Standard Precautions and Bloodborne Pathogens

1. Standard Precautions and Bloodborne Pathogens

2. Infection • Nurses play an integral role in preventing infection and creating a biologically safe environment for their patients. • Many diseases are considered to be infectious or communicable. Infectious diseases are the result of microorganisms known as pathogens that enter the body and cause disease.

3. An infectionis an invasion of the body by a disease causing organism called an infectious agent. Once an infection occurs, the signs and symptoms are distinct. Disease causes the body to function differently. Some pathogens are stronger than others in their ability to cause disease and this is known as virulence. Infections also differ in their ability to be communicated to another person. The common cold or flu can be spread readily through coughing, sneezing, etc; whereas, Hepatitis B or HIV are much more difficult to transmit as they require blood to blood transmission.

4. A communicable or infectious disease is a disease that can be transmitted from one person to another through direct or indirect contact. The mode by which a infectious disease can move from one to another is known as a vector.

5. Types of Microorganisms • *Bacteria are the most common type of microorganism . They can live and be transported in the air, food, water, soil, inanimate objects as well as be transported in body tissues and body fluids. • *Viruses can also cause infections but are the smallest disease-causing agent. • *Fungi are either yeast or molds. • *Parasites live on other living organisms.

6. Chain of Infection

7. Infectious Agent Able to cause infection. Carrier has ability to cause infection but no signs or symptoms. Eliminated or controlled through disinfection or sterilization

8. Reservoir Where the organism normally lives. Includes humans, animals, plants, insects, birds, or food/water. Proper handling of food, blood, and body fluids.

9. Portal of exit • The way the organism leaves the reservoir. • May be a body fluid. • Proper handling prevents organism from exiting the reservoir

10. Portal of Entry Usually the same as portal of exit. Intact skin and mucous membranes provide a barrier.

11. Transmission • The way the organism gets to the host. • Direct contact • Organism passes directly from one person to the other. • Indirect contact • Organism passed via contaminated equipment or hands. • Airborne • Organism passed through dust or droplets. • Prevention • Barrier devices such as masks, gowns, gloves. • Proper hand hygiene and cleaning contaminated equipment.

12. Susceptible Host • Cannot cause infection if host is not susceptible. • Factors that increase susceptibility: • Age • Nutrition • Diseases • Heredity • Medications • Stress • Prevention: minimize factors that increase susceptibility.

13. Risk Factors for Increased Susceptibility Age Genetics Stress Nutrition Medical therapies/diseases Medications Smoking Culture/ethnicity/socioeconomics

14. Nosocomial Infections Definition: Infections that occur after hospital admission (Hospital-acquired). Proper hand hygiene: Essential to prevent the spread of infection. Correct technique with medical devices: Proper use of supplies and equipment. Resistant organisms: MRSA/VRE, etc.

15. Prevention of Infection Infection can be prevented if one link in the chain is disrupted.

16. Standard Precautions All clients in all facilities: Standard Precautions are the same at every facility with every client. Proper hand hygiene: Proper hand washing is essential in breaking the chain of infection. Barrier devices: Proper and appropriate use of PPE. Disposal of contaminated equipment: Disposal in accordance with the facility to which you are assigned. Disinfection of reusable equipment and linen: Disinfect in accordance with the facility to which you are assigned. Placement of infected clients: Per infection control guidelines for the facility to which you are assigned.

17. Standard Precautions

18. Transmission Based Precautions Clients with known or suspected infections: Precautions should be taken if any communicable or infectious disease is known or suspected. Tailored to the mode of transmission: Appropriate isolation measures should be taken. Personal protective equipment: Use the appropriate level of PPE for the care you will be providing and the anticipated risk of exposure.

19. Transporting the client: Transporting of clients with communicable/infectious diseases outside of their room should be done only if necessary to carry out care for the client. The client must adhere to isolation precautions such as wearing a mask outside of the room. Reverse Isolation: May be placed on isolation precautions to protect the client who may have had an organ transplantation, bone marrow transplant, etc that makes them more susceptible to infection. Removal of contaminated items :Removal of all equipment and supplies that have been contaminated is essential to infection control. Ensure these items have been cleaned per the recommendations of the CDC and the in accordance with the policies of the facility to which you have been assigned.

20. Hand Hygiene Adjust the Water Flow Some sinks will have knee or foot pedals that control the water, while others will be the more traditional sink.

21. Interlace Fingers Figure 9-6 Interlacing the fingers during hand hygiene. (Photographer: Elena Dorfman.)

22. Figure 9-8 The hands are held higher than the elbows during hand hygiene before a sterile technique.

23. Figure 9-7 Using a paper towel to grasp the hand-operated faucet to turn off the water if foot pedals are not available. (Photographer: Elena Dorfman.)

24. Personal Protective Equipment Gloves Gowns Eyewear Masks It is essential to utilize the appropriate level of PPE when providing care for the client with a communicable or infectious disease.

25. Disposal of Soiled Items Disinfection Disposal Bagging Use only facility approved solutions for the disinfecting of equipment. Disposal of items that cannot be cleaned thoroughly or disposal of items that are not for re-use should be done according the facility’s policy to which you are assigned.

26. WHAT IS HEPATITIS? Hepatitis means an inflammation, or swelling, of the liver. Viruses can cause hepatitis. Alcohol, drugs (including prescription medications), or poisons can also cause hepatitis. So can opportunistic infections such as Mycobacterium Avium Complex (MAC, see fact sheet 514) or Cytomegalovirus (CMV, see fact sheet 504). Hepatitis is a very common disease. It can affect people even if their immune systems are healthy. Hepatitis can lead to serious scarring (cirrhosis) of the liver and liver failure, which can be fatal. Many cases of hepatitis aren’t treated because people either don’t feel sick at all, or think they have the flu. The most common symptoms are loss of appetite, fatigue, fever, body aches, nausea and vomiting, and stomach pain. Some people may have dark urine, light-colored bowel movements, and a yellowing of the skin or of the eyes (jaundice).

27. Hepatitis A and E are both acute diseases. They are spread by contact with fecal matter, either directly or from water that has sewage in it, or through food handled by someone with contaminated hands. Hep A and Hep E do not cause chronic illness. Hepatitis B is the most common hepatitis virus. It can be transmitted from mother to infant, through sexual contact, or through contact with infected blood. Globally, about 10% of people with HIV also are infected with hepatitis B (HBV.) People with HIV are much more likely to develop chronic HBV. Hepatitis B is more serious in people with HIV, but some HIV drugs (3TC, tenofovir, emtricitabine) fight HIV and HBV. For more information, see the Treatment Action Group's Guide to Hepatitis B at http://www.treatmentactiongroup.org/hcv/publications/2009/hbv-guide Hepatitis C is usually spread by direct contact with blood, usually through sharing needles and other injection equipment. Although it doesn’t happen as often, some people—especially HIV+ MSM—have gotten HCV from unprotected sex. About 75-85% of people infected with HCV develop chronic hepatitis. Hepatitis C can be very mild or show no symptoms, but over 15-50 years, can cause serious liver damage in about 20% of people. .HIV worsens hepatitis C. See Fact Sheet 507 for more information on hepatitis C and HIV. Hepatitis D only shows up in people who get hepatitis B. People who get type D get sicker than people who just have type B. The best way to prevent viral hepatitis is through cleanliness and by avoiding contact with blood. You may not know if someone else is infected. Condoms can help prevent transmission of hepatitis B and C. Also, there are vaccines that can protect you against developing hepatitis A and B, even if you’ve already been exposed to them. These vaccines may not work for people with CD4 counts below 350. There are no treatments for hepatitis A and E, but they usually only last a couple of weeks. Pegylated interferon and three drugs used against HIV - lamivudine (3TC), tenofovir (TDF) and emtricitabine (FTC) - help treat hepatitis B and D. In September 2002, adefovirdipivoxil (Hepsera) was approved in the US to treat hepatitis B, Tenofovir was approved in August of 2008 and is a better treatment for hepatitis. Fact sheet 507 has more information on drug treatments for hepatitis C. Several drugs are being developed to treat HCV.

28. Hepatitis C Virus (HCV) Structure of Hepatitis C Virus The Hepatitis C virus (HCV) is a major cause of acute hepatitis and chronic liver disease, including cirrhosis and liver cancer. According to estimates from the Centers for Disease Control and Prevention, an estimated 3.9 million Americans (1.8%) have been infected with HCV, and 2.7 million are chronically infected. The number of new infections per year has declined from an average of 240,000 in the 1980s to about 30,000 in 2003. Illegal injection drug use is the primary cause of infection. Approximately 80% of the persons infected with Hepatitis C have no signs or symptoms. Those that have symptoms and signs may exhibit the following: • Jaundice • Fatigue • Dark Urine • Abdominal Pain • Loss of Appetite • Nausea

29. HIV is the human immunodeficiency virus. It is the virus that can lead to acquired immune deficiency syndrome, or AIDS. CDC estimates that about 56,000 people in the United States contracted HIV in 2006. There are two types of HIV, HIV-1 and HIV-2. In the United States, unless otherwise noted, the term “HIV” primarily refers to HIV-1. Both types of HIV damage a person’s body by destroying specific blood cells, called CD4+ T cells, which are crucial to helping the body fight diseases. 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. All people with HIV should be seen on a regular basis by a health care provider experienced with treating HIV infection. 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. Untreated early HIV infection is also associated with many diseases including cardiovascular disease, kidney disease, liver disease, and cancer.  Support services are also available to many people with HIV. These services can help people cope with their diagnosis, reduce risk behavior, and. find needed services.

30. AIDS is the late stage of HIV infection, when a person’s immune system is severely damaged and has difficulty fighting diseases and certain cancers. 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. 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. Despite major advances in diagnosing and treating HIV infection, in 2007, 35,962 cases of AIDS were diagnosed and 14,110 deaths among people living with HIV were reported in the United States.

31. HIV is spread primarily by: • Not using a condom when having sex with a person who has HIV. • All unprotected sex with someone who has HIV contains some risk. • However: • Unprotected anal sex is riskier than unprotected vaginal sex. • Among men who have sex with other men, unprotected receptive anal sex is riskier than unprotected insertive anal sex. • Having multiple sex partners or the presence of other sexually transmitted diseases (STDs) can increase the risk of infection during sex. • Unprotected oral sex can also be a risk for HIV transmission, but it is a much lower risk than anal or vaginal sex. • Sharing needles, syringes, rinse water, or other equipment used to prepare illicit drugs for injection. Being born to an infected mother—HIV can be passed from mother to child during pregnancy, birth, or breast-feeding. Less common modes of transmission include: Being “stuck” with an HIV-contaminated needle or other sharp object. This risk pertains mainly to healthcare workers. Receiving blood transfusions, blood products, or organ/tissue transplants that are contaminated with HIV.  This risk is extremely remote due to the rigorous testing of the U.S. blood supply and donated organs/tissue. HIV may also be transmitted through unsafe or unsanitary injections or other medical or dental practices.  However, the risk is also remote with current safety standards in the U.S.

32. Eating food that has been pre-chewed by an HIV-infected person.  The contamination occurs when infected blood from a caregiver’s mouth mixes with food while chewing.  This appears to be a rare occurrence and has only been documented among infants whose caregiver gave them pre-chewed food.  Being bitten by a person with HIV. Each of the very small number of cases has included severe trauma with extensive tissue damage and the presence of blood. There is no risk of transmission if the skin is not broken.  Contact between broken skin, wounds, or mucous membranes and HIV-infected blood or blood-contaminated body fluids. These reports have also been extremely rare.  There is an extremely remote chance that HIV could be transmitted during “French” or deep, open-mouth kissing with an HIV-infected person if the HIV-infected person’s mouth or gums are bleeding.

33. Tattooing or body piercing present a potential risk of HIV transmission, but no cases of HIV transmission from these activities have been documented. Only sterile equipment should be used for tattooing or body piercing. There have been a few documented cases in Europe and North Africa where infants have been infected by unsafe injections and then transmitted HIV to their mothers through breastfeeding.  There have been no documented cases of this mode of transmission in the U.S. HIV cannot reproduce outside the human body. It is not spread by: Air or water. Insects, including mosquitoes. Studies conducted by CDC researchers and others have shown no evidence of HIV transmission from insects. Saliva, tears, or sweat.  There is no documented case of HIV being transmitted by spitting. Casual contact like shaking hands or sharing dishes. Closed-mouth or “social” kissing. All reported cases suggesting new or potentially unknown routes of transmission are thoroughly investigated by state and local health departments with assistance, guidance, and laboratory support from CDC.

34. What are bloodborne pathogens? Bloodborne pathogens are microorganisms in human blood or certain body fluids that cause disease in humans. The most common ones are the hepatitis B virus (HBV), which causes a severe form of Hepatitis in some or acts as a carrier in others, and the human immunodeficiency virus (HIV), which causes AIDS. How do you become infected? Bloodborne pathogens may be passed on when the microorganisms enter the body through mucus membranes, through breaks in the skin or through needle sticks. In non-medical occupations, exposure is most common when an injured worker’s blood contacts a co-worker rendering first aid. Practicing universal precautions and wearing the proper personal protective equipment will prevent exposure. What are universal precautions? Universal precautions are methods of preventing infection by treating all human body fluids as if they were contaminated and using proper personal protective equipment whenever you are required to come into contact with these fluids. Qualified, trained first-aid providers should be knowledgeable of these precautions. What should I do to protect myself? Personal protective equipment (PPE) includes latex gloves, gowns, mouth pieces, resuscitation bags, face masks and foot protection. Proper use can significantly reduce the health risks for exposed workers.

35. Utilizing the proper PPE and being cautious about Bloodborne Pathogens, you can avoid making yourself and your clients ill.