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Bloodborne Pathogens. ENVH 451/541 November 12, 2008. Bloodborne Pathogens (BBPs). Present in Blood. O ther P otentially I nfectious M aterials. or. Bloodborne Pathogens. OPIM. any unfixed tissue or organ (other than intact skin) from a human (living or dead)

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bloodborne pathogens

Bloodborne Pathogens

ENVH 451/541

November 12, 2008

bloodborne pathogens bbps
Bloodborne Pathogens (BBPs)

Present in

Blood

Other Potentially Infectious Materials

or

bloodborne pathogens1
Bloodborne Pathogens

OPIM

  • any unfixed tissue or organ (other than intact skin) from a human (living or dead)
  • HIV- or HBV-containing cultures (cell, tissue, or organ), culture medium, or other solutions
  • blood, organs, & tissues from animals infected with HIV, HBV, or BBPs
  • semen
  • vaginal secretions
  • body fluids such as pleural, cerebrospinal, pericardial, peritoneal, synovial, and amniotic
  • saliva in dental procedures (if blood is present)
  • any body fluids visibly contaminated with blood
  • body fluid where it is difficult to differentiate
2 methods of entry
2 Methods of Entry:
  • Mucocutaneous
    • Enters through mucus membranes
  • Percutaneous
    • Enters through some opening of the skin
slide5

Modes of Transmission

  • Mucocutaneous (through a mucous membrane)
  • Having infected blood or other body
  • fluids splashed into eyes, nose or
  • mouth
slide6

Modes of Transmission

  • Percutaneous (through the skin)
  • Being stuck with needles or other sharps
  • Having infected blood or other body
  • fluids splashed onto skin that is cut,
  • scratched, has sores or rashes or other
  • skin conditions
bloodborne pathogen diseases
Bloodborne Pathogen Diseases

Some examples of bloodborne pathogens:

  • Malaria
  • Syphilis
  • Brucellosis
  • Leptospirosis
  • Arboviral infections
  • Relapsing fever
  • Creutzfeld-Jakob Disease
  • Viral Hemorrhagic Fever
    • Ebola, Marburg

Primary Pathogens of Concern:

  • Hepatitis B Virus (HBV)
  • Hepatitis C Virus (HCV)
  • Human Immunodeficiency Virus (HIV)
hiv aids in king county
HIV/AIDS in King County
  • HIV - 2,773
  • AIDS - 3,532
  • HIV/AIDS -

6,305

hiv and aids

HIV and AIDS

The CDC defines AIDS as a positive HIV test and one of the following:

The development of an opportunistic infection

an infection that occurs when your immune system is impaired

A CD4 lymphocyte count of 200 or less

a normal count ranges from 800 to 1,200

directly attack and kill invading cells

symptoms
Symptoms
  • Immediately following infection
    • Nonspecific “viral illness”
      • Low grade fever, rash, muscle aches, headache, fatigue
      • Resolve in 5-10 days
  • Asymptomatic
    • Immune system is cycling with CD4 cells
  • AIDS
    • Extreme fatigue, rapid weight loss, swollen lymph nodes, dry cough and shortness of breath, night sweats
management
Management
  • No “cure”
  • HAART
    • “cocktail” of 3 -4 AR drugs
    • Difficult: complex regimes, severe side effects, compliance very important
  • Diarrhea, vomiting, nausea, headache, blurred vision, dizziness, congestion, dry mouth, fatique, body ache, fever, rash, sores, feeling loss, difficulty sleeping, changing body shape, hair loss, dry skin, etc.
hiv in blood
HIV IN BLOOD
  • SURVIVAL OUTSIDE THE BODY
    • In dry blood the virus can survive for up to 6 days in laboratory conditions
  • QUANTITY OF VIRUS IN BLOOD
    • 1 mL of blood contains 200-10,000 particles of virus.
  • RISK OF INFECTION FOLLOWING NEEDLE STICK INJURY
    • Low - 0.3% - 3 people in 1,000.
  • RISK OF INFECTION FOLLOWING EYE SPLASH
    • Low - 0.09%

* Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis. MMWR Recommendations and Reports, June 29, 2001 / 50(RRll);1-42. Centers for Disease Control and Prevention

hepatitis c symptoms
Hepatitis C Symptoms
  • flu-like symptoms
  • jaundice
  • fatigue
  • dark urine
  • abdominal pain
  • loss of appetite
  • nausea
slide19

US HCV Infection

  • Incubation period Average 6-7 weeks
  • Range 2-26 weeks
  • Acute illness (jaundice) Mild (<20%)
  • Case fatality rate Low
          • 8-10 K
  • Chronic infection 60%-85%
    • 2.7M people
  • Chronic hepatitis 10%-70%
  • Cirrhosis <5%-20%
  • Mortality from CLD 1%-5%
sources of infection for persons with hepatitis c
Sources of Infection forPersons With Hepatitis C

Injecting drug use 60%

Sexual 15%

Transfusion 10%

(before screening)

Occupational 4%

Other 1%*

Unknown 10%

* Nosocomial; iatrogenic; perinatal

Source: Sentinel Counties, CDC

occupational transmission
Occupational Transmission
  • Inefficient by occupational exposures
  • Incidence 1.8% following needle stick from HCV-positive source
    • Associated with hollow-bore needles
  • Prevalence 1-2% among health care workers
    • Lower than adults in the general population
    • Most appear related to HCW substance abuse
    • No restrictions routinely recommended for HCV-infected HCWs
perinatal transmission of hcv
Perinatal Transmission of HCV
  • Transmission only from women HCV-RNA positive at delivery
    • Average rate of infection 6%
    • Higher (17%) if woman co-infected with HIV
    • Role of viral titer unclear
  • No association with
    • Delivery method
    • Breastfeeding
  • Infected infants do well
    • Severe hepatitis is rare
hepatitis c in blood
HEPATITIS C IN BLOOD
  • SURVIVAL OUTSIDE THE BODY
    • Little is known but likely to be the same as hepatitis B, up to 10 days
  • QUANTITY OF VIRUS IN BLOOD
    • 1 mL of blood contains 1,000 - 10,000 particles of virus
  • RISK OF INFECTION FOLLOWING NEEDLE STICK INJURY
    • Medium - 3% - 3 people in 100
  • RISK OF INFECTION FOLLOWING EYE SPLASH
    • Low

* Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis. MMWR Recommendations and Reports, June 29, 2001 / 50(RRll);1-42. Centers for Disease Control and Prevention

hepatitis b1
Hepatitis B

Incubation

  • 60-120 days following infection

Duration

  • Several weeks to months

Symptoms

  • flu-like symptoms
  • fatigue
  • abdominal pain
  • loss of appetite
  • nausea, vomiting
  • joint pain
  • jaundice
global patterns of chronic hbv infection
Global Patterns of Chronic HBV Infection
  • High (>8%): 45% of global population
    • lifetime risk of infection >60%
    • early childhood infections common
  • Intermediate (2%-7%): 43% of global population
    • lifetime risk of infection 20%-60%
    • infections occur in all age groups
  • Low (<2%): 12% of global population
    • lifetime risk of infection <20%
    • most infections occur in adult risk groups
slide29

Risk Factors Associated with

Reported Hepatitis B, 1990-2000, United States

*Other: Surgery, dental surgery, acupuncture, tattoo, other percutaneous injury

Source: NNDSS/VHSP

transmission of hbv
Transmission of HBV
  • Concentration of HBV in various body fluids
    • High: Blood, serum, wound exudates
    • Medium: saliva, semen, and vaginal secretions
    • Low/not detectable: urine, feces, sweat, tears, breastmilk
  • Household transmission – less risk than percutaneous but significant - can occur in settings such as shared toothbrushes, razors, combs, washcloths
transmission of hbv1
Transmission of HBV
  • Likelihood of becoming a carrier varies inversely with the age at which infection occurs.
  • Pool of carriers in U.S. is 1-1.25 million persons.
  • ~5000 persons die/yr. from HBV-related cirrhosis.
prevention treatment
Prevention & Treatment
  • “Advisory Committee on Immunization Practices (ACIP) recommends that all children receive their first dose of hepatitis B vaccine at birth and complete the vaccine series by age 6–18 months” (CDC)
    • Adults where deficient
  • Acute Infection
    • no medication is available; treatment is supportive
  • Chronic Infection
    • several antiviral drug
    • require regular monitoring to determine whether disease is progressing and to identify liver damage or hepatocellular carcinoma.
hepatitis b in blood
HEPATITIS B IN BLOOD
  • SURVIVAL OUTSIDE THE BODY
    • In dry blood the virus can survive for up to 10 days
  • QUANTITY OF VIRUS IN BLOOD
    • 1 mL of blood contains 100,000,000 particles of virus
  • RISK OF INFECTION FOLLOWING NEEDLE STICK INJURY
    • Very High - 30% - 3 people in 10
  • RISK OF INFECTION FOLLOWING EYE SPLASH
    • High.

* Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis. MMWR Recommendations and Reports, June 29, 2001 / 50(RRll);1-42. Centers for Disease Control and Prevention

transmission of bbps
Transmission of BBPs

Occupational Exposure

  • means reasonably anticipated skin, eye, mucous membrane, or parenteral (piercing of the skin) contact with blood or OPIM that may result from the performance of an employee's duties

Exposure Incident

  • is a specific contact with blood or OPIM that is capable of transmitting a bloodborne disease
slide36

Most Common Occupational Exposure

Needlestick Injuries

Over 85% of documented

occupational transmissions

health care workers and bloodborne pathogens
Health Care Workers and Bloodborne Pathogens
  • HBV: 6%-30%
  • HCV: 1.8%(range 0%-7%)
  • HIV: 0.3%

Occupational Transmission

Risk of infection following needlestick/cut from a positive (infected) source:

transmission of bbps1
Transmission of BBPs

Risk of infection depends on several factors:

  • The pathogen involved
  • The type/route of exposure
  • The amount of virus in the infected blood at the time of exposure
  • The amount of infected blood involved in the exposure
  • Whether post-exposure treatment was taken
  • Specific immune response of the infected individual

Courtesy of Owen Mumford, Inc.

health care workers and bbps

Causes of percutaneous injuries with hollow-bore needles, by % total percutaneous injuries

Handling/transferring specimens

Improperly disposed sharp

Manipulating needle in patients

Other

Disposal-related causes

4%

5%

10%

27%

12%

8%

8%

11%

10%

5%

IV line-related causes

Collision w/health care worker or sharp

Clean-up

Handling or passing device during or after use

Recapping

Source: CDC [1999]

Health Care Workers and BBPs

Occupational Transmission

  • Most common: needlesticks
  • Cuts from other contaminated sharps (scalpels, broken glass, etc.)
  • Contact of mucous membranes (eye, nose, mouth) or broken (cut or abraded) skin with contaminated blood
exposure controls
Exposure Controls
  • Universal precautions (or equivalent system*)
  • Equipment and Safer Medical Devices
  • Work practices
  • Personal protective equipment
  • Housekeeping
  • Laundry handling
  • Hazard communication- labeling
  • Regulated Waste
exposure controls1
Exposure Controls

Unprotectedposition

Protectedposition

universal precautions
Universal Precautions
  • A system of infection control in which all human blood and OPIM are treated as if known to be infectious with a bloodborne disease.