Infectious Diseases in Healthcare Focusing on HIV/ AIDS SM II.

Infectious Diseases in Healthcare

Focusing on HIV/ AIDSSM II

Objective

• The purpose of this unit is to increase your knowledge and understanding of HIV and AIDS and review some important information about other infectious diseases commonly encountered in healthcare.

Outline• Dates and Statistics-

HIV/ AIDS• HIV Transmission

and Infection• HIV Testing• Stages of HIV

Infection• How HIV Works in

the Body• Treatment for HIV

• Tuberculosis• Hepatitis B• Hepatitis C• Risk of BBP

Transmission• Disinfecting and

Disposal• Treatment after

Potential Exposure• Legal and Ethical

Issues• Psychosocial Issues

Dates and Statistics- HIV/ AIDS


• In 1999, an international team of researchers reported that they traced the origin of HIV-1 to a subspecies of chimpanzees native to west equatorial Africa. The researchers believe that HIV-1 was introduced into the human population when hunters became exposed to infected blood.


• AIDS was first recognized in the United States in 1981.

• The first reported case in Washington State was in 1982.

• In 1983, HIV was discovered to be the cause of AIDS.

• The first HIV antibody test was available in 1985.


• Globally, most of the people who are infected with HIV have not been tested and are unaware that they are living with the virus.

• The CDC estimates that 25% of people with HIV are unaware that they have the disease.


• The CDC estimates that there are between 1,039,000 and 1,185,000 persons infected with HIV in the US.

• The CDC estimates that there are 40,000 people in the US who become newly infected with HIV each year.


• 2000: 3 million deaths from AIDS worldwide.

• 2005: The United Nations AIDS Program estimates there were 38.6 million people in the world living with HIV or AIDS.

• 2005: An estimated 4.1 million people worldwide became infected with HIV. Half of the new infections were in people between the ages of 15 and 24.


• 2004: Estimated 41,000+ cases of AIDS in the United States.

• 2004: Estimated 15,000+ deaths of persons with AIDS, down from 17,000+ in 2000.


• The discovery of antiviral “combination” drug therapies in 1996 resulted in a dramatic increase in the number of deaths due to AIDS (in the people taking the drug therapies).

HIV Transmission and Infection


• HIV is considered to be a fragile virus when exposed to air and room temperatures and is not spread by casual contact.

• It must be acquired.


• In order for HIV transmission to occur, this means:

1. There must be a source of HIV (pathogen present).

2. There must be a sufficient dose of the virus (sufficient quantity).

3. There must be access to the bloodstream of another person (correct entry site).

HIV Transmission and Infection• Anyone infected with the virus is

potentially a source of HIV infection.• Transmission occurs primarily through

infected:– Blood– Semen– Vaginal Secretions– Breast Milk– From Infected Mother to Baby either before

or during birth


• Unless visibly contaminated with blood the following are not generally considered capable of transmitting HIV:– Sweat– Tears– Saliva– Urine– Feces

HIV Transmission and Infection• Other bodily fluids such as:

– Cerebrospinal Fluid– Synovial Fluid (joint)– Pleural Fluid (lung)– Pericardial Fluid (heart)– Amniotic Fluid

• May be considered infectious if the source is HIV positive.

• However, these fluids are not generally found outside a hospital setting.


• HIV is not transmitted through the air.

• Sneezing, breathing and coughing do not transmit HIV.

• Touching, hugging and shaking hands do not transmit HIV.

• HIV transmission is not possible from food that is prepared by an HIV-infected people.

HIV Transmission and Infection• HIV is not transmitted through casual

contact in the workplace.• No cases of HIV transmission have

been linked to sharing computers, food, telephone, paper, water fountains, swimming pools, bathrooms, desks, office furniture, toilet seats, showers, tools, equipment, coffee pots or eating facilities.


• However, personal items which may be contaminated with blood, such as toothbrushes and razors, should not be shared.


• There aren’t any documented cases of HIV transmission through participation in athletics.

HIV Testing

HIV Testing

• The first HIV antibody test was available in 1985.

• Currently antibody tests have a two step process:– Screening Test

• And if the screening test is reactive a:

– Confirmatory Test

HIV Testing

• The first test is a screening test that screens for the presence of antibodies to HIV in blood, urine or oral fluid.

• Screening tests are inexpensive tests that are highly accurate.

HIV Testing• There are conventional screening tests

where a specimen is collected from a person and sent to the laboratory for testing.

• If the screening test is negative, results are given to the patient.

• If the screening test is positive, an addition confirmatory test is performed on the same specimen before results are given to the patient.

HIV Testing

• There are also rapid screening tests where the test is conducted at the testing site.

• Since testing is done at the testing site, results are often available in an hour or so.

• “Reactive” or positive test results must be confirmed by additional testing.

HIV Testing

• There is a small chance that HIV screening tests may detect proteins related to other autoimmune diseases and “react” to these proteins with a “positive” result.

• Any positive screening test need to be confirmed by a confirmatory test called the Western Blot Test.

HIV Testing

• The Western Blot Test is done to verify the presence of HIV antibodies.

• The Western Blot Test is much more specific (but more expensive) than the screening tests.

HIV Testing

• Note: The virus is the disease. The virus causes infection. Antibodies are the immune system’s response to the disease. Antibodies are not the disease and do not cause the disease, they fight the infection.

HIV Testing

• It is important to remember that HIV antibody testing has a “window period”.

• Until the infected person’s immune system makes enough antibodies to be detected, the test will be negative even though the person is infected with HIV.

HIV Testing

• Some infected people are able to produce antibodies as early as two weeks after infection and almost everybody who is infected will produce enough antibodies by 12 weeks.

• Therefore, to be sure people should test three months after the last potential HIV exposure.

HIV Testing

• A positive screening test and Western Blot Test (confirmatory test) means:

1. The person is infected with HIV.2. The person can spread the virus to

others.3. The person is infected for life.

HIV Testing

• Remember, if the test is negative it means one of two things:

1. The person is not infected with HIV OR

2. The person became infected recently and has not produced enough antibodies to be detected by the test

HIV Testing

• If a person is tested confidentially (he or she gives real name), a positive HIV test result is reported to the local healthcare officer.

• Anonymous testing does not involve giving a real name so a positive HIV result is not reportable.

HIV Testing

• It is important to remember that information about a person’s HIV status is confidential and must not be shared with others.

• People who perform HIV counseling and testing must sign strict confidentiality agreements.

• Patient records are kept in locked files.

How HIV Works in the Body

How HIV Works in the Body• HIV enters the bloodstream and seeks out “T-

helper lymphocyte”, the white blood cells (lymphocytes) essential to the functioning of the immune system.

• One of the functions of the T-helper lymphocytes is to regulate the immune system response in the event of an attack from disease-causing organisms such as bacteria or viruses.

• When HIV infects the T-helper lymphocytes, the cell sends signals to other cells which produce antibodies.

How HIV Works in the Body• Antibodies are produced by the immune

system to help get rid of specific foreign invaders that can cause disease.

• Producing antibodies is an essential function of our immune system.

• The body makes a specific antibody for each disease.

• When our immune system is working properly, it protects against these foreign invaders.


• HIV infects and destroys the T-helper lymphocytes and damages their ability to signal for antibody protection.

• This results in the eventual decline of the immune system.


• HIV Affects:– The kind and number of blood cells– The amount of fat and muscle

distribution in the body– The structure and functioning of the

brain– The normal functioning of the immune

system– The body’s basic metabolism

How HIV Works in the Body• HIV Can Cause:

– Confusion or dementia– Diarrhea– Fatigue– Fever– Nausea or vomiting– Painful joints, muscles or nerve pain– Difficulty breathing– Vision or hearing loss– Chronic pneumonias, sinusitis or bronchitis– Loss of muscle tissue and body weight

How HIV Works in the Body• It is important to know that children show

significant differences in their HIV disease progression.

• Without drug treatment, most children are very sick by age 7.

• Significant improvements have been made and in 1994, it was discovered that a short course of the medication AZT for HIV positive pregnant women would dramatically decrease the number of children infected in he womb.

Stages of HIV Infection

Stages of HIV Infection• After viral transmission, the first stage of

HIV disease is primary/ acute HIV infection, typically lasting only a week or two, when the virus first establishes itself in the body.

• During the first few weeks of HIV infection, an infected person has a very high amount of virus in his or he bloodstream.

• An HIV infected person may become infectious to other within 5 days of viral transmission.


• Remember, during primary infection, most people are unaware they have HIV.

• The most common symptoms noticed by persons newly infected by HIV are fever, swollen glands, rash, fatigue and a sore throat.

• These symptoms are also common with many other types of infections (like mononucleosis).

Stages of HIV Infection• The “Window Period” is the period of time

between when the body first becomes infected with HIV and when the body is able to produce antibodies to HIV.

• It may take between two weeks to three months for antibodies to develop. Most people develop antibodies by 6 to 12 weeks.

• During the window period, the person is “infectious”, meaning he or she can pass the virus to someone else, and will remain infectious throughout life.

Stages of HIV Infection• The window period is the time when a person

may not produce sufficient antibodies to be detectable on an HIV antibody test.

• This means they might get a negative result on an antibody test, while actually having HIV.

• This is why a newly infected person can infect others before antibodies develop, when high amounts of virus in the blood are present, and the newly infected person does not yet know they have HIV.


• After the acute stage of HIV infection, people infected with HIV continue to look and feel completely well for long periods, usually for many years.

• This is generally referred to as the asymptomatic stage.


• During this time, the virus is replicating and slowly destroying T-helper lymphocytes and the immune system.

• This means that although the person may look and feel healthy, he or she can infect other people, especially if the person has not been tested and doesn’t know he or she is infected.


• Without antiretroviral therapy, there is an average of ten years between the time a person is infected with HIV and the start of persistent symptoms of AIDS.


• During the symptomatic stage of HIV infection, the person begins to have noticeable physical symptoms that are related to HIV.

• There are no symptoms that are specific to HIV.


• Some common symptoms include:– Persistent low grade fever– Pronounced weight loss not due to dieting– Persistent headaches– Diarrhea lasting more than one month– Difficulty recovering from colds and the flu– May become sicker than they normally

would


• An AIDS diagnosis must be made by a licensed healthcare provider.

• The diagnosis is based on a positive HIV blood test and the person’s physical condition.

• There is a list of “AIDS- defining illnesses” as well as white blood cell counts and other conditions.

Stages of HIV Infection• Once a person has been diagnosed with

AIDS, they do not “go backwards” in diagnosis even though they may feel better.

• Over time, people with AIDS frequently have a reduced white blood cell count and develop poor health.

• When a person’s immune system is suppressed, they have weaker defenses against a variety of bacteria, viruses and other pathogens.

Treatment for HIV

Treatment for HIV

• Research led an important discovery in HIV therapy in 1996.

• Taking combinations of medications, called “highly active antiretroviral therapy” (HAART) may drastically reduce the amount of HIV in a person’s bloodstream.

• It is important to note that this therapy DOES NOT CURE HIV/ AIDS.

Treatment for HIV

• Not everyone with HIV benefits from HAART.

• Some people cannot tolerate the side effects or follow the complex treatment schedule.

• The cost of these medications may be upwards of $2,000 each month.

Treatment for HIV

• Many promising developments have been made towards an HIV vaccine.

• It is possible that a vaccine will be available this decade……

• Right now, prevention is the only way to avoid HIV infection.

Tuberculosis

Tuberculosis

• Tuberculosis (TB) is transmitted by airborne droplets from people with active TB during coughing, sneezing or talking.

• TB can live anywhere in the body, but pulmonary (lungs) or laryngeal (larynx) TB is the greatest threat to public health.

Tuberculosis

• There are probably 8 million active cases of TB in the world each year.

• TB is one of the leading causes of death globally.

Tuberculosis

• When infectious secretions from a person with TB are breathed in by another person, the bacteria may come to rest in the lungs.

• After several weeks, the bacteria multiply and some pneumonia-like symptoms may occur.

Tuberculosis

• The TB bacteria are carried through the bloodstream and lymph system, pumped through the heart and to the body.

• The largest amount of bacteria usually goes to the lungs.

• In most cases this process resolves by itself.

Tuberculosis

• In 90% of the cases of TB, “latent TB” develops and the person never experiences subsequent disease.

• In 10% of the cases, the person will develop active TB at some point.

Tuberculosis

• Symptoms of TB Include:– Cough– Weight Loss– Fever

Tuberculosis

• Studies have shown that daily preventative therapy for 6 months may reduce the risk for TB disease by 69% in patients with latent TB.

Hepatitis B

Hepatitis B

• Hepatitis B (HBV) is a virus that is transmitted by the blood and bodily fluids of an infected person.

Hepatitis B

• Each year in the US, an estimated 60,000 people become infected with HBV.

• There are an estimated 1,250,000 carriers of HBV in the US.

• Each year, 4,000 to 5,000 people will die in the US from chronic liver disease or liver cancer caused by HBV.

Hepatitis B• It is important to remember that HBV is a

blood borne pathogen and is spread by contact with infected blood or bodily fluids.

• HBV is NOT Transmitted By:– Sneezing– Hugging– Coughing– Sharing eating utensils or drinking glasses– Food or water

Hepatitis B

• The average incubation period for HBV is about 12 weeks.

• HBV causes damage to the liver and other body systems, which can range in severity from mild, to severe, to fatal.

Hepatitis B

• Most people recover from their HBV infection and do not become carriers.

• Carriers (about 2-6% of people who become infected) have the virus in their body for months, years or life.

• They can infect others with HBV through contact with their blood or other bodily fluid.

Hepatitis B• People with HBV may look and feel fine.• Some people with HBV display only mild

symptoms:– Loss of appetite– Extreme fatigue– Abdominal pain– Jaundice– Joint Pain– Malaise– Dark urine– Nausea or vomiting– Skin rashes

Hepatitis B• Some people who are infected with HBV

experience more severe symptoms, and may be incapacitated for weeks or months.

• Long-term complications are also possible and include:– Chronic hepatitis– Recurring liver disease– Liver failure– Chronic liver damage (cirrhosis)

Hepatitis B• A vaccine is available to prevent

HBV (and has been since 1982). • The vaccine is given intramuscularly

by 3 shots over 6 months.• More than 90% of people who

complete the 3 injections are immune to HBV.

• The vaccine is suitable for all ages, even infants.

Hepatitis B

• Follow Standard and Universal Precautions to avoid contact with blood, bodily fluid or accidental needle sticks.

Hepatitis C

Hepatitis C• Hepatitis C (HCV) is a liver disease caused

by the hepatitis C virus.• HCV is the leading cause of chronic liver

disease in the US.• Globally, 180 million people are infected

with HCV.• In the US, an estimated 4.1 million people

have been infected with HCV.• The CDC estimates that 3.75 million

Americans do not know they are HCV positive.

Hepatitis C

• In the US, 8,000 to 10,000 deaths per year are attributed to HCV-associated liver disease and the number of deaths is expected to triple in the next 10- 20 years.

Hepatitis C

• HCV is transmitted primarily by blood and blood products (transfusions).

• HCV is not transmitted by:– Sneezing– Hugging– Kissing– Coughing– Sharing eating utensils or drinking glasses– Food or water

Hepatitis C• The CDC estimates that for every 100

people who are infected with HCV:– About 15% will recover fully and have no

liver damage– 85% may develop long term infection– 70% may develop chronic liver disease– 20% may develop liver damage

(cirrhosis) over a period of 20-30 years– 1-5% may die from chronic liver disease

Hepatitis C

• The symptoms of HCV include:– Nausea and vomiting– Weakness– Fever– Muscle and joint pain– Jaundice– Dark-colored urine– Tenderness in the upper abdomen

Hepatitis C

• There is no vaccine to prevent HCV infection.

• Follow Universal and Standard Precautions to avoid contact with blood, bodily fluids or accidental needle sticks.

Risk of BBP Transmission


• The risk of HIV infection to a healthcare worker through a needle stick is less than 1 percent. Approximately 1 in 300 exposures through a needle or sharp instrument result in infection.


• The risk of HIV infection through splashes of blood to the eyes, nose or mouth is even smaller- approximately 1 in 1,000.


• There have been no reported cases of HIV transmission from blood contact with intact skin.

• There is a theoretical risk of of blood contact to an area of skin that is damaged, or from a large area of skin that is covered in blood from a long period of time.


• The risk of getting HBV from a needle stick is 22-31%.

• The risk of getting HCV from a needle stick is 1.8%


• The risk of getting HBV or HCV from a blood splash to the eyes, nose or moth is possible but believed to be very small.

Disinfectant and Disposal

Disinfectant and Disposal• If there is blood on a vinyl floor, pre-treat

with full-strength disinfectant or detergent.• Wipe up the body fluid spill with either a mop

and hot, soapy water or appropriate gloves and paper towels.

• Use a good disinfectant (1 part bleach to 10 parts water) to disinfect the area where the spill occurred.

• If a mop or sponges are used to clean up bodily fluid, they should be soaked and water disposed of in the toilet instead of a sink.

Disinfectant and Disposal• If there is a blood spill on the carpet, pour

dry kitty litter or other absorbent on the spill.

• Then pour full-strength liquid detergent on the carpet to help disinfect the area.

• Use a carpet safe liquid disinfectant (instead of 10% bleach solution) on the entire contaminated area.

• Follow this by absorbing the spill with paper towels and sturdy rubber gloves.

• Vacuum normally afterwards.

Disinfectant and Disposal• If there is blood or OPIM on clothing,

remove it as soon as possible.• Soak the clothing in cold, soapy water to

remove any blood from the clothing. Hot water permanently sets blood stains.

• Use hot soapy water for the next washing cycle and include sufficient detergent which will act as a disinfectant.

• Dry items in a clothes dryer.


• Disposal of needles and other sharp instruments (“sharps”) needs to be done in a puncture resistant container (sharps container).


• Found used syringes or needles present a risk for HIV, HBV, HCV and other pathogens.

• If you find a syringe or needle, do not pick it up with your bare hands. Use gloves and tongs, shovel or broom and dustpan to pick it up.

• Hold the needle away from your body.


• Do not break the needle from the syringe.

• Do not flush needles or syringes down the toilet.

Disinfectant and Disposal• Please used sharps and syringes in a safe

container- one with at least a one-inch opening and a lid that will seal tightly.

• An empty plastic laundry detergent, shampoo, pickle, oil or similar bottle or jar will work.

• If a glass jar is used, place it in a larger plastic bucket or container that has a tight fitting lid.

• Soda cans are not good disposal containers (people often try to recycle discarded cans).


• Tape the lid hut for added safety.• Label it with the warning, “Sharps,

do not recycle”.• Call the local health department to

find a disposal site.

Treatment after Potential Exposure at Work

Treatment after Potential Exposure at Work• Follow the protocol of your employer.• As soon as safely possible, wash the

affected area (s) with soap and water.• Application of antiseptics should not

be a substitute for washing.• It is recommended that any

potentially contaminated clothing be removed as soon as possible.


• If the exposure is to the eyes, nose or mouth, flush thoroughly with water, saline or sterile irrigates.

• The risk of contracting HIV through this type of exposure is estimated to be less one percent.

• Follow up with your employer and healthcare provider ASAP.

Treatment after Potential Exposure at Work• If you have a SHARPS injury or needle

stick, wash the exposed area with soap and water.

• You may use antiseptics if you like, but there is no evidence to show it will reduce the risk of transmission.

• The risk of contracting HIV from this type of exposure is 0.3%.

• Follow up with your employer and healthcare provider ASAP.

Treatment after Potential Exposure at Work• If you have a bite or scratch wound, it is

important to know that exposure to saliva is not considered substantial unless there is visible contamination from blood or the saliva is from a dental procedure.

• Wash the area with soap and water and cover with sterile gauze.

• Follow up with your employer and healthcare provider ASAP. All bites should be evaluated by a doctor.


• Exposure to urine, feces or vomit is not considered a potential BBP exposure unless the fluid is visibly contaminated with blood.


• Post-exposure prophylaxis (PEP) provides anti-HIV medications to someone who has had a substantial exposure, usually to blood.

• Research suggests that cellular HIV infection happens within 2 days of exposure to HIV and the virus is detectable in the blood within 5 days.


• PEP should be started as soon as possible, within hours not days, after exposure and continued for 28 days.


• PEP is not as simple as swallowing one pill. The medications must be started as soon as possible and continued for 28 days.

• Many people experience significant medication side effects.


• Please note: PEP for HIV does not provide prevention of other BBPs, like HBV or HCV.

• PEP for HBV for susceptible persons would include administration of HBV vaccine and hepatitis B immune globulin and needs to occur no later then 7 days after exposure.

Treatment after Potential Exposure at Work• Antibody testing for HIV, HBV and

HCV should be conducted for more than 6 months after exposure at work.

• After baseline testing at the time of the exposure, follow-up testing should be done at 6 weeks, 12 weeks and 6 months after exposure (up to 12 months if there is the possibility of exposure to HIV and HCV).

Legal and Ethical Issues Surrounding HIV and BBPs

Legal and Ethical Issues• AIDS, symptomatic HIV infection and

asymptomatic HIV infection are all reportable conditions.

• “Reportable” means that in the case of HIV or AIDS, the provider who diagnoses the person, must submit a confidential case report to the local health jurisdiction within 3 days.

• Reporting of HIV and AIDS cases assists local and state officials in tracking the epidemic and allows for planning and intervention efforts.

Legal and Ethical Issues

• All medical records are confidential and there are special requirements concerning HIV and AIDS.

• Confidentiality of medical records means that a person’s medical information (including HIV and AIDS status) may not be disclosed to anyone unless the individual signs a medical release.

Legal and Ethical Issues• However, there are some exceptions to

this.• Medical information can be disclosed

under certain circumstances including:– From one health care provider to another for

related on-going medical care.– Life or death emergency– To a third party payor (insurance)– In the case of reportable conditions to the

Department of Health (DOH)

Legal and Ethical Issues

• Violation of confidentiality of medical records is a misdemeanor and may result in fines of $10,000 or the actual damages in the case, whichever is greater.

Legal and Ethical Issues• HIV and AIDS status (and other

conditions) fall under additional protection because disclosure of the information to the wrong person or agency could result in additional harm to the patient.

• There is a level of prejudice, fear and discrimination directed at people with these medical conditions.

Legal and Ethical Issues• People with AIDS and HIV are protected

under a number of state and federal (national) laws including the Americans with Disability Act (ADA).

• These laws mean that it is illegal to discriminate against people with AIDS or HIV, on the basis of their medical condition and that reasonable accommodations need to be made in the workplace.

Legal and Ethical Issues• Washington State law also gives

state and local health care officials the authority to carry out certain measures to protect the public from the spread of sexually transmitted diseases including HIV.

• The local health officer is a physician hired to direct the operations of the local county’s health department.

Legal and Ethical Issues• The local health officer has the authority

to:– Interview persons with a disease– Notify partners of exposure to a disease– Order persons suspected of being infected to

receive testing and treatment– Issue orders to cease and desist from behaviors

that endanger the public– Can take the additional step of detention of an

HIV infected individual who continues to endanger the health of others

Psychosocial Issues

Psychosocial Issues• Persons with HIV and their families and

friends must face many difficult realities including (but not limited to):– Even with current therapies, people with AIDS still

die prematurely– Social pressure, stress and discrimination– 90% of all adults with AIDS are in the prime of life

and not prepared to deal with death and dying– The infections and malignancies that accompany

AIDS can diminish and disfigure the body– Taking medications for the rest of their lives

Psychosocial Issues• HIV often produces many losses including

(but not limited to) loss of:– Physical strength and abilities– Mental abilities– Income and savings– Health insurance– Job/ work– Housing and personal possessions (pets)– Self-sufficiency and privacy– Social contacts– Self Esteem

Psychosocial Issues

• People experiencing these types of losses may feel:– Guilt– Grief– Helplessness– Rage– “Numbness”

Psychosocial Issues

• Don’t forget that friends and caregivers may go through some of these same stages and need support as well as the patient.

References/ Resources

• www.cdc.gov• Arnheim’s Principles of Athletic

Training• Sports Medicine Essentials• Washington State DOH KNOW

2007

Infectious Diseases in Healthcare Focusing on HIV/ AIDS SM II.

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Transcript of Infectious Diseases in Healthcare Focusing on HIV/ AIDS SM II.