04/21/23 1

Murrieta Fire Bloodborne Pathogen Training 2012

Art Durbin, Paramedic, RN, MICN, BSHS, MA

04/21/23 2

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

04/21/23 3

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

04/21/23 4

COMPLETE the Pre Evaluation Quiz

How much do you remember?

04/21/23 5

Chain of Disease Transmission

The organism

Mode of Entry

Host Resistance

Dosage

Virulence

04/21/23 6

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

04/21/23 7

Chain of Disease Transmission Defined (cont.)

Host immune system – Are you healthy

Mode of entry – puncture, eye or mouth splash of blood,

04/21/23 8

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.

04/21/23 9

Primary BBP fluids

1. Blood *2. Semen3. Vaginal secretions

* = most concerned with in our everyday job!

04/21/23 10

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

04/21/23 11

No Risk, HBV, HCV, HIV*reference CDC 1910.1030

Tears & Sweat * Sputum & Saliva * Urine & Stool * Vomit * Nasal secretions **{UNLESS they contain visible

blood}

04/21/23 12

Airborne Diseases

1. Contact time/Transport time2. Ventilation - 3. Organism type - 4. Host resistance – PPE used

04/21/23 13

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.

04/21/23 14

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.

04/21/23 15

HIV Statistics Review the most current CDC stats

04/21/23 16

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

04/21/23 17

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

04/21/23 18

*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

04/21/23 19

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

04/21/23 20

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

04/21/23 21

*>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

04/21/23 22

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

04/21/23 23

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

04/21/23 24

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.

04/21/23 25

Hepatitis B Incubation > up to 200 days Means of transmission >percutaneous,

sex, blood. Susceptible host >anyone with risk

activity and worsens with age.

04/21/23 26

Hepatitis B (Cont.) Mortality > 25% develop liver disease

10% become carriers. Medical Rx: Documentation, Blood

testing, Counseling. Vaccine (YES).

04/21/23 27

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.

04/21/23 28

Hepatitis C Incubation > 6 to 7 weeks Means of transmission

>percutaneous, sex, tattooing, blood before 1992

Medical RX: Documentation, Counseling, Follow up blood work

04/21/23 29

Hepatitis C (Cont.)

Mortality > 50% develop liver disease 85% become carriers

Prevention – Use of PPE

04/21/23 30

Hepatitis C treatment Interferon alfa-2b Interferon alfa-2b + ribaviron

04/21/23 31

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

04/21/23 32

West Nile Virus (WNV) Mode of transmission – Mosquito

bite Blood transfusion, Organ donation,

Breast milk, Sharps injury

04/21/23 33

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.

04/21/23 34

West Nile Virus (WNV) (Cont.)

Incubation – 3 – 14 days PPE – BSI, Needle Safe devices,

DEET, long sleeves Post exposure TX – NONE

04/21/23 35

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

04/21/23 36

Tuberculosis Pulmonary (TB) (Cont.)

Medical RX. – INH Prevention – Mask the patient,

exposure follow-up, Annual skin testing.

04/21/23 37

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

04/21/23 38

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.

04/21/23 39

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

04/21/23 40

Old & New antiviral agents (Cont.)

Amprenavir (Agenerase) 1999 PI Didanosine (Videx EC) 2000 Lopinavir/ritonavir (Kaletra) 2000

two PIs

04/21/23 41

Side Effects of AntiVirals and Protease Inhibitors

Hepatitis (chemical) Liver damage or failure Kidney damage or failure

04/21/23 42

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

04/21/23 43

Complete Your quiz & turn in your Pre Test.

04/21/23 44

Thank You

The END Questions?