Super Pathogens

1. Super Pathogens WHAT ARE THEY AND HOW TO AVOID THEM Evan Collette Ashley Tourigney

2. Community BasedDisease As members of any emergency response team it important for us to be aware of new strains of communicable disease which we may be exposed to and universally approved prevention techniques used to safeguard health care workers.

3. VREVancomycin-resistant enterococci Enterococci is a bacteria. It is present in intestines and female genital tract normally and can live without causing harm. When the bacteria seeds elsewhere it will cause infections including urinary tract, blood, and wound infections.

4. Vancomycin Vancomycin in an antibiotic used to treat the infections caused by enterococci. In some cases the bacteria has become resistant to this antibiotic. They call this resistant bacteria VRE (vancomycin-resistant enterococci).

5. How is VRE spread? VRE is usually passed to others by direct contact with stool, urine or blood containing VRE. It can also be spread indirectly via the hands or on contaminated environmental surfaces. VRE usually is not spread through casual contact such as touching or hugging. VRE is not spread through the air by coughing or sneezing.

6. People at increased Risk Individuals who have been treated in the past with vancomycin and combinations of other antibiotics. People in hospitals, esp. on antibiotics for long durations. People with weak immune systems or who have had surgical procedures. People with indwelling percutaneous medical devices and catheters.

7. Treatment Most VRE infections can be treated with antibiotics other than vancomycin. The treatment of VRE is determined by laboratory testing to determine which antibiotics are effective. People who are colonized (bacteria are present, but have no symptoms of an infection) with VRE do not usually need treatment.

8. Prevention Always wash your hands thoroughly after using the bathroom and before preparing food. Wash with soap and water (particularly when visibly soiled) or clean with alcohol-based hand cleaner. Use a household disinfectant or a mixture of one-fourth cup bleach and one quart of water to clean those areas and surfaces that are touched frequently. Wear gloves if you may come in contact with body fluids that may contain VRE, such as stool. Always wash your hands after removing gloves.

9. Hepatitis Hepatitis means an inflammation of the liver. There are 5 viruses that can cause hepatitis. Some of the viruses can change over time making it difficult for the body to fight.

10. Hepatitis Hepatitis A: is a liver disease caused by the hepatitis A virus (HAV). Hepatitis A can affect anyone. In the United States, hepatitis A can occur in situations ranging from isolated cases of disease to widespread epidemics.

11. Hepatitis Hepatitis B: is a serious disease caused by a virus that attacks the liver. The virus, which is called hepatitis B virus (HBV), can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death.

12. Hepatitis Hepatitis C: is a liver disease caused by the hepatitis C virus (HCV), which is found in the blood of persons who have the disease. HCV is spread by contact with the blood of an infected person.

13. Hepatitis Hepatitis D: is a liver disease caused by the hepatitis D virus (HDV), a defective virus that needs the hepatitis B virus to exist. Hepatitis D virus (HDV) is found in the blood of persons infected with the virus.

14. Hepatitis Hepatitis E: is a liver disease caused by the hepatitis E virus (HEV) transmitted in much the same way as hepatitis A virus. Hepatitis E, however, does not occur often in the United States.

15. Hepatitis

16. Acute Hepatitis – Clinical SymptomsAsymptomatic > Symptomatic > Fulminant Liver Failure > DeathSymptoms (if present) are the same, regardless of cause (e.g., A, B, C, other viruses, toxins)Nausea, vomitingAbdominal painLoss of appetiteFeverDiarrheaLight (clay) colored stoolsDark urineJaundice (yellowing of eyes, skin)

17. Hepatitis A

18. Hepatitis A NUMBER OF YEARS REPORTED INCIDENCE OF HEPATITIS A EXCEEDED 10 CASES PER 100,000, BY COUNTY, 1987-1997

19. Hepatitis A Transmitted through close personal contact (e.g., household contact, sex contact, child day-care centers), contaminated food, water (e.g., infected food handlers), blood exposure (rare) (e.g., injection drug use, rarely by transfusion) It occurs most often in children and young adults, esp. in autumn and winter. Symptoms include: jaundice, malaise, nausea, diarrhea, abdominal pain, and lack of appetite for a period of 2 days-3 weeks.

20. Preventing Hepatitis A Vaccine: 97%-100% of children, adolescents, and adults have protective levels of antibody within 1 month of receiving first dose; essentially 100% have protective levels after second dose. Serum titers for up eight years. Hygiene (e.g., hand washing) Sanitation (e.g., clean water sources) Hepatitis A vaccine (pre-exposure) Immune globulin (pre- and post-exposure)

21. hepatitis B virus hepatitis B virus hepatitis B virus hepatitis B virus Hepatitis B

22. Hepatitis B Hepatitis B is a serious disease caused by a virus that attacks the liver. The virus, which is called hepatitis B virus (HBV), can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death. About 30% of persons have no signs or symptoms.  Signs and symptoms are less common in children than adults. It occurs in people of all ages with about the same incidence throughout the year.

23. Hepatitis B Occurs when blood from an infected person enters the body of a person who is not infected. HBV is spread through having sex with an infected person without using a condom, by sharing needles, needlesticks or sharps exposures on the job, or from an infected mother to her baby during birth. Persons at risk for HBV infection might also be at risk for infection with hepatitis C virus (HCV) or HIV.

24. Hepatitis B The hepatitis B virus takes about 2 months to show up in your blood. It may stay in your blood for months or years. Acute Hepatitis B: 9 out of every 10 adults will get rid of the virus from their bodies after a few months. The symptoms will go away on their own within a few weeks there is no treatment other than alleviating the symptoms. Chronic Hepatitis B: 1 out of every 10 adults will never get rid of the virus from their bodies. They are called carriers. After having the virus the person has immunity to it and for others a vaccine is available.

25. Hepatitis C Hepatitis C can lead to cirrhosis or liver cancer, it is a leading reason for liver transplants. It is transmitted person to person by blood or body fluids. Although the disease usually is mild or seemingly inapparent, the infection can be severe in compromised individuals and will become chronic in about 80% of those infected.

26. Hepatitis C There is no cure or vaccine for Hepatitis C. No immunity is developed following an infection. Some medications are currently used to help control the disease.

27. Staphylococcus aureus“staph” Staphylococcal Infections -Staph is short for Staphylococcus, a type of bacteria. There are over 30 types, but Staphylococcus aureus causes most staph infections, including Skin infections, Pneumonia, Food poisoning, and Toxic shock.

28. Staphylococcus aureus“staph” This bacteria is carried on the skin or in the nose of healthy people. Not everyone gets infections from “staph” bacteria when it is present on their body. Some people do get skin infections such as pimples and boils, they are treatable. In other cases the infection can be serious causing wound infections, bloodstream infections, and pneumonia.

29. Methicillin-resistant Staphylococcus aureus (MRSA) MRSA is a type ot “staph” infection that is resistant to antibiotics called beta-lactams. β-lactam antibiotics are a broad class of antibiotics that include penicillin derivatives, cephalosporins, monobactams (imipenem), carbapenems (aztreonam), and β-lactamase inhibitors Of 25-30% of people colonized with staph about 1% is colonized with MRSA.

30. Methicillin-resistant Staphylococcus aureus (MRSA) Methicillin-resistant Staphylococcus aureus (MRSA) are identified as nosocomial pathogens throughout the world. People who get MRSA are frequently in hospitals and healthcare facilities, with weakened immune systems. Recently, however, cases of MRSA have been documented in healthy community-dwelling persons without established risk factors for MRSA acquisition.

31. How do you get MRSA? You can get MRSA by having physical contact with someone who is infected with it or carrying it on their body. Another way is to touch an object that has MRSA on it, ex: a door knob. Normal skin of people does not allow the infection to develop, however an abrasion or cut on the skin will allow it to.

32. MRSA Signs and Symptoms Infection of the skin starting with small red bumps in the skin Pus-filled infections of hair follicles Collections of pus in under the skin Infection of eyelid gland Infections of the skin with openings Pus filled blisters MRSA can spread to internal organs as well and can cause chills, low BP, rash, joint pains, severe headaches and shortness of breath.

33. Treatments for MRSA Most MRSA can be treated by certain antibiotics like vancomycin and linezolid. The entiredosage of antibiotic needs to be taken to “cure” the infection.

34. Avoid getting MRSA by… • Cover any skin breaks with antiseptic cream and a Band-Aid • Use excellent hygiene practices • Wash clothes in contact with MRSA patients or carriers • Use disposable items when treating MRSA patients • Use antiseptic solutions and wipes to clean both hands and surfaces that may contact MRSA

35. Clostridium difficile(C.difficle) This is a bacterium that causes diarrhea and more serious intestinal conditions. There is an increased risk when on antibiotics, because the antibiotic alters the bodies levels of good bacteria in the intestines. Clindamycin is the antibiotic most frequently associated with C.difficile infections followed by ampicillin and cephalosporins.

36. Clostridium difficile The elderly and people in the hospital are at greater risk, healthy people are not usually affected. Once C.difficile has established its self in an environment it is difficult to remove. Symptoms of this colitis include abdominal cramps, diarrhea, fever, electrolyte imbalance, and potential perforation of the colon in severe infections.

37. Modes of Transmission Contact Transmission Vector Transmission Vehicle Transmission

38. Contact Transmission Direct contact transmission requires body contact between individuals. In the health care worker these can be spread through unhygienic practice. An example would be direct fecal-oral transmission transfers fecal pathogens to mouth via unwashed hands. Staphylococcal infections, warts and STD’s are of major concern.

39. Contact Transmission Indirect contact transmission occurs through non-living objects that can harbor and transmit an infectious agent. Examples include soiled handkerchiefs, dishes, eating utensils, doorknobs, bar soap and money. Tetanus, common cold, enterovirus and ringworm are commonly transmitted this way.

40. Contact Transmission Droplet transmission occurs when a person speaks, coughs, or sneezes near others. The area of greatest exposure is within one meter of the infected person. Common cold, influenza, measles, pneumonia, and whooping cough are commonly spread this way.

41. Vehicle Transmission Waterborne pathogens thrive in water contaminated by untreated sewage. Cholera, shigellosis and Campylobacter infections can be transmitted this way. Of major concern would be indirect fecal transmission when pathogens of feces of one organism affect another organism.

42. Vehicle Transmission Airborne microorganisms including dust particles can be transients from soil, water, plants or animals. Chickenpox, tuberculosis, measles and influenza are commonly transmitted this way. Pathogens are said to be airborne if they travel more than one meter this way.

43. Vehicle Transmission Foodborne transmission has been a mode of spreading hepatitis A, staphylococcal food poisoning, salmonellosis, typhoid fever and botulinum toxin. They are usually the result of poorly refrigerated, incompletely cooked or poorly processed foods. They manifest themselves through gastrointestinal symptoms.

44. Vector Transmission Mechanical transmission (on insect bodies such as flies) spreading diseases. These include E. coli diarrhea, salmonellosis and trachoma. Pathogens are spread from insects to food which is then ingested by humans.

45. Best Defense USE GLOVES AND DON’T TOUCH BODY FLUIDS UNPROTECTED

46. Best Defense WASH HANDS OFTEN

47. Best Defense Use of masks are recommended when exposure to infected individuals is identified but it is important to note that even surgical masks will not prevent the spread of all droplets.

48. Best Defense Masks are very useful in impeding the spread of airborne disease but of even greater impact is the cleaning of areas of exposure with wet mops and damp cloths.

49. Best Defense In the event of an emergency, drinking of bottled water would be advised.

50. Best Defense In an emergency situation when food goods are being supplied dried packaged foods are the best safe source of nutrition.