1 INFECTIOUS DISEASE PREVENTION Saving the Lives of Our Providers MIEMSS.

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INFECTIOUS DISEASE INFECTIOUS DISEASE PREVENTIONPREVENTION

INFECTIOUS DISEASE INFECTIOUS DISEASE PREVENTIONPREVENTION

Saving the Lives of Saving the Lives of Our ProvidersOur Providers

Saving the Lives of Saving the Lives of Our ProvidersOur Providers

MIEMSS

22

Infectious Disease Prevention

Awareness Prevention General infection

control principles and practices

Specific diseases Immunizations

Infectious disease laws & guidelines

Notification laws MAIS run report Infection control plan Designated infection

control officer

33


Public health concern

Health care providers

Understanding

1992 1993 1994 19950

5

10

15

20

25

30

35

40

45

1992 1993 1994 1995

AIDSHBVHCVTB

CASES PER 100,000 POPULATIONCASES PER 100,000 POPULATION

44


Routes of Transmission:Routes of Transmission:

• Direct contactDirect contact• Indirect contactIndirect contact• Droplet contactDroplet contact• Airborne transmissionAirborne transmission• Common vehicle transmissionCommon vehicle transmission

55


Infectious Agent

Reservoir

Means ofExit

Mode ofTransmission

Means ofEntry

SusceptibleHost

Chain of Infection

66

Bloodborne Pathogen OSHA / MOSH Bloodborne Pathogen OSHA / MOSH UpdateUpdate

• Occupational Safety and Health Act MOSH Occupational Safety and Health Act MOSH 09.12.31 Maryland 09.12.31 Maryland

• OSHA Standard 29 CFR 1910.1030OSHA Standard 29 CFR 1910.1030

Bloodborne Pathogen OSHA / MOSH Bloodborne Pathogen OSHA / MOSH UpdateUpdate

• Occupational Safety and Health Act MOSH Occupational Safety and Health Act MOSH 09.12.31 Maryland 09.12.31 Maryland

• OSHA Standard 29 CFR 1910.1030OSHA Standard 29 CFR 1910.1030


77


Make sure your department has an accessible copy of the Bloodborne Pathogen Standard 29 CFR 1910.1030

88


Develop a general understanding of the epidemiology & symptoms of bloodborne pathogens

99


Bloodborne PathogensBloodborne Pathogens• microorganisms that can cause disease in microorganisms that can cause disease in

humanshumans• can be transmitted from one person to can be transmitted from one person to

anotheranother

Exposure occurs through broken skin: Exposure occurs through broken skin: percutaneouspercutaneous or or through a mucous membrane: through a mucous membrane: mucocutaneousmucocutaneous

1010


Bloodborne Pathogens of Special Concern To Health Care Providers

• HBV: Hepatitis B virus

• HCV: Hepatitis C virus

• Other emerging viral hepatitis

• HIV: Human Immunodeficiency virus

1111


Hepatitis B (HBV)

• Infection of liver caused by HBV

• Virus is in blood and other body fluids

• Spread by exposure to blood and body fluids

• Some people are at higher risk of HBV

1212


Tiredness Loss of appetite Fever Vomiting

Yellow skin & eyes (jaundice)

Dark-colored urine.

Light colored stool

Hepatitis B (HBV) Symptoms:Hepatitis B (HBV) Symptoms:

1313


HBV Treatment

No cure Fluids Rest Right diet Avoid alcohol & some medicines

1414


Hepatitis B Prevention

Avoid exposure Get complete vaccination

series

1515


Hepatitis C (HCV)

Infection of the liver

Virus is in blood and other body fluid

HCV mainly spread by exposure to blood and blood products

Certain people are at higher risk of getting HCV

1616


Tiredness Loss of appetite Abdominal pain Nausea

Vomiting Yellow skin &

eyes (jaundice) Urine that is

dark in color

Hepatitis C (HCV) Symptoms:Hepatitis C (HCV) Symptoms:

1717


No cure Treatment limited Rest & fluids Avoid alcohol & some medicines

Hepatitis C (HCV) TreatmentHepatitis C (HCV) Treatment

1818


Hepatitis C (HCV) Prevention

Avoid exposure No vaccine

1919


AIDS is caused by the HIV virus

Some people at higher risk than others

HIV is in blood and other body fluids

HIV is spread by exposure to HIV infected blood and HIV infected body fluids

Human Immunodeficiency Virus (HIV)Human Immunodeficiency Virus (HIV)

2020


AIDS annual rates per 100,000 population - United States, January - December 1996

MD. 44.4MD. 44.4

D.C. 232.3D.C. 232.3

25.325.3

12..012..0

3.93.9

30.130.1

14.514.5

50.950.9

4.04.0

14.214.213.413.4

6.16.126.626.6

2121


HIV Certain symptoms &

conditions may be associated with HIV/AIDS

Fever Weight loss Swollen lymph

nodes

White patches in mouth (thrush)

Certain cancers eg. Kaposi’s sarcoma, certain lymphomas

Infections eg. pneumocystis pneumonia, TB, etc.

2222


HIV A blood test may tell

if you have HIV infection or AIDS

HIV treatment No cure Treatment includes

drug “cocktails”

Combination therapy with a variety of medications help people with HIV by slowing the disease process

2323


HIV and AIDS are Preventable

There is NO vaccine however Avoid exposureAvoid exposure Follow standard (universal

precautions) such as the use of: gloves, eye protection, gowns, etc.

2424


Transmission of Bloodborne Pathogens

Percutaneous: through the skin

Mucocutaneous: through a mucous membrane

2525


Chain of Infection

Infectious Agent Reservoir Means of Exit Mode of Transmission Means of Entry Susceptible Host

2626


Local Exposure Control Plan

How can each member get a copy?

2727


Identify tasks and other activities that may involve exposure to blood or other potentially infectious body materials

2828


Patient assessment Airway management Assisting

respirations Bleeding control Contact with body

fluids

Clean-up of scene & equipment

Establishing an IV Emergency childbirth Other patient care

activities where contact with blood or body fluids occur

2929


Methods that will prevent or reduce exposure include:

Engineering controls Work practices Personal protective equipment

3030


Isolation supplies Hand washing

facilities Waterless hand

cleaners

Sharps containers Ventilation Medical waste

containers Self sheathing needles

or needleless systems

Engineering Controls That Help Prevent Engineering Controls That Help Prevent Contact With Blood & Body Fluids Contact With Blood & Body Fluids Include:Include:

3131


Washing hands Prohibited in work

areas (ambulance)• Eating, drinking,

smoking, applying cosmetics or lip balm, handling contact lenses

Never bend, break or recap needles

Avoid causing splashes and splatters of blood or body fluids

Properly handle contaminated items

Work Practice Controls Include:Work Practice Controls Include:

3232


Gloves Gowns Face shields or masks Eye protection

Mouth pieces or pocket masks

Disposable resuscitation bags

Lab coats

Personal Protective Equipment (PPE)Personal Protective Equipment (PPE) must be used when in contact with blood must be used when in contact with blood or other body fluids. or other body fluids.

Examples include:Examples include:

3333


Personal protective equipment: types, storage location, removal, handling and disposal

Each department may have some variation (different manufacturer) of PPE. Discuss your department’s PPE types, storage location, etc.

3434


Following use, PPE should be removed and properly decontaminated or disposed of in an approved container

Handle contaminated PPE as little as possible

3535


Review your department’s policy on the proper decontamination, storage and disposal of contaminated PPE

3636


Selection of Personal Protective Equipment:

PPE shall be provided at no cost to the provider

Considered “appropriate” if it does not permit blood or other potentially infectious materials to pass through

3737


Hand washing Gloves Gown Mask, eye protection,

face shield Respiratory protection

(N95 or (9508) HEPA, (99%))

Patient care equipment

Environmental control

Linen

Standard PrecautionsStandard Precautions

3838


Hepatitis B (HBV) Immunization

Three shot series over six months Vaccine determined to be safe by the

Centers for Disease Control & Prevention

Majority of vaccine recipients develop adequate antibodies against HBV

3939


HBV Immunization is provided at no cost to the member

Should be provided prior to working in an area where occupational exposure could occur

Discuss HBV vaccination availability in your department

4040


Other Common Vaccines

Td - Tetanus diphtheria MMR - Measles, Mumps & Rubella Influenza Varivax - Varicella virus vaccine

(Chicken pox)

4141


Appropriate actions to take & persons to contact following an exposure incident

Each department has a written Infection control plan. Discuss your department’s plan and determine appropriate contacts and actions.

4242


Appropriate actions to take after an exposure incident typically include:

Contacting your immediate supervisor and / or infection control officer

Go to an approved treatment facility or provider

Complete all required written reports

4343


Procedure to follow if an exposure incident occurs:

Discuss your departments policy on post exposure evaluation

In general, always report the incident & document the route of exposure

4444


Medical Follow-Up & Treatment

Should be provided as soon after exposure as possible (within one to two hours with HIV exposure)

Shall be consistent with U.S. Department of Health & Human Services, Public Health Service, and CDC Prevention Guidelines

4545


General Post Exposure Evaluation & Follow-Up Guidelines:

Document route of exposure & circumstances under which the exposure occurred

Identification & documentation of source individual information

4646


Obtain source individual’s blood testing for HBV, HCV, and HIV (if source gives consent).

If obtained, results of source individuals blood test provided to exposed provider

4747


Exposed provider baseline blood testing as soon after exposure as possible (with consent)

Post exposure prophylaxis shall be provided when medically indicated, according to the U.S. Public Health Service (CDC) Standards

4848


Signs, Labels and / or Color Coding Required by the Bloodborne Pathogen Standard:

Communications of hazards to employees (members) shall be accomplished by the use of signs and labels

4949


Warning labels shall be affixed to containers of regulated waste

Universal biohazard symbol (orange or red-orange in color)

Red bags or red containers may be substituted for labels

Contaminated sharps containers and bags must be labeled appropriately

5050


Signs shall be posted at the entrance of work areas where occupational exposure may occur, e.g. areas used for cleaning and decontamination, or storage of medical waste

5151


Maryland’s Run Sheet (MAIS)

A “runsheet” box for reporting an exposure is located next to the “hospital signature” section

This is for tracking purposes ONLY and does not meet the documentation necessary to report an exposure incident

5252


Notification Laws

Federal Law: 1990 Ryan White Comprehensive AIDS Resources Emergency ActSubtitle B, 42 U.S.C 300 ff-80

Maryland Notification Law: Health General 18-213

5353

Hospitals are required to:• develop written procedures• make copies available upon request• provide notification of possible exposure

within 48 hours of confirmation of diagnosis

• protect the confidentiality of the patient and the “first responder”


5454

Infectious Disease Prevention HG §18-213• Disease notification

–All forms of viral hepatitis including but not limited to Hepatitis A,B,C,D,E,F, and G

–HIV–Meningococcal meningitis– Tuberculosis–Mononucleosis–Diphtheria–Plague–Hemorrhagic fevers–Rabies

5555


HG §18-213• Provides notification after contact with a

person with certain diseases.–Notification 48 hours after confirmation of the

disease by the hospital

• Hospital makes notification in writing to Infection Control Officer.

5656


Communicable Disease Fact Sheets

This program includes a series of “fact sheets” on more than forty communicable diseases

Provided by the Maryland Department of Health & Mental Hygiene with Web Site: www.edcp.org/html/index.html

5757

Tuberculosis

Infectious Disease PreventionInfectious Disease Prevention

5858

MMWRMMWR October 28, 1994 / Vol. 43 / No. RR-13October 28, 1994 / Vol. 43 / No. RR-13


MORBIDITY AND MORTALITY WEEKLY REPORT

Guidelines for Preventing the Transmission ofMycobacterium tuberculosis in Health-Care Facilities, 1994

5959


Who does this document apply to?Who does this document apply to? Health Care Workers (HCWs) Health Care Workers (HCWs)

““HCWs refers to all paid and unpaid HCWs refers to all paid and unpaid persons working in health-care persons working in health-care settings who have the potential for settings who have the potential for exposure to M. tuberculosis. This exposure to M. tuberculosis. This may include... emergency medicalmay include... emergency medicalservice (EMS) personnel.”service (EMS) personnel.”

6060


Specific measures to reduce the risk for transmission of M. tuberculosis include assigning responsibility:

Designated Officer

6161


Specific measures to reduce the risk for transmission of M. tuberculosis include:

Conducting a risk assessment to evaluate the risk for transmission of M. tuberculosis in your community and work setting

Develop a written TB Infection Control Program based on your risk assessment

6262


Periodically repeating the risk assessment to evaluate the effectiveness of the TB Infection Control Program

6363


Developing, implementing, and Developing, implementing, and enforcing policies and protocols to enforcing policies and protocols to ensure early identification of patients ensure early identification of patients who may have infectious TBwho may have infectious TB

6464

Infectious Disease PreventionA diagnosis of TB should be suspected in any patient with the following:

Productive cough (<2 to 3 wks duration) Fever - Chills Night sweats Easily fatigable Loss of appetite (anorexia) - weight loss Hemoptysis (bloody sputum)

6565


Managing patients who may have TB in ambulatory care setting and emergency departments:

Attempt to identify any potentially TB infected patient e.g. history, signs & symptoms, any previous positive TB treatment, or any current anti-tuberculosis medications

6666


Utilize engineering controls where possible and use of approved PPE when treating and transporting a patient suspected of having TB

TB patients, if medically stable, should remain in the transport unit (with a provider) until receiving facility is notified and ready to accept the patient

6767


Developing, implementing, maintaining, and evaluating a respiratory protection program:

Personal Protective Equipment (PPE): Respiratory Protection (NIOSH approved mask e.g. N-95 or HEPA and other PPE as per local protocol)

Meets adequate filtration standards

6868

Qualitatively or quantitatively fit tested Respirators available in at least three

sizes Ability to be checked for face piece fit

(OSHA) Must comply with CFR 1910.134

(OSHA Respiratory Standard)


6969


Use precautions while performing cough-inducing and other high hazard procedures:

Characterized by potential to generate airborne / droplet secretions

Aerosolized medication treatment Endotracheal Intubation Suctioning Transporting a patient with active

TB disease in a closed vehicle

7070


Educating and training HCWs about TB, effective methods for preventing transmission of M. tuberculosis, and the benefits of medical screening programs.

Tuberculosis Training Program

7171


What Is Tuberculosis?

Mycobacterial disease Caused by the infectious agent:

Mycobacterium tuberculosis Transmitted by infected airborne

particles called droplet nuclei

7272


What Is infectious?

Capable of causing infection Caused by a pathogen Illness resulting from an invasion

of a host by a disease producing organism

7373


TB Infection can result from exposure to infectious droplet nuclei

Positive PPD but, no clinically apparent signs or symptoms of TB

Negative CXR & negative smears and cultures which means usually not infectious

May develop into TB disease

7474


TB disease develops in a person with tuberculosis infection

Usually is infectious if not treated Signs and symptoms apparent with

positive lab test

7575


Develop and implement a program for routine periodic counseling and screening of HCWs for active and latent TB infection:

PPD skin testing is used to detect TB infection

7676


Skin test conversion from negative to positive indicates a new infection with TB

A person with a positive PPD should be clinically evaluated for active tuberculosis

A person with a positive PPD should be evaluated for preventive therapy if no active disease is present

If TB disease is detected, begin treatment per local policy

7777


Interpretation of TB Skin TestIndurations of:

5 mm or larger considered positive after close personal contact, abnormal CXR or in known HIV infected persons

10 mm or larger considered positive in persons with other known risk factors (HCW)

15 mm or larger considered positive in all other populations

7878


Promptly evaluate possible episodes of M. tuberculosis transmission in your health care setting

An exposure to TB is defined as: Potential exposure to the exhaled air of an

individual with suspected or confirmed TB disease

Exposure to high hazard procedure performed on persons with suspected or confirmed TB disease

7979


Risk Factors for TB Disease Development

Only about 1 in 10 people infected ever suffer active disease

Reactivation of TB is likely if the host has impaired immunity, including diabetes, chronic renal failure, malnourished, high-dose corticosteroid therapy, some hematologic disorders, or HIV infection

8080


Treatment of Tuberculosis Drug susceptibility testing should be

performed on all initial isolates from patients with TB

Until results are known, two basic principles of therapy apply:1) Start with the four primary drugs used in the treatment of TB until sensitively and resistance are known2) Continue treatment regimen with at least two drugs known to be effective on the isolate

8181


Drug Resistant Tuberculosis

Where therapy is not continuous or incomplete, multi-drug resistant tuberculosis can develop (MDR-TB).

MDR-TB can be treated but, treatment is with second line drugs that are less effective.

MDR-TB requires longer treatment regimens: 18 to 24 months (due to lower efficacy)

8282


TB Surveillance & Reporting

Skin test conversions among personnel PPD done at time of employment and

(annually) periodic re-testing thereafter Evaluation of exposure incidents Evaluations & management of positive PPD

skin tests or symptoms of TB Follow-up of personnel with positive PPD

skin test

8383


Follow-up After TB Exposure

Clinically evaluate for active TB Negative PPD in preceding 3 months

- repeat 12 weeks after exposure Negative PPD longer than 3 months ago,

repeat baseline and if this one is negative, repeat in 12 weeks

A positive PPD requires clinical evaluation and management

8484


Tuberculosis Prevention & Control Unit ventilation: keep adequate ventilation in

the treatment area of the transport vehicle e.g., windows, exhaust fans, air out vehicle after run

Work practices to prevent the spread of airborne droplets

When treating and transporting HIV infected patients, IVDAs, foreign born, and other high risk groups for TB, PPE should routinely include airborne protection

8585


TB Prevention & Control - Continued Face & eye protection during exposure

prone activities, e.g. endotracheal intubation, suctioning, positive pressure demand valve ventilation

Decontamination with E.P.A. approvedhospital grade detergent disinfectant

Tuberculosis screening program Preventive therapy or treatment Documentation

8686


Preventive Therapy

Coordinating activities with the local public health department, emphasizing reporting, and ensuring adequate follow-up and continuation and completion of therapy

8787


Preventive drug therapy substantially reduces the risk of developing clinically active tuberculosis in infected persons

If an infected person is a candidate for preventive therapy he/she could be placed on six to twelve months of daily (specific) anti-tuberculosis drug therapy

8888


5.3 - 10.4

0.0 - 5.2

> 15.6

> 15.6

5.3 - 10.4

10.5 - 15.6

10.5 - 15.6

0.0 - 5.2Wash. DC

>15.6

Alaska - 5.3 - 10.4Hawaii - >15.6

Tuberculosis in the U.S.Rates per 100,000 Population by State

8989

Prevention and Vigilance is Your Only Cure

1 INFECTIOUS DISEASE PREVENTION Saving the Lives of Our Providers MIEMSS.

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Transcript of 1 INFECTIOUS DISEASE PREVENTION Saving the Lives of Our Providers MIEMSS.