Infectious Disease Training Bloodborne Airborne Pathogens Toggenburg Ski

Infectious Disease Training Bloodborne & Airborne Pathogens Toggenburg Ski Patrol Narrated by: Beau Blair

Infectious Disease Training • • Review Applicable Standards Review Infection Control Policy & Procedures Review Engineering Controls and Work Practices Identify PPE Discuss Body Substance Isolation Review Bloodborne Pathogens Review Airborne Pathogens

OSHA Standards • CFR 1910. 1030 • Bloodborne Pathogens • CFR 1910. 134 • Respiratory Protection • Airborne Pathogens

What can you be exposed to ? Bloodborne Hepatitis B & C HIV Syphilis Airborne Tuberculosis Meningitis Influenza Measles Mumps Chicken Pox Small Pox SARS

How can you be exposed? Bloodborne Airborne • Needle stick • Inhalation of droplets from a person coughing, • Blood or other body fluids sneezing, or breathing in contacting close proximity or in an non intact skin, enclosed area. (Patrol eyes, or Room) mucus membranes. • Inhalation of droplets from an aerosolized source.

Bloodborne Pathogens • HIV • Hepatitis B, C, D, G? • Syphilis

Hepatitis • Hepatitis Viral Infection A B C D E G - Food or contaminated water / Poor hygiene Bloodborne - must have HBV Food or contaminated water / Poor hygiene Not a lot known currently under research

Hepatitis B (HBV) • Viral Infection • Virulent • Lives outside of body for weeks – Dried blood • No known cure • Destroys the liver • Usually Fatal

HIV • Cause : HIV Virus Very Fragile – Not Many Virus / Unit of blood Cannot live outside the body for very long • Transmission: Blood and many body fluids • Incubation: 8 to 11 years • Onset: Mild flu-like, fever, headache, rash, swollen glands, then remission and dormant illness

HIV (con’t. ) • Course: AIDS is end-stage of HIV; complications from damaged immunity, infections, pneumonias, cancers; fatal • Treatment: Drug treatment to delay onset of AIDS; Post-exposure prophylaxis may be an option within 36 hours of exposure. • No cure • Prevention: Body Substance Isolation; safe sex • Will not live outside the body.

Airborne Pathogens • • Tuberculosis Meningitis Influenza Measles Mumps Chicken Pox Small Pox SARS

Tuberculosis (TB) • • Cause : Mycobacterium Tuberculosis Transmission: Airborne droplets Incubation: 1 to 8 weeks - maybe longer Symptoms: Persistent productive cough, weight loss, fever, night sweats, coughing up blood, shortness of breath, fatigue

Tuberculosis (con’t. ) • Treatment: INH, Rifampin , Pyrazinamide • Prevention: Respiratory BSI precautions; postexposure medications can be offered to prevent infection. • T. B. test • A surveillance form shall be completed annually for those employees who have previously tested positive.

Tuberculosis High risk Groups • • Homeless people in shelters Alcoholics Prisoners IV drug users HIV infected individuals Residents of long-term care facilities People with previous positive skin tests

Tuberculosis High Risk Groups • • Contacts of known TB patients Elderly; chronically ill Immunosuppressed Foreign born, especially Asian, African, or Latin America • Healthcare Providers –Ski Patrollers

Signs & Symptoms of TB • • • Frequent Coughing up blood Night Sweats Fever Fatigue Weight loss

SARS • Severe Acute Respiratory Syndrome • These diseases are grouped in a category know as Febrile (fever causing) Respiratory Illness • Infectious

Febrile Respiratory Illness • Signs and symptoms of febrile respiratory illness are: – Fever of at least 100. 5 degrees F o – One or more clinical findings of respiratory illness, such as cough, shortness of breath, difficulty breathing, hypoxia;

Respiratory Etiquette Strategy • Implement the use of N 95 Respirator masks by healthcare personnel, during the evaluation of patients with respiratory symptoms • Provide N 95 respirator masks to all patients with symptoms of a respiratory illness. • Provide instructions on the proper use and disposal of N 95 masks.

Respiratory Etiquette Strategy (Cont) • For patients who cannot wear a respirator mask: (in addition to medical treatment being provided) • Provide tissues and instructions on proper use when coughing, sneezing, or controlling nasal secretions • How and where to dispose of them • And the importance of hand hygiene

Respiratory Etiquette Strategy (Cont) • Continue to use respiratory precautions to manage patients with respiratory symptoms • Until it is determined that the cause of symptoms is not an infectious agent

What is an Exposure? : Direct or indirect contact of blood or other body fluids with non-intact skin or mucous membranes

Body Fluids Requiring Precautions • Blood Components – Serum – Plasma • • Vitreous fluid (eyes) Synovial Fluid (joints) Semen Pleural Fluid (lungs) • • Cerebral-spinal Fluid Pericardial Fluid (heart) Peritoneal Fluid (belly) Saliva Vaginal secretions Amniotic Fluid Wound Drainage Respiratory Droplets

Body Fluids that may contain blood: • • Breast milk Tears Nasal Secretions Urine • • Stool Emesis Sweat CSF

Engineering Controls Reduce the risk by removing the hazard or isolating the worker from the hazard

Engineering Controls • PPE (G 3) – Gloves – Goggles – Gowns • • • Disposable suction components and catheters Disposable BVM Resuscitators Pocket masks Self sheathing needles (Patients may have own) Needle less syringes and medication systems

Work Practice Controls • Reduce the hazard the by changing the manner in which the task is performed

Accepted Work Practice Controls • • Washing hands Use of PPE Not breaking off or recapping needles – (SHARPS) No eating, drinking, smoking, applying cosmetics or touching contact lens in work areas. • Limit the number of people contacting patient • Use of Pocket Mask or BVM to ventilate patients

Body Substance Isolation • Wash hands before and after patient contact • Wash hands immediately when soiled with blood or body fluids. • Use Waterless Gel hand cleaner if soap and running water are not available. • Wash hands immediately after removing gloves • Wear protective eyewear and mask whenever splashing is possible

Body Substance Isolation • Wear protective clothing when soiling is likely • Use pocket masks and/or Bag-valve-masks (BVM’s) to resuscitate • Avoid direct patient care when your skin is not intact • Follow procedures for handling sharps

Body Substance Isolation • Use red bag procedures for contaminated articles • Use approved decontamination and cleaning procedures • Wear gloves for all contact with blood and body fluids – including during cleaning and decon

Personal Protective Equipment • • Gloves Gowns Protective eyewear Masks: approved N-95 PPE should be worn during treatment of patients when there is any risk of exposure to blood Body fluids or airborne pathogens.

Hepatitis B Vaccine • Hepatitis B vaccination (3 -shot) series is highly recommended. However, since we are not “employees” by NSP rules & regulations, the Hep -B series would be at your own expense, through your own physician.

What is a Reportable Exposure? • Needle sticks • Blood or body fluid splash to: – Non-intact skin – Mucous membranes • Eyes • Nose • Mouth

What to do if you’ve been exposed…. • Thoroughly cleanse the area of exposure. • Report the Exposure to the Infection Control Officer. – Patrol Leader or Designated Representative • Complete the Exposure Report Form • The IC Officer will immediately determine exposure classification & contact Patrol Leader • Referrals for any necessary post-exposure treatment or follow-up

Post Exposure Evaluation and Follow up

Testing • Infection Control Officer or Patrol Leader will seek existing information on the source individual. • Have the source individual’s blood tested for HIV and Hepatitis B & C, as allowed by law. • Exposed employee should be tested for base line HIV and Hepatitis status and antibody level. • Subsequent HIV testing should be performed at 6 weeks, 12 weeks, 6 months and 1 year

Work Related Illnesses Failure to comply with baseline testing, recommendations and or treatments of the physician or infectious disease professional may jeopardize your right to further medical care.

Counseling • Test results reviewed with the exposed employee • Post exposure counseling – Health status – Treatment options. – Information on prophylactic medications.

Treatment Options • HIV Post-Exposure Prophylaxis can be offered to those assessed to have suffered a high risk exposure. • Prophylaxis medications should be administered – Optimally within 2 -3 hours of exposure – Can be provided up to 36 hrs after exposure • The risk of transmission of Hepatitis B or Hepatitis C is much greater than the risk of transmission of HIV

Treatment Options (con’t) • Hepatitis B infection can be prevented • Pre-exposure – Prophylactic Hepatitis B vaccine series – No known effective prophylaxis for Hepatitis C • Post-exposure – Administration of Hepatitis B immune globulin – May not be as effective as prophylactic vaccine

Labeling Methods for Contaminated Articles • Bright fluorescent orange or orange-red colored stickers which contain the biohazard symbol and the word “BIOHAZARD” in a contrasting color • Red biohazard waste bags with the biohazard symbol and the word “BIOHAZARD” in a contrasting color

The following items shall be labeled: • • • Containers of regulated waste Sharps disposal containers Laundry bags and containers Contaminated equipment for repair or cleaning Containers used to store, transport, or ship blood or other potentially infectious materials

Q&A Beau Blair 692 -4344

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