Download Infectious Diseases

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