Infectious Disease Training

1. Infectious Disease Training Bloodborne & Airborne Pathogens Toggenburg Ski Patrol 2011 - 2012 Narrated by: Beau Blair

2. 2011-2012Infectious Disease Training • Review Applicable Standards • Review Infection Control Policy & Procedures • Review Engineering Controls and Work Practices • Identify PPE • Discuss Body Substance Isolation • Review Bloodborne Pathogens • Review Airborne Pathogens

3. OSHA Standards • CFR 1910.1030 • Bloodborne Pathogens • CFR 1910.134 • Respiratory Protection • Airborne Pathogens

4. Bloodborne Hepatitis B & C HIV Syphilis Airborne Tuberculosis Meningitis Influenza Measles Mumps Chicken Pox Small Pox SARS What can you be exposed to ?

5. Bloodborne Needle stick Blood or other body fluids contacting non intact skin, eyes, or mucus membranes. Airborne Inhalation of droplets from a person coughing, sneezing, or breathing in close proximity or in an enclosed area. (Patrol Room) Inhalation of droplets from an aerosolized source. How can you be exposed?

6. Bloodborne Pathogens • HIV • Hepatitis B, C, D, G? • Syphilis

7. Hepatitis • Hepatitis Viral Infection A - Food or contaminated water / Poor hygiene B - Bloodborne C - Bloodborne D - Bloodborne - must have HBV E - Food or contaminated water / Poor hygiene G - Not a lot known currently under research

8. Hepatitis B (HBV) • Viral Infection • Virulent • Lives outside of body for weeks • Dried blood • No known cure • Destroys the liver • Usually Fatal

9. HIV • Cause : HIV Virus Very Fragile – Not Many Virus / Unit of blood Cannot live outside the body for very long • Transmission: Blood and many body fluids • Incubation: 8 to 11 years • Onset: Mild flu-like, fever, headache, rash, swollen glands, then remission and dormant illness

10. HIV (con’t.) • Course: AIDS is end-stage of HIV; complications from damaged immunity, infections, pneumonias, cancers; fatal • Treatment: Drug treatment to delay onset of AIDS; Post-exposure prophylaxis may be an option within 36 hours of exposure. • No cure • Prevention: Body Substance Isolation; safe sex • Will not live outside the body.

11. Airborne Pathogens • Tuberculosis • Meningitis • Influenza • Measles • Mumps • Chicken Pox • Small Pox • SARS

12. Tuberculosis (TB) • Cause : Mycobacterium Tuberculosis • Transmission: Airborne droplets • Incubation: 1 to 8 weeks - maybe longer • Symptoms: Persistent productive cough, weight loss, fever, night sweats, coughing up blood, shortness of breath, fatigue

13. Tuberculosis (con’t.) • Treatment: INH, Rifampin , Pyrazinamide • Prevention: Respiratory BSI precautions; post-exposure medications can be offered to prevent infection. • T.B. test • A surveillance form shall be completed annually for those employees who have previously tested positive.

14. Tuberculosis High risk Groups • Homeless people in shelters • Alcoholics • Prisoners • IV drug users • HIV infected individuals • Residents of long-term care facilities • People with previous positive skin tests

15. TuberculosisHigh Risk Groups • Contacts of known TB patients • Elderly; chronically ill • Immunosuppressed • Foreign born, especially Asian, African, or Latin America • Healthcare Providers • Ski Patrollers

16. Signs & Symptoms of TB • Frequent Cough • Coughing up blood • Night Sweats • Fever • Fatigue • Weight loss

17. SARS • Severe Acute Respiratory Syndrome • These diseases are grouped in a category know as Febrile (fever causing) Respiratory Illness • Infectious

18. Febrile Respiratory Illness • Signs and symptoms of febrile respiratory illness are: • Fever of at least 100.5 degrees F o • One or more clinical findings of respiratory illness, such as cough, shortness of breath, difficulty breathing, hypoxia;

19. Respiratory Etiquette Strategy • Implement the use of N95 Respirator masks by healthcare personnel, during the evaluation of patients with respiratory symptoms • Provide N95 respirator masks to all patients with symptoms of a respiratory illness. • Provide instructions on the proper use and disposal of N95 masks.

20. Respiratory Etiquette Strategy (Cont) • For patients who cannot wear a respirator mask: (in addition to medical treatment being provided) • Provide tissues and instructions on proper use when coughing, sneezing, or controlling nasal secretions • How and where to dispose of them • And the importance of hand hygiene

21. Respiratory Etiquette Strategy (Cont) • Continue to use respiratory precautions to manage patients with respiratory symptoms • Until it is determined that the cause of symptoms is not an infectious agent

22. What is an Exposure?: Direct or indirect contact of blood or other body fluids with non-intact skin or mucous membranes

23. Blood Blood Components Serum Plasma Vitreous fluid (eyes) Synovial Fluid (joints) Semen Pleural Fluid (lungs) Cerebral-spinal Fluid Pericardial Fluid (heart) Peritoneal Fluid (belly) Saliva Vaginal secretions Amniotic Fluid Wound Drainage Respiratory Droplets Body Fluids Requiring Precautions

24. Breast milk Tears Nasal Secretions Urine Stool Emesis Sweat CSF Body Fluids that may contain blood:

25. Engineering Controls Reduce the risk by removing the hazard or isolating the worker from the hazard

26. Engineering Controls • PPE (G3) • Gloves – Goggles – Gowns • Disposable suction components and catheters • Disposable BVM Resuscitators • Pocket masks • Self sheathing needles (Patients may have own) • Needle less syringes and medication systems

27. Work Practice Controls • Reduce the hazard the by changing the manner in which the task is performed

28. Accepted Work Practice Controls • Washing hands • Use of PPE • Not breaking off or recapping needles – (SHARPS) • No eating, drinking, smoking, applying cosmetics or touching contact lens in work areas. • Limit the number of people contacting patient • Use of Pocket Mask or BVM to ventilate patients

29. Body Substance Isolation • Wash hands before and after patient contact • Wash hands immediately when soiled with blood or body fluids. • Use Waterless Gel hand cleaner if soap and running water are not available. • Wash hands immediately after removing gloves • Wear protective eyewear and mask whenever splashing is possible

30. Body Substance Isolation • Wear protective clothing when soiling is likely • Use pocket masks and/or Bag-valve-masks (BVM’s) to resuscitate • Avoid direct patient care when your skin is not intact • Follow procedures for handling sharps

31. Body Substance Isolation • Use red bag procedures for contaminated articles • Use approved decontamination and cleaning procedures • Wear gloves for all contact with blood and body fluids – including during cleaning and decon

32. Gloves Gowns Protective eyewear Masks: approved N-95 PPE should be worn during treatment of patients when there is any risk of exposure to blood Body fluids or airborne pathogens. Personal Protective Equipment

33. Hepatitis B Vaccine • Hepatitis B vaccination (3-shot) series is highly recommended. However, since we are not “employees” by NSP rules & regulations, the Hep-B series would be at your own expense, through your own physician.

34. What is a Reportable Exposure? • Needle sticks • Blood or body fluid splash to: • Non-intact skin • Mucous membranes • Eyes • Nose • Mouth

35. What to do if you’ve been exposed…. • Thoroughly cleanse the area of exposure. • Report the Exposure to the Infection Control Officer. • Patrol Leader or Designated Representative • Complete the Exposure Report Form • The IC Officer will immediately determine exposure classification & contact Patrol Leader • Referrals for any necessary post-exposure treatment or follow-up

36. Post Exposure Evaluation and Follow up

37. Testing • Infection Control Officer or Patrol Leader will seek existing information on the source individual. • Have the source individual’s blood tested for HIV and Hepatitis B & C, as allowed by law. • Exposed employee should be tested for base line HIV and Hepatitis status and antibody level. • Subsequent HIV testing should be performed at 6 weeks, 12 weeks, 6 months and 1 year

38. Work Related Illnesses Failure to comply with baseline testing, recommendations and or treatments of the physician or infectious disease professional may jeopardize your right to further medical care.

39. Counseling • Test results reviewed with the exposed employee • Post exposure counseling • Health status • Treatment options. • Information on prophylactic medications.

40. Treatment Options • HIV Post-Exposure Prophylaxis can be offered to those assessed to have suffered a high risk exposure. • Prophylaxis medications should be administered • Optimally within 2-3 hours of exposure • Can be provided up to 36 hrs after exposure • The risk of transmission of Hepatitis B or Hepatitis C is much greater than the risk of transmission of HIV

41. Treatment Options (con’t) • Hepatitis B infection can be prevented • Pre-exposure • Prophylactic Hepatitis B vaccine series • No known effective prophylaxis for Hepatitis C • Post-exposure • Administration of Hepatitis B immune globulin • May not be as effective as prophylactic vaccine

42. Labeling Methodsfor Contaminated Articles • Bright fluorescent orange or orange-red colored stickers which contain the biohazard symbol and the word “BIOHAZARD” in a contrasting color • Red biohazard waste bags with the biohazard symbol and the word “BIOHAZARD” in a contrasting color

43. The following items shall be labeled: • Containers of regulated waste • Sharps disposal containers • Laundry bags and containers • Contaminated equipment for repair or cleaning • Containers used to store, transport, or ship blood or other potentially infectious materials

44. Q & A Beau Blair 692-4344

45. Please fill-out, Sign & Return BBP/ABP Training Forms