1 / 61

Blood Borne Pathogenes “BBP “

Blood Borne Pathogenes “BBP “. Blood Borne Pathogens & Diseases. Blood Borne = Found in Blood Pathogen = Disease-Producing Microorganism. Protecting yourself & Your Patients from blood and other body fluids is essential. Blood Borne Diseases. Hepatitis B Hepatitis C HIV ( AIDS ).

quintessa-haley
Download Presentation

Blood Borne Pathogenes “BBP “

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Blood Borne Pathogenes “BBP “

  2. Blood Borne Pathogens & Diseases Blood Borne = Found in Blood Pathogen = Disease-Producing Microorganism. Protecting yourself & Your Patients from blood and other body fluids is essential

  3. Blood Borne Diseases Hepatitis B Hepatitis C HIV ( AIDS )

  4. Standard (Universal) Precautions CDC recommendation: Blood and/or body fluid precautions should be observed for all patients Individualized guidelines set up for specific settings Hospital Dentist Day Care/School

  5. Hepatitis B • Incubation: 42-160 days • Transmission • Hepatitis B virus • Blood borne • blood, saliva (tattooing, acupuncture, razors, toothbrushes) • Sexual • semen, vaginal fluids • Perinatal • High risk populations • Hemophiliacs • Dialysis patients • IV drug abusers • Health care personnel • Infants of infected mothers • Can survive as dried, visible blood for > 7 days • Chronic carrier state exists • 5-10% of infected become asymptomatic carriers

  6. Hepatitis BAbout 30% of persons have no signs or symptoms • Symptoms & Signs • Within 2-3 months, gradually develop non-specific Sx • Anorexia • N/V, Fever • Abdominal discomfort • Joint pain, Fatigue • Generalized rashes • Dark urine, clay-colored stool • May progress to jaundice • Treatment & Preventive care • Supportive care • Prevention: BSI and Handwashing • Vaccine available • Protective immunity develops if HBs antibody is present in serum • Provide long lasting immunity, 95-98% of time

  7. HEPATITIS B VACCINATION • Effective in preventing hepatitis B • 95% develop immunity • 3-dose vaccination series (0-1-6 months ) • May be given to Pregnant pts • Test for Antibodies to HBsAg 1 to 2 months after 3-dose vaccination series completed. • Re-vaccinate who do not develop adequate antibody response. • HBIG + vaccine (exposed is HBsAg negative) • Blood exposure to pt w/acute Hep B

  8. Postexposure prophylaxis against HBV infection

  9. HBV - SUMMARY Transmission Oral Not likely Percutaneous Common Sexual Common Perinatal Common Incubation period 60-180 (days) Clinical Illness at 10 - 15% presentation Jaundice 5 –20% Fulminant <1% Diagnostic tests Acute infection HBsAg, IgM anti-HBc Chronic infection HBsAg, IgG anti-HBc Immunity IgG anti-HBc, anti-HBs Case-fatality rate 1 – 3% Chronic infection >90% infants <5% adults

  10. Hepatitis D (Delta Virus) • Defective, requires HBV presence to replicate • Acquired as HBV coinfection or chronic HBV superinfection • Increases disease severity, fulminant hepatitis risk (2 to 20%) • Increases chronic liver disease risk (70 to 80%) • When virus becomes active with HBV, resulting disease extremely pathogenic • Transmission similar to HBV • Most cases transmitted percutaneously • Coinfection can be prevented by HBV vaccine • No products exist to prevent superinfections • Symptoms & Signs • abrupt onset with Sx/Sx like HBV infection • always associated with HBV infection • Treatment and Prevention similar to HBV • HBV vaccine indirectly prevents HDV

  11. HDV - SUMMARY Transmission Oral No Percutaneous Common Sexual Yes, rare Perinatal No Incubation period 21 - 45 (days) Clinical Illness at 10%, higher with presentation Superinfection Jaundice Unknown Fulminant 2 – 7.5% Diagnostic tests Acute infection IgM anti-HDV Chronic infection IgG anti-HDV, HBsAg + Immunity Not applicable Case-fatality rate 1 – 2% Chronic infectionSuperinfection – 80% Coinfection < 5%

  12. Hepatitis C Hepatitis C is the major cause of liver cancer No immunization available Can live in a drop of dried blood for as long as 30 days-HIV lives outside the body for only a few seconds Develops into a chronic infection in 85% of all infected persons Chronic liver diseases in 70 % HCV related deaths will most likely double or triple in the next 10-20 years. Many with chronic disease are now in the 40-65 age range. 12

  13. Hepatitis C • Transmission • Hepatitis C virus • Primarily bloodborne • Also sexual, perinatal • High risk populations • IV drug abusers • Dialysis patients • Health care personnel • Clotting factors before 1987 • Transfusion before 1982

  14. Occupational Transmission of HCV • Inefficient by occupational exposures • Incidence <0.5%-2% following needle stick from HCV-positive source • Associated with hollow-bore needles, deep injury • Case reports of transmission from blood splash to eye; one from exposure to non-intact skin • Prevalence 1-2% among health care workers • Lower than adults in the general population • 10 times lower than for HBV infection

  15. Global Differences in HCV Transmission Patterns Contribution of exposures to disease burden by HCV prevalence Exposures among prevalent infectionsLowModerateHigh Injecting drug use++++ ++ + Transfusions before testing - +/- +++ Unscreened transfusions- - +++ Unsafe therapeutic injections + ++++ ++++ Occupational+ + + Perinatal+ + + High-risk sex++ + +/-

  16. Hepatitis C • Symptoms & Signs • Same as Hepatitis B, less progression to jaundice • Possible association of Hepatitis C infection with liver cancer • Degree of post infection immunity unknown • High percentage of infected become carriers • Treatment & Preventive Care • Interferone & Ribavirin • No recognized benefit from prophylactic IgG • No Vaccine available yet • Standard precautions

  17. Recommendation for HCV If you have an exposure history: Get tested. If you have any of these risk factors: Get tested. Injection drug use Blood transfusion before 1982 Use of blood clotting components before 1987 Tatoos/piercings with questionable sterile technique Occupational exposure to blood Sexual contact with an infected partner (risk less) 17

  18. Postexposure Management for HCV • IG, Antivirals not recommended for prophylaxis • Follow-up after needlesticks, sharps, or mucosal exposures to HCV-positive blood • Test source for anti-HCV • Test worker if source anti-HCV positive • Anti-HCV and ALT at baseline and 4-6 months later • For earlier diagnosis, HCV RNA at 4-6 weeks • Confirm all anti-HCV results with RIBA • Refer infected worker to specialist for medical evaluation and management

  19. Hepatitis C:The Course of the Disease Acute infection= rarely recognized Acute stage=flu-like symptoms or no symptoms Evolution from acute phase to cirrhosis usually requires decades: average time is 20-30 years When disease discovered, damage to the liver has most likely occurred. 19

  20. HCV - SUMMARY Transmission Oral No Percutaneous Common Sexual Yes, rare Perinatal Yes, low frequency Incubation period 14 - 160 (days) Clinical Illness at 5 - 10% presentation Jaundice 5 – 10% Fulminant Rare Diagnostic tests Acute infection HCV RNA (anti-HCV) Chronic infection HCV RNA (anti-HCV), >6 months Immunity Unknown Case-fatality rate 1 – 2% Chronic infection55 – 85%

  21. Human Immunodeficiency Virus • Kills T4 lymphocytes • Interferes with immune system function • Produces acquired immunodeficiency syndrome (AIDS) • Virus present in all body fluids, all body tissues • Virus spread by: • Blood • Semen • Vaginal fluid • Breast milk • Other body fluids containing blood • Health care workers may be at risk from CSF, synovial fluid, and amniotic fluid

  22. HIV • Epidemiology (worldwide) • 2.8 million deaths worldwide in 1999 • 18.8 million cumulative deaths 80% of cases have resulted from heterosexual intercourse AIDS is the 5th leading cause of deaths in the U.S. for people ages 24 to 44

  23. Risk of Contracting Infection • Dependent on • Viral load • Integrity of the exposed site • Type of body fluid • Volume of body fluid • Risk after a single exposure • TRANSFUSION- 3-5% • 5 10 % vertical • 0.5-1% injection drug use • 0.2-0.5% genital mucous membrane • <0.1% non-genital mucous membrane • HEALTH CARE WORKERS- <0.01%

  24. Modes of HIV/AIDS Transmission 1. Through these bodily fluids BREAST MILK VAGINAL SECRETIONS BLOOD CERVICAL SECRETIONS SEMEN 2. Through these acts: H INFECTED MOTHER: DURING 1. PREGNANCY 2. BIRTH 3. BREAST FEEDING UNPROTECTED PENETRATIVE INTERCOURSE (HOMOSEXUAL OR HETEROSEXUAL) WITH SOMEONE WHO IS INFECTED 1. INJECTION OR TRANSFUSION OR INFECTED BLOOD / BLOOD PRODUCTS 2. SHARING UNSTERALISED NEEDLES WITH SOMEONE WHO IS INFECTED

  25. AIDS • Asymptomatic infection (1 to 10 years) • About 50% of HIV-infected patients develop true AIDS within 10 years • Acute Infection • Lasts 2 to 4 weeks • Symptoms • Fever • Sore throat • Lymphadenopathy • Seroconversion • Occurs at 6 to 12 weeks

  26. AIDS • AIDS - related complex (ARC) • Weight loss > 10% • Diarrhea for >1 month • Fever • Night sweats • True AIDS = Life-threatening opportunistic infections • Pneumocystis carini • Candida albicans • Cytomegalovirus (CMV) • Kaposi’s sarcoma

  27. AIDS • Pneumocystis carini • Most common life-threatening opportunistic infection • Pneumonia • Often leads to AIDS diagnosis • Candida albicans • Yeast infection • Called “thrush” in infants • Can disseminate to GI tract, bloodstream • Cytomegalovirus (CMV) • Retinitis, blindness • Colitis • Pneumonitis

  28. AIDS • Kaposi’s sarcoma • Purple-brown, painless lesions • May enlarge, coalesce, bleed • Can affect internal organs

  29. Fungi Aspergillosis pulmonary infection Cryptococcus meningitis, pulmonary infection, disseminated infection Histoplasma disseminated infection Coccidiomyces disseminated infection Viruses Herpes simplex skin and visceral Herpes zoster skin, ophthalmic nerve, disseminated, visceral JC virus progressive multifocal leukoencephalopathy AIDS

  30. Parasites Toxoplasma encephalitis Cryptosporidia Isospora Microspora Giardia Bacteria Streptococcus pneumonia Hemophilus influenza Nocarida asteroides Pseudomonas aeruginosa Rhodococcus equi Bartonella hanselae Salmonella Staphylococcus aureus Treponema pallidum AIDS

  31. Mycobacteria Mycobacterium tuberculosis M. avium M. kansasii M. haemophilum M. gordonae M. genavense M. xenopi M. fortuitum M. malmonese M.chelonei AIDS

  32. AIDS • AIDS Dementia Complex • Infection of CNS cells • Cerebral atrophy • Characterized by: • Cognitive dysfunction • Declining motor performance • Behavioral changes

  33. AIDS • Safety • Wash hands between patients • Clean blood spills with bleach solution • All sharp objects potentially infective • Do NOT recap needles • Wear mask to avoid exposing patient • Pregnant paramedics should avoid contact with AIDS patients (risk of CMV exposure)

  34. AIDS • Treatment • Support care • No immunization available • Post Exposure Prophylactic treatment • Recommended within 3 hours of significant exposure • CDC recommendations • zidovudine • lamivudine • indinavir • nelfinavir

  35. HIV Less than 1% seroconversion rate for health care professionals if exposed to a know HIV positive source. 36

  36. Why is Privacy Important? Patients have a right to privacy Violation of patient’s privacy (confidentiality) can affect the personal lives and careers of patients It is your job to protect patient privacy 37

  37. Potentially Harmful Body Fluids with Universal/Standard Precautions Blood Semen Vaginal Secretions Pleural Fluid Cerebrospinal Fluid Synovial Fluid Synovial Fluid Pleural Fluid Peritoneal Fluid Pericardial Fluid Amniotic fluid 38

  38. Fluids to Which Universal/Standard PrecautionsDo Not Apply Unless Blood is Visible Feces Nasal secretions Sputum Sweat Tears Vomitus Urine Saliva-except in dental situations* Breast milk* *only in large quantities (breast milk bank or dental work) 39

  39. Concentration of Hepatitis B Virus in Various Body Fluids Low/Not High Moderate Detectable Blood Semen Urine Serum Vaginal fluid Feces Wound exudates Saliva Sweat Tears Breast milk

  40. Relative Efficiency of HBV, HCV, HIV Transmission by Type of Exposure Type of exposure Efficiency of transmission to infected sourceHBVHCVHIV Transfusion ++++ ++++ ++++ Injecting drug use ++++ ++++ ++++ Unsafe injections +++ +++ + Needlestick +++ + <+ Sexual +++ + +++ Perinatal ++++ ++ +++ Non-intact skin ++ +/- +/- Intact skin - - -

  41. Relative Infectivity of HBV, HCV, HIV HBVHCVHIV Copies/mL 108-9 105 103 Environmental stability ++++ ++ - Infectious after drying at room temperature >7 days >16 h 0

  42. HCV NOT EASILY TRANSMITTED IN HEALTH CARE SETTING • POTENTIAL TRANSMISSION RISK TO HEALTH CARE WORKERS • CONC/ml TRANSMISSION RATE (%) • PATHOGENSERUM/PLASMAPOST NEEDLESTICK INJURY • HBV 1000 - 100,000,000 6.0 - 30.0 • HCV 10 - 1,000,000 2.7 - 6.0 • HIV 10 - 1000 0.31

  43. Average Risk of Transmission after Percutaneous Injury Risk (%) Source HIV Hepatitis C Hepatitis B (only HBeAg+) 0.3 1.8 30.0

  44. PREVENTION STRATEGY - HBV, HCV, HDV • CLEAN BLOOD SPILLS WITH BLEACH • DON’T SHARE RAZORS, TOOTHBRUSHES, NAIL CLIPPERS or NEEDLES • WHEN GETTING A MANICURE, TATTOO, or HAVING A BODY PART PIERCED, MAKE SURE THE INSTRUMENTS ARE STERILE

  45. Standard Precautions A set of precautions designed to prevent transmission of HIV, HBV, and other blood borne pathogens Blood and certain body fluids of all patients are considered potentially infectious Universal precautions are actually a part ofwhat is now referred to as Standard Precautions. 46

  46. Protect Yourself Gloves Gown Apron Masks Hand washing Safety precautions with sharps Eye shields 47

  47. Viral Hepatitis - Historical Perspectives Enterically transmitted “Infectious” A E Viral hepatitis NANB Parenterally transmitted B D C “Serum” F, G, TTV ? other

  48. Viral Hepatitis  HAV HBV HCV HDV HEV Incubation   4 weeks 4 – 12 weeks 7 weeks 4 – 12 weeks   6 weeks Onset Acute Acute / insidious Insidious Acute / insidious Acute Transmission Fecal – oral Parenteral +++ Perinatal +++ Sexual ++ +++ variable + +++ + ++ Fecal - oral Clinical Fulminant Progression to chronicity 0.1 % None 0.1 – 1 % Neonates 90% Adults 1-10% 0.1 % Infect 80-90% Hepatitis –70% 5 – 20 % Common 1 – 2% None HCCancer + + + Prophylaxis Immune globulin Inactivated vacc Immune globulin Recombinan vacc NONE HBV vaccine NONE Therapy NONE IFN Lamivudine Interferon Ribavirin Interferon + None

  49. Viral Hepatitis B & C • B and Ctransmit by blood and blood products • Methods • Mother to child at birth • Sex • IVDU • Same razor, tooth brush, tattoo etc. • Differences between B & C • B - Transmitted mainly (90%) from mother at birth • C - Transmitted < 8% from mother at birth • B - Transmitted more sexually • C - Transmitted less sexually • C and B - Transmitted by IVDU

More Related