BEDFORD COUNTY

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BEDFORD COUNTY

• BLOODBORNE PATHOGENS
• UPDATE 2009
• By June Leffke CEN, CFRN, NRCCEMT-P

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DISEASES OF CONCERN

• Aids
• Hep C
• Hep. B
• Syphilis

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NON-BBP OF CONCERN

• TB
• Avian Flu
• WNV
• Flu

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STATUS OF BBP NATIONALLY

• Syphilis is the only BBP on the rise in the US.
  All others are declining in number of new cases
  annually.

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STATUS OF BBP INCIDENCE IN VIRGINIA

• Only BBP on rise in Va. is Syphilis.

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RYAN WHITE LAW

• Being reinstituted this year
• Was inadvertantly removed
• Why is it important for volunteers
• Requirs all emergency response employers(includes
  volunteers) to have a designated infection
  control officer
• Forces medical facilities to provide source
  patient disease status in a timely fashion.

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DESIGNATED OFFICER

• Every crew has to have a DO
• DO needs to register with hospital
• It is through the DO only that information about
  the source patient is released.
• DO acts as a liason between hospital and any
  person exposed.
• DO also there to guide crew member and find
  additional resources if needed.

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DEFINITION OF AN EXPOSURE

• A contaminated needlestick injury.
• Blood or OPIM contact with inner surface of
  eye,nose,or mouth.
• Blood or OPIM in contact with open area of the
  skin.
• Cuts with sharp objects covered in blood.

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HUMAN BITES

• If you are bitten by another person you are not
  exposedit is YOUR blood in THEIR mouth. The
  exposed is the biter.
• Their saliva unless grossly filled with their
  blood is not potentially infectious

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OTHER POTENTIALLY INFECTIOUS MATERIALS (OPIM)

• CSF
• Synovial fluid
• Pleural fluid
• Amniotic fluid
• Peritoneal fluid
• Any body fluid containing gross visible blood.

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NON-RISK FLUIDS

• Tears
• Saliva
• Urine
• Stool
• Sweat
• Vomitus
• Nasal secretions
• Sputum
• UNLESS GROSSLY VISIBLE BLOOD IS PRESENT.

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HEPATITIS B VACCINE

• Offers protection via immunological memory.
• There is NO recommendation for a booster.
• Titer 1 to 2 months after completion of vaccine
  series is required and enforced by OSHA.

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HEPATITIS B VACCINE TITERS

• If titer not done in 2 month window after series
  do not go back and do one.
• Titer then only done if there is an exposure.
• Once you have a positive titer you never have to
  have a titer done again even if exposed.

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HEPATITIS C CASES

• Incident rate continues to decline
• Risk for contracting HCV from a contaminated
  sharps injury is 1.5 or less.
• Biggest risk of Hep C is in tattoo parlors
  because they are not regulated for the most part.
  There are rules for them to follow but no
  enforcement is done.

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HEP C TEST AXSYM

• AxSym Anti HCV is the new rapid test done for Hep
  C.
• Takes 23 minutes
• More accurate than other antibody tests.
• Performed on the source patient.
• Cost 65.00.

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HEP C EXPOSURE

• If you are exposed to Hep C you should have a
  blood test in 4 to 6 weeks.
• Test is HCV-RNAblood test
• Cost is 65.00
• If negative you are clear
• If positive there are drugs you can take that
  will clear the viral load in 24 weeks and prevent
  you from contracting the disease chronically.
• There is still no vaccine for Hep C.

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HIV / AIDS

• In North America and Western Europe cases remain
  the same.

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RAPID HIV TESTS

• Rapid tests currently available.
• Oraquick
• Reveal
• Uni-gold
• Multispot
• Clearview

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RAPID HIV TESTS

• OSHA states rapid HIV testing must be available
  or employer is in violation of OSHA standards.
• If source patient is negative with rapid testing
  no further testing of health care worker needed.

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RAPID HIV TEST

• Use of rapid tests prevents healthcare workers
  from being put on toxic drugs for even a short
  period of time.

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SYPHILIS CASES

• Continue to rise in US
• Post exposure follow up if source patient is HIV
  or Hep C positive.
• Syphilis is a common in those patients.

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SYPHILIS

• States with highest cases
• California
• Texas
• New York City
• Florida
• All of these states are entry states and states
  with high homeless populations.

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TUBERCULOSIS

• Risk for TB is based on number of
  active-untreated TB patients you transported in
  past year.
• Lowest number of cases since 1953 in 2007.

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MULTI-DRUG RESISTANT TB

• 84 in foreign born persons.
• Now screening immigrants

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TB TESTING

• Now an FDA approved blood test
• More accurate
• Done once only
• Cost effective

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ANNUAL TB TESTING

• Not needed in low risk areas(less than 3
  untreated cases per year)
• Costly
• Have many false positives because they are done
  wrong and read wrong.
• Recommendation
• No annual TB testing
• Do on hire only if exposed
• Or do blood test once be done

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WEST NILE VIRUS

• Cases in 20081,227
• Cases moved westward
• Highest cases
• California
• Arizona
• Mississippi
• Colorado
• North Dakota

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FLU VACCINE -ANNUAL

• Recommended for all healthcare workers doing
  Direct Patient Care
• Employers must offer.
• Employers must pay.
• Employees who decline must sign a declination
  form.
• Flu vaccine is available in nasal spray form for
  those 2-49 years of age.

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FLU VACCINE RATIONALE

• Reduces annual illness in staff.
• Increases protection from flu viruses
  cumulatively. Each year it is a slightly
  different vaccine but it increases your
  resistance to many viruses.

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FLU

• Healthcare workers should wear masks (simple
  surgical masks) when in close proximity with
  patient with flu.
• Flu spread by droplet
• Be more careful with patients running fevers and
  coughing.

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MRSA COMMUNITY CASES

• OUTBREAKS
• Close contact sports
• Injection drug users
• Inmates
• Group home residents
• Men who have sex with men
• gyms

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COMMUNITY STRAIN

• Community acquired
• More easily transmitted.
• predominantly skin and soft tissue acquired
• Community strain carries different chromosomes

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HOSPITAL ACQUIRED MRSA

• Usually multiple sites
• Skin
• Urine
• Feces
• Blood
• Wounds
• Usually multi drug resistant

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TREATMENT OF MRSA

• Need to incise and drain area that is infected.
• High powered antibiotics if needed.

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AVIAN FLU

• No rapid human to human transmission cases have
  been documented.
• Majority of cases in Indonesia
• Outbreaks in 2009 in
• China
• Viet Nam
• Nigeria
• West Africa
• Sierra Leone

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RECOMMENDED VACCINES / IMMUNIZATIONS FOR
HEALTHCARE WORKERS

• Hepatitis B Vaccine
• MMR
• Tdap (1 dose) for Tetanus
• Chickenpox Vaccine
• Influenza Vaccine

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CDC RECOMMENDS

• Hep B Vaccine for persons doing direct patient
  care activities
• Tetanus-booster if not immunized in past 10 years

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CLEANING RECOMMENDATIONS FOR RESCUE SQUADS

• Use 1100 bleach H20 solution or approved
  commercial product.
• ¼ cup in 1 gallon H20
• Good for 24 hours after mixed.
• Wipe down all surfaces touched or potentially
  touched by patient or you after touching patient.

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CLEANING

• Surfaces often forgotten
• Radio mike
• IV or drug box handles
• Stretcher railings
• Bench seats
• Steering wheel
• Tuff book handles and case
• Clipboard
• IV poles
• O2 tanks

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HANDWASHING

• Handwashing prevents spread of 90 of diseases.
• Use waterless solutions only as a temporary
  solution until you can get to sink and soap.
• Gloves are not the end all protection.
• Can spread disease via gloves. ie work on
  patient then leave gloves on and drive to
  hospital.
• wash hands after removing gloves

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SUMMARY

• Understand transmission of diseases.
• Understand prevention of transmission.
• Work only when healthy.
• Receive recommended vaccines
• Report all exposures to your DO.