facts of disease transmission for: • TB • Hepatitis B & C • HIV/AIDS • STIs • Discuss PEP acronym and importance of following protocol within your hospital or clinic

22. Tuberculosis: WHO Facts • Currently, approximately 2 billion people are infected with tuberculosis • 1/3 of the world’s population • According to the World Health Organization: • 8 million people worldwide develop active tuberculosis infections • Nearly 2 million people die each year

23. Latent Tuberculosis Infection Facts • Not everyone with an infection becomes sick • Immune system of patient can fight the infection • Patient will have no symptoms of infection

24. Active Tuberculosis Infection Facts • Immune system of patient can no longer fight the infection • Patient will have symptoms of infection • Patient can spread bacteria to others during this stage

25. Hepatitis B and C Facts • Hepatitis B • Viable for one week at room temperature • Sexually transmitted in >50% of cases • Second leading cause of cancer in humans • High infectivity • Hepatitis C • 85% develop chronic infection • Major cause of end-stage liver disease • No preventative vaccine

26. HIV/AIDS:Myths and Facts • Myth: Having multiple sex partners boosts men’s prestige and status among their peers • Fact: Multiple sex partners greatly increase the risk of HIV infection • Myth: For a man infected with HIV/AIDS, sex with a virgin provides a cure • Fact: Presently, HIV/AIDS has no cure

27. HIV/AIDS:Myths and Facts • Myth: condoms have pores thus it is wise to use two or more at the same time. • Fact: the latex or polyurethane condoms provide effective protection against HIV, STIs, and pregnancy as long as they are correctly and consistently used. Using two or more condoms at the same time greatly increases the chances that the condom will break.

28. HIV/AIDS Facts • May be reduced by compliance to standard precautions. • CDC recommends Post Exposure Prophylaxis (PEP) to reduce the likelihood of HIV infection after occupational exposure • PEP is recommended in the comprehensive standard precautions package • PEP-increases staff motivation to work with people with HIV

29. HIV/AIDS Facts • Risky groups: Dentists, nurses, laboratory technologists • Among Healthcare Workers, occupational exposure has resulted in HIV seroconversion • Laboratory workers are among the most prone to HIV - proximity to infectious material

30. HIV/AIDS Facts • HIV/AIDS is the most serious of infectious disease challenges to public health • It has the highest incidence in Sub-Saharan Africa among the most productive segment of the labour force • Among health care workers, the risk of occupational exposure to HIV/AIDS is high

31. Sexually-Transmitted Infections: Facts • STIs include: syphilis, gonorrhea, chlamydia, bacterial vaginosis, genital herpes, human papillomavirus, pelvic inflammatory disease, trichomoniasis • If you have an STI, get treatment because persons infected with STIs more likely to acquire HIV infection

32. Sexually-Transmitted Infections: Facts • Not stopping risky sexual behavior can lead to infection with other STIs, including HIV • Infections affect men and women of all backgrounds and economic levels • Women have higher rates of infection which are more frequent and cause more serious health problems

33. Today’s Agenda • Discuss universal precautions, standards, and protocol as applied to TB, Hepatitis B and C, HIV/AIDS • Differentiate between myths and facts of disease transmission for: • TB • Hepatitis B & C • HIV/AIDS • STIs • Discuss PEP acronym and importance of following protocol within your hospital or clinic

34. Post-Exposure Prophylaxis (PEP) • PEP is the protocol for health care workers to follow after a needle-stick or other injury involving exposure to contaminated blood or other body fluids • Antiretroviral medications, which may reduce the risk of HIV seroconversion in an exposed employee, are taken for 4 weeks • To be most effective, the medications must be taken as soon as possible after exposure, preferably within 6 hours and usually no later than 48 hours after exposure

35. When PEP Might be Indicated • When source patient is known to be HIV+ • When source patient is at high risk for HIV • When the HIV status of source is unknown • Often the exposed individual will begin the PEP medications until HIV status of source patient is clarified

36. When PEP is Not Indicated • PEP is not indicated for low risk exposures or in persons already HIV infected • Indications for PEP drugs are determined on a case by case basis • PEP drugs are powerful and can have side effects • Strict adherence to doctor’s orders and follow up is necessary

37. PEP: A Sample Protocol • Confidential testing may be offered at baseline, 3, and 6 months • Status of source patient, if known, will be communicated • Individuals with high risk exposures may be advised for the next 6 months to: • Avoid sharing body fluids (e.g., have only protected sex) • Stop breastfeeding • Avoid pregnancy

38. Methods to Prevent Spread of TB Infection • Administrative methods • Designed to implement work practices to decrease risk of spread of infection • All health care workers at risk for exposure to tuberculosis should be tested • Health care workers need to be trained on proper infection control techniques, such as the disinfection of contaminated equipment

39. Methods to Prevent Spread of TB Infection • Respiratory protection • Train all health care workers in protection methods • Inform all patients infected with tuberculosis in how bacteria is spread • Use of personal protective equipment to prevent the spread of the bacteria

40. Methods to Prevent Spread of TB Infection • Environmental methods • Using environmental controls to decrease the spread of infection • Ensure proper airflow near patients infected with tuberculosis

41. Treatment of Tuberculosis Infections • Tuberculosis is curable, even in patients with HIV • Patients with latent or active tuberculosis infections should be treated with antibiotics • Medication needs to be taken as directed to prevent drug resistance from occurring

42. Summary After this presentation and activity you can: • Discuss universal precautions, standards, and protocol as applied specifically to • TB • Hepatitis B and C • HIV/AIDS • Differentiate between myths and facts of disease transmission for: • TB • Hepatitis B & C • HIV/AIDS • STIs

43. Summary After this presentation and activity you can: • Discuss PEP acronym and importance of following protocol within your hospital or clinic

44. Any questions?Thank you!