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Murrieta Fire Bloodborne Pathogen Training 2012
Art Durbin, Paramedic, RN, MICN, BSHS, MA
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At the end of this class the student will be able to: List the Five Microorganisms CDC and
OSHA require you to understand. Verbalize the S/S of hepatitis infection Cite appropriate Measures for personal
protection. Verbalize the chain of disease
transmission and how it can be broken
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At the end of this class the student will be able to: (Cont.)
Verbalize the procedure to follow if you are exposed.
List the OLD & New antiviral agents When to use Antiviral agents for HIV
or Hepatitis Discuss Vaccines
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COMPLETE the Pre Evaluation Quiz
How much do you remember?
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Chain of Disease Transmission
The organism
Mode of Entry
Host Resistance
Dosage
Virulence
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Chain of Disease Transmission Defined
Organism – Bacteria Versus Virus Dosage – The number of the
organism you receive from the exposure
Virulence – the ability of the organism to survive in the environment
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Chain of Disease Transmission Defined (cont.)
Host immune system – Are you healthy
Mode of entry – puncture, eye or mouth splash of blood,
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Factors for Evaluating theDegree of exposure
1. Contaminated needle-stick injury.2. Blood/OPIM contact with the
surface of the eye, or inner surface of the nose or mouth.
3. Blood/OPIM in contact with open area of the skin.
4. Cuts with sharp objects covered with blood or OPIM.
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Primary BBP fluids
1. Blood *2. Semen3. Vaginal secretions
* = most concerned with in our everyday job!
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Other Potential Infectious Material/fluids
1. Cerebral Spinal Fluid2. Synovial fluid *3. Amniotic fluid *4. Peritoneal fluid *5. Any fluid with gross (visible) blood
* = with visible blood
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No Risk, HBV, HCV, HIV*reference CDC 1910.1030
Tears & Sweat * Sputum & Saliva * Urine & Stool * Vomit * Nasal secretions **{UNLESS they contain visible
blood}
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Airborne Diseases
1. Contact time/Transport time2. Ventilation - 3. Organism type - 4. Host resistance – PPE used
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Human Immunodeficiency Virus Transmission > Blood, Semen &
Vaginal secretions and OPIM Portal of exit > Bleeding or OPIM
especially if contaminated with blood.
Means of transmission > Sexual both Heterosexual & MSM Contaminated Needle, infected blood in the mouth, eyes.
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Human Immunodeficiency Virus (Cont.)
Portal of entry > Percutaneous or Mucous membranes
Susceptible host > everyone depending on the virus load and those with poor immune systems.
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HIV Statistics Review the most current CDC stats
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Estimated Incidence of AIDS and Deaths of AIDSCases* Attributed to Heterosexual Contact, 1985-1999,
United States
DeathsAIDS
0
1500
1000
500
2000
2500
3000
3500
1985 1986198719881989199019911992199319941995199619971998 1999
Quarter-Year of Diagnosis/Death*Adjusted for reporting delays and unreported risk
Nu
mb
er
of
Case
s/D
eath
s
1993 definitionimplementation
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Estimated AIDS Prevalence* among Men,by Risk Exposure, 1985-1999, United States
*Adjusted for reporting delays and unreported risk
Nu
mb
er
of
Case
s(t
hou
san
ds)
0
20
40
60
80
100
120
140
160
19851986198719881989199019911992199319941995 1996199719981999
MSM
MSM-IDUIDU
Heterosexual contact
Quarter-Year
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*Adjusted for reporting delays and unreported risk
Nu
mb
er
of
Case
s(t
hou
san
ds)
198519861987198819891990199119921993199419951996199719981999
IDUHeterosexual contact
Estimated AIDS Prevalence* among Women,by Risk Exposure, 1985 - 1999, United States
0
20
40
60
80
100
120
140
160
Quarter-Year
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Mother's Exposure Category by Year of Child's Birth forPerinatally Acquired AIDS, 1980-1998, United States
Year of Birth
Perc
en
t of
Case
s
1980 1982 1984 1986 1988 1990 1992 1994 1996 19980
10
20
30
40
50
60
70
Injection drug use
Heterosexual contact
Mother's risk not specified
Transfusion
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Children <13 Years of Age Living with HIV Infection*and AIDS, Reported through 1999
NJDEMDDC
CTRIMA
6
4
13
7
42
5
6
4
5
2
1
1
9
13
12
4
3392
1743
767
79
17
2318
29
54
24
3299
52
258
16315
9284
15
7
9
23
0
05
0
6
7
3
1
5
16
27
27
335
65
41
2051
45
105
43
107
36797
7327
116
383
167
214126
153279
90
174
803
608
175 93
141
* 34 areas conduct confidential HIV infection surveillance for children <13 years old
HIV infection reporting initiated in July 1999
1
HIV
N=1,876 N=3,622
AIDS
P.R. V.I.
ConfidentialHIV Reporting**
Required
Pediatric only
**HIV cases reported by patient name
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*>1 diagnosis reported for some children
Mycobacterium avium infection
Condition
Lymphoid pneumonitisRecurrent bacterial infectionsHIV wasting syndrome
Candida esophagitis
Number
29002061179415641462
% of Cases*
3324211817
Pneumocystis carinii
HIV encephalopathy1372 16
Cytomegalovirus disease 838 10
Pulmonary candidiasis 418 5
Severe herpes simplex infection 422 5Cryptosporidiosis
326 4
709 8
AIDS-Defining Conditions Most Commonly Reported for Children <13 Years of Age, N=8,718, Reported through 1999, United States
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Born1993-March 1999 in 34 States,‡ United States
who Received or whose Mothers Received any ZDV*
Quarter-Year of Birth
Percent of Perinatally HIV Exposed or Infected Children
Perc
ent
Rece
ivin
g Z
idovudin
e
1993N=1437
1994N=1371
1995N=1393
1996N=1343
1997N=1466
1998N=1389
1999N=302
0
20
40
60
80
100
*Any ZDV=Prenatal, intrapartum, or neonatal receipt of Zidovudine to reduce perinatal HIV transmission Includes 34 areas that conduct pediatric HIV Surveillance; data reported through December 1999
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Hepatitis General Signs and Symptoms of Infection May or may not have jaundice Dark urine, painful joints Enlarged tender liver General weakness & weight loss Photophobia and headache N/V, muscle ache Fever 100 to 104
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Hepatitis A Incubation > 2 to 6 weeks. Means of transmission >oral-fecal
route contaminated food, water & shell fish.
Susceptible host >anyone with risk activity.
Mortality > very rare, 0% carriers state.
Vaccine YES.
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Hepatitis B Incubation > up to 200 days Means of transmission >percutaneous,
sex, blood. Susceptible host >anyone with risk
activity and worsens with age.
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Hepatitis B (Cont.) Mortality > 25% develop liver disease
10% become carriers. Medical Rx: Documentation, Blood
testing, Counseling. Vaccine (YES).
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Recommendations for Post Exposure Treatment of Hepatitis B
If the employee has not had the Hep series then HBIG shot plus start the vaccination program.
No prophylactic medication is recommended by CDC.
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Hepatitis C Incubation > 6 to 7 weeks Means of transmission
>percutaneous, sex, tattooing, blood before 1992
Medical RX: Documentation, Counseling, Follow up blood work
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Hepatitis C (Cont.)
Mortality > 50% develop liver disease 85% become carriers
Prevention – Use of PPE
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Hepatitis C treatment Interferon alfa-2b Interferon alfa-2b + ribaviron
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Syphilis (Treponema palladium)
Mode of Transmission – Sex, Needle Stick, Direct contact with draining lesion
Incubation - 10days to 3 months Prevention – Gloves, good
handwashing Medical RX: PCN or Tetracycline
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West Nile Virus (WNV) Mode of transmission – Mosquito
bite Blood transfusion, Organ donation,
Breast milk, Sharps injury
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West Nile Virus (WNV) (Cont.)
Signs/symptoms – Mild headache, fever, body aches, skin rash on trunk, Swollen Lymph glands, Eye pain, N/V.
Severe – Stiff neck, disorientation, coma, tremors, seizures, paralysis, high fever.
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West Nile Virus (WNV) (Cont.)
Incubation – 3 – 14 days PPE – BSI, Needle Safe devices,
DEET, long sleeves Post exposure TX – NONE
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Tuberculosis Pulmonary (TB) Mode of Transmission – Inhalation
of Airborne droplets Incubation – 4 to 12 weeks S/S – Persistent cough for 2 – 3
weeks, weight loss, fever/night sweats, coughing up blood or bloody sputum
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Tuberculosis Pulmonary (TB) (Cont.)
Medical RX. – INH Prevention – Mask the patient,
exposure follow-up, Annual skin testing.
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What Happens if I am Exposed???
WHO/CDC Recommendations for Post Exposure Treatment for HIV exposure and Review!
1. Determine if it is an Exposure2. Notify your supervisor
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What Happens if I am Exposed??? (Cont.)
1. Supervisor retrieve red MFD exposure packet (follow exposure algorhythm)
We will review the contents of the red exposure packet now.
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Old & New antiviral agents AZT – zidovudine (Retrovir) 1987 ZDV – zidovudine/lamivudine
(Combivir) 1996 3TC – lamivudine (Epivir) 1995 IDV - indinavir (Crixivan) 1996 PI Abacavir (Ziagen) 1998
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Old & New antiviral agents (Cont.)
Amprenavir (Agenerase) 1999 PI Didanosine (Videx EC) 2000 Lopinavir/ritonavir (Kaletra) 2000
two PIs
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Side Effects of AntiVirals and Protease Inhibitors
Hepatitis (chemical) Liver damage or failure Kidney damage or failure
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Summary HIV infected patients are living
longer You can be protected from
Hepatitis A, B & D by vaccination. Hepatitis C is on the rise, no
vaccine yet and may claim more lives than AIDS by 2010
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Complete Your quiz & turn in your Pre Test.
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Thank You
The END Questions?