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Infectious Diseases Infectious and Communicable Diseases • Agency responsibility relative to infectious agent exposure – CDC Center For Disease Control WWW.CDC.gov – Meck. Co. Health Dept. http://charmeck.org/mecklenburg/county/HealthDepartment/ CDControl/Pages/default.aspx Infectious and Communicable Diseases • Infectious disease – Refers to any illness caused by a specific microorganism • Communicable disease – An infectious disease that can be transmitted from one person to another Infectious and Communicable Diseases • Diseases spread: – Directly – Indirectly Infectious and Communicable Diseases • Diseases are caused by pathogens, which are microorganisms such as bacteria and viruses. These pathogens can spread in a number of ways including by way of blood and other body fluids or through the air. An infectious disease is one that spreads from person to person. Infectious and Communicable Diseases • It can spread directly through blood-to-blood contact, contact with open wounds and exposed tissue, and contact with the mucous membranes of the eyes and mouth. It can also spread indirectly by way of a contaminated object such as a needle. Airborne pathogens are spread by one person coughing, sneezing, or exhaling infected droplets that are then breathed into the respiratory tract of another person. Modes of Transmission • Bloodborne pathogens are transmitted when blood or body fluids come in contact with mucous membranes or non-intact skin (cuts, abrasions, burns, rashes, acne, paper cuts, and hangnails). • Transmission may occur from splashes or sprays of blood, handling or touching contaminated items or surfaces and injection under the skin by puncture wounds or cuts from contaminated sharps. Modes of Transmission • Types – Direct contact – organism is moved from one person to another through touching – Indirect contact – infection is spread through inanimate object (needle stick) – Airborne – spread through droplet or dust – Food borne- spread through infected food or water. – Vector borne (insects or parasitic worms) CDC Recommendations • ALL persons are potentially infected or can spread an organism that could be transmitted in the healthcare setting. • Standard precautions must be used on all patient encounters. Infectious and Communicable Diseases • The U.S. Department of Occupational Safety and Health Administration (OSHA) guidelines require emergency care personnel to take precautions against disease transmitted by blood and other potentially infectious substances or body fluids. The Law • Certain jobs may involve contact with blood or other body fluids • The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) issued regulations to protect employees from bloodborne pathogens. • 29 CFR 1910.1030 is the regulation number • It was issued in 1991. The Law • These regulations require employers to use a combination of engineering, work practice controls, personal protective equipment, medical surveillance and additional safety precautions in the work place. • Any employees that are at risk from contact with human blood are required to receive training in bloodborne pathogens. Reporting • An occupational exposure incident occurs if you are in a work situation and come in contact with blood or body fluids. • For OSHA 2000 record keeping purposes, an occupational bloodborne pathogens exposure incident such as needle stick, laceration or splash is classified as an injury because it is usually the result of an instantaneous event or exposure. Reporting • After an exposure employees’ names are placed on the OSHA 2000 log. • The goal of reporting an exposure is to ensure that an employee receives prompt access to medical services and to identify and adopt other methods or devices to prevent exposure incidents from recurring. Reporting • The following should be included in the report: – – – – – Date and time of incident Job classification Worksite location Work practices being followed Engineering practices in place including name or brand of device such as sharps/needles, PPE – Procedure being performed and training received OSHA Expectations • The objective of the standard is to limit or prevent exposure to blood or body fluids however, exposure to a bloodborne may occur. • If there is a risk of exposure or injury, it is important for you to know the following… • There is a way to prevent infection as a result of exposure to the pathogen, such as immunizations. OSHA Expectations • The symptoms caused by infection with the pathogen, as well as the natural course of the infection • Counseling specific to the exposure incident is available • The post-exposure treatments and follow-up that may be provided to you • THE BOTTOM LINE • EDUCATE YOURSELF!!! The Ryan White Act • This public law – 101-381, Creates a notification system for emergency response employees listed as police, fire and EMS who are exposed to diseases such as tuberculosis, hepatitis B and C and HIV. • The CDC is currently working on a final list of diseases that will be included in this law. Body Substance Isolation (BSI) • BSI is based on the premise that all exposures to body fluids, under any circumstances, are potentially infectious. Infectious and Communicable Diseases • The practice of protecting yourself from disease transmission through exposure to blood and other body fluids is referred to as body substance isolation (BSI). Infectious and Communicable Diseases • The equipment utilized for body substance isolation practices is referred to as personal protective equipment (PPE). Remember also, that the patient may come into contact with medical equipment (such as vital signs equipment) that must be properly cleaned or disposed of to avoid cross-contamination. Pathophysiology of Infectious Diseases • Development of clinical disease depends on several factors including: – – – – Virulence (degree of pathogenicity) Number of infectious agents (dose, how much) Resistance (immune status) of the host Correct mode of entry Body Substance Isolation (BSI) • The best way to protect the responder: – Hand Washing – PPE (Personal Protective Clothing) – Proper disposal Body Substance Isolation (BSI) Personal Protective Equipment (PPE) Gloves for touching blood or body fluids for touching mucous membranes and non-intact skin Gowns protect skin and / or clothing Mask protect mouth and nose Infectious and Communicable Diseases • Protecting yourself from accidental injury – Your most important concern! – Scenes can be (or become) dangerous • • • • Rescue operations Hazardous materials Violence Environmental extremes Infectious and Communicable Diseases • As an EMT you need to protect yourself during rescue operations involving hazardous materials, potentially life-threatening rescues, violence, and biological and chemical weapons of mass destruction. It is imperative that you not fall victim to the same hazards that affect your patients. Chain of Elements • The pathogenic agent • An environment conducive to transmission of the pathogenic agent • A portal of entry into the new host • Susceptibility of the new host to the infectious disease Pathogenic Agent • Pathogens are organisms that can create pathological processes in the human host and are classified according to: – – – – Morphology Chemical composition Growth requirements Viability Pathogenic Agent • • • • • Bacteria Viruses Fungi Protozoa Helminths – Worms, including tapeworms, roundworms Pathogenic Agent • Factors affecting any pathogen's ability to create pathological processes are: – Its ability to invade and reproduce within a host and the mode in which it does so – Its speed of reproduction, ability to produce a toxin, and the extent of tissue damage that it causes – Its potency – Its ability to induce an immune response in the host Reservoir • The environment (reservoir) in which a pathogen lives and reproduces • The life cycle of the infectious agent depends on: – The demographics of the host – Genetic factors – The efficacy of therapeutic interventions once infection has been established Portal of Exit • The mechanism or method by which a pathogenic agent leaves one host to invade another involves a “portal of exit”. – The portal of exit from the human host depends on the agent and may be single or multiple involving the: • GU tract • Intestinal tract • Oral cavity • Respiratory tract • An open lesion • Or any wound through which blood escapes Transmission/Portal of Entry • Determined by the portal of exit, which may be direct or indirect – Direct transmission occurs when there is physical contact between the source and the victim – In indirect transmission, the organism survives on animate or inanimate objects for a period without a human host • Portal of entry – Refers to the means by which the pathogenic agent enters a new host Host Susceptibility • Host susceptibility is influenced by a person's immune response and by several other factors, some of which include: – – – – – – Human characteristics General health status Immune status Geographical and environmental conditions Cultural behaviors Sexual behaviors Human Response to Infection • External barriers – – – – Skin GI system Upper respiratory tract Genitourinary tract Human Response to Infection • Internal barriers – Protect against pathogenic agents when the external lines of defense are breached – Include: • Inflammatory response • Immune response Inflammatory Response • Inflammation (a local reaction to cellular injury) • The inflammatory response is generally protective and beneficial – May initiate destruction of the body’s own tissue if the response is sustained or directed toward the host's own antigens • May be divided into two separate stages – Cellular response to injury – Vascular response to injury Defensive Response • White blood cells are the backbone of the immune system – Time-consuming response – Specialized white blood cells (B-cells) eventually differentiate into antibodies Defensive Response • Cell-mediated immunity component – Time-consuming response – Specialized white blood cells (T-cells) coordinate the activity of other components of the immune system to deal with foreign material Reticuloendothelial System (RES) • Composed of immune cells in the spleen, lymph nodes, liver, bone marrow, lungs, and intestines • Works in conjunction with the lymphatic system to dispose of “garbage” material that results from immune system attack of intruders • RES structures serve as sites where mature Band T-cells are stored until the immune system is activated by the presence of intruders Reticuloendothelial System Defensive Response System • Part of the immune system that can recognize and kill invaders on first sight • Doesn’t take time to mobilize specialized responses like components of white blood cells Stages of Infectious Diseases • Latent period: interval between exposure to an infectious organism and the clinical appearance of disease • The incubation period: the time elapsed between exposure to a pathogenic organism, a chemical or radiation, and when symptoms and signs are first apparent • The communicability period: ability to spread from infected to susceptible hosts • The disease period HIV • HIV is present in blood and serum-derived body fluids (semen, vaginal, or cervical secretions) in individuals infected with the virus • Directly transmitted person to person – Through anal or vaginal intercourse – Across the placenta – By contact with infected blood or body fluids on mucous membranes or open wounds HIV • AIDS: acquired immunodeficiency syndrome • A condition in humans in which the immune system begins to fail, leading to life-threatening opportunistic infections. HIV • HIV may be indirectly transmitted by: – Transfusion with contaminated blood or blood products – Transplanted tissues and organs – Use of contaminated needles or syringes HIV Risk Factors • Occurrence is highest in persons with the following risk factors: – – – – High-risk sexual behavior IV drug abuse Transfusion recipient between 1978 and 1985 Hemophilia or other coagulation disorders requiring blood products – Infant born of HIV-positive mother 2014 Ebola Virus Disease Outbreak Facts, Myths, Response, Protection M. W. Stanford, Supervisor Emergency Preparedness and Special Operations Created by CDC microbiologist Frederick A. Murphy, this colorized transmission electron micrograph (TEM) revealed some of the ultrastructural morphology displayed by an Ebola virus virion. 2014 Ebola Virus Disease Outbreak 2014 Ebola Virus Disease Outbreak Produced by NIAID, this digitally-colorized scanning electron micrograph (SEM) depicts numerous filamentous Ebola virus particles (blue) budding from a chronically-infected VERO E6 cell (yellow-green) 2014 Ebola Virus Disease Outbreak Facts and Myths Spread through direct contact (through broken skin or mucous membranes in, for example, the eyes, nose or mouth) with Blood or body fluids (including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with Ebola Objects (like needles and syringes) that have been contaminated with the virus Infected animals outside the United States (bats, monkeys, apes) 2014 Ebola Virus Disease Outbreak Facts and Myths EVD Could be spread by droplets Is not airborne (TB) Is not spread by water Is not spread by food in the United States 2014 Ebola Virus Disease Outbreak Facts and Myths EVD 2 to 21 days incubation period Most become sick at 8 to 10 days Can live outside the body Several hours on dry surface Several days at room temperature in body fluids Killed with hospital grade disinfectant 2014 Ebola Virus Disease Outbreak Facts and Myths EVD Is not transmitted until a person develops signs and symptoms Fever, severe headache, diarrhea, vomiting, stomach pain, muscle pain, weakness, unexplained bleeding or bruising The longer a patient has EVD the higher the risk for other individuals to contract EVD 2014 Ebola Virus Disease Outbreak Facts and Myths United States cases of EVD Ebola Contact Tracing, Dallas, Texas Date: 08NOV14 Confirmed Cases: 3 As of November 8, 2014 all Dallas contacts have completed the 21day monitoring period. Contacts* Current: 0 Completed Surveillance^: 11 Total: 11 Possible Contacts** Current: 0 Completed Surveillance^: 166 Total: 166 Totals Current: 0 Completed Surveillance^: 177*** Total: 177 *Contacts – Definite exposure **Possible Contacts – Possible exposure ^Completed active surveillance ***Data for last date of exposure is still in progress 2014 Ebola Virus Disease Outbreak Facts, Myths, and Protection United States cases of EVD Dallas, Tx Index patient Duncan reports to ED September 25th Febrile with head and abdominal pain Blood testing and CT scan Discharged home No contacts have become sick (October 17th) Index patient Duncan admitted to hospital on September 28th. Diagnosed with EVD September 30th (October 22nd) Died October 8th 2014 Ebola Virus Disease Outbreak Protection Personal Protective Equipment (PPE) Universal Precautions (Blood borne Pathogens Policy) Gloves, Mask, Gown, Eye Protection (First Level) Boot/Shoe Covers, Head Cover N-95 Respirator, Tyvek Suit (Second Level) Red Bag, Tape, Fluid Impervious Sheet Procedure Sequence for putting on PPE Sequence for removing PPE Fluid Impervious blanket for containment (RAD) 2014 Ebola Virus Disease Outbreak Protection Hand Hygiene Change gloves frequently. RAD procedures Alcohol-based hand rub followed by hand washing Hand washing Eliminate Exposure Risk Keep 3 foot distance Keep hands away from face Hair pulled up Jewelry removed 2014 Ebola Virus Disease Outbreak Response CMED identifies patient utilizing EIDS tool Immediate notification to responding crew “SIGNAL XX, PPE” Dispatch of closest Field Operations Supervisor “SIGNAL XX, PPE” Notification to First Responders “SIGNAL XX, PPE” Notification to EROA ****Follow Suspected / Potential VHF Protocol (335-336) 2014 Ebola Virus Disease Outbreak Response Field Crew identifies potential patient after arrival Immediately notify CMED “SIGNAL XX, PPE” Follow Suspected / Potential VHF Protocol (335336) Travel to Guinea, Liberia, Mali, Sierra Leone as of 02DEC14 2014 Ebola Virus Disease Outbreak Response Patient Contact Get PPE kit Place one kit in cab of unit Limit exposure One person with patient in PPE (level one) Surgical mask on patient Obtain history (travel, symptoms) If positive screen Close window between cab and box, tape FIB on window Primary caregiver into PPE (level two) 2014 Ebola Virus Disease Outbreak Response This is an evolving process. Watch for updates and any changes to be communicated. CBP temp checks; DHS travel requirements through 5 screening airports CDC, State, Local PH now to do follow up for 21 days PPE EMS guidance updated Hepatitis • A viral disease that produces pathological alterations in the liver (inflammation of the liver) • Three main classes of hepatitis viruses – – – – Hepatitis A (viral hepatitis) Hepatitis B (serum hepatitis) Hepatitis C (non-A/non-B hepatitis) Hepatitis means inflammation of the liver and also refers to a group of viral infections that affect the liver. Hepatitis • Hepatitis non-ABC is a fourth class of hepatitis caused by infection from the hepatitis D virus and the newer hepatitis viruses (E and G) Hepatitis A Virus (HAV) • Most common type of viral hepatitis in the United States – transmitted person-to-person by ingestion of contaminated food or water or through direct contact with an infectious person. – Vaccination is the most effective means of preventing HAV transmission among persons at risk for infection. Hepatitis A Virus (HAV) • The time between infection and the appearance of the symptoms, is between two and six weeks and the average incubation period is 28 days. • HAV infection produces a self-limited disease that does not result in chronic infection or chronic liver disease. Acute liver failure from Hepatitis A is rare. The disease can be prevented by vaccination, and hepatitis A vaccine has been proven effective in controlling outbreaks worldwide. Hepatitis B Virus (HBV) • Transmission of hepatitis B virus results from exposure to infectious blood or body fluids. – Vaccination is the most effective means of preventing HBV transmission among persons at risk for infection. – The acute illness causes liver inflammation, vomiting, jaundice and rarely, death. Hepatitis C Virus • Hepatitis C virus is spread by blood-to-blood contact. • HCV is transmitted primarily through large or repeated percutaneous (i.e., passage through the skin) exposures to infectious blood. Hepatitis C Virus • Injection drug use (currently the most common means of HCV transmission in the United States) • Receipt of donated blood, blood products, and organs (once a common means of transmission but now rare in the United States since blood screening became available in 1992) • Needlestick injuries in healthcare workers • Birth to an HCV-infected mother Hepatitis C Virus • Hepatitis C can cause lifelong illness and extreme damage to the liver, including death. Tuberculosis (TB) • TB is a common and often deadly infectious disease caused by various strains of mycobacteria. • Body systems affected and potential secondary complications: Lungs • Routes, it is spread through the air when people who have the disease cough, sneeze, or spit. • Untreated persons that have acquired TB develop other complications and can result in death. Tuberculosis (TB) • Body systems affected and potential secondary complications: Lungs • Routes of transmission: body fluid, whether from coughing, sneezing, or spitting Tuberculosis (TB) • HEPA respirator for BSI – In most cases must be fitted Meningococcal Meningitis • It carries a high mortality rate if untreated. • Meningococcal disease causes life-threatening meningitis and sepsis conditions. • Even with antibiotics, approximately 1 in 10 victims of meningococcal meningitis will die; However, about as many survivors of the disease lose a limb or their hearing, or suffer permanent brain damage. • Bacterial toxins rupture blood vessels and can rapidly shut down vital organs. Meningococcal Meningitis • Rash and other significant symptoms may include headache, nausea and/or vomiting, severe lethargy, fever or clinical evidence of shock. • It typically presents with high fever, stiff neck, severe headache, vomiting, sensitivity to light, and sometimes chills, altered mental status, or seizures. Tetanus • A nail or sharp metal object affords a means to puncture skin and deliver endospore into the wound. • Tetanus can be prevented by vaccination. • The CDC recommends that adults receive a booster vaccine every ten years. • The first sign is trismus, or lockjaw, and facial spasms Tetanus • Stiffness of the neck, difficulty in swallowing, and rigidity of pectoral and calf muscles • Elevated temperature, sweating, elevated blood pressure, and episodic rapid heart rate Rabies (Hydrophobia) • Rabies is a viral disease that causes acute inflammation of the brain in warm-blooded animals. • Most commonly transmitted by a bite from an infected animal but occasionally by other forms of contact. • Rabies is almost invariably fatal if post-exposure prophylaxis is not administered prior to the onset of severe symptoms. Rabies (Hydrophobia) • The early symptoms of rabies in people are similar to that of many other illnesses, including fever, headache, and general weakness or discomfort. As the disease progresses, more specific symptoms appear and may include insomnia, anxiety, confusion, slight or partial paralysis, excitation, hallucinations, agitation, hypersalivation (increase in saliva), difficulty swallowing, and hydrophobia (fear of water). Death usually occurs within days of the onset of these symptoms. Rubella • Rubella, commonly known as German measles, is a disease caused by the rubella virus. • The disease can last one to three days. The disease has an incubation period of 2 to 3 weeks. • Rubella is transmitted via airborne droplet emission from the upper respiratory tract of active cases. Rubella • Rubella is a common childhood infection usually with minimal systemic upset although transient arthropathy may occur in adults. • Immunization available Rubella Rubeola • Rubeola, also known as measles, is an infection of the respiratory system caused by a virus. • It’s spread through respiration (contact with fluids from an infected person's nose and mouth, either directly or through aerosol transmission), and is highly contagious—90% of people without immunity sharing living space with an infected person will catch it. Rubella German Measles • Rubeola infection has an average incubation period of 14 days (range 6–19 days) and infectivity lasts from 2–4 days prior, until 2–5 days following the onset of the rash (i.e. 4–9 days infectivity in total). • The classical symptoms of measles include four day fevers, cough, coryza (runny nose) and conjunctivitis (red eyes). Rubeola • A rash that begins several days after the fever starts. It starts on the head before spreading to cover most of the body, often causing itching. The rash is said to "stain", changing color from red to dark brown, before disappearing. • Immunization available Rubeola Mumps • Mumps is a viral disease. • Painful swelling of the salivary glands (classically the parotid gland) is the most typical presentation. • Painful testicular swelling (orchitis) and rash may also occur. • Fever and headache are also common. • Immunization available Mumps • When an infected person coughs or sneezes, the droplets aerosolize and can enter the eyes, nose, or mouth of another person. • Mumps can also be spread by sharing food and drinks. The virus can also survive on surfaces and then be spread after contact in a similar manner. • A person infected with mumps is contagious from approximately 6 days before the onset of symptoms until about 9 days after symptoms start. Mumps • The incubation period (time until symptoms begin) can be from 14–25 days, but is more typically 16–18 days. Mumps Chickenpox • Chickenpox is a highly contagious illness caused by primary infection with the varicella zoster virus. • It usually starts with vesicular skin rash mainly on the body and head rather than at the periphery. It becomes itchy, leaving raw pockmarks which eventually heal without scarring. Chickenpox • Chicken pox is an airborne disease spread easily through coughing or sneezing of ill individuals or through direct contact with secretions from the rash. Chickenpox • The contagious period continues for 4 to 5 days after the appearance of the rash, or until all lesions have crusted over. Patients are probably contagious during the entire period new lesions keep appearing. • Crusted lesions are not contagious. • It takes from 10 to 21 days after contact with an infected person for someone to develop chickenpox. Chickenpox • Chickenpox is rarely fatal, although it is generally more severe in adult males than in adult females or children. Pregnant women and those with a suppressed immune system are at highest risk of serious complications. The most common late complication of chicken pox is shingles, caused by reactivation of the varicella zoster virus decades after the initial episode of chickenpox. Chickenpox Pertussis • Pertussis, also known as whooping cough is a highly contagious disease caused by the bacterium Bordetella pertussis. • Contracted by breathing in droplets expelled from the nose or throat of an infected person during coughing or sneezing • Many medical sources describe the whoop as "high-pitched“. This is generally the case with infected babies and children only, not adults. Pertussis • The incubation period is typically 7 to 10 days, in infants or young children, after which there is usually mild respiratory symptoms, mild coughing, sneezing, or runny nose. • The immunizations are given in combination with tetanus, diphtheria, polio and haemophilus influenza type B immunizations, at ages 2, 4, and 6 months, and a single later booster at 3 to 4 years of age. Influenza • Influenza, commonly referred to as the flu, is an infectious disease caused by RNA viruses. • Most common symptoms of the disease are chills, fever, sore throat, muscle pains, severe headache, coughing, weakness/fatigue and general discomfort. • Typically, influenza is transmitted through the air by coughs or sneezes, creating aerosols containing the virus. Influenza • Influenza viruses can be inactivated by sunlight, disinfectants and detergents. • Influenza spreads around the world in seasonal epidemics, resulting in the deaths of between 250,000 and 500,000 people every year. • In April 2009 a novel flu strain evolved that combined genes from human, pig, and bird flu, initially dubbed "swine flu" and also known as influenza A/H1N1, emerged in Mexico, the United States, and several other nations. Mononucleosis • Mononucleosis is a condition where there is an unusual proliferation of lymphocytes in the blood due to an infection with the Epstein-Barr virus (EBV). • Also known as the kissing disease from its oral transmission, or simply as mono • The disease is characterized by fever, sore throat and fatigue, along with several other possible signs and symptoms. Mononucleosis • The infection is spread via saliva and has an incubation period of 4–7 weeks. Symptoms usually persist for 2–3 weeks, but fatigue is often more prolonged. • It's generally believed that a person can spread the infection for many months after the symptoms are completely gone, some studies show as long as 18 months. Mononucleosis Sexually Transmitted Diseases • A group of disease syndromes that can be transmitted sexually, whether or not the disease has genital pathological manifestations. – A number of pathogenic agents are responsible for the host of STDs including bacteria, viruses, protozoa, fungi, and ectoparasites. – Many of these pathogens can produce multiple disease syndromes, and patients with STD syndromes frequently have multiple STDs. Syphilis • The primary route of transmission of syphilis is through sexual contact however, it may also be transmitted from mother to fetus during pregnancy, or at birth resulting in congenital syphilis. • Approximately 3–90 days after the initial exposure (average 21 days) a skin lesion appears at the point of contact called a chancre. Syphilis • Symptoms may include fever, sore throat, malaise, weight loss, hair loss, and headache. • On mucous membranes it may form flat, broad, whitish, wart-like lesions known as condyloma latum. All of these lesions are infectious, harboring bacteria. Avoid contact. Syphilis Gonorrhea • Gonorrhea (also known as the clap) is a common sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. • The usual symptoms in men are burning with urination and penile discharge. Women, on the other hand, are asymptomatic half the time or have vaginal discharge and pelvic pain. In both men and women if gonorrhea is left untreated, it may spread locally causing epididymitis or pelvic inflammatory disease or throughout the body, affecting joints and heart valves. Gonorrhea • One of the complications of gonorrhea is systemic dissemination resulting in skin pustules or petechia, septic arthritis, meningitis or endocarditis. Herpes Simplex Virus • Symptoms of herpes simplex virus infection include watery blisters in the skin or mucous membranes of the mouth, lips or genitals. Lesions heal with a scab characteristic of herpetic disease. • HSV-1 and -2 are transmitted from contact with an infectious area of the skin during reactivations of the virus. Herpes Simplex Virus • HSV-1 is usually acquired orally during childhood, but may also be sexually transmitted. HSV-2 is primarily a sexually transmitted infection but rates of HSV-1 genital infections are increasing. Herpes Simplex Virus Lice and Scabies • Lice and scabies are potential health hazards for all emergency care providers – Both are medically important as potential vectors of communicable skin disease and systemic illness. Lice • Most lice are scavengers, feeding on skin and other debris found on the host's body, but some species feed on sebaceous secretions and blood. • In humans, different species of louse inhabit the scalp and pubic hair. Lice generally cannot survive for long, if removed from their host. • Easily transmitted by sharing head wear, combs • or brushes. Lice Scabies • Scabies is a contagious skin infection that occurs among humans. • It is caused by a tiny and usually not directly visible parasite, the mite Sarcoptes scabiei, which burrows under the host's skin, causing intense allergic itching. • The disease in humans may be transmitted from objects or bedding (like mattresses,etc.), but is most often transmitted by direct skin-to-skin contact, with prolonged contact being more efficient. Scabies • The characteristic symptoms of a scabies infection include intense itching and rashes. Scabies Reporting an Exposure • All suspected exposures to an infectious or communicable disease must be reported to the Designated Officer – An exposure incident (significant exposure) is any specific eye, mouth, other mucous membrane, nonintact skin, parenteral contact with blood, blood products, bloody body fluids, or other potentially infectious materials. Reporting an Exposure • Who to report to: Infectious control officer • Medical evaluation and follow up – Steps involved • The written report and confidentiality must be maintained. Preventing Disease Transmission • Ensure that your immunization status is current relative to: – – – – – – – MMR Hepatitis B, A (if deemed appropriate by your agency) DPT Polio Chickenpox Influenza (seasonally) Rabies, if appropriate to your occupational/ recreational risk Preventing Disease Transmission • Approach with caution and the right attitude. • Control the scene – an uncontrolled scene increases the likelihood for transmission of body fluids. Preventing Disease Transmission • Observe BSI – Always wear gloves. – If chance of splash, wear protective eyewear or face shield. – If large volumes of blood are a possibility, go one step further and wear gown. – When contacting a possible TB patient, wear appropriate particulate mask. Preventing Disease Transmission • Don’t treat your patient differently, or avoid caring for your patient because you think there is the possibility of an infectious process. Preventing Disease Transmission • After the call, disinfect your equipment and patient compartment of the ambulance with a disinfectant that claims bactericidal activity against M. tuberculosis, which will kill the hepatitis viruses. – Any soap kills HIV. – Use high-level disinfection on laryngoscope blades. Preventing Disease Transmission • After a call with lice, scabies, ticks, or other insect vectors: – Spray the stretcher and patient compartment with an insecticide, then wipe off/mop-up insecticide residue. – Bag the linen separately, and ensure that it is not taken home – must be washed separately. – Report any infectious exposure to the Designated Officer/manager identified as such by your agency. Preventing Disease Transmission • Final Thoughts • PPE is available to protect you from exposure to infectious agents in the healthcare workplace • Know what type of PPE is necessary for the duties you perform and use it correctly