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Biological agents

Biological agents . Chapter 2.3 JF Gehanno , M.D., Ph.D . University of Rouen. Biological hazards. Non infectious effects Toxic effects : Part of the membranes of bacteria ( Endotoxins ) Toxins produced by moulds ( mycotoxins ) Allergy Infectious effects

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Biological agents

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  1. Biological agents Chapter 2.3 JF Gehanno, M.D., Ph.D. University of Rouen

  2. Biologicalhazards • Non infectiouseffects • Toxiceffects : • Part of the membranes of bacteria (Endotoxins) • Toxinsproduced by moulds (mycotoxins) • Allergy • Infectiouseffects • Bacteria, fungi, viruses … • Wewill focus on infection …

  3. European Classification of biological agents (basedonly on the risk of infection) Hazardous agents are thosebelonging to group 2, 3 and 4 Exemples : Group 2 : Clostridium perfringens, Cytomegalovirus Group 3 : Mycobacteriumtuberculosis, Hepatitis B virus, Plasmodium falciparum Group 4 : Lassa virus, Ebola virus

  4. Sources of exposure • Patients in hospital settings • Bugs (ticks, sarcoptes …) • Animals (veterinarians, slaughterhouses)

  5. The way to infection Host Reservoir Dispersion infection Emission of germs Aerial Contact – ingestion Percutaneous Infection if susceptible

  6. Main occupations exposed • Healthcareworkers (manyviruses) • hazards represented by biological agents present in patients • Farmers (brucellosis, zoonosis) • Outdoor workers (Leptospirosis, lyme disease)

  7. Somebiological agents

  8. Hepatitis A • Spread in the feces of infectedindividuals • Risk for travellers in lowincome countries • Risk of spreading to the community by infectedfoodhandlers

  9. Hepatitis B • A highrisk for healthcareworkers (HCWs) • Blood exposure • Needlestickexposures for HCWs • Up to 45% of risk to beinfected in case of needlestickexposurewith a needlethat have been used for an infected patient • Skin contact (rescuers) • Wounds (police officers, firefighters)

  10. Tuberculosis • Occupationalrisk for • HCWs • People workingwith migrants fromhighprevalence countries • Transmition by smalldroppletsreleased by infected patients • Droppletstoosmall to settle • Can spreadatseveralmetersfrom the patient

  11. Prevention

  12. Riskassessment • Identify the sources of biological agents • Identify the possible ways of transmission • Identify susceptible workers

  13. Avoidexposure Host Reservoir Dispersion Isolation of patient

  14. Avoidexposure Barriers Host Reservoir Dispersion Gloves Masks Long sleeves for outdoorworkers

  15. Whichmask for HCWs ? • Bigdropplets (pertussis, meningococcal infection, influenza …) • Settleat short distance (1m) & straight trajectory • Surgicalmaskenough • Small dropplets (tuberculosis, chickenpox …) • Don’tsettle (airborne transmission) • Respiratorneeded (N95 or FFP2)

  16. Avoid contamination Hand washing Host Reservoir Dispersion Standard precautions Desinfection of surfaces Earlyremoval of ticks

  17. Vaccination Host Reservoir Dispersion Hepatitis B vaccine for HCWs Hepatitis A vaccine for sewageworkers Leptospirosis vaccine for foresters

  18. Avoid infection Preventivetreatment Host Reservoir Dispersion infection Chemoprophylaxis for HIV in case of needlestickexposure Antibioprophylaxis in case of exposure to Bordetellapertussis

  19. Treat infection Earlytreatment Host Reservoir Dispersion infection Antibiotics in case of erythemamigransskin lesionfollowingtick bite

  20. Treat infection Follow up Screaning Host Reservoir Dispersion infection

  21. And in any case … • INFORMATION OF THE WORKER ABOUT THE RISKS AND THEIR PREVENTION

  22. Don’tforget the WARP • Work : could the work of the patient be (part of) the cause or the aggravation of his/her complaint or disease? • Skin lesion for a sewage worker • Activities : could the complaint / disease of the patient have consequences for his/her activities and participation in work • Hepatitis B infection in a surgeon • Tuberculosis in an HCW • Referral : should I refer my patient to an occupational physician or another specialist • Should this pregnant HCW, unprotected against rubella, take specific precautions ? • Prevention : Can I do something to prevent the (return of the) complaint or disease? • Is this HCW protected against hepatitis B ?

  23. Someuseful links • Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare InfectionControl Practices Advisory Committee, 2007 Guideline for Isolation Precautions: Preventing Transmission of Ifnectious Agents in Healthcare Settings, June 2007 • http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf • Canadian Centre for Occupational Health and Safety. Biological Hazards. http://www.ccohs.ca/oshanswers/biol_hazards/ • National Institute for Occupational Safety and Health (NIOSH). Health Care Workers. http://www.cdc.gov/niosh/topics/healthcare/ • National Institute for Occupational Safety and Health (NIOSH). Diseases & Injuries. http://www.cdc.gov/niosh/topics/diseases.html

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