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PowerPoint® presentation to accompany: Medical Assisting Third Edition Booth, Whicker, Wyman, Pugh, Thompson

Chapter 21. HIV, Hepatitis, and Other Blood-Borne Pathogens. PowerPoint® presentation to accompany: Medical Assisting Third Edition Booth, Whicker, Wyman, Pugh, Thompson. Learning Outcomes. 21.1 Describe ways in which blood-borne pathogens can be transmitted.

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PowerPoint® presentation to accompany: Medical Assisting Third Edition Booth, Whicker, Wyman, Pugh, Thompson

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  1. Chapter 21 HIV, Hepatitis, and Other Blood-Borne Pathogens PowerPoint® presentation to accompany: Medical Assisting Third Edition Booth, Whicker, Wyman, Pugh, Thompson

  2. Learning Outcomes 21.1 Describe ways in which blood-borne pathogens can be transmitted. 21.2 Explain why strict adherence to Universal Precautions is essential in preventing the spread of infection. 21.3 Describe the symptoms of hepatitis and AIDS. 21.4 List and describe the blood tests used to diagnose HIV infection.

  3. Learning Outcomes(cont.) 21.5 Identify chronic disorders often found in patients who have AIDS. 21.6 Compare and contrast drugs used to treat AIDS/HIV infection. 21.7 Describe the symptoms of infection by other common blood-borne pathogens.

  4. Learning Outcomes(cont.) 21.8 Describe the steps involved in reporting a communicable disease. 21.9 Explain how to educate patients about minimizing the risks of transmitting blood-borne infections to others. 21.10 Describe special issues you may encounter when dealing with patients who have terminal illnesses.

  5. Chapter 21 expands on OSHA blood-borne pathogen standards How to reduce your risk of exposure HIV, hepatitis, and other blood-borne infections Reporting guidelines Educating patients Issues associated with terminal illnesses such asAIDS Introduction

  6. Transmission of Blood-Borne Pathogens • Blood-borne pathogens are disease-causing microorganisms carried in the host’s blood. • Transmission occurs from one host to another through contact with • Infected blood • Tissue • Body fluids • Mucous membranes

  7. Cerebrospinal fluid Synovial fluid Pleural fluid Peritoneal fluid Pericardial fluid Amniotic fluid Transmission(cont.) • Transmission agents for blood-borne diseases • Blood • Blood products • Human tissue • Semen • Vaginal secretions • Saliva from dental procedures Identified by the Centers for Disease Control and Prevention (CDC)

  8. Transmission agent only if there is visible blood Feces Nasal secretions Perspiration Sputum Tears Urine Vomitus Saliva Transmission(cont.)

  9. Transmission(cont.) • Blood-borne pathogens may be introduced into a new host by • Needlesticks • Cuts or abrasions • Any body opening • Transfusion of infected blood

  10. Transmission: People at Increased Risk • Anyone who comes in contact with substances that may harbor the pathogens • Health-care professionals • Law enforcement officers • Mortuary or morgue attendants • Firefighters • Medical equipment service technicians • Barbers and cosmetologists

  11. Transmission: People at Increased Risk (cont.) • Pathogens • Hepatitis B virus (HBV) • Hepatitis C virus (HCV) • HIV  AIDS

  12. Transmission: Research • Incidence of many infectious diseases • Reported to state health departments • Information then sent to CDC • Trends in spread • Identify control tactics • Allocate resources

  13. Apply Your Knowledge Good Answer! How are blood-borne pathogens transmitted from host to host? ANSWER: Transmission occurs from one host to another through contact with infected blood, tissue, body fluids, and mucous membranes.

  14. Universal Precautions The most effective means of preventing the spread of HIV, hepatitis, and other blood-borne pathogens is to avoid contamination Universal Precautions are required by OSHA

  15. Universal Precautions • For medical offices, includes all • Body fluids • Secretions • Excretions • Moist body surfaces • Assume every patient is contaminated

  16. Apply Your Knowledge In a medical office, to what items do Universal Precautions apply, and with which patients should you practice these precautions? • ANSWER: In medical offices, Universal Precaution applies to body fluids, secretions, excretions, and moist body surfaces. Assume every patient is contaminated and use Universal Precautions with everyone. Right!

  17. Disease Profiles • Keep up-to-date so you can • Identify symptoms that may indicate that a patient has a blood-borne disease • Identify habits of your patients that increase risk of spreading the disease • Educate patients to limit risks of contracting disease

  18. Disease Profiles:Hepatitis • Viral infection of the liver that can lead to cirrhosis and death • Hepatitis A – spread by fecal-oral route • Hepatitis B – blood-borne disease that spreads by contact with contaminated blood or body fluids or sexual contact

  19. Disease Profiles:Hepatitis(cont.) • Hepatitis C (non-A/non-B) • Spread through contact with contaminated blood or body fluids and sexual contact • No cure • Many people are carriers • Flu-like symptoms, if any • Damages liver; causing cirrhosis, liver failure and cancer

  20. Disease Profiles:Hepatitis (cont.) • HepatitisD (delta agent hepatitis) • Occurs only in people that are infected with HBV • May mimic symptoms of hepatitis B, but more severe • Associated with liver cancer • Hepatitis E • Caused by hepatitis E virus (HEV) • Transmitted by fecal – oral route

  21. Risk factors – same for HBV and HCV Occupation that requires exposure to blood and body fluids High-risk sexual activity IV drug use Hemophilia Travel to areas with high incidence Blood transfusions prior to screen Hemodialysis Living with partner with hepatitis B or hepatitis C Multiple sexual partners Disease Profiles:Hepatitis (cont.)

  22. Disease Profiles:Hepatitis (cont.) • Risk in medical community • HIV • Approximately 0.5% from a single needlestick • Hepatitis B • 6% to 33% from single needlestick The primary risk factor for HBV and HCV infection is occupational exposure to the virus.

  23. Infection progression Acute illness lasts about 16 weeks Prodromal stage – general malaise, maybe nausea or vomiting, or no symptoms Icteric, or jaundice, stage – yellowing of the skin, eyes, and mucous membranes Appears 5 – 10 days after initial infection Convalescent (after acute stages) – can last 2 to 3 weeks Disease Profiles:Hepatitis (cont.)

  24. Symptoms Jaundice Decreased appetite Fatigue Nausea and vomiting Joint pain / tenderness Stomach pain General malaise Diagnosis Investigation of Risk factors Exposure incidents Blood tests Antigen-antibody systems Determine stage of disease Disease Profiles:Hepatitis (cont.)

  25. Disease Profiles:Hepatitis (cont.) • Preventive measures • Avoid contact with contaminated substances • Use Universal Precautions with all patients • Vaccination is available to prevent HBV infections • Will not protect you from other strains of hepatitis • CDC recommends routine vaccination for everyone • HBIG for postexposure inoculation

  26. Disease Profiles: AIDS / HIV Infection • Virus that infects and destroys components of the immune system • HIV infection develops into AIDS • Pathogen destroys • Helper T cells – white blood cells that are a key component of immune system • Neurons, causing demyelination • Patients develop opportunistic infections

  27. Disease Profiles: AIDS / HIV Infection (cont.) • Risk factors • Unprotected sexual activity • Sharing needles used by IV drug users • Passes from mother to fetus during pregnancy or to infant during delivery or breastfeeding • Incubation period of 8 to 15 years

  28. Disease Profiles: AIDS / HIV Infection (cont.) • Risk in medical community • Percutaneous exposure • Exposure through a puncture wound or needlestick • Mucocutaneous exposure • Exposure through a mucous membrane

  29. Disease Profiles: AIDS / HIV Infection (cont.) • Progress of the infection –three main stages • Initial infection • Can occur years after exposure • Virus enters cell and makes copies • Helper T cells die • Immune system responds • Cleans the blood supply of the virus • Virus enters an inactive phase

  30. Disease Profiles: AIDS / HIV Infection (cont.) • Progress of the infection • Incubation period • Virus genetic material incorporated into the genetic material of the helper T cells • Virus trapped in lymph system • Incubation period can be 8 to 15 years • As helper T cells decrease, patients are more prone to opportunistic infections

  31. Disease Profiles: AIDS / HIV Infection (cont.) • Progress of the infection • Full-blown AIDS • During the incubation period, HIV becomes active again and continues to attack and kill helper T cells • 200 or fewer helper T cells/mL blood indicates full-blown AIDS • Opportunistic infections and neurological deterioration

  32. Disease Profiles: AIDS / HIV Infection (cont.) • Diagnosis • Enzyme-linked immunosorbent assay (ELISA) • Confirms presence of antibodies in response to HIV • 85% accurate – cross-reactivity with other viruses • Western Blot Test or immunofluorescent antibody (IFA) • Confirms positive ELISA test • Specific to individual viruses • Accurate diagnosis – ELISA plus one of the other two • Home tests available – may give false results

  33. Kaposi’s Sarcoma Disease Profiles: AIDS / HIV Infection (cont.) • Symptoms • Systemic • Respiratory • Oral – hairy leukoplakia • Gastrointestinal • Peripheral nervous system • Skin-related • Kaposi’s sarcoma

  34. Preventive measures Sexual contact Use protection Avoid multiple partners Avoid concurrent sexually transmitted infections IV drug users Avoid sharing or reusing needles Medical procedures Universal Precautions Wash hands Education Dangers of HIV/AIDS How HIV/AIDS is spread and not spread Preventive measures Disease Profiles: AIDS / HIV Infection (cont.)

  35. Apply Your Knowledge Which statements are true and which are false? ____ Risk factors are the same for HBV and HCV. ___ Hepatitis A is spread via contaminated blood or body fluids. ____ Helper T cells are red blood cells and are a key component of immune system. ____ Percutaneous exposure occurs through a puncture wound or needlestick. Right! ANSWER: T F Hepatitis A is spread by the fecal-oral route. F Helper T cells are white blood cells. T

  36. AIDS Patients: Patient Profile • No one is immune to AIDS • 2005: 40.3 million men, women, and children were HIV-infected worldwide. • People infected • Homosexual males (rate decreasing) • Young people in large metropolitan areas • IV drug users • Women

  37. Kaposi’s Sarcoma AIDS Patients: Chronic Disorders of the AIDS Patient • Impaired immune system permits opportunistic infections • Pneumocystis carinii pneumonia • Protozoal infection • Occurs in 75% of AIDS patients • Kaposi’s sarcoma • Aggressive malignancy • Non-Hodgkin’s lymphoma • Second most common malignancy associated with HIV infection

  38. AIDS Patients: Chronic Disorders of the AIDS Patient (cont.) • Tuberculosis • Often drug-resistant • Mantoux skin test often negative in AIDS patients • Anergic reaction – no response to any substances injected as a skin test • Mycobacterium avium complex (MAC) infections • 97% of nontuberculous bacterial infections • Meningitis • Can lead to AIDS dementia complex

  39. AIDS Patients: Chronic Disorders of the AIDS Patient (cont.) • Candidiasis • Oral – thrush • Vaginal – females • Herpes simplex • Infections caused by HSV can be mild to life-threatening • Herpes zoster • Virus that causes chickenpox becomes dormant • Returns as herpes zoster, or shingles • Lesions last longer in immunocompromised patients – patients with impaired or weakened immune systems

  40. AIDS Patients: Treating Opportunistic Infections • Drug side effects problematic • Patients develop • Allergies to treatment • Intolerance to medications • Pathogens become resistant to treatments • Treatments may conflict with other treatments

  41. AIDS Patients:Testing Regulations • CDC does not require mandatory HIV testing for health-care workers • Health-care workers’ chances of being infected by a patient are greater than a patient being infected by a health-care worker

  42. Drugs Slow reproduction of virus, no current cure List of FDA approved drugs – Table 21-2 Treatment goals Increase the time between infection and symptomatic disease Improve quality of life Reduce transmission To uninfected Maternal-infant Reduce HIV-related deaths AIDS Patients:Drug Treatments

  43. AIDS Patients:Drug Treatments (cont.) • Treatment guidelines • Panel of Clinical Practices for Treatment of HIV Infections • Initial and follow-up testing • Drug resistance testing • HAART – combination of drug treatment • Initiating therapy • Decision made made by patient and physician • AIDS diagnosis or CD4 T cell count is < 200cells/mm3

  44. AIDS Patients:Drug Treatments (cont.) • Delayed treatment • Benefit • Postponement of drug-related adverse affects • Development of drug resistance • Preserving treatment options • Risks • Irreversible immune system damage • Increase risk of transmission of disease

  45. Early treatment Benefits Suppression of viral replication (preserves immune function) Reduction in chance of transmission Helps patient live symptom-free longer Disadvantages Drug toxicity Drug resistance Adverse effects on quality of life Loss of treatment options AIDS Patients:Drug Treatments (cont.)

  46. Treating complications Must also treat opportunistic infections Patients more prone to Bacterial infections Protozoal infections Viral infections Fungal infections Malignancies Continuing research Global issue Keep informed of new treatments and prevention methods AIDS Patients:Drug Treatments (cont.)

  47. Apply Your Knowledge Identify where these opportunistic infections affect the body. • Herpes simplex • Pneumocystis carinii • Kaposi’s sarcoma • Tuberculosis • Meningitis • Oral candidiasis ANSWER: mouth, lips, genitalia lungs arms, legs, chest, neck, face, conjunctiva, palate lungs brain CORRECT! mouth, tongue

  48. Cytomegalovirus Antibodies found in 80% of adults Erythema infectiosum Parvovirus B19 Fifth disease Human T-cell lymphotropic virus HTLV-1 Appears in IV drug users, among others Listeriosis Caused by bacteria Listeria monocytogenes Fever, shock, rash, and aches Other Blood-Borne Infections All are problematic for people with impaired immune systems.

  49. Malaria Parasite enters bloodstreamthrough mosquito’s bite Cyclical symptoms Syphilis Caused by spirochete Treponema pallidum Three stages Difficult to identify and treat in HIV-positive persons Toxoplasmosis Caused by Toxoplasma gondii in cat feces Other Blood-Borne Infections (cont.)

  50. Apply Your Knowledge Which blood-borne pathogen is found in 80% of adults and rarely causes noticeable symptoms? ANSWER: Cytomegalovirus (CMV) Good Job!

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