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Blood Borne Pathogens


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presence of microorganisms without multiplication
presence of microorganisms with multiplication but NO invasion of tissues
microorganisms present, multiplying, and invading tissue
risk of infection
dose of bacterial contamination * virulence / resistance of host
characteristics of viruses
1. smallest microorganisms
2. require living tissue for growth and reproduction
3. not killed by antibiotics
characteristics of fungi (yeasts)
1. reproduce by spores
2. present in air, soli, water
3. not killed by antibiotics
4. cause infection in the immunosuppressed
- single celled
- parasitic
contributing factors for infection
- age
- immune response
- underlying conditions and illnesses
- interventions and treatments
transmission of infection
1. airborne
2. droplet - mucous membranes
3. contact
4. vehicle - in food or water
5. vector
preventing spread of infection
1. hand hygiene
2. medical asepsis
3. standard precautions
4. isolation
5. barrier practices
Airborne Precautions
- neg. pressure isolation room
- respiratory protection
- limit transport of patient from room to room
Airborne Diseases
- TB: active, untreated pulmonary or layngeal
- measles
- varicella-zoster
Droplet Precautions
- single room
-wear mask w/in 3 feet of patinet
-use mask on patient during transport
Droplet Diseases
- meningococcal meningitis
- influenza, pertussis, diptheria
- rubella, mumps
Contact Precautions
- single room or cohort
- gown and gloves for contact with patient or support equipment
- dedicated equipment
contact diseases
- antimicrobial-resistant organisms
- lice
- scabies
- C. difficile
- varicella-zoster
Neutropenic precautions
- single room
- handwashing
- limit traffic into the room
- no fresh fruits or vegetables
Neutropenic person
- person at-risk for acquiring infection
- absolute granulocyte count < 1000
Healthcare - Associated Infection
- aka Nosocomial infection
- not present or incubating on admission
stats for healthcare-associated infection
- 5% of all hospital admissions
- ~2 million patients per year
- $4.5 billion associated
- 1/3 may be preventable
Urinary Tract Infections
- 10^5 or greater organisms on culture
- > 10 WBCs per high power field on urinalysis
UTI associated with indwelling urinary catheters
- chronic indwelling urinary catheters - colonization of urine
- residents in LTC facilities frequently colonized and asymptomatic
- leading nosocomial infection in acute and long term care
- 2nd most common nosocomial infection in the US (15%)
Pneumoina - Long term care
- Bacterial pneumonia usually secondary to aspiration
- may also occur following viral URI and influenza
organisms that cause pneumonia
- streptococcus pneumoniae
- klebsiella pneumoniae
- staphylococcus aureus
types of skin and soft tissue infection
- surgical wound infections
- chronic wound: pressure ulcers, stasis ulcers
- soft tissue infections
- topcial skin infections
Incisional Surgical Site Infection
-within 30 days of surgery and involves skin, subq tissue, or muscle above fascia and any of the following:
- purulent drainage, postive culture from fluid from would, surgeon opens wound, doctor diagnosis of infection
Intrinsic factors for wound infection
- age - extremes
- nutritional status - serum albumin <3.5g/dl
- diabetes - glucose > 200mg/dl in immediate post-op period
- smoking - nicotine delays healing
- obestiy >20% ideal body weight
barriers to wound healing
Host factors:
- age
- underlying disease
- malnutrition
Altered immune response:
- disease / conditions
- drugs / tratemtns
- bypass natural defenses
Non-surgical skin and soft tissue infections (ex)
- chronic wounds --> pressure ulcers and static ulcers
- cellulitis
- fungal skin infection
C. difficile diarrhea
- profuse, watery
- associated with prior antibiotic use
- higher incidence in patients receiving tube feeding
- environmental contamination
- cross-infection potential
Def - Mulit-drug-resistant organism
- organism that has developed mechanism to protect it from being killed by the use of anitmicrobial agents
significance of multi-drug-resistant organisms
- increased potential for sepsis and death in patients with MDRO
- increased length of hospitilization
- increase cost
- patiens with MDRO are reservoirs for trnasmission of MDRO to others
Methicillin-resistant Staphylococcus aureus
- also resistant to Nafcillin, oxacillin
- not just hospital bug
Treatment for MRSA (methicillin-resistant staph aureus)
control measures for MRSA
- single room or cohort if colonized or infected
-contact precautions
- if outbreak suspcted, take additional precautions
- glycopeptide intermediate resitance staph aureus or vanomycin intermediate resistance staph aureus
problem with GISA or VISA
No treatment
control measures for GISA
- rapid identification of staph with th ereduced sensitivity to glycopeptide agents
- isolation
- 1:1 care for patient or cohort
- baseline cultures of HCW, roommates, and others with direct contact with pateint
more control measures for GISA
- avoid patient transfer between facilities
- notify local and state DOH and CDC
Vancomycin-resistant enerococci
- E. faecium predominantly
VRE characteristics
- survives on environmental surfaces
- transient carriage on HCW hands
- NO rectal colonization of healthy HCWs
- VRE coloniation frequent, but infx uncommon
- concern that will shart resistance factor with S aureus
VRE and C. difficile
- electronic thermometes and transmission of C. difficile
- tx. of C. difficile my predispose to dev. of VRE
- patients at risk for C. difficile may be reservoirs for VRE
control measures for VRE
- prudent vancomycin use
- education
- rapid identification of VRE
- isolation
-dedicated noncritical items
- env. cleaning and disinfection
control for VRE in LTC
- consider room with person not at high riske for VRE disease
VRE patients in LTC - when to allow them to ambulate and participate in activities?
1. moist body substances are contained
2. resident washes hands prior to leaving the room
types ofPediculosis
1. head - most common
2. body
3. pubic
eggs of lice
- do not wash or blow away
-most often found at nape of neck, behind ears, crown
treatment of head lice
1. insecticidal shampoo (not use Lindane)
2. fine tooth comb - removes nits
3. nit check for 10 days
Scabies - what caused by
caused by the mite - Sarcoptes scabiei --> burrows under skin
- spread skin to skin contact
symptoms of scabies
- severe itching - esp at night
- rash - back "tracks"
- symptoms not releived by moisturizing or other interventions
usual loctaions of scabies
wrist, finger webs, elbows, skin fold, pelvic girdle, butt, behind knees, sides of feet
Tx of scabies
- contact precautions
- insecticide lotion - apply in shower
- change linens and clothes
Infection with varicella-zoster virus
- chickenpox
- attaches to nerve endings and becomes dormant
local zoster vx. disseminated zoster
local - nerve endings in one dermatome, unilateral distribution, standard precautions
disseminated - full body involved, airborne and contact precautions
Herpes Zoster
reactivation of varicella-zoster virus when immune response compromised.
- shingles
#2 leading cause of death due to infectious disease in the world
etiologic agent and transmission of TB
- Mycobacterium tuberculosis
- droplet expelled and inhaled
T/F: YOu can be infected with TB without disease
TB infection with NO disease
- cannot spread
- + skin test
- neg x-ray
- no symptoms
sites of active TB
- lungs
- larynx
- lymph nodes
- brain
- kidneys
- bone
why has there been a recent return in TB?
- decreased funding and attention
- lack of compliance with infx control measures
- poor ventialation and air in older facilities
- HIV epidemic
- Inc immigaration from high-prevalence countries
- inc inmates and homeless
impact on reappearnce of TB
- increased morbidity and mortality
- resistant strains
- $$
- new quidelines for prevention and control
populations with high prevalence of TB infection
- residents LTC facilites
- HIV +
- Inmates
- ppl who inject drugs
- ppl with occupational exposure
S&S of TB
- long duration
- fatigue
- malaise
- weight loss
- fever
- night sweats
- cough / blood (pulmonary)
Mantoux Tuberculin Skin Test
- for TB
- inject PPD into skin
- Examined 48-72 hours
- measured for induration NOT redness
other diagnostic tests for TB
- x-ray
- AFB smear
-AFB culture
infx control for TB
- airborne isolation
- precaution for cough-inducing procedures
- effective anti-TB tx
which Hepatitis viruses are caused by viruses?
Hep A, B, C, D, E
Hep A mode of trnsmission, incubation period
-15-50 days - avg 28 days
Hep A - diagnosis, outcome,
- anti-HAVIgM
- outcome: mild, self-limiting
which strands of hepatitis can use a vaccine
Hep A
Hep B
Hep D
Which strands of Hepatitis have prevention with hygiene?
Hep A
Hep E
Hepatitis transmitted by blood and body fluids
Hep B
Hep C
Hep D
Hepatitis transmitted by fecal-oral route
Hep A
Hep E
Diagnosis of Hep B
Diagnosis of Hep C
HCV-PCR and elevated LTFs
super infection with HBV
Hep D
20% mortalilty in pregnant women
Hep E
stages of HIV
- acute retroviral syndrome
- asymptomatic
- early symptomatic
- late symptomatic
- advanced
epidemiology of HIV in the US
- 800,000 - 900,000 with HIV in US
- 40,000 new cases per year
- 70% infx in men
transmission of HIV
- sexual contact
- blood to blood
- perinatally
body fluids for HIV transmission
- blood - highest amt virus
- semen - high amt virus
- vaginal secretion - lower
- breast milk - low
components of OSHA bloodborne pathogen rule
- written exposure control plan
- enginerring controls
- safe work practices
- hep B vaccine
- education and post-exposure follow-up
percutaneous exposure
any new break in the skin caused by contaminated needle or other sharp object
mucous membrane exposure
any splash of blood or body fluds to the eyes, eras, nose, mouth, etc.
non-intact skin
any contact of blood or body fluid with an existing break in the skin
bloodborne pathogens
- Hep B
- Hep C
- Hep D
risk of HIV infx after exposure
why the risk of HIV varies with an exposure
- amount of blood involved
- amount of virus in blood
- if postexposure treatment taken
risk of infection with hep B after exposure to HBV infected blood?
- 6-12% risk
- varies with amount blood, amount virus, and whether HCW had antibody to HBV
factors that contribute to development of infection
- immune response
- underlying conditions / illness
- occupational exposure
- unsafe work practices
- missing or poor engineering controls
infection control for healthcare worker
- hand hygiene
- safe practices
- be kind to immune system
- up to date immunizations
post-exposure follow up for blood and body fluid exposure
- wash / flush with water or saline
- report to supervisor
- medical evaluation and follow-up
post-exposure follow up for communicable disease
- report to supervisor
- review your immune status
- medical evaluation if susceptible

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