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Infectious & Communicable Diseases. Chemeketa Community College. Are we at risk?. Patient contact Co-workers Hygiene Hazardous scenes. Overview. Infectious diseases affect entire populations Important to understand population demographics Their ability to move internationally

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Infectious communicable diseases

Infectious & Communicable Diseases

Chemeketa Community College


Are we at risk
Are we at risk?

  • Patient contact

  • Co-workers

  • Hygiene

  • Hazardous scenes


Overview
Overview

  • Infectious diseases affect entire populations

  • Important to understand population demographics

    • Their ability to move internationally

    • Age distributions

    • Socioeconomic considerations

    • Genetic factors

  • Study of an infectious disease cluster is regional; consequences may be international.

  • Think of consequences of person-to-person contacts


Public health agencies
Public Health Agencies

  • Local – that’s YOU!

  • State

    • Health dept

  • Federal

    • US DHS CDC & P

      • Monitors

      • Studies & researches

      • Manages

    • OSHA


Agency responsibility relative to isolation from exposure
Agency responsibility relative to isolation from exposure

  • Exposure plan

    • Maintenance and surveillance

    • Appointing a DO

    • Schedule of standards implemented

    • PPE

      • gowns

      • gloves

      • face shields

      • masks

      • protective eyewear


  • BSI

  • Procedures for evaluation of circumstances and counseling

  • personal, building, vehicular, equipment disinfection and storage

  • After action analysis

  • Correct disposal

  • Correct handling


Guidelines recommendations standards laws
Guidelines, Recommendations, Standards, Laws

  • PPE must be available to all employees at high risk

  • All employees must be offered HB vaccine

  • All high risk employees must be offered protection from bloodborne pathogens including TB testing, measles vaccination.


Host defense mechanisms
Host Defense Mechanisms

  • Nonspecific and surface defense mechanisms

  • Flora

    • Enhances effectiveness of surface barrier by interfering with establishment of agents

    • Can be responsible for infection

  • Skin

    • Intact skin defends against infection by:

      • Maintaining an acidic pH level

      • Preventing infection


  • GI System

    • Resident bacterial flora provides competition between colonies of microorganisms for nutrients and space; helps prevent proliferation of pathogenic organisms

    • Stomach acid may destroy some microorganisms

    • Eliminates pathogens through feces


  • Upper Respiratory system

    • Turbinates

    • Mucous

    • Mucociliary escalator

    • Normal bacterial flora

    • Lymph tissues of tonsils and adenoids permit rapid local immunological response


  • GU tract

    • Natural process of urination and bacteriostatic properties of urine help prevent establishment of microorganisms in GU tract

    • Antibacterial substances in prostatic fluid and vaginal fluid help prevent infection in GU system.


  • Internal Barriers

  • Protect against pathogenic agents when external lines of defense are breached.

  • Include

    • Inflammatory response

    • Imune response


Inflammatory response
Inflammatory response

  • A local reaction to cellular injury

  • Generally protective and beneficial

  • May initiate destruction of the body’s own tissue


Three separate stages
Three separate stages

  • Cellular response to injury

    • Decreasing energy stores

    • Cell membrane deteriorates, begin to leak

  • Vascular response to injury

    • Capillary permeability increases, = edema

    • Leukocytes collect

  • Pagocytosis

    • Leukocytes engulf, digest, destroy invaders


Immune response
Immune response

  • Possesses self-nonself recognition

  • Produces antibodies

  • Some lymphocytes become memory cells

  • Is self-regulated to activate only when invading pathogens

IgG

IgM

IgA

IgD

IgE


  • B-cells

    • Produces antibody

  • T-cells

    • Processes antigen for B-cell,

    • Killer T cells are stimulated to multiply by presence of antigens on abnormal cells

    • Helper T cells turn on activities of killer cells

    • Suppressor T cells turn off action of helper and killer T cells

    • Inflammatory T cells stimulate allergic reactions, anaphylaxis, autoimmune reactions


Approach to call
Approach to call

  • Wear appropriate PPE

  • Patient Assessment:

    • Focused history and physical

    • History of present illness

      • Onset - gradual or sudden?

      • Fever

      • Antipyretic usage (ASA, APAP)

      • Neck pain or rigidity?

      • Difficulty swallowing, secretions?

      • How did sx change over time?


  • Past medical history

    • Chronic infections, inflammation

    • Use of steroids, antibiotics

    • Organ transplant and associated medicines

    • Diabetes or other endocrine disorders

    • COPD or respiratory complications


Detailed history and physical
Detailed history and physical

  • Assess skin for temperature, hydration, color, mottling, rashes, and petechiae

  • Assess sclera for icterus

  • Assess patient reaction to neck flexion

  • Assess for lymphadenopathy in neck

  • Assess digits and extremities for purulent lesions



Stages of an infectious disease
Stages of an infectious disease disinfect ambulance and equipment


The ryan white act
The Ryan White Act disinfect ambulance and equipment

  • Ryan Wayne White - 1971 – 1990

  • Dx /c Hemophilia at 3 days old

    • Tx /c Factor VIII and blood transfusions

  • 1984 – Dx /c AIDS

  • 1990, 1996 – Ryan White law passed


What does it mean
What does it mean? disinfect ambulance and equipment

  • Employees must be notified within 48 hours if an exposure is found to have occurred.

  • Employers must name a DO to coordinate communications between hospital and agency



Individual responsibilities
Individual Responsibilities disinfect ambulance and equipment

  • Be familiar with laws, regulations

  • Proactive attitude – infection control

  • Maintain personal hygiene

  • Attend to wounds

  • Effective hand washing after every patient contact

  • Remove or dispose of work garments- handle uniforms properly


  • Handle and launder soiled work clothes properly disinfect ambulance and equipment

  • Prepare food and eat in appropriate areas

  • Maintain general and psychological health

  • Dispose of needles and sharps appropriately

  • Don’t wipe face and/or rub eyes, nose, mouth etc.


Pathophysiology
Pathophysiology disinfect ambulance and equipment



We ll talk about

HIV disinfect ambulance and equipment

Hepatitis A

Hepatitis B

Hepatitis C

Hepatitis non-ABC

Tuberculosis

Mengococcal meningitis

Pneumonia

Rabies

Hantavirus

Chicken pox

Mumps

We’ll talk about...


And these too

Rubella disinfect ambulance and equipment

Measles

Whooping cough

Influenza

Mononucleosis

Herpes simplex 1 & 2

Syphilis

Gonorrhea

Chlamydia

Scabies & Lice

Lyme disease

Gastroenteritis

And these too


Infectious agents
Infectious agents disinfect ambulance and equipment

  • Bacteria

    • Prokaryotic

      • Nuclear material is not contained within a distinctive envelope

  • self-reproducing without host cell – BUT require host for food, support

  • s/s depend on cells and tissues infected



  • Viruses disinfect ambulance and equipment

    • Eukaryotic

      • Nuclear material contained within a distinct envelope

  • must invade host cells to reproduce

  • Can’t survive outside of host cell


Other microorganisms
Other Microorganisms disinfect ambulance and equipment

  • Prions

    • Slow viruses – particles of protein

      • Accumulate in nervous tissue and brain tissue

    • Mad Cow Disease

    • Fatal familial insomnia

    • Alzheimers Disease

    • Parkinsons’ Disease


  • Fungi disinfect ambulance and equipment

    • Protective capsules surround the cell wall and protect fungi from phagocytes

    • Broad-spectrum antibiotics can cause fungal infections

    • Pneumonia, Yeast infections


Protozoans single celled microorganisms more complex than bacteria
Protozoans disinfect ambulance and equipmentSingle-celled microorganismsMore complex than bacteria

  • Live in soil – opportunistic infections – fecal-oral or mosquito bites

    • Malaria

    • Some forms of Gastroenteritis

    • trichomoniasis


Parasites helminths worms
Parasites – disinfect ambulance and equipmentHelminths (worms)

  • Roundworms

    • Live in intestinal mucosa

    • S/S – abdominal cramping, fever, cough

  • Pinworms

    • Common in US

      • 20% of children in temperate

        climates are infected

    • Live in distal colon

    • S/S – anal itching

  • Hookworms

    • 25% world population – rare in US

      • Walking barefoot in contaminated area

      • S/S – epigastric pain, anemia


Human immunodeficiency virus hiv slim disease
Human immunodeficiency virus (HIV) Slim disease disinfect ambulance and equipment

  • Present in blood and serum-derived body fluids

  • Directly transmitted person-person

  • Indirectly transmitted via

    • blood transfusion, organ transplant, contaminated needles


Statistics
Statistics disinfect ambulance and equipment

  • US- 850,000 – 950,000

    • >180,000 undiagnosed

  • Oregon – 5,599 (12/03)


  • International Travel disinfect ambulance and equipment

  • 'Patient Zero‘ - Gaetan Dugas

    • Analysis of several of the early cases of AIDS -infected individuals were either direct or indirect sexual contacts of the flight attendant.

  • The Blood Industry

  • In some countries such as the USA paid donors were used, including intravenous drug users.

    • This blood sent worldwide.

    • Also, in the late 1960's hemophiliacs benefit from Factor VIII. To produce the coagulant, blood from thousands of individual donors had to be pooled.


  • Drug Use disinfect ambulance and equipment

    • The 1970s - increase in availability of heroin following the Vietnam War and other conflicts in the Middle East,

    • the development of disposable syringes and the establishment of 'shooting galleries' provided another route.

  • What other theories have there been about the origin of HIV?

    • conspiracy theories - manufactured by the CIA vs genetically engineered.


  • Occurrence highest: disinfect ambulance and equipment

    • High-risk sexual behavior

    • IV drug abuse

    • Transfusion recipient between 1978-1985

    • Hemophilia or other coagulation disorders requiring blood products

    • Infant born from HIV-pos. mother

  • Other factors

    • Coexisting STD’s (esp. with ulceration)

    • Penile foreskin


  • Causative agent - HIV-1 & HIV-2 disinfect ambulance and equipment

    • Seeks cell receptor CD4+ T cells

    • Found on surface of T helper cells

  • Both types are seriologically distinct but share similar characteristics

HIV infected T-cell


  • HIV-1 is far more pathogenic; most cases world-wide are HIV-1, Group M

    • first case in US of HIV-1, Group O, identified in 6/96

  • Est. AIDS dx through 2003 in US- 929,985. Adult and adolescent: 920,566

    Males: 749,887

    Females: 170,679

    Children: 9,419

    • HIV-antibody tests in US detect HIV-1 Group M, with 99% accuracy; HIV-1 Group O with 50-90%.

  • HIV-2 – milder sx, slower development – mainly in West Africa. US cases: 79



Classifications categories
Classifications & Categories HIV-1, Group M

Category A

  • Acute retroviral infection

  • 2-4 weeks after exposure

  • Mono-like illness; lasts 1 – 2 weeks

    • Fever

    • Adenopathy

    • Sore throat


  • Transient decrease in CD4+T cell counts HIV-1, Group M

  • Seroconversion; 6-12 weeks after transmission

    • CD4+T cell count return to normal levels

  • Asymptomatic infection; persistent generalized lymphadenopathy; gradual decline in CD4+T cell count


  • Category B HIV-1, Group M

    • Early symptomatic HIV

    • Decreased CD4+T cell count

    • Common complications

      • Localized Candida infections

      • Oral lesions

      • Shingles

      • PID

      • Peripheral neuropathy

      • Fever/Diarrhea lasting more than one month


  • Category C HIV-1, Group M

    • Late symptomatic HIV

    • Represents all AIDS-defining diagnoses

    • CD4+T cell count 0 to 200 per uL

    • Severe opportunistic infections

      • Bacterial pneumonia (Pneumocystis Carinii Pneumonia)

      • Pulmonary tuberculosis

      • Debilitating diarrhea

      • Tumors in any body system, including Kaposi’s sarcoma

      • HIV-associated dementia

    • Advanced HIV: CD4+T cell counts 0-50 per uL.


  • Nervous system - toxoplasmosis of CNS HIV-1, Group M

  • Immune system - major site of compromise

  • Respiratory system - pneumocystis carinii pneumonia

  • Integumentary system - Karposi’s sarcoma


  • 13-30% transmission to infants born to HIV-infected mothers HIV-1, Group M

  • Breast feeding can result in HIV transmission

  • Virus has occasionally been found in saliva, tears, urine, bronchial secretions.

  • Vector transmission has not been known to occur.

  • Risk of oral sex is not quantified; believed low.


Patient management
Patient management HIV-1, Group M

  • Out-of-hospital care - supportive.

  • BSI as appropriate

  • effective hand washing

  • Use of eye protection, masks and gowns highly recommended when exposure to large volumes of body fluids.


  • HCW infection: HIV-1, Group M

    • Nonintact skin exposure (6/2000) – 56 +

      138 ?

  • Susceptibility and resistance

    • Infectiousness may be high during initial period after infection and at end-stage

    • Race and gender are not risk factors for susceptibility.



Hiv testing
HIV testing HIV-1, Group M

  • OraQuick Rapid HIV 1 / 2 test

    • Oral fluid, plasma, whole blood

    • 20 – 40 minutes

    • Accuracy

      • Positive – 99.3%

      • Negative – 99.8%


Post exposure prophylaxis
Post-exposure prophylaxis HIV-1, Group M

  • < 72 hours non-occupational exposure

    • highly active antiretroviral therapy (HAART)

      • PMPA (tenofovir) – 28 days

  • Repeat testing 4-6 weeks after exposure; again at 3 months, 6 months, 1 year


Who recommendations for a first line regimen in adults and adolescents
WHO Recommendations for a First Line Regimen in Adults and Adolescents

  • d4T+3TC+NVP

  • ZDV+3TC+NVP

  • d4T+3TC+EFZ

  • ZDV+3TC+EFZ

  • d4T (NRTI) alternative name Stavudine

  • ZDV (NRTI) alternative names Zidovudine or AZT

  • EFZ (NNRTI) alternative name Efavirenz

  • NVP (NNRTI) alternative name Nevirapine

  • 3TC (NRTI) alternative name Lamivudine


  • Hepatitis
    Hepatitis Adolescents

    • A viral disease

    • Produces pathologic alterations in the liver


    Hepatitis a
    Hepatitis-A Adolescents

    • Causative agent-Hepatitis A virus

    • Most common type of viral hepatitis

    • Once infected, person is immune to HAV for life


    Statistics1
    Statistics Adolescents

    • Oregon 1994 – 2003 – 6650 cases

    • Marion Cty: 632

    • Multnomah Cty: 1,512


    • Many infections asymptomatic Adolescents

      • Liver may be affected

      • Often occurs without jaundice, esp. children

      • Only recognizable by liver function studies

    • Only hepatitis virus that does not lead to chronic liver disease or chronic carrier state.


    • Routes of transmission Adolescents

      • stool of infected person

      • contaminated water, ice or food

      • Sexual and household contact can spread virus

      • Can survive on unwashed hands for 4 hours


    Susceptibility and resistance
    Susceptibility and Adolescentsresistance

    • No clearly defined populations at increased risk.

    • 75% of people with H-A have sx.

    • In developing nations with poor sanitation, infection is common

    • In developed nations, often associated with day care, nursing homes


    S/S Adolescents

    • Onset is abrupt with fever, weakness, anorexia, abdominal discomfort, nausea and darkening of urine, sometimes followed w/in a few days by jaundice/icterus.

    • Mild severity lasting 2-6 weeks.

    • Rarely serious.


    Patient management1
    Patient management Adolescents

    • Care is supportive for fluid intake and prevention of shock.

    • Person is most infectious during first week of sx.

    • BSI mandatory.


    Immunization
    Immunization Adolescents

    • Prophylactic IG may be administered within two weeks after exposure

    • If traveling to Africa, the Middle East, Central and South America, Asia - get immunized.


    • Hepatitis A vaccine available for 2 y/o or older Adolescents

      • Close contact with people who live in areas with poor sanitary conditions

      • Male-male sex

      • Illicit drugs

      • Children in populations with repeated epidemics

      • Chronic liver disease or clotting factors disorders


    Hepatitis b
    Hepatitis-B Adolescents

    • Causative agent - H-B virus.

    • Potential secondary complication - liver necrosis

    • HBV usually lasts < 6 months

      • Carrier state may persist for years


    Statistics2
    Statistics Adolescents

    • Oregon – 1994 – 2003; 1,578 cases

    • Marion Cty: 195

    • Multnomah Cty: 556


    Routes of transmission
    Routes of transmission Adolescents

    • Blood, semen, vaginal fluids, saliva, blood transfusion, dialysis, needle and syringe sharing, tattooing, sexual contact, acupuncture, communally-used razors and toothbrushes.

    • HBV stable on environmental surfaces > 7 days

    • Transmission by insects and fecal-oral route not demonstrated.


    S/S Adolescents

    • Within 2-3 months, infected persons gradually develop non-specific symptoms such as anorexia, n/v, fever, joint pain, generalized rashes, sometimes jaundice.

    • Risk of developing chronic infection varies inversely with age.



    Patient management2
    Patient management mortality increasing > 40 y/o.

    • out-of-hospital - supportive

    • BSI

    • Effective handwashing

    • care in use of equipment.

    • Careful handling of sharps

    • high-level disinfection of equipment esp. laryngoscopy blades is mandatory.


    Immunizations
    Immunizations: mortality increasing > 40 y/o.

    • Recombivax HB and

    • Engerix B are effective.

    • Vaccines: initial, one-month, six-month provide long-lasting immunity in 95-98% of cases.

    • Postexposure prophylaxis

      • HBV vaccine

      • HB IG


    Hepatitis c
    Hepatitis C mortality increasing > 40 y/o.

    • Causative agent - H-C virus.

    • Organ affected - liver.

    • Most frequent infection 2ndary to needlestick & sharp injury

    • 85% infected healthcare workers become chronic carriers



    Statistics3
    Statistics when exposed to contaminated blood. Transmission by household and sexual contact low.

    • Oregon: 1994 – 2003; 142

    • Marion Cty: 4

    • Multnomah Cty: 17


    S/S when exposed to contaminated blood. Transmission by household and sexual contact low.

    • same as for HBV but less progression to jaundice

    • chronic liver disease common with >80% developing chronic liver disease.

    • Apparent association between HCV infection and liver cancer


    • Patient management when exposed to contaminated blood. Transmission by household and sexual contact low.

      • Same as for HBV

    • Immunization:

      • Prophylactic administration of IG not supported by current data

      • Post exposure testing important

      • Vaccine may be available


    Hepatitis non abc
    Hepatitis non-ABC when exposed to contaminated blood. Transmission by household and sexual contact low.

    • Hepatitis D; infects a cell with other hepatitis virus

      • when virus active in HBV patients, resulting disease extremely pathogenic

    • Hepatitis E not bloodborne; is spread like H-A


    • Hepatitis G - newly identified when exposed to contaminated blood. Transmission by household and sexual contact low.

    • Major epidemics documented in young adults.

    • Women in 3rd trimester especially susceptible to liver disease


    S/S when exposed to contaminated blood. Transmission by household and sexual contact low.

    • Onset abrupt with s/s resembling HBV

    • Always associated with HBV

  • Patient management

    • Same as for HBV

  • Immunization

    • HB vaccine can indirectly prevent H-D, but has no effect on H-E.


  • Tuberculosis
    Tuberculosis when exposed to contaminated blood. Transmission by household and sexual contact low.

    • Causative agent - mycobacterium tuberculosis

    • 8 million new TB/yr worldwide

    • 3 million die of disease


    • TB Epidemic in US when exposed to contaminated blood. Transmission by household and sexual contact low.

      • Immigration

      • Transmission in high-risk environments

        • Prisons, homeless shelters, hospitals, nursing homes

    • Oregon: 106/100,000 (11/03)



    Susceptibility and resistance1
    Susceptibility and resistance persons

    • period of incubation 4-12 weeks.

    • Period for development of disease 6-12 months after infection.

    • Risk of developing disease highest in children < 3, lowest in later childhood and high among adolescents, young adults and elders.

    • High in immuno-compromised patients; HIV-infected, underweight, undernourished.


    S/S: persons

    • First infection usually subclinical

      • These bacteria lie dormant but can reactivate into secondary TB

    • Most common site of reactivation TB is in apices of lungs.

    • Patients present with

      • chronic productive/non-productive cough (persistent for 2-3 weeks),

      • low-grade fevers,

      • night sweats,

      • weight loss, fatigue

      • Hemoptysis common.


    • Body systems affected; persons

      • indirectly affects respiratory system including larynx

      • Left untreated, TB can spread to other organ systems and cause other sx.

    • Cardiovascular; pericardial effusions may develop

    • Skeletal:

      • Generally affects thoracic and lumbar spine, destroying intervertebral discs

      • Chronic arthritis of one joint is common

    • CNS

      • causes a subacute meningitis and forms granulomas in brain


    Patient care
    Patient care persons

    • Primarily supportive

    • Prevent shock


    • Routine evaluation of Health care workers persons

      • PPD (purified protein derivative)

        • Positive reaction indicates past infection

      • CXR

      • Sputum stain and culture

    • Remember; TB is communicable with prolonged exposure to droplet infection.


    Drug therapy
    Drug therapy persons

    • prophylactic INH; recommended routinely for persons <35 y/o who are PPD positive; not recommended > 35 due to hepatic complic.

    • Therapeutic: Isoniazid, Rifampin, Pyrazinamide, Streptomycin

    • Side effects of INH

      • Paresthesias, seizures, orthostatic hypotension, N/V, Hepatitis


    Meningococcal meningitis
    Meningococcal personsmeningitis

    • Causative organism: Neisseria meningitidis, meningococcus

    • Tissues affected:

      • Colonize lining of throat and spread easily through resp. secretions

      • Est. 2-10% of population carriers, but are prevented from illness by throat’s epithelial lining.


    Statistics4
    Statistics persons

    • Oregon – 1994 – 2003: 887

    • Marion Cty: 111

    • Multnomah Cty: 182



    S/S: intubation, suctioning, CPR etc.

    • onset is rapid;

      • fever,

      • chills,

      • joint pain,

      • neck stiffness or nuchal rigidity,

      • petechial rash,

      • projectile vomiting,

      • headache




    • Patient management: maternal antibodies protect neonates to 6 mo.

      • protective measures with surgical masks to patient.

      • Prophylactic tx available; rifampin, etc.

      • Immunizations: esp. for older children and adults.


    Other infectious agents cause meningitis
    Other infectious agents cause meningitis: maternal antibodies protect neonates to 6 mo.

    • Streptococcus pneumoniae (bacterial)

      • 2nd most common cause in adults

      • most common cause of pneumonia in adults and OM in children

      • spread by droplets, prolonged contact or soiled linen.


    • Hemophilus influenza type B (bacterial) maternal antibodies protect neonates to 6 mo.

      • gram negative rods. Prior to 1981, leading cause of meningitis in children 6 mo-3 y/o.

      • Although tx with antibiotics very effective, >50% infected children have long-term neurological deficits.

      • Implicated in epiglottitis, septic arthritis, generalized sepsis.



    Pneumonia
    Pneumonia maternal antibodies protect neonates to 6 mo.

    • Causative organisms

      • Bacterial

      • Viral

      • Fungal


    • Systems affected maternal antibodies protect neonates to 6 mo.

      • Respiratory - pneumonia

      • CNS - meningitis

      • ENT - otitis, pharyngitis media

    • Routes of transmission

      • Droplet, Direct contact, Soiled linen


    Susceptibility
    Susceptibility maternal antibodies protect neonates to 6 mo.

    • pulmonary edema

    • Flue

    • exposure to inhaled toxins

    • chronic lung disease and aspiration

    • Geriatrics

    • Pediatrics with low birth weight and malnourishment


    Other high risk groups
    Other high-risk groups maternal antibodies protect neonates to 6 mo.

    • sickle cell disease

    • cardiac disease

    • Diabetes

    • kidney disease

    • HIV

    • organ transplants

    • Hodgkins disease

    • Asplenia


    S/S maternal antibodies protect neonates to 6 mo.

    • Sudden onset chills, high-grade fevers, chest pain with respirations, dyspnea.

    • PEDS: fever, tachypnea, chest retractions are ominous.

    • Purulent exudates may develop in one or more lobes.

    • Patient may have productive cough with yellow-green phlegm.


    Patient management3
    Patient management maternal antibodies protect neonates to 6 mo.

    • several antibiotics effective to treat bacterial pneumonia

    • Protective measures for health-care workers.

  • Immunizations:

    • vaccine exists for some causes


  • Tetanus
    Tetanus maternal antibodies protect neonates to 6 mo.

    • Causative organism;

      Clostridium tetani

      • Live mainly in soil and manure

      • Also found in human intestine


    Statistics5
    Statistics maternal antibodies protect neonates to 6 mo.

    • 500,000 cases/year worldwide

      • 45% mortality

    • 100 cases/year in U.S.

      • Patients > 50 y/o

    • Oregon: 1992-2001; 6

    • Marion Cty – 1997: 1


    • Affects musculoskeletal system maternal antibodies protect neonates to 6 mo.

    • Mode of transmission

      • wounds, burns, other disruptions in skin.

      • Puncture wounds introducing soil, street dust and animal or human feces.

      • Dead or necrotic tissue favorable environment.


    S/S maternal antibodies protect neonates to 6 mo.

    • muscular tetany

    • Painful contractions, esp. trismas or locklaw and neck muscles; secondarily of trunk muscles.

    • PEDS: abnormal rigidity may be first sign.

    • Painful spasms with risus sardonicus

    • Can lead to respiratory failure.


    Patient management4
    Patient management: maternal antibodies protect neonates to 6 mo.

    • Support vital functions

    • Valium for muscle spasms

    • Consider paralytics

    • Magnesium sulfate

    • Narcotics

    • Antidysrhythmics

    • Administration of antitoxin - TIG



    Rabies hydrophobia
    Rabies - hydrophobia immunizations UTD.

    • Acute viral infection of the CNS

    • Causative organism - rabies virus

    • Affects nervous system

    • Route of transmission

      • saliva from bite or scratch of infected animal.

      • Person-person transmission theoretically possible.

      • Airborne spread in bat caves -rare


    Statistics6
    Statistics immunizations UTD.

    • Oregon; 1994 – 2003; 77

    • Marion Cty:

      • 1996 – 2

      • 1998 – 2

      • 2001 – 1




    S/S: immunizations UTD.

    • sense of apprehension

    • H/A

    • Fever

    • Malaise

    • poorly defined sensory changes.

    • Progresses to weakness or paralysis

    • spasm of swallowing muscles (causes hydrophobia),

    • delirium,

    • convulsions

  • w/o medical care, disease lasts 2-6 days; often results in death.


  • Patient management5
    Patient immunizations UTD.management:

    • EMS workers; transmission never documented.

    • After bite:

      • thorough debridement of wound

      • free bleeding and drainage.

      • Vigorously clean wound with soap and water and irrigate with 70% alcohol.

      • Prophylactic Tetanus vaccine

    • Administration of human rabies immune globulin

      • Over several weeks


    Hantavirus
    Hantavirus immunizations UTD.

    • Known to be associated with hemorrhagic fever with renal syndrome; occurs in Asia.

    • Also associated with a syndrome of severe respiratory distress & shock in Southwestern U.S.

      • Deermouse

    • Transmitted via inhalation of aerosols of rodent urine and feces


    Statistics7
    Statistics immunizations UTD.

    • Oregon: 1993 – 2003; 5 cases


    S/S immunizations UTD.

    • Typically healthy adults

    • Onset of fever and malaise – 1 – 5 weeks later

      • Followed several days later by respiratory distress

      • fever,

      • Chills

      • H/A

      • GI upset

      • Capillary hemorrhage

      • Kidney failure, hypotension, severe infection may ensue

    • Death from poor cardiac output


    Patient management6
    Patient management immunizations UTD.

    • Supportive

    • BSI


    Chickenpox
    Chickenpox immunizations UTD.

    • Causative agent; variella-zoster virus (member of the Herpes virus group).

    • System affected; primarily integumentary


  • Mainly airborne

    • soiled linen implicated.

  • Incubation period 10-21 days


  • S/S: viral infection

    • more severe in adults

    • Begins with respiratory symptoms, malaise, low-grade fever.

    • Rash begins as small red spots that become raised blisters on a red base. Eventually dry into scabs. Rash is profuse on trunk

    • Itching

  • Patient management:

    • Isolation until all lesions are crusted and dry.


    • Disease self-limited viral infection

    • Complications

      • Secondary bacterial infections

      • Aseptic meningitis

      • Mononucleosis

      • Reye syndrome


    Mumps
    Mumps viral infection

    • Causative agent:Mumps virus

      • Acute, communicable systemic viral disease

    • Glands most commonly affected:

      • Parotid

      • Testes

      • Pancreas


    S/S: viral infection

    • Mode of transmission; droplet spread, direct contact

    • Incubation period; 12-25 days.

    • Immunity general after recovery

    • 30% asymptomatic

      • Fever, swelling and tenderness of salivary glands, esp. parotid.

      • After onset of puberty;

        • Orchitis

        • Testicular atrophy


    Patient management7
    Patient management: viral infection

    • EMS workers - MMR immunity

    • Patients wear masks

    • Caution with soiled linen


    Rubella german measles
    Rubella (German measles) viral infection

    • Causative agent - rubella virus

    • Mild, febrile, highly communicable disease

    • Systems affected;

      • integumentary,

      • musculoskeletal,

      • lymph nodes


    Mode of transmission
    Mode of transmission viral infection

    • maternal transmission gravest risk:

      • congenital heart diseases, eye inflammations, retardation,

      • deafness (90% of neonates born to mothers infected in first trimester develop congenital rubella syndrome).


  • Person-person contact via mucous secretions


  • S/S: first 6 month

    • generally mild; fever, flue sx, red rash that spreads from forehead to face to torso to extremities and lasts 3 days.

    • Serious complications do not occur in Rubella.


    Patient management8
    Patient management: first 6 month

    • BSI including mask.

    • All EMS workers, especially females should be screened for immunity.

    • No specific treatment.

    • Immunizations: known to be 98-99% effective


    Measles rubeola hard measles
    Measles first 6 month(rubeola, hard measles)

    • Causative organism - measles virus

      • Highly communicable

    • Systems affected: respiratory, CNS, pharynx, eyes, systemic

    • Mode of transmission - air droplets, direct contact.


    S/S: first 6 month

    • prodrome - conjunctivitis, swelling of eyelids, photophobia, high fevers to 105 degrees, hacking cough, malaise



    • Rash usually lasts for 6 days, initially appears thicker over head and shoulders, clears up and follows that pattern toward feet.

    • Pneumonia, eye damage and myocarditis are all possible but most life-threatening is subacute sclerosing panencephalitis

      • Deterioration of mental capacity, muscle coordination


    Patient management9
    Patient management: over head and shoulders, clears up and follows that pattern toward feet.

    • BSI, including mask

    • EMS workers should be immunized

    • No specific treatment.


    Pertussis whooping cough the 100 day cough
    Pertussis (Whooping Cough) over head and shoulders, clears up and follows that pattern toward feet.The 100-day cough

    • Causitive organism - Bordetella pertussis

    • Mainly affects infants and young childred

    • Affects oropharynx

    • Mode of transmission; direct contact with airborne droplets.


    S/S: over head and shoulders, clears up and follows that pattern toward feet.

    • Insidious onset of cough which becomes paroxysmal in 1-2 weeks, lasts 1-2 months.

    • Paroxysms are violent, inspiratory whoop. Whoop often not present in infants < 6 mo., adults

    • Before pertussis vaccine in 1950’s, disease killed more children in U.S. than all other infectious diseases combined


    Patient management10
    Patient management: over head and shoulders, clears up and follows that pattern toward feet.

    • EMS workers be cautious about handling linens, supplies etc. on all patients with hx of recent onset of paroxysmal cough

  • Tx patient with mask.

    • Communicable period thought to be greatest before onset of coughing.

    • Incubation period 6-20 days.

    • Erythromycin decreases period of communicability, but only reduces sx if given during incubation period.


  • Influenza the flu
    Influenza – the flu over head and shoulders, clears up and follows that pattern toward feet.

    • Causative organisms; influenza viruses types A, B, C

    • Affects respiratory system primarily

    • Mode of transmission: airborne, direct contact

    • Virus can persist for hours, esp. in low humidity and cold temp.

    • Incubation period 1-3 days.


    S/S: over head and shoulders, clears up and follows that pattern toward feet.

    • URI- type sx which last 2-7 days.

      • Chills

      • Fever

      • Headache

      • Muscle aches

      • Anorexia

      • fatigue

      • Cough often severe, protracted.


    • Patient management: over head and shoulders, clears up and follows that pattern toward feet.

      • Supportive

    • Immunizations:

      • Health care workers should be immunized by mid-Sept. (flu season Nov.-Mar. in US).


    Mononucleosis
    Mononucleosis over head and shoulders, clears up and follows that pattern toward feet.

    • Causative organism - Epstein-Barr virus or cytomegalovirus (both herpesvirus family)

    • Body regions affected: oropharynx, tonsils


    • Modes of transmission over head and shoulders, clears up and follows that pattern toward feet.

      • person-to-person spread by saliva

      • kissing

      • care providers to young children is common


    S/S: over head and shoulders, clears up and follows that pattern toward feet.

    • Appear gradually

      • Fever

      • sore throat

      • oropharyngeal discharges

      • Lymphadenopathy

      • splenomegaly

    • Recovery usually in a few weeks, but may take months


    Patient management11
    Patient management over head and shoulders, clears up and follows that pattern toward feet.

    • No specific treatment

    • No immunization available.


    Herpes simplex virus type 1
    Herpes simplex virus type 1 over head and shoulders, clears up and follows that pattern toward feet.

    • Causative organism: HSV 1

    • Affects: oropharynx, face, lips, skin, fingers, toes, CNS in infants

    • Mode of transmission:

      • Saliva

      • Skin – skin contact


    S/S: over head and shoulders, clears up and follows that pattern toward feet.

    • cold sores, fever blisters

      • Tx with acyclovir (Zovirax) helpful.


    Patient management12
    Patient management: over head and shoulders, clears up and follows that pattern toward feet.

    • BSI, including mask

    • Lesions are highly contagious


    Herpes simplex virus type 2
    Herpes simplex virus type 2 over head and shoulders, clears up and follows that pattern toward feet.

    • Causative organism - HSV 2

    • Mode of transmission - sexual activity

    • S/S - Males:

      • Lesions of penis, anus, rectum, and/or mouth


    • S/S - Females: over head and shoulders, clears up and follows that pattern toward feet.

      • Sometimes asymptomatic; lesions of cervix, vulva, anus, rectum and mouth; recurrent disease generally affects vulva, buttocks, legs, perineal skin.


    Syphilis
    Syphilis over head and shoulders, clears up and follows that pattern toward feet.

    • Causative organism; Treponema pallidum, a spirochete

    • Affects:

      • skin,

      • CNS,

      • eyes,

      • joints,

      • skeletal system,

      • kidneys,

      • cardiovascular


    Mode of transmission1
    Mode of transmission: over head and shoulders, clears up and follows that pattern toward feet.

    • Direct contact with exudates from moist, early, obvious or concealed lesions of skin and mucous membranes

    • semen,

    • blood,

    • saliva,

    • vaginal discharges,

    • blood transfusions,

    • needle sticks

    • Congenital transmission


    S s occurs in 4 stages
    S/S: Occurs in 4 stages over head and shoulders, clears up and follows that pattern toward feet.

    • Primary stage - painless lesion develops at point of entry called a chancre, 10-90 days after initial contact.

      • Lesion heals spontaneously within 1-5 weeks

      • Highly communicable at this stage




    • Third stage - latent syphilis 1 – 40 years warm sites like inguinal area. Extremely infectious, lasts @ 6 weeks.

      • 25% may relaps and develop secondary stage symptoms again.

      • After 4 years, there are generally no more relapses

      • 33% of patients will progress to tertiary syphilis; the rest will remain asymptomatic.


    • Tertiary syphilis warm sites like inguinal area. Extremely infectious, lasts @ 6 weeks.

      • Granulomatous lesions (gummas) found on skin and bones; skin gummas are painless with sharp borders; bone lesions cause a deep, growing pain.

      • Cardiovascular syphilis; occurs 10 years after primary infection; generally results in dissecting aneurysm of ascending aorta or aortic arch. Antibiotics don’t reverse this disease process.


    • Neurosyphilis; asymptomatic, develop menengitis, warm sites like inguinal area. Extremely infectious, lasts @ 6 weeks.

    • spinal cord disease that results in loss of reflexes and loss of pain and temperature sensation.

    • Tabes dorsalis; spinal column degeneration; wide gait and ataxia

    • Spirochetes attack cerebral blood vessels and cause CVA.

    • Psychosis, Insanity


    • Patient management: warm sites like inguinal area. Extremely infectious, lasts @ 6 weeks.

      • BSI

      • Causative agent extremely fragile and is easily killed by heat, drying, or soap and water.

      • Treatment is effective with penicillin, erythromycin, doxycycline.


    Statistics8
    Statistics warm sites like inguinal area. Extremely infectious, lasts @ 6 weeks.

    • Oregon: 2002 – 47 cases reported

    • 115% increase over 2001


    Gonorrhea
    Gonorrhea warm sites like inguinal area. Extremely infectious, lasts @ 6 weeks.

    • Causative agent; Neisseria gonorrheae

    • Affect genital organs and associated structures

    • Mode of transmission: direct contact with exudates of mucous membranes; unprotected sex.


    Statistics9
    Statistics warm sites like inguinal area. Extremely infectious, lasts @ 6 weeks.

    • Oregon:

    • 1980 – 11,162

    • 1995 – 854

    • 2001 – 1,039


    • S/S - males: warm sites like inguinal area. Extremely infectious, lasts @ 6 weeks.

      • Initial inflammation of urethra with dysuria and purulent urinary discharge . Left untreated, can progress to epididymitis, prostitis, and strictures of urethra.


    • S/S - females: warm sites like inguinal area. Extremely infectious, lasts @ 6 weeks.

      • Dysuria and purulent vaginal discharge may occur.

      • Most females have no pain and minimal urethral discharge.




    • Males and females: abscesses of fallopian tubes, ovaries, peritoneum, and peritonitis.

      • in rare cases, systemic bacteremia

      • septic arthritis with fever, pain, swelling of 1 or 2 joints can occur.

    • Patient management:

      • BSI

      • antibiotics


    Chlamydia
    Chlamydia abscesses of fallopian tubes, ovaries, peritoneum, and peritonitis.

    • Causative organism; Chlamydia trachomatis

    • Affects; eyes, genital area and associated organs, respiratory system


    Statistics10
    Statistics abscesses of fallopian tubes, ovaries, peritoneum, and peritonitis.

    • Most common reported STD in Oregon

    • 2002 – 7,200



    Scabies
    Scabies clothing or towels.

    • Scabies; a mite; a parasite

    • Female burrows into epidermis to lay eggs; remains in burrow for 1 month.

    • Affects skin

    • Modes of transmission; skin-skin contact

      • Bedding only if within 24 hours.

      • Mite can burrow into skin in 2.5 minutes.


    S/S: clothing or towels.

    • intense itching, esp. at night with vesicles, papules, linear burrows.

      • Males; lesions prominent around finger webs, anterior surfaces of wrists and elbows, armpits, belt line, thighs, external genitalia

      • Females; lesions prominent on nipples, abdomen, lower portion of buttocks.

      • Infants; head, neck, palms, soles.


    Patient management13
    Patient management: clothing or towels.

    • BSI

    • Personal - launder everything used in last 48 hours in hot water. Tx with Kwell


    Lice clothing or towels.

    • Infesting agents:

    • head louse, body louse

    • (responsible for outbreaks of epidemic typhus & trench fever in WWI)

    • Modes of transmission:

      • head lice and body lice - direct contact

      • Body lice - indirect contact, esp. shared clothing

      • Crab lice - sexual contact


    Head louse infestation
    Head Louse infestation clothing or towels.



    S s itching
    S/S: Itching clothing or towels.

    • Infestation of Head lice is of hair, eyebrows, eyelashes, mustache, beards.

    • Infestation of body lice is of clothing, especially along seams of inner surfaces.


    Patient management14
    Patient management: clothing or towels.

    • Personal treatment - Kwell, etc. repeat in 7-10 days.

      • Wash all bedding, clothing, etc. in hot water, or place in dryer on hot cycle.

      • EMS workers - clean patient area well.


    Lyme disease
    Lyme Disease clothing or towels.

    • Causative organisms; Borrelia burgdorferi

    • Affects skin, CNS, cardiovascular system, joints

    • Mode of transmission; tick borne with reservoirs in mice and deer

    • Western Black-legged Tick


    Statistics11
    Statistics clothing or towels.

    • Oregon – 1994 – 2003; 151 Cases

    • Marion Cty: 5

    • Jackson Cty: 26

    • Month - July


    S/S: clothing or towels.

    • Early, localized stage with painless skin lesion at site of bite (starts out as red, flat, round rash which spreads out.





    Almost time to go
    Almost time to go…. heart, joints


    Body fluids to which universal precautions apply
    Body fluids to which universal precautions apply heart, joints

    • Blood, other body fluids containing blood

    • Semen, vaginal secretions

    • Human tissue

    • Human fluids

      • CSF

      • Synovial

      • Pleural

      • Peritoneal

      • Pericardial

      • Amniotic


    Body fluids to which universal precautions do not apply
    Body fluids to which universal precautions do not apply heart, joints

    In the absence of blood

    • Feces

    • Nasal secretions

    • Sputum

    • Sweat

    • Tears

    • Urine

    • Vomitus


    Precautions for other body fluids in special settings
    Precautions for other body fluids in special settings heart, joints

    • Human breast milk if mother HIV positive

    • Saliva if person HBV or HIV positive


    Remember
    Remember! heart, joints

    • Prepare food and eat in appropriate areas

    • Maintain general and psychological health

    • Dispose of needles and sharps appropriately

    • Don’t wipe face and/or rub eyes, nose, mouth etc.


    Bye bye now
    Bye Bye now... heart, joints


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