Chapter 21
1 / 61

- PowerPoint PPT Presentation

  • Uploaded on

Chapter 21. HIV, Hepatitis, and Other Blood-Borne Pathogens. PowerPoint® presentation to accompany: Medical Assisting Third Edition Booth, Whicker, Wyman, Pugh, Thompson. Learning Outcomes. 21.1 Describe ways in which blood-borne pathogens can be transmitted.

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about '' - chung

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Slide1 l.jpg

Chapter 21

HIV, Hepatitis, and Other Blood-Borne Pathogens

PowerPoint® presentation to accompany:

Medical Assisting

Third Edition

Booth, Whicker, Wyman, Pugh, Thompson

Learning outcomes l.jpg
Learning Outcomes

21.1 Describe ways in which blood-borne pathogens can be transmitted.

21.2 Explain why strict adherence to Universal Precautions is essential in preventing the spread of infection.

21.3 Describe the symptoms of hepatitis and AIDS.

21.4 List and describe the blood tests used to diagnose HIV infection.

Learning outcomes cont l.jpg
Learning Outcomes(cont.)

21.5 Identify chronic disorders often found in patients who have AIDS.

21.6 Compare and contrast drugs used to treat AIDS/HIV infection.

21.7 Describe the symptoms of infection by other common blood-borne pathogens.

Learning outcomes cont4 l.jpg
Learning Outcomes(cont.)

21.8 Describe the steps involved in reporting a communicable disease.

21.9 Explain how to educate patients about minimizing the risks of transmitting blood-borne infections to others.

21.10 Describe special issues you may encounter when dealing with patients who have terminal illnesses.

Introduction l.jpg

Chapter 21 expands on OSHA blood-borne pathogen standards

How to reduce your risk of exposure

HIV, hepatitis, and other blood-borne infections

Reporting guidelines

Educating patients

Issues associated with terminal illnesses such asAIDS


Transmission of blood borne pathogens l.jpg
Transmission of Blood-Borne Pathogens

  • Blood-borne pathogens are disease-causing microorganisms carried in the host’s blood.

  • Transmission occurs from one host to another through contact with

    • Infected blood

    • Tissue

    • Body fluids

    • Mucous membranes

Transmission cont l.jpg

Cerebrospinal fluid

Synovial fluid

Pleural fluid

Peritoneal fluid

Pericardial fluid

Amniotic fluid


  • Transmission agents for blood-borne diseases

    • Blood

    • Blood products

    • Human tissue

    • Semen

    • Vaginal secretions

    • Saliva from dental procedures

Identified by the Centers for Disease Control and Prevention (CDC)

Transmission cont8 l.jpg

Transmission agent only if there is visible blood


Nasal secretions








Transmission cont9 l.jpg

  • Blood-borne pathogens may be introduced into a new host by

    • Needlesticks

    • Cuts or abrasions

    • Any body opening

    • Transfusion of infected blood

Transmission people at increased risk l.jpg
Transmission: People at Increased Risk

  • Anyone who comes in contact with substances that may harbor the pathogens

    • Health-care professionals

    • Law enforcement officers

    • Mortuary or morgue attendants

    • Firefighters

    • Medical equipment service technicians

    • Barbers and cosmetologists

Transmission people at increased risk cont l.jpg
Transmission: People at Increased Risk (cont.)

  • Pathogens

    • Hepatitis B virus (HBV)

    • Hepatitis C virus (HCV)

    • HIV  AIDS

Transmission research l.jpg
Transmission: Research

  • Incidence of many infectious diseases

    • Reported to state health departments

  • Information then sent to CDC

    • Trends in spread

    • Identify control tactics

    • Allocate resources

Apply your knowledge l.jpg
Apply Your Knowledge

Good Answer!

How are blood-borne pathogens transmitted from host to host?

ANSWER: Transmission occurs from one host to another through contact with infected blood, tissue, body fluids, and mucous membranes.

Universal precautions l.jpg
Universal Precautions

The most effective means of preventing the spread of HIV, hepatitis, and other blood-borne pathogens is to avoid contamination

Universal Precautions are required by OSHA

Universal precautions15 l.jpg
Universal Precautions

  • For medical offices, includes all

    • Body fluids

    • Secretions

    • Excretions

    • Moist body surfaces

  • Assume every patient is contaminated

Apply your knowledge16 l.jpg
Apply Your Knowledge

In a medical office, to what items do Universal Precautions apply, and with which patients should you practice these precautions?

  • ANSWER: In medical offices, Universal Precaution applies to body fluids, secretions, excretions, and moist body surfaces. Assume every patient is contaminated and use Universal Precautions with everyone.


Disease profiles l.jpg
Disease Profiles

  • Keep up-to-date so you can

    • Identify symptoms that may indicate that a patient has a blood-borne disease

    • Identify habits of your patients that increase risk of spreading the disease

    • Educate patients to limit risks of contracting disease

Disease profiles hepatitis l.jpg
Disease Profiles:Hepatitis

  • Viral infection of the liver that can lead to cirrhosis and death

    • Hepatitis A – spread by fecal-oral route

    • Hepatitis B – blood-borne disease that spreads by contact with contaminated blood or body fluids or sexual contact

Disease profiles hepatitis cont l.jpg
Disease Profiles:Hepatitis(cont.)

  • Hepatitis C (non-A/non-B)

    • Spread through contact with contaminated blood or body fluids and sexual contact

    • No cure

    • Many people are carriers

    • Flu-like symptoms, if any

    • Damages liver; causing cirrhosis, liver failure and cancer

Disease profiles hepatitis cont20 l.jpg
Disease Profiles:Hepatitis (cont.)

  • HepatitisD (delta agent hepatitis)

    • Occurs only in people that are infected with HBV

    • May mimic symptoms of hepatitis B, but more severe

    • Associated with liver cancer

  • Hepatitis E

    • Caused by hepatitis E virus (HEV)

    • Transmitted by fecal – oral route

Disease profiles hepatitis cont21 l.jpg

Risk factors – same for HBV and HCV

Occupation that requires exposure to blood and body fluids

High-risk sexual activity

IV drug use


Travel to areas with high incidence

Blood transfusions prior to screen


Living with partner with hepatitis B or hepatitis C

Multiple sexual partners

Disease Profiles:Hepatitis (cont.)

Disease profiles hepatitis cont22 l.jpg
Disease Profiles:Hepatitis (cont.)

  • Risk in medical community

    • HIV

      • Approximately 0.5% from a single needlestick

    • Hepatitis B

      • 6% to 33% from single needlestick

The primary risk factor for HBV and HCV infection is occupational exposure to the virus.

Disease profiles hepatitis cont23 l.jpg

Infection progression

Acute illness lasts about 16 weeks

Prodromal stage – general malaise, maybe nausea or vomiting, or no symptoms

Icteric, or jaundice, stage – yellowing of the skin, eyes, and mucous membranes

Appears 5 – 10 days after initial infection

Convalescent (after acute stages) – can last 2 to 3 weeks

Disease Profiles:Hepatitis (cont.)

Disease profiles hepatitis cont24 l.jpg



Decreased appetite


Nausea and vomiting

Joint pain / tenderness

Stomach pain

General malaise


Investigation of

Risk factors

Exposure incidents

Blood tests

Antigen-antibody systems

Determine stage of disease

Disease Profiles:Hepatitis (cont.)

Disease profiles hepatitis cont25 l.jpg
Disease Profiles:Hepatitis (cont.)

  • Preventive measures

    • Avoid contact with contaminated substances

    • Use Universal Precautions with all patients

    • Vaccination is available to prevent HBV infections

      • Will not protect you from other strains of hepatitis

      • CDC recommends routine vaccination for everyone

    • HBIG for postexposure inoculation

Slide26 l.jpg

Disease Profiles: AIDS / HIV Infection

  • Virus that infects and destroys components of the immune system

  • HIV infection develops into AIDS

  • Pathogen destroys

    • Helper T cells – white blood cells that are a key component of immune system

    • Neurons, causing demyelination

  • Patients develop opportunistic infections

Slide27 l.jpg

Disease Profiles: AIDS / HIV Infection (cont.)

  • Risk factors

    • Unprotected sexual activity

    • Sharing needles used by IV drug users

    • Passes from mother to fetus during pregnancy or to infant during delivery or breastfeeding

  • Incubation period of 8 to 15 years

Slide28 l.jpg

Disease Profiles: AIDS / HIV Infection (cont.)

  • Risk in medical community

    • Percutaneous exposure

      • Exposure through a puncture wound or needlestick

    • Mucocutaneous exposure

      • Exposure through a mucous membrane

Slide29 l.jpg

Disease Profiles: AIDS / HIV Infection (cont.)

  • Progress of the infection –three main stages

    • Initial infection

      • Can occur years after exposure

      • Virus enters cell and makes copies

      • Helper T cells die

      • Immune system responds

        • Cleans the blood supply of the virus

        • Virus enters an inactive phase

Slide30 l.jpg

Disease Profiles: AIDS / HIV Infection (cont.)

  • Progress of the infection

    • Incubation period

      • Virus genetic material incorporated into the genetic material of the helper T cells

      • Virus trapped in lymph system

      • Incubation period can be 8 to 15 years

      • As helper T cells decrease, patients are more prone to opportunistic infections

Slide31 l.jpg

Disease Profiles: AIDS / HIV Infection (cont.)

  • Progress of the infection

    • Full-blown AIDS

      • During the incubation period, HIV becomes active again and continues to attack and kill helper T cells

      • 200 or fewer helper T cells/mL blood indicates full-blown AIDS

      • Opportunistic infections and neurological deterioration

Slide32 l.jpg

Disease Profiles: AIDS / HIV Infection (cont.)

  • Diagnosis

    • Enzyme-linked immunosorbent assay (ELISA)

      • Confirms presence of antibodies in response to HIV

      • 85% accurate – cross-reactivity with other viruses

    • Western Blot Test or immunofluorescent antibody (IFA)

      • Confirms positive ELISA test

      • Specific to individual viruses

    • Accurate diagnosis – ELISA plus one of the other two

    • Home tests available – may give false results

Slide33 l.jpg

Kaposi’s Sarcoma

Disease Profiles: AIDS / HIV Infection (cont.)

  • Symptoms

    • Systemic

    • Respiratory

    • Oral – hairy leukoplakia

    • Gastrointestinal

    • Peripheral nervous system

    • Skin-related

    • Kaposi’s sarcoma

Slide34 l.jpg

Preventive measures

Sexual contact

Use protection

Avoid multiple partners

Avoid concurrent sexually transmitted infections

IV drug users

Avoid sharing or reusing needles

Medical procedures

Universal Precautions

Wash hands


Dangers of HIV/AIDS

How HIV/AIDS is spread and not spread

Preventive measures

Disease Profiles: AIDS / HIV Infection (cont.)

Apply your knowledge35 l.jpg
Apply Your Knowledge

Which statements are true and which are false?

____ Risk factors are the same for HBV and HCV.

___ Hepatitis A is spread via contaminated blood or body fluids.

____ Helper T cells are red blood cells and are a key component of immune system.

____ Percutaneous exposure occurs through a puncture wound or needlestick.





Hepatitis A is spread by the fecal-oral route.


Helper T cells are white blood cells.


Aids patients patient profile l.jpg
AIDS Patients: Patient Profile

  • No one is immune to AIDS

  • 2005: 40.3 million men, women, and children were HIV-infected worldwide.

  • People infected

    • Homosexual males (rate decreasing)

    • Young people in large metropolitan areas

    • IV drug users

    • Women

Aids patients chronic disorders of the aids patient l.jpg

Kaposi’s Sarcoma

AIDS Patients: Chronic Disorders of the AIDS Patient

  • Impaired immune system permits opportunistic infections

    • Pneumocystis carinii pneumonia

      • Protozoal infection

      • Occurs in 75% of AIDS patients

    • Kaposi’s sarcoma

      • Aggressive malignancy

    • Non-Hodgkin’s lymphoma

      • Second most common malignancy associated with HIV infection

Aids patients chronic disorders of the aids patient cont l.jpg
AIDS Patients: Chronic Disorders of the AIDS Patient (cont.)

  • Tuberculosis

    • Often drug-resistant

    • Mantoux skin test often negative in AIDS patients

      • Anergic reaction – no response to any substances injected as a skin test

  • Mycobacterium avium complex (MAC) infections

    • 97% of nontuberculous bacterial infections

  • Meningitis

    • Can lead to AIDS dementia complex

Aids patients chronic disorders of the aids patient cont39 l.jpg
AIDS Patients: Chronic Disorders of the AIDS Patient (cont.)

  • Candidiasis

    • Oral – thrush

    • Vaginal – females

  • Herpes simplex

    • Infections caused by HSV can be mild to life-threatening

  • Herpes zoster

    • Virus that causes chickenpox becomes dormant

    • Returns as herpes zoster, or shingles

    • Lesions last longer in immunocompromised patients – patients with impaired or weakened immune systems

Aids patients treating opportunistic infections l.jpg
AIDS Patients: Treating Opportunistic Infections

  • Drug side effects problematic

  • Patients develop

    • Allergies to treatment

    • Intolerance to medications

  • Pathogens become resistant to treatments

  • Treatments may conflict with other treatments

Aids patients testing regulations l.jpg
AIDS Patients:Testing Regulations

  • CDC does not require mandatory HIV testing for health-care workers

  • Health-care workers’ chances of being infected by a patient are greater than a patient being infected by a health-care worker

Aids patients drug treatments l.jpg


Slow reproduction of virus, no current cure

List of FDA approved drugs – Table 21-2

Treatment goals

Increase the time between infection and symptomatic disease

Improve quality of life

Reduce transmission

To uninfected


Reduce HIV-related deaths

AIDS Patients:Drug Treatments

Aids patients drug treatments cont l.jpg
AIDS Patients:Drug Treatments (cont.)

  • Treatment guidelines

    • Panel of Clinical Practices for Treatment of HIV Infections

      • Initial and follow-up testing

      • Drug resistance testing

      • HAART – combination of drug treatment

  • Initiating therapy

    • Decision made made by patient and physician

    • AIDS diagnosis or CD4 T cell count is < 200cells/mm3

Aids patients drug treatments cont44 l.jpg
AIDS Patients:Drug Treatments (cont.)

  • Delayed treatment

    • Benefit

      • Postponement of drug-related adverse affects

      • Development of drug resistance

      • Preserving treatment options

    • Risks

      • Irreversible immune system damage

      • Increase risk of transmission of disease

Aids patients drug treatments cont45 l.jpg

Early treatment


Suppression of viral replication (preserves immune function)

Reduction in chance of transmission

Helps patient live symptom-free longer


Drug toxicity

Drug resistance

Adverse effects on quality of life

Loss of treatment options

AIDS Patients:Drug Treatments (cont.)

Aids patients drug treatments cont46 l.jpg

Treating complications

Must also treat opportunistic infections

Patients more prone to

Bacterial infections

Protozoal infections

Viral infections

Fungal infections


Continuing research

Global issue

Keep informed of new treatments and prevention methods

AIDS Patients:Drug Treatments (cont.)

Apply your knowledge47 l.jpg
Apply Your Knowledge

Identify where these opportunistic infections affect the body.

  • Herpes simplex

  • Pneumocystis carinii

  • Kaposi’s sarcoma

  • Tuberculosis

  • Meningitis

  • Oral candidiasis


mouth, lips, genitalia


arms, legs, chest, neck, face, conjunctiva, palate




mouth, tongue

Other blood borne infections l.jpg


Antibodies found in 80% of adults

Erythema infectiosum

Parvovirus B19

Fifth disease

Human T-cell lymphotropic virus


Appears in IV drug users, among others


Caused by bacteria Listeria monocytogenes

Fever, shock, rash, and aches

Other Blood-Borne Infections

All are problematic for people with impaired immune systems.

Other blood borne infections cont l.jpg


Parasite enters bloodstreamthrough mosquito’s bite

Cyclical symptoms


Caused by spirochete Treponema pallidum

Three stages

Difficult to identify and treat in HIV-positive persons


Caused by Toxoplasma gondii in cat feces

Other Blood-Borne Infections (cont.)

Apply your knowledge50 l.jpg
Apply Your Knowledge

Which blood-borne pathogen is found in 80% of adults and rarely causes noticeable symptoms?

ANSWER: Cytomegalovirus (CMV)

Good Job!

Reporting guidelines l.jpg
Reporting Guidelines

  • Requirements for reporting HIV infections and AIDS determined by state

  • Verify the specific guidelines in the state where you are employed

Reporting guidelines cont l.jpg
Reporting Guidelines (cont.)

  • Report forms

    • Different for each disease

    • Information needed

      • Disease identification

      • Patient identification

      • Infection history

      • Information about reporting institution

Apply your knowledge53 l.jpg
Apply Your Knowledge

What information is generally needed when making a report of an infectious disease?

  • ANSWER: Information needed includes:

    • Disease identification

    • Patient identification

    • Infection history

    • Information about reporting institution


Patient education l.jpg
Patient Education

  • An effective means of preventing disease transmission

  • Assess the patient’s understanding of the risk for infection

  • Provide information about preventions and treatments

Patient education cont l.jpg
Patient Education (cont.)

  • Clinical drug trials

    • Recognized research protocols designed to

      • Evaluate the efficacy or safety of drugs

      • Produce scientifically valid results

    • Information on trials available from

Patient education patients with special concerns l.jpg
Patient Education: Patients with Special Concerns

  • Teenagers

    • Dangers of HIV and AIDS

    • Establish trust and provide facts

  • Patients about to be discharged

    • Patient must understand the importance of

      • Returning for follow-up

      • Reporting any adverse reactions

      • Watching for signs and symptoms that need to be reported

  • Multicultural concerns

    • High-risk groups based on CDC reports

    • Written information available in appropriate language

Apply your knowledge57 l.jpg
Apply Your Knowledge

What guidance could you give a patient with AIDS or hepatitis who requests more information about the disease?

ANSWER: Suggest that the patient contact government agencies such as the CDC or the Consumer Information Center by mail or on the Internet. In addition, there may be local support groups and resource organizations available in your area.


Special issues with terminal illness l.jpg
Special Issues with Terminal Illness

  • Terminal – fatal

  • Reactions will vary

  • Help by

    • Supporting and accepting patient regardless of reaction

    • Encouraging patient to express feelings

    • Communicating respect through nonverbal communication

    • Meeting reasonable needs and demands

    • Providing referrals to hospices

Apply your knowledge59 l.jpg
Apply Your Knowledge

Mr. Andrews recently learned his HIV status has progressed to AIDS. When he comes into the office for an appointment, his mood swings from anger to crying. What should you do to help him?

  • ANSWER: You should show support and acceptance of Mr. Andrews regardless of his reactions, encourage him to express feelings, and show respect for him. If his demands are reasonable, attempt to meet them. At this time, you should not refer him to a hospice because there may still be treatment options available.


In summary l.jpg
In Summary

Medical Assistant

Helps prevent the spread of HIV, HBV, and HCV by:

  • Using Universal Precautions

  • Watching for signs of infectious disease

  • Educating patients about risk factors associated with blood-borne diseases

End of chapter l.jpg
End of Chapter

End of Chapter 21

Thought is an infection. In the case of certain thoughts, it becomes an epidemic.

~ Wallace Stevens