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Unit F: Infectious Diseases. Bioterrorism Agents and Containment BT 06.05. Bioterrorism. Terrorism is defined as violent acts or acts dangerous to human life that appear to be intended to: Intimidate or coerce a civilian population Influence the policy of a govt Affect the conduct of

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Unit f infectious diseases

Unit F: Infectious Diseases


Agents and Containment

BT 06.05


  • Terrorism is defined as violent acts or acts dangerous to human life that appear to be intended to:

    • Intimidate or coerce a civilian population

    • Influence the policy

      of a govt

    • Affect the conduct of

      a govt

Bioterrorist agents
Bioterrorist Agents

  • Bacterial – like Anthrax and Plague

  • Viral – like smallpox

  • Toxins – like Botulism and Ricin


  • Acute infectious disease caused by bacillus anthracis

  • Infection in humans:

    • Skin contact – cutaneous, ingestion-gastrointestinal, inhalation-pulmonary

    • Person-to-person transmission of inhalation disease does not occur.

Pulmonary anthrax s s
Pulmonary Anthrax S/S

  • Flu-like symptoms that may briefly improve 2-4 days after initial symptoms

  • Abrupt onset of respiratory failure

  • Hemodynamic collapse

  • Thoracic edema

  • Widened mediastinum on xray

  • Positive blood culture in 2-3 days of illness

  • Incubation Period: 2-60 days

Pulmonary anthrax cont
Pulmonary Anthrax cont:

  • Prognosis is good only if treated early.

  • Increased mortality rate if treated after respiratory onset.

Cutaneous anthrax s s
Cutaneous Anthrax S/S

  • Local skin involvement with direct contact

  • Commonly seen on head, forearms, or hands

  • Localized itching followed by papular lesion that turns vesicular within 2-6 days – develops into depressed black eschar.

  • Incubation period: 1-7 days

  • Prognosis good if treated with antibiotics.

Gastrointestinal anthrax
Gastrointestinal Anthrax

  • S/S:

    • Abdominal pain, nausea, vomiting, & fever

    • Bloody diarrhea, hematemesis

    • Positive culture after 2-3 days

    • Incubation period: 1-7 days

  • Prognosis:

    • If progression to toxemia and sepsis, prognosis is poor

Anthrax overview
Anthrax overview

  • Modes of Transmission

    • Inhalation of spores

    • Skin contact

    • Ingestion of contaminated food

  • Incubation Periods:

    • Pulmonary: 2-60 days

    • Cutaneous: 1-7 days

    • Gastrointestinal: 1-7 days

  • Transmission: Anthrax IS NOT airborne person to person. Direct contact with infectious skin lesions CAN transmit infections.

  • Prevention: Vaccine available – quantities limited


  • Potent neurotoxin caused by an anaerobic bacillus-clostridium botulinum

  • Transmission

    • Contaminated food

    • inhalation

  • S/S

    • GI symptoms

    • Drooping eyelids

    • Weakened jaw clench

    • Difficulty swallowing or


    • Blurred vision

    • Respiratory distress

Botulism cont
Botulism Cont:

  • Incubation period:

    • Neurological S/S for food borne botulism – 12-36 hours after ingestion

    • Neurological S/S for inhalation botulism – 24-72 hours after exposure

  • Prevention:

    • Vaccine is available

    • Botulism CANNOT be

      transmitted from person

      to person


  • Plague is an acute bacterial disease caused by yersiniapestis.

  • S/S

    • Fever - Chest pains - Hemoptysis - Watery sputum

    • Cough - Bronchopneumonia on xray

  • Mode of Transmission:

    • Plague normally transmitted form an infected flea (that has bitten an infected rat!)

    • Can be aerosol-probably use in bioterrorism

    • Can be transmitted person to person

Plague cont
Plague Cont:

  • Incubation period:

    • Flea bite – 2-8 days

    • Aerosol – 1-3 days

  • Prognosis:

    • Good if treated with antibiotics early.


  • Ricin is a potent protein toxin derived from Castor beans. The toxin is fairly easily produced.

  • Can be used as a biological weapon with relative ease.

Ricin cont
Ricin Cont:

  • Infections in Humans:

    • Aerosol

    • Ingestion

  • Incubation period:

    • 8-18 hours

  • S/S:

    • Within 18-24 hours:

      • Weakness

      • Fever

      • Cough

      • Pulmonary edema

Ricin cont1
Ricin Cont:

  • S/S continued:

    • Within 36-72 hours:

      • Severe respiratory distress

      • Death from hypoxemia

  • Prognosis:

    • Poor – No vaccine available

    • You’re GOING TO DIE!

    • Ricin DOES NOT spread easily from person to person


  • Smallpox is an acute viral illness caused by the variola virus.

  • Mode of transmission:

    • Airborne :droplets (sneeze, cough, drip, or exhale)

  • S/S:

    • Flu like symptoms – fever, myalgia

    • Skin lesions quickly progressing from macules to papules to vesicles

    • Rash scabs over in 1-2 weeks

    • Rash occurs in all areas at once, not in crops

Smallpox cont
Smallpox Cont.

  • Incubation Period:

    • From 7-17 days, average is 12 days

    • Contagious when the rash is apparent and remains infectious until scabs separate (appx 3 weeks)

  • Prognosis:

    • Vaccine available and effective post-exposure

    • Passive immunization is also available in the form of a vaccina immune globulin (Vig) antibody transfer

    • Smallpox has a high mortality rate.

Containment of bioterrorism agents

1. Isolation Precautions

  • All pts in healthcare facilities, including symptomatic pts with suspected or confirmed bioterrorism-related illnesses, should be managed utilizing STANDARD PRECAUTIONS

  • Standard precautions include things like:

    • Handwashing - after touching blood, body flds, etc

    • Wearing gloves – clean gloves, exchange b/w tasks and procedures. Remove gloves and wash hands B4 leaving a pt care area.

Standard precautions cont
Standard Precautions Cont.

  • Gowns

    • Worn to protect skin and prevent soiling of clothes

    • Soiled gowns are promptly removed and hands are washed when finished

  • Masks/ Eye protection or Face Shields

    • Worn to protect mucus membranes

    • Prevent splashes of blood, body fluids

Containment of bioterrorism agents 2 patient placement
Containment of bioterrorism agents2. Patient placement

  • Normal infection control practices should be followed if numbers allow.

  • With large numbers, group affected patients together into designated ward or floor (possibly even a separate building)

  • Consult with engineering staff (airflow and ventilation, plumbing and waste disposal, and capacity)

Containment of bioterrorism agents 3 patient transport
Containment of bioterrorism agents3. Patient Transport

  • Most bioterroristic agents cannot be transmitted from patient to patient.

  • Transport and movement of pts should be limited to movement that is essential to provide pt care.

  • This SHOULD reduce the opportunities for transmission of microorganisms within healthcare facilities.

Unit f infectious diseases
Containment of bioterrorism agents4. Cleaning, disinfection, and sterilization of equipment & environment

  • Standard precautions should be followed.

  • All facilities have in place procedures.

  • Cleaning agents should be available for spills and disinfecting equipment.

  • Contaminated equipment – wear gloves

  • Sterilize all instruments

Containment of bioterrorism agents 5 discharge management
Containment of bioterrorism agents5. Discharge management

  • Pts will not be discharged until they are deemed non-infectious

  • Home care instructions should include barrier precautions, handwashing, waste mgmt, and cleaning and disinfection.

Containment of bioterrorism agents 6 post mortem care
Containment of bioterrorism agents6. Post-mortem care

  • Pathology depts and labs should be informed!

  • All autopsies should be performed carefully using PPE and standard precautions.

  • Instruct funeral directors of diagnosis

Containment of bioterrorism agents 7 handwashing
Containment of bioterrorism agents7. Handwashing

  • Push sleeves and watch 4-5 inches up on arms

  • Stand back from sink and adjust water temperature until warm

  • Wet wrists and hands without splashing and with fingertips pointed downward

  • Apply soap using friction

  • Later well, keeping hands lower than elbows

  • Rush hands together in circular motion, being sure

    to wash between fingers and two inches above wrists

  • Clean under nails by rubbing against palms

  • Wash for at least 15 seconds or longer if contaminated

  • Rinse wrists and hands with running water

  • Dry hands thoroughly with paper towel and discard towel into trashcan

  • Turn faucets off with a new paper towel and discard into trash can

Response to bioterrorism agents
Response to bioterrorism agents

  • Internal reporting requirements (within a facility)

    • Infection control personnel

    • Epidemiologist (local and state)

    • Administration (health care facility)

    • Office of public affairs (media coverage)

Response to bioterrorism agents1
Response to bioterrorism agents

  • External contacts (outside of facility)

    • Local health department

    • State health department

    • FBI

    • CDC

    • Local police

    • EMS