Infectious Diseases
Bill Edstrom, EpidemiologistSpokane Regional Health District
OSHA
Bloodborne Pathogen Standard
• Designed to eliminate or minimize employees’ exposure to human blood and other potentially infectious materials (OPIM) in the workplace
Who is Covered?
• All employees who may reasonably expect to be exposed to blood and OPIM that may contain pathogens
• Anyone whose job involves handling or possibly being exposed to blood or blood products, or OPIM
Germs transmitted from one person to another
through contact with blood or OPIM
What are pathogens?
Caution!
You do NOT need to directly contact someone carrying a bloodborne pathogen to be at risk for exposure!
Risks also come from:
• Clinical specimens• Biohazardous trash• Blood- or body fluid-
soaked laundry• Needles or sharps
Annual Training Required:
• How diseases are transmitted and their symptoms
• Protective measures to prevent exposure
• Procedures to be followed if exposed
Exposure Control Plan
• OSHA requirement• Must describe:
– Exposure prevention– Engineering and work practice controls– Universal precautions– Personal protective equipment
Infectious Disease Transmission
• Stages of Disease Transmission:
1. Someone has an infection
2. The infectious pathogen leaves the
Infected person’s body
Infectious Disease Transmission:
3. The infectious pathogen
reaches another person and
enters his or her body.
Transmission:- Bloodborne- Airborne - Vector - Direct or indirect contact
4. The second person develops the infection.
Serious Bloodborne Pathogens
• Hepatitis B virus (HBV)
• Hepatitis C virus (HCV)
• Human immunodeficiency virus (HIV)
Hepatitis A Hepatitis B Hepatitis C
Transmission Person-to-Person through fecal-oral
Exposure to fecally contaminated food/water
Blood/Semen
OPIM
All Body Fluids
Contaminated needles
Unclean tattoo/piercing tools
Sharing contaminated items
Signs & Symptoms
Fever
Fatigue
N/V
ABD pain
Dark Urine
Clay-colored stool
Joint pain
Loss of appetite
Jaundice
Flu-like symptoms
Loss of Appetite
Nausea
Fatigue
Muscle/joint aches
Mild fever
Stomach pain
Jaundice
MOST INFECTED PEOPLE DO NOT HAVE SYMPTOMS•Fatigue
•Loss of appetite
•Nausea
•Anxiety
•Weight Loss
•Alcohol Intolerance
•Abdominal pain
•Loss of concentration
•Jaundice
Severity Symptoms last < 2 months, can last up to 6 months
Major liver damage
Cirrhosis
Liver CA
Infection for decades
No Cure –
Prevention is
critical
Prevention Vaccine Vaccine No Vaccine
Measures
• Measures you take to prevent HBV, HCV, and HIV also help prevent diseases caused by other bloodborne pathogens
Do Exposures Always Cause Infection?
• Whether pathogens are present in the source blood or body fluid
• The number of pathogens present
• The type of injury or exposure
• Your current health and immunization status
• NONO • The risk of infection• after an exposure
depends• on:
HIV and AIDS
• Acquired immunodeficiency syndrome (AIDS) is caused by the human immunodeficiency virus (HIV)
• There are almost one million HIV-positive people in the U.S.
HIV and AIDS
• AIDS damages cells essential for immune function
• People with AIDS are more susceptible to opportunistic infections
• The disease is eventually fatal
HIV and AIDS
Transmission Through an infected person’s body fluids
Signs & Symptoms One quarter of the HIV-infected persons in the U.S. do not know that they are infected.Loss of appetite Weight Loss
Fever Skin rashes
Swollen lymph nodes Diarrhea
Night sweats Tiredness
Inability to fight off infection
Severity Life-long
Prevention No Vaccine
Prevention
OSHA Standard
• Requires employers to use strategies to reduce occupational exposures:
• Engineering controls
• Work practice controls
• Personal protective equipment
• Universal precautions
Engineering Controls
• Needleless systems
• Eye wash stations
• Handwashing facilities
• Biohazard labels
Work Practice Controls
• Use of personal protective equipment (PPE)
• Handwashing
• Decontamination and sterilization of equipment and areas
Personal Protective Equipment
• Gloves
• Jumpsuits, aprons
• Eye shields, goggles
• Face masks, face shields
• Caps
• Booties
OSHA Standard
Requires that your employer:
– Provide PPE at no cost
– Train you how to use equipment
– Must clean, repair, or replace it as needed
For Unexpected Exposure
• If blood or OPIM splashes in your eyes or other mucous membranes, flush area with running water for 20 minutes
• Wash any exposed area well with soap, using an antibacterial soap
– Gently treat any scabs and sores
• Report the exposure to your supervisor
• Save any potentially contaminated object for testing purposes
• Seek medical care
Employer Responsibilities
• Identify and document source of blood or OPIM
• Obtain consent and arrange to test the source blood
• Inform you of the test results
• Arrange for you to have your blood tested
• Arrange counseling and medical care for you as needed
Airborne Pathogens
Three Types of Airborne Pathogens
• Viral
• Bacterial
• Fungal
Airborne Pathogens
• Precautions for tuberculosis also lower the risk for other airborne pathogens
– Meningitis
– Influenza
– Pneumonia
– Tuberculosis
Airborne Pathogens
• Spread by inhaling the germ
• Coughing or sneezing tiny droplets of moisture into the air containing pathogens
• Pathogens can remain airborne for several hours
Airborne Transmission
• Depends On:– How contagious the
infectious person is
– Where the exposure occurs
– How long the exposure lasts
– How healthy you are at the time of the exposure
TuberculosisTransmission Inhaling the TB pathogen after an
infected person coughs or sneezes
Signs & Symptoms Many people with TB infection have no symptoms!
Weight loss
Fever
Night sweats
Feeling weak
Severity Skin test cannot distinguish between TB infection and TB disease
Chest x-ray and phlegm sample needed to determine diagnosis
Prevention Engineering Controls
H1N1 (“Swine Flu”)
H1N1 and EMS
• EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza.
• Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following: nasal congestion/ rhinorrhea, sore throat, or cough).
H1N1 and EMS
• If no acute febrile respiratory illness, proceed with normal EMS care.
• If symptoms of acute febrile respiratory illness, then assess all patients for travel to a geographic area with confirmed cases of swine-origin influenza within the last 7 days or close contact with someone with travel to these areas.
H1N1 and EMS
• If travel exposure, don appropriate PPE for suspected case of swine-origin influenza.
• If no travel exposure, place a standard surgical mask on the patient (if tolerated) and use appropriate PPE for cases of acute febrile respiratory illness without suspicion of swine-origin influenza (as described in PPE section).
Questions
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