Communicable Diseases Stacey Montelongo ICEMS System 2005
OSHA • OSHA published the final regulation on occupational exposure to bloodborne pathogens on December 6, 1991
Ryan White Law • Enacted in 1990 • Required medical facilities to inform emergency responders when they may have been exposed to a communicable disease
29 CFR 1910.1030 • Originally issued December 6, 1991 • Places responsibility for protection of personnel onto the employer: • Mandatory in-service training • Work practice controls/engineering controls • Incident reporting/treatment protocols • Hepatitis B vaccinations
What are Bloodborne Pathogens? • Disease-causing microorganisms that may be present in human blood. • They may be transmitted with any exposure to blood or OPIM (Other Potentially Infectious Material)
Modes of Transmission • Piercing of the skin barrier • Contamination of the mucous membranes
Transmission • Blood borne pathogens are transmitted when blood or OPIM come in contact with mucous membranes, non-intact skin, or by handling or touching contaminated items or surfaces • Also occurs by injection under the skin by puncture wounds or cuts from contaminated sharps
Modes of TransmissionContact Transmission • Direct contact – straight from person to person, exchange of blood or body fluids ex: blood splash into the eyes • Indirect contact – person to object; infection can spread by touching surfaces that have been contaminated with the bacteria or virus ex: Loading stretcher into ambulance and not removing contaminated gloves before touching steering wheel of ambulance touching a contaminated needle
Airborne Transmission • Results from inhaling aerosolized particles from micro-organisms that are present in the air • Small droplet nuclei from sneezing or coughing • Dust particles from contaminated clothes, bedding or floor surfaces
Airborne Transmission • Poses a risk in EMS/Fire workplace • A key to risk reduction lies in the recognition of signs and symptoms and using the appropriate barrier device, i.e. mask for personal protection Ex: Tuberculosis, meningitis, and childhood diseases such as measles, mumps and chickenpox
The Immune System • Helps resist disease-causing bacteria, viruses, and other germs or infections • 4 components of the immune system: • Physical barriers • Chemical barriers • Inflammatory response • Immune response
Physical barriers • Intact skin • Prevents foreign substances from entering the body • First line of defense against most diseases • Mucous membranes • Secrete a fluid call mucous that entraps small foreign particles, so they may be swept away and destroyed
Inflammatory Response • Tissue reaction to an injury or disease-causing agent • Response may include pain, swelling, itching, redness, heat, loss of function, or any combination of symptoms • Commonly referred to as an “infected” site
Infectious Disease • An infectious disease is a disease that results from invasion of a host by a disease-producing organisms, such as bacteria, viruses, fungi, or parasites.
Communicable Disease • A communicable (contagious) disease is a disease that can be transmitted from one person to another.
Not all infectious diseases are communicable.For example, salmonella is a highly infectious disease that is not contagious.
Pathogen • Pathogens are microorganisms capable of producing disease, such as bacteria and viruses.
Incubation Period • Incubation period is the time between contact with a disease organism and the appearance of the first symptoms.
Hepatitis A • Mode of Transmission • Fecal-oral route—not washing your hands (may last on hands as long as four hours) • Sexual contact • Is a vaccine available? • Yes (Havrix & Vaqta) • Signs and Symptoms • Usually asymptomatic • Usually found only during liver function studies
Hepatitis B • Mode of Transmission • Blood, semen, vaginal fluids, & saliva • Transfusion, dialysis, needle sticks, tattoos, IV drug sharing, razors, sexual contact • Is a vaccine available? • Yes (Recombivax HB & Engerix B) • Signs and Symptoms • Joint pain and mild rash (60-80% are asymptomatic)
Hepatitis C Formerly (Non A & Non B) • Mode of Transmission • IV drug use & Sexual contact • Before 1989—blood transfusions • Is a vaccine available? • No effective vaccine as of yet • Signs and Symptoms • Liver fibrosis—cirrhosis, jaudice, ascites, esophageal varices
Hepatitis D(Formerly Delta Hepatitis) • Mode of Transmission • Coexists with HBV • Is a vaccine available? • Same as HBV • Signs and Symptoms • Not much is known at this time, is rare but mortality rate is high
Hepatitis E • Mode of Transmission • Fecal-Oral route • Seems to be associated with contaminated drinking water • Is a vaccine available? • None yet • Signs and Symptoms • Very rare in the US • More common in 3rd world countries
AIDS / HIV • Mode of Transmission • Blood, blood products & body fluids • Semen, vaginal secretions, breast milk • Tears, amniotic fluid, urine, saliva, & bronchial secretions • Is a vaccine available? • No, there are currently only treatments for the symptoms • Signs and Symptoms • Fatigue, fever, sore throat, enlarged spleen, rash, and diarrhea—earlier signs • Kaposi’s sarcoma, dementia, psychosis, encephalopathy, and peripheral neurological disorders—all of these are late signs Kaposi’s Sarcoma
Chickenpox • Mode of Transmission • Inhalation of airborne droplets, direct contact w/ weeping lesions, tainted linen • Is a vaccine available? • Varivax or childhood immunity from actual disease • Signs and Symptoms • Respiratory symptoms, malaise, low-grade fever, and rash
Herpes Simplex (Cold Sores) • Mode of Transmission • Saliva • Is a vaccine available? • no • Signs and Symptoms • Cold sore or fever blister in the oral cavity or on the genitals
Varicella Zoster (Shingles) • Mode of Transmission • Similar to chicken pox • More common in adults • Is a vaccine available? • No, varivax may be helpful • Signs and Symptoms • Painful condition that causes skin lesions along the pathway of a peripheral nerve and dermatome bands
Influenza (flu) • Mode of Transmission • Types A,B, C • Crowds and droplets known to last for hours on surfaces • autoinfection • Is a vaccine available? • Yes—flu vaccine • Signs and Symptoms • Fever, chills, malaise, muscle aches, nasal secretions, and cough
Lice: Head, Body, Pubic • Mode of Transmission • Direct or close contact • Is a vaccine available? • No, but there is shampoo and other treatments Signs and Symptoms Itching particularly behind the ears, and lower occiput region (head) Itching under arms, pubs for body
Measles • Mode of Transmission • Inhalation of infected droplets and direct contact • Is a vaccine available? • No vaccine, immunity for life is common if contracted in childhood—maternal protection for up to 5 months post partum • Signs and Symptoms • Severe cold, fever, conjunctivitis, photophobia, malaise, cough, congestion,rash • Koplik’s Spots-bluish-white spots w/ red halo on oral mucosa Koplik’s Spots
Meningitis (meningococcal) • Mode of Transmission • Respiratory droplets • Peak is in midwinter months w/ low temperature and humidity • Is a vaccine available? • Yes for bacterial • No for viral • Signs and Symptoms • Fever, chills, headache, nuchal rigidity w/ flexion, arthralgia, lethargy, malaise, vomiting, diarrhea, altered LOC and seizures
Brudzinki’s sign-physical exam finding in which flexion of neck causes flexion of the hips Kernig’s signs-inability to fully extend the knees with hips flexed
Mononucleosis • Mode of Transmission • Caused by the Epstein-Barr Virus • Exchange of saliva • Is a vaccine available? • No vaccine • Signs and Symptoms • Fatigue, fever, severe sore throat, oral discharge, swollen glands
Mumps • Mode of Transmission • Respiratory droplets & direct contact • Is a vaccine available? • Yes-live virus vaccine • Signs and Symptoms • Painful enlargement of the salivary glands, earache, difficulty in chewing/swallowing
Scabies • Mode of Transmission • Direct or close contact • Is a vaccine available? • No, treatments available • Signs and Symptoms • Small red bumps/ bites between toes, fingers, beltline—may progress to rest of body without treatment
Whooping Cough (pertussis) • Mode of Transmission • Respiratory droplets • Is a vaccine available? • DTP Vaccine • Signs and Symptoms • Coughing thick secretions, vomiting, increased ICP and intracerebral bleeding, pneumothorax,
Tuberculosis, pulmonary • Mode of Transmission • Airborne respiratory droplets (cough, sneeze, speaking, & singing) • 10-15 million Americans carry TB Infection—1 in 10 infected person progress to the active disease stage • Is a vaccine available? • Isoniazid (INH), rifampin, pyrazinamide, ethambutol, streptomycin • PPD Test annually (or chest x-ray) • Signs and Symptoms • Chills, fever, fatigue, productive or non-productive chronic cough and weight loss, night sweats
PPD Test • Yearly Mantoux (Purified Protein Derivative) test required • If first result is positive, then chest x-ray is mandated • Medical attention necessary if chest x-ray positive for TB
Tuberculosis • Bacterial infection that enters the body and establishes itself in the alveoli and spreads throughout the body • A healthy immune system will prevent TB infection from becoming TB disease • TB can cause permanent body damage and death
What is considered a TB exposure? • Any exposure with an infected TB patient within an enclosed or confined space • If an exposure has occurred you should be tested at baseline and again at 12 weeks • The average treatment regimen may last up to 6, 12, or 18 months (depending upon patient presentation)
Multi-Drug Resistant TB • Failure of a person to complete the regimen of drug therapy for TB disease • Remaining bacteria becomes resistant to the medication • If untreated TB and MDRTB have a 50% mortality rate • Treatment may last for MDR-TB up to 18 months
Transmission of TB • Only persons with active disease in their lungs or larynx can spread TB • Persons who are being treated for TB with medication usually become non-infectious • People who have TB infection, but do not have activedisease are not infectious
People who share breathing space with someone who has active TB disease Poor and homeless Persons from foreign countries Nursing home residents and employees Correctional facility personnel Autopsy workers Persons with HIV People with diabetes, cancer, or cardiovascular disease Incarcerated populations Groups at High Risk for TB
Prevention • Engineering controls • Work practice controls • PPE • Universal Precautions
Engineering Controls • Attempt to design safety into the tools and workspace organization • Structural or mechanical devices the company provides
Engineering Controls (cont.) Examples: • Handwashing facilities • Eye wash stations • Sharps containers • Biohazard labels
Universal Precautions • Concept that all blood and certain body fluids are to be treated as contaminated with blood borne pathogens.
Universal Precautions (cont.) Potentially infectious materials that require Universal Precautions: • Blood • Semen • Vaginal secretions • Cerebrospinal Fluid • Synovial Fluid • Pleural Fluid • Any body fluid with visible blood • Any unidentifiable body fluid • Saliva from dental procedures
Infection Control • Precautions – Universal and BSI • Gloves • Protective eyewear and facemask • Do not recap needles • Cleaning/infection control procedures • Wear gowns • Barrier devices • Contaminated clothes • Wash hands