Bloodborne Pathogens Update 2011: Important Information for Healthcare Workers

1. BEDFORD COUNTY BLOODBORNE PATHOGENS UPDATE 2011 By June Leffke RN, CEN, CFRN, NRCCEMT-P

2. DISEASES OF CONCERN • HIV • Hep C • Hep. B • Syphilis

3. NON-BBP OF CONCERN • TB • Seasonal Flu

4. STATUS OF BBP NATIONALLY Syphilis is the only BBP on the rise in the US. All others are declining in number of new cases annually.

5. STATUS OF BBP INCIDENCE IN VIRGINIA Only BBP on rise in Va. is Syphilis.

6. RYAN WHITE LAW • Has been re-instituted • Was inadvertently removed • Why is it important for volunteers • Requires all emergency response employers(includes volunteers) to have a designated infection control officer • Forces medical facilities to provide source patient disease status in a timely fashion.

7. Definitions you need to know • Normal flora • Bacteria • Virus • Infectious • Communicable • Direct contact • Indirect contact

8. DESIGNATED OFFICER • Every crew has to have a DO • DO needs to register with hospital • It is through the DO only that information about the source patient is released. • DO acts as a liason between hospital and any person exposed. • DO also there to guide crew member and find additional resources if needed.

9. DEFINITION OF AN EXPOSURE • A contaminated needlestick injury. • Blood or OPIM contact with inner surface of eye,nose,or mouth. • Blood or OPIM in contact with open area of the skin. • Cuts with sharp objects covered in blood.

10. Five factors to consider in expsure • Dosage • Amount of virus being shed • Virulence • Strength of organism • Mode of Entry • Each disease has a specific entry portal to the body • Host Resistance • Status of immune system

11. More Terminology • Incubation period • Time of exposure to first symptoms • Window phase • Time of exposure until have positive lab tests. • Exposure • When actually come in contact with disease.

12. HUMAN BITES • If you are bitten by another person you are not exposed—it is YOUR blood in THEIR mouth. The exposed is the biter. • Their saliva unless grossly filled with their blood is not potentially infectious for BBP but remember medical attention would be needed for potential bacterial infection.

13. OTHER POTENTIALLY INFECTIOUS MATERIALS (OPIM) • CSF • Synovial fluid • Pleural fluid • Amniotic fluid • Peritoneal fluid • Any body fluid containing gross visible blood.

14. NON-RISK FLUIDS • Tears • Saliva • Urine • Stool • Sweat • Vomitus • Nasal secretions • Sputum • UNLESS GROSSLY VISIBLE BLOOD IS PRESENT.

15. HEPATITIS B VACCINE • Offers protection via “immunological memory”. • There is NO recommendation for a booster. • Titer 1 to 2 months after completion of vaccine series is required and enforced by OSHA.

16. HEPATITIS B VACCINE TITERS • If titer not done in 2 month window after series do not go back and do one. • Titer then only done if there is an exposure. • Once you have a positive titer you never have to have a titer done again even if exposed.

17. HEPATITIS C CASES • Incident rate continues to decline • Risk for contracting HCV from a contaminated sharps injury is 1.5% or less. • Biggest risk of Hep C is in tattoo parlors because they are not regulated for the most part. There are rules for them to follow but no enforcement is done.

18. HEP C TEST AXSYM • AxSym Anti HCV is the new rapid test done for Hep C. • Takes 23 minutes • More accurate than other antibody tests. • Performed on the source patient. • Cost $ 65.00.

19. HEP C EXPOSURE • If you are exposed to Hep C you should have a blood test in 4 to 6 weeks. • Test is HCV-RNA—blood test • Cost is $65.00 • If negative you are clear • If positive there are drugs you can take that will clear the viral load in 24 weeks and prevent you from contracting the disease chronically. • There is still no vaccine for Hep C.

20. HIV / AIDS • In North America and Western Europe cases remain the same.

21. RAPID HIV TESTS • Rapid tests currently available. • Oraquick • Reveal • Uni-gold • Multispot • Clearview

22. RAPID HIV TESTS • OSHA states rapid HIV testing must be available or employer is in violation of OSHA standards. • If source patient is negative with rapid testing no further testing of health care worker needed.

23. RAPID HIV TEST • Use of rapid tests prevents healthcare workers from being put on toxic drugs for even a short period of time.

24. SYPHILIS CASES • Continue to rise in US • Post exposure follow up if source patient is HIV or Hep C positive. • Syphilis is a common in those patients.

25. SYPHILIS • States with highest cases: • California • Texas • New York City • Florida • All of these states are entry states and states with high homeless populations.

26. TUBERCULOSIS • Risk for TB is based on number of active-untreated TB patients you transported in past year. • TB cases at an all time low.

27. MULTI-DRUG RESISTANT TB • 84% in foreign born persons. • Now screening immigrants

28. TB TESTING • Now an FDA approved blood test • More accurate • Done once only • Cost effective

29. ANNUAL TB TESTING • Not needed in low risk areas(less than 3 untreated cases per year) • Costly • Have many false positives because they are done wrong and read wrong. • Recommendation: • No annual TB testing • Do on hire only & if exposed • Or do blood test once & be done

30. FLU VACCINE -ANNUAL • Recommended for all healthcare workers doing “Direct Patient Care” • Employers must offer. • Employers must pay. • Employees who decline must sign a declination form. • Flu vaccine is available in nasal spray form for those 2-49 years of age.

31. FLU VACCINE RATIONALE • Reduces annual illness in staff. • Increases protection from flu viruses cumulatively. Each year it is a slightly different vaccine but it increases your resistance to many viruses.

32. FLU • Healthcare workers should wear masks (simple surgical masks) when in close proximity with patient with flu. • Flu spread by droplet • Be more careful with patients running fevers and coughing.

33. MRSA COMMUNITY CASES • OUTBREAKS • Close contact sports • Injection –drug users • Inmates • Group home residents • Men who have sex with men • gyms

34. COMMUNITY STRAIN • Community acquired • More easily transmitted. • predominantly skin and soft tissue acquired • Community strain carries different chromosomes

35. HOSPITAL ACQUIRED MRSA • Usually multiple sites • Skin • Urine • Feces • Blood • Wounds • Usually multi drug resistant

36. TREATMENT OF MRSA • Need to incise and drain area that is infected. • High powered antibiotics if needed.

37. RECOMMENDED VACCINES / IMMUNIZATIONS FOR HEALTHCARE WORKERS • Hepatitis B Vaccine • MMR • Tdap (1 dose) for Tetanus • Chickenpox Vaccine • Influenza Vaccine

38. CDC RECOMMENDS • Hep B Vaccine for persons doing direct patient care activities • Tetanus-booster if not immunized in past 10 years

39. CLEANING RECOMMENDATIONS FOR RESCUE SQUADS • Use 1:100 bleach & H20 solution or approved commercial product. • ¼ cup in 1 gallon H20 • Good for 24 hours after mixed. • Wipe down all surfaces touched or potentially touched by patient or you after touching patient.

40. CLEANING • Surfaces often forgotten: • Radio mike • IV or drug box handles • Stretcher railings • Bench seats • Steering wheel • Tuff book handles and case • Clipboard • IV poles • O2 tanks

41. HANDWASHING • Handwashing prevents spread of 90% of diseases. • Use waterless solutions only as a temporary solution until you can get to sink and soap. • Gloves are not the end all protection. • Can spread disease via gloves. ie work on patient then leave gloves on and drive to hospital. • wash hands after removing gloves

42. HBV Facts • Viral • Transmitted: • Blood to blood • Sexual contact • Indirect contact • Needlestick greatest risk for infection • 50 to 60% infected persons are not aware they have it--Carriers

43. HBV Facts • Incubation Period • 2 to 6 months • Signs & Symptoms • Vague flu-like • Malaise,fatigue,anorexia, nausea, general muscle aches,distaste for cigarettes • Progress to jaundice • Dark clay colored urine • Pruritic skin(itchy, dry) • Enlarged liver

44. HBV Facts • Preventable Vaccines • 3 types of outcomes • Complete recovery • Chronic illness • Death • Very young • Elderly

45. HCV Facts • Recipients of blood or organs before 1992. • Chronic dialysis patients • Persons with HIV • Children born to +HIV mothers • HCV leading indication for liver transplants • Hepatitis leads to higher incidence of Ca of liver

46. HCV Facts • Signs and symptoms similar in all types of hepatitis • Blood test determines type of hepatitis • High risk for HCV • Current or former drug users • Recipients of clotting factor concentrates before 1987

47. HCV Facts • No vaccine • Treatable with drugs

48. HIV Facts • Fragile virus • Must have a live host to survive. • Dies within 60-90 seconds without a host. • Signs & Symptoms: • Flu-like: fever, fatigue, arthralgia, sore throat • Later stages necrotizing periodontal disease

49. HIV Facts • Severe weight loss • Wasting disease • Secondary infections common & primary cause of death. • Pneumocystis carinii(fungus)-common cause of pneumonia in HIV pts. & is frequently the cause of death • TB incidence high in AIDS patients.

50. HIV Facts • Increased incidence of all cancers • Kaposi sarcoma common • Affects skin • Mucus membranes • Internal organd