Unit F: Infectious Diseases

1. Unit F: Infectious Diseases Bioterrorism Agents and Containment BT 06.05

2. Bioterrorism • Terrorism is defined as violent acts or acts dangerous to human life that appear to be intended to: • Intimidate or coerce a civilian population • Influence the policy of a govt • Affect the conduct of a govt

3. Bioterrorist Agents • Bacterial – like Anthrax and Plague • Viral – like smallpox • Toxins – like Botulism and Ricin

4. ANTHRAX • Acute infectious disease caused by bacillus anthracis • Infection in humans: • Skin contact – cutaneous, ingestion-gastrointestinal, inhalation-pulmonary • Person-to-person transmission of inhalation disease does not occur.

5. Pulmonary Anthrax S/S • Flu-like symptoms that may briefly improve 2-4 days after initial symptoms • Abrupt onset of respiratory failure • Hemodynamic collapse • Thoracic edema • Widened mediastinum on xray • Positive blood culture in 2-3 days of illness • Incubation Period: 2-60 days

6. Pulmonary Anthrax cont: • Prognosis is good only if treated early. • Increased mortality rate if treated after respiratory onset.

7. Cutaneous Anthrax S/S • Local skin involvement with direct contact • Commonly seen on head, forearms, or hands • Localized itching followed by papular lesion that turns vesicular within 2-6 days – develops into depressed black eschar. • Incubation period: 1-7 days • Prognosis good if treated with antibiotics.

8. Gastrointestinal Anthrax • S/S: • Abdominal pain, nausea, vomiting, & fever • Bloody diarrhea, hematemesis • Positive culture after 2-3 days • Incubation period: 1-7 days • Prognosis: • If progression to toxemia and sepsis, prognosis is poor

9. Anthrax overview • Modes of Transmission • Inhalation of spores • Skin contact • Ingestion of contaminated food • Incubation Periods: • Pulmonary: 2-60 days • Cutaneous: 1-7 days • Gastrointestinal: 1-7 days • Transmission: Anthrax IS NOT airborne person to person. Direct contact with infectious skin lesions CAN transmit infections. • Prevention: Vaccine available – quantities limited

10. BOTULISM • Potent neurotoxin caused by an anaerobic bacillus-clostridium botulinum • Transmission • Contaminated food • inhalation • S/S • GI symptoms • Drooping eyelids • Weakened jaw clench • Difficulty swallowing or speaking • Blurred vision • Respiratory distress

11. Botulism Cont: • Incubation period: • Neurological S/S for food borne botulism – 12-36 hours after ingestion • Neurological S/S for inhalation botulism – 24-72 hours after exposure • Prevention: • Vaccine is available • Botulism CANNOT be transmitted from person to person

12. PLAGUE • Plague is an acute bacterial disease caused by yersiniapestis. • S/S • Fever - Chest pains - Hemoptysis - Watery sputum • Cough - Bronchopneumonia on xray • Mode of Transmission: • Plague normally transmitted form an infected flea (that has bitten an infected rat!) • Can be aerosol-probably use in bioterrorism • Can be transmitted person to person

13. Plague Cont: • Incubation period: • Flea bite – 2-8 days • Aerosol – 1-3 days • Prognosis: • Good if treated with antibiotics early.

14. RICIN • Ricin is a potent protein toxin derived from Castor beans. The toxin is fairly easily produced. • Can be used as a biological weapon with relative ease.

15. Ricin Cont: • Infections in Humans: • Aerosol • Ingestion • Incubation period: • 8-18 hours • S/S: • Within 18-24 hours: • Weakness • Fever • Cough • Pulmonary edema

16. Ricin Cont: • S/S continued: • Within 36-72 hours: • Severe respiratory distress • Death from hypoxemia • Prognosis: • Poor – No vaccine available • You’re GOING TO DIE! • Ricin DOES NOT spread easily from person to person

17. SMALLPOX • Smallpox is an acute viral illness caused by the variola virus. • Mode of transmission: • Airborne :droplets (sneeze, cough, drip, or exhale) • S/S: • Flu like symptoms – fever, myalgia • Skin lesions quickly progressing from macules to papules to vesicles • Rash scabs over in 1-2 weeks • Rash occurs in all areas at once, not in crops

18. Smallpox Cont. • Incubation Period: • From 7-17 days, average is 12 days • Contagious when the rash is apparent and remains infectious until scabs separate (appx 3 weeks) • Prognosis: • Vaccine available and effective post-exposure • Passive immunization is also available in the form of a vaccina immune globulin (Vig) antibody transfer • Smallpox has a high mortality rate.

19. CONTAINMENT OF BIOTERRORISM AGENTS 1. Isolation Precautions • All pts in healthcare facilities, including symptomatic pts with suspected or confirmed bioterrorism-related illnesses, should be managed utilizing STANDARD PRECAUTIONS • Standard precautions include things like: • Handwashing - after touching blood, body flds, etc • Wearing gloves – clean gloves, exchange b/w tasks and procedures. Remove gloves and wash hands B4 leaving a pt care area.

20. Standard Precautions Cont. • Gowns • Worn to protect skin and prevent soiling of clothes • Soiled gowns are promptly removed and hands are washed when finished • Masks/ Eye protection or Face Shields • Worn to protect mucus membranes • Prevent splashes of blood, body fluids

21. Containment of bioterrorism agents2. Patient placement • Normal infection control practices should be followed if numbers allow. • With large numbers, group affected patients together into designated ward or floor (possibly even a separate building) • Consult with engineering staff (airflow and ventilation, plumbing and waste disposal, and capacity)

22. Containment of bioterrorism agents3. Patient Transport • Most bioterroristic agents cannot be transmitted from patient to patient. • Transport and movement of pts should be limited to movement that is essential to provide pt care. • This SHOULD reduce the opportunities for transmission of microorganisms within healthcare facilities.

23. Containment of bioterrorism agents4. Cleaning, disinfection, and sterilization of equipment & environment • Standard precautions should be followed. • All facilities have in place procedures. • Cleaning agents should be available for spills and disinfecting equipment. • Contaminated equipment – wear gloves • Sterilize all instruments

24. Containment of bioterrorism agents5. Discharge management • Pts will not be discharged until they are deemed non-infectious • Home care instructions should include barrier precautions, handwashing, waste mgmt, and cleaning and disinfection.

25. Containment of bioterrorism agents6. Post-mortem care • Pathology depts and labs should be informed! • All autopsies should be performed carefully using PPE and standard precautions. • Instruct funeral directors of diagnosis

26. Containment of bioterrorism agents7. Handwashing • Push sleeves and watch 4-5 inches up on arms • Stand back from sink and adjust water temperature until warm • Wet wrists and hands without splashing and with fingertips pointed downward • Apply soap using friction • Later well, keeping hands lower than elbows • Rush hands together in circular motion, being sure to wash between fingers and two inches above wrists • Clean under nails by rubbing against palms • Wash for at least 15 seconds or longer if contaminated • Rinse wrists and hands with running water • Dry hands thoroughly with paper towel and discard towel into trashcan • Turn faucets off with a new paper towel and discard into trash can

27. Response to bioterrorism agents • Internal reporting requirements (within a facility) • Infection control personnel • Epidemiologist (local and state) • Administration (health care facility) • Office of public affairs (media coverage)

28. Response to bioterrorism agents • External contacts (outside of facility) • Local health department • State health department • FBI • CDC • Local police • EMS