Download Infections and Precautions

Infections
and Precautions
Infections and Precautions
Introduction
A1. Infection Process
A2. Hepatitis
A3. Tuberculosis
A4. Influenza
A5. Common Cold
A6. HIV/AIDS
A6. Standard Precautions
A7. Other Infection Controls
A8. Conclusions
2
Infection Process
The first step in understanding the infection process, is knowing that an
infection always has a source. This source is the microorganism that
causes the infection.
From the source, the infection must have transportation. The
transportation process is called transmission.
Transmission may occur in many ways. Some of the more common
means of transmission are person-to-person, through the air or by being
carried on an object.
The final link in the chain is the host. Unfortunately, this means a
person…..this could mean you!
3
Infection Process
Understanding the chain of infection means that we
as employees need to learn how to protect
ourselves and our consumers from infection.
This means that we need to understand the actions
we must take to protect everyone and minimize
their and your exposure to pathogens that cause
disease.
4
Purpose of Training
This module covers some of the diseases that we need
to protect ourselves from and how we prevent the
spread of infections at the Center by using Standard
Precautions and other infection controls.
You, as an employee of the Center, should take caution
every day to maintain your health, as well as the health
of others. This module will help you be successful.
5
Facts: Hepatitis
An inflammation of the liver caused by viruses, bacterial
infections or continuous exposure to alcohol, drugs or other
chemicals.
Reduces the ability of the liver to perform its critical
functions and
Caused by different types of viruses that are all contagious
but are passed between people in different ways. There are
5 kinds of viral Hepatitis (Hepatitis A, Hepatitis B, Hepatitis C,
Hepatitis D, and Hepatitis E). In this module we will discuss
only A, B and C.
6
Hepatitis A Virus (HAV)
Hepatitis A is an infectious liver disease caused
by the Hepatitis A Virus (HAV). The disease varies
in clinical severity from a mild illness lasting 1-2
weeks to a severely disabling disease lasting
several months.
7
Symptoms of Hepatitis A
Three of every four persons infected with Hepatitis A virus
have symptoms that include:
• fever
• tiredness
• loss of appetite
• nausea
• abdominal pain
• dark urine
• yellowing of the skin
and eyeballs (jaundice)
8
Symptoms of Hepatitis A
Infected individuals can spread the virus from
two (2) weeks before the symptoms begin to
two (2) weeks after symptoms end.
An infected person who has no symptoms can
still spread the virus.
Unlike some other forms of viral Hepatitis,
Hepatitis A does not cause long-term (chronic)
damage and is usually not fatal.
9
Hepatitis A Transmission
The Hepatitis A virus
• is found in the feces of infected persons. (usually spread from
person to person by putting something in the mouth that has
been contaminated with the feces of a person with Hepatitis A)
• is more easily spread under poor sanitary conditions and when
good personal hygiene is not practiced
• can be transmitted through oral and anal sexual activity
(continued)
10
Hepatitis A Transmission
• can be contracted by drinking contaminated water
• can be contracted by eating raw and undercooked shellfish
harvested from contaminated water
• can be contracted by eating fruits and vegetables or other foods
contaminated during handling
There continues to be little evidence of risk for Hepatitis A
infection in the workplace, even sharing an office with an
infected person does not pose a risk for Hepatitis A.
11
Prevention of Hepatitis A
in the Workplace
Health care workers are not considered to be at increased risk
when they follow standard infection control procedures.
The prevention of Hepatitis A in the workplace is based on good
hygiene and sanitation.
• Careful hand washing is extremely important in the prevention of
disease. You should wash your hands frequently, and before
eating, drinking, or smoking.
• You should avoid nail biting.
12
Hepatitis B (HBV)
Hepatitis B is an infectious liver disease. It is caused by the Hepatitis B Virus
(HBV). Infections of Hepatitis B occur only if the virus is able to enter the
blood stream and reach the liver.
• Ten percent of people who develop Hepatitis B become carriers of the
disease. Their blood remains infected for months, years, sometimes for life.
• Seventy percent of carriers develop chronic persistent Hepatitis B but most
do not appear to be ill.
• The remaining 30 percent of carriers experience continuous liver disease
that often progresses to cirrhosis and possibly to liver cancer.
• At present, there is no way of curing the disease in people who are carriers
of the Hepatitis B Virus.
13
Symptoms of Hepatitis B
In mild cases, the signs and symptoms are those of a minor
infection. More than half of Hepatitis B infections occur and pass
without noticeable symptoms. Sometimes, only mild symptoms
such as a general discomfort occur.
Rarely is medical attention needed. Often, the infection disappears
without treatment. In fact, laboratory testing is often the only way
of determining whether someone has had Hepatitis B.
14
Symptoms of Hepatitis B
When symptoms develop, they may include
• general discomfort
• fatigue
• lack of appetite
• skin rash
• nausea, vomiting or other flu-like symptoms
• jaundice causing skin to yellow and urine to darken--typical
signs of a malfunctioning liver.
In severe cases, liver failure can occur. People
with serious cases of Hepatitis B require
hospitalization and a very small proportion of
those infected die from the disease.
15
Hepatitis B Transmission
Blood can transmit the Hepatitis B Virus through
• punctures of the skin with blood-contaminated needles or
other sharp objects
• splashes on skin that get into tiny scratches, abrasions,
burns, or minor rashes
• splashes into the mouth, nose, or eyes
• contact with dried blood on surfaces for up to 7 days.
Saliva of people with Hepatitis B contain low concentrations
compared with blood. However, bite injuries can spread
the disease.
16
Hepatitis B Transmission
Semen and vaginal secretions can transmit Hepatitis B during
unprotected sexual intercourse.
Breast milk can transmit Hepatitis B through breast feeding.
Hepatitis B can be passed from mother to infant during birth.
Shared household items (such as toothbrushes and razors)
can transmit Hepatitis B.
Hepatitis B is not transmitted by casual contact.
17
Treatment for Hepatitis B
Currently, there is no specific treatment for people with
Hepatitis B.
18
Prevention of Hepatitis B
in the Workplace
The risk of Hepatitis B can be significantly reduced by
• Implementing infection control guidelines, including
Standard Precautions
• Immunizing staff
19
StarCare Provides Hepatitis B Vaccine Series
The Center provides the Hepatitis B Vaccine (a three
shot series is available to all employees at no cost)
which can prevent Hepatitis B, if the employee keeps all
three appointments for shots.
If an employee fails to keep any of the appointments
and then chooses to get the vaccine, they will be
responsible for getting the vaccine on their own at their
own cost.
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StarCare Provides Hepatitis B Vaccine Series
Hepatitis B vaccine provides safe, reliable protection from Hepatitis B
when used before exposure to the virus. Tests show 90 to 95 percent
of vaccinations of healthy people result in the development of
resistance against Hepatitis B. At present, vaccination is the surest
way to avoid acquiring Hepatitis B.
The CDC recommends the vaccination of people who are at increased
risk of contracting Hepatitis B because of exposure to the virus at
their workplace. They also recommend vaccination for people who
have sexual or household contacts with carriers of Hepatitis B.
21
Hepatitis C Virus (HCV)
Hepatitis C is an infectious liver disease caused by the
Hepatitis C Virus (HCV). An infection by Hepatitis C only
occurs if the virus is able to enter the blood stream and
reach the liver.
22
Hepatitis C Virus (HCV)
Half of all people who develop Hepatitis C never fully
recover and carry the virus for the rest of their lives.
These people have chronic Hepatitis C, and some may
eventually develop cirrhosis of the liver or liver failure.
23
Symptoms of Hepatitis C
The symptoms of Hepatitis C infection include
• fever
• nausea and vomiting
• loss of appetite
• stomach pain
• extreme fatigue
• yellowing of the skin and eyes (jaundice)
24
Symptoms of Hepatitis C
Some people who are infected with Hepatitis C virus have
no symptoms and can infect others without knowing it.
These persons are at risk of becoming ill at some time in
the future. It has been estimated that it may take 10 years
to develop symptoms.
25
Hepatitis C Transmission
The Hepatitis C virus is spread primarily by exposure to
blood. People may get Hepatitis C by
• sharing needles while injecting drugs
• exposure to blood
• blood transfusion (minimal but still exists)
• unprotected sex
• contact among household members who are infected
26
Hepatitis C Transmission
There is no evidence that Hepatitis C virus is spread by:
• casual contact
• sneezing, coughing or hugging
• by food or water
27
Treatment for Hepatitis C
Interferon is used to treat Hepatitis C but is effective in
less than 30% of cases.
The combination of Interferon and Ribavirin (antiviral
drug) is used for people who relapse after Interferon
treatment.
28
Prevention of Hepatitis C
in the Workplace
There is currently no vaccine for Hepatitis C.
The risk of acquiring Hepatitis C from the workplace
depends on the amount of exposure to human blood
and needle-stick injuries.
Standard Precautions are the first line of defense to
protect workers from this virus.
29
Tuberculosis (TB)
Tuberculosis is an infectious disease caused by a
germ.
The germ usually causes an infection in the lungs,
but it can affect other parts of the body.
30
Symptoms of Tuberculosis
The symptoms of Tuberculosis are similar to the
symptoms of many other diseases. Symptoms include:
•
•
•
•
•
loss of weight
loss of energy
poor appetite
fever
wet cough
31
Tuberculosis Transmission
Tuberculosis is transmitted through the air.
When an infected person coughs or sneezes, tiny
droplets which contain the germs are released and
can be inhaled by anyone in the area.
32
Tuberculosis Transmission
Not everyone infected develops TB. In fact, about 90% of
infected persons remain infected for life without having any
symptoms. A person infected with the TB germs who does
not develop the disease, cannot infect others because no
germs are discharged in the sputum or saliva.
About 10% of infected persons develop the disease. These
persons can transmit Tuberculosis because they discharge
germs in their sputum or saliva.
33
The Treatment for Tuberculosis
Medical tests such as skin tests and chest
x-ray can determine if a person has been exposed to the
germs or whether the person has the disease.
Tuberculosis can be treated very effectively through a
combination of drugs.
34
Prevention of TB
in the Workplace
• In the workplace employees can contract Tuberculosis
from infected persons.
• Screening programs that identify persons who have
been exposed to the germs causing TB can reduce the
risk of infection.
35
StarCare Testing for TB
• The Center requires every employee to have a TB test
or a chest x-ray annually.
• The Center pays the cost and the TB tests are
performed on site.
• People who have tested positive in the past are
required to go, at the Center’s expense, to OccMed
annually for a chest
x-ray.
36
Influenza (Flu)
Influenza, commonly called “the flu,” is a contagious
disease caused by viruses that infect the respiratory
tract including nose, throat, and lungs.
37
Symptoms of Influenza
The symptoms of flu include:
• fever
• cough
• sore throat
• runny nose
• headache
• muscle aches
• fatigue
Most people who get the flu recover completely. However,
some people, especially the elderly and those with chronic
health problems, can develop pneumonia.
38
Influenza Transmission
The influenza (flu) viruses are spread from person to
person when an infected person sneezes or coughs on
another person.
The influenza viruses can also be transmitted by
touching a contaminated object or surface (door knobs,
telephones, towels, money, clothing, dishes, books, etc.)
and then touching your own mouth, eyes or nose before
washing your hands. Viruses can survive on surfaces up
to eight hours.
39
Influenza Prevention
The best defense against Influenza is an annual vaccination. The CDC
recommends the influenza vaccine for the following:
• people with chronic heart or lung disease
• people who are residents of nursing homes and other chronic care
facilities
• people over the age of 65 years
• people with chronic conditions such as diabetes, cancer, and kidney
disease
• health care workers and those providing essential community services
• people wishing to protect themselves against influenza even if they are
not in a high risk group
40
Other Ways to Prevent the Flu
To prevent the transmission of the flu use the following
hygiene practices:
• cover your mouth and nose when coughing or sneezing
• use tissues to contain respiratory droplets
• wash your hands after contact with respiratory droplets and
contaminated objects
However, the most effective method of prevention is
vaccination.
41
StarCare Offers the Flu Vaccine
• StarCare offers the flu vaccine to all staff each year, usually
in October. The Center encourages all staff to take the
vaccine at no cost to the employee.
• In addition, people who live in homes operated by the
Aging and Disabilities Program and patients at SRC are
offered the flu shot.
• Other consumers are encouraged to go annually to the
Health Department for a flu shot.
42
Common Cold
The common cold is an infection of the upper
respiratory tract (the nose, nasal passages and the
throat) caused by more than 200 viruses.
43
Symptoms of the Common Cold
Symptoms of the common cold usually show up about two days
after a person becomes infected and lasts 2 to 7 days. Signs of a
cold are:
• a sore, scratchy throat
• sneezing
• a runny or stuffy nose
• headache
• watering eyes
• hacking cough
• chills
• general malaise (ill-feeling)
44
Symptoms of the Common Cold
The common cold may be accompanied by:
• laryngitis (inflammation of the larynx or
"voice box")
• tracheitis (inflammation of the membrane lining the
trachea or "wind pipe")
• bronchitis (inflammation of the bronchial membranes)
45
Common Cold Transmission
Close personal and prolonged contact is necessary for the
cold viruses to spread.
The viruses must get into the nose where they can infect the
nasal membranes. Inhaling contaminated droplets produced
when someone else coughs or sneezes is one way
to catch a cold.
You can catch a cold if you handle something that is
contaminated with a cold virus and then touch your nose or
rub your eyes.
46
Common Cold is Widespread
Common cold infections are so widespread that there can be very few
people who escape the infection each year. It has been estimated that
adults suffer 2 to 5 colds per year.
In the U. S. there are nearly 61 million cases of common cold annually
resulting in approximately 58 million bed-days.
More people catch colds when the weather temperature is cold, not
because the weather is cold, but because they are inside longer and have
closer and longer contact with people who have a cold.
47
Prevention of Colds
in the Workplace
You cannot cure a cold but you can help protect yourself from getting a
cold by following good personal hygiene practices including:
• washing your hands properly and frequently
• covering your mouth when coughing or sneezing
• wiping your nose using disposable tissues in a way that secretions are
contained by the tissue without contaminating your hands
• avoiding rubbing your eyes with dirty hands
• avoiding biting your nails (especially important for infections that are
transmitted orally)
• eating a healthy diet
• getting sufficient sleep
48
AIDS
Acquired Immune Deficiency Syndrome
AIDS is a condition in which the infection control function of the human
body weakens to the point that the body becomes likely to get a variety
of diseases. It is caused by the human immunodeficiency virus (HIV).
There is currently no cure.
The full name for AIDS, Acquired Immune Deficiency Syndrome,
describes the characteristics of the disease.
• Acquired indicates that it is not an inherited condition.
• Immune Deficiency indicates that the body's immune system breaks
down.
• Syndrome indicates that the disease results in a variety of health
problems.
49
AIDS
Acquired Immune Deficiency Syndrome
AIDS is transmitted from an infected person by body fluids
such as blood, semen or other blood-containing secretions.
As a result, anyone who has a job where they are exposed to
these body fluids has a risk of getting the disease.
50
AIDS Factors
The factors that help determine a person’s vulnerability
to HIV infection includes:
• poor social conditions
• malnutrition
• drug abuse
• infection with hepatitis B virus
• infection with sexually transmitted diseases such as
syphilis
51
AIDS Transmission
The AIDS virus can be transmitted from one person to another
through:
• unprotected sexual intercourse with infected persons (the single
most important risk of infection)
• Sharing needles during drug use with people who are infected
• contaminated needles
• transfusion of infected blood or blood products
• prenatal infection (can be transmitted from an infected mother
to her unborn child)
• organ transplants from an infected donor
52
Non-Transmitters of AIDS
The transmission of the AIDS virus occurs only when the virus
enters the bloodstream.
Casual contact with a person with AIDS does NOT pose a risk
when sharing:
• household items
• housing
• telephones
• swimming pools
• toilets
53
Non-Transmitters of AIDS
The virus:
• is NOT transmitted during the preparation or serving of food and
beverages
• is NOT known to travel through air
• is NOT transmitted by mosquitoes or other insects
• is NOT transmitted by bites from people infected with the AIDS virus
• is NOT transmitted by the following body fluids unless blood is also
present:
•
•
•
•
•
•
sweat
nasal secretions
tears
urine
vomit
saliva and sputum
54
Gloves
Even though the term Standard Precautions generally applies to
body fluids containing blood, healthcare workers should ALWAYS
wear gloves whenever handling items contaminated with the
following bodily fluids
• nasal secretions
• sweat
• tears
• urine
• vomit
• saliva and sputum
55
HIV/AIDS Tests
• An individual can be screened for HIV using a blood
test or an oral test using a swab called Orasure.
• Doctors use a laboratory test (Western Blot) to confirm
the HIV virus infection.
• Doctors diagnose AIDS by the presence of specific
illnesses that overcome the weakened immune system
and cause the high death rate
56
StarCare Makes HIV Testing Available to Staff
HIV testing is available to all staff and consumers at
StarCare.
An appointment for a confidential test can be scheduled
by calling Freddie Harris, a StarCare HIV Outreach
Worker, at
786-5246
57
Prevention of AIDS
in the Workplace
Wherever there is the possibility of contact with blood
in the workplace, workers should take precautions to
prevent contact with the skin, eyes or mucous
membranes (e.g. mouth, nose).
58
Prevention of AIDS
in the Workplace
The CDC recommends using Standard Precautions to
prevent the spread of HIV
in the workplace.
In the case of AIDS, prevention is
the only cure.
59
Standard Precautions
The U.S. Centers for Disease Control has developed the
strategy of Standard Precautions or guidelines to protect
workers from exposure to diseases spread by blood and
certain body fluids.
These precautions stress that all patients should be
assumed to be infectious for blood-borne diseases such
as AIDS and Hepatitis B.
60
Standard Precautions Use
at StarCare
Under Standard Precautions, blood and certain body fluids of all
patients are considered potentially infectious for HIV and other
blood-borne pathogens. At StarCare Standard Precautions should
be followed by any employee who is exposed to:
• blood
• semen
• vaginal secretions
• other body fluids containing visible blood
• all unknown body fluids
61
Standard Precautions
Use at StarCare
Standard Precautions should be followed by any employee
who is at risk to become exposed to any body fluid (such as
blood because they were doing an activity that they didn’t
think would lead to any exposure, such as helping someone
brush their teeth).
Standard Precautions are to be used in conjunction with
other control measures (washing hands whenever gloves are
removed or whenever the skin contacts potentially infectious
fluids).
62
Standard Precautions
• Standard Precautions refer to the practice, in medicine, of
avoiding contact with patients' bodily fluids.
• Standard Precautions are the infection control techniques
that were recommended following the AIDS outbreak in the
1980s.
• It means that every patient is treated as if they are infected
and therefore precautions are taken to minimize risk.
• Essentially, Standard Precautions are good hygiene habits,
such as hand washing and the use of gloves and correct
needle handling.
63
Prevention of Exposure
to Blood
Standard Precautions recommend the
use of:
• engineering controls (containers for disposing of used
sharps)
• safe work practices (good hand washing)
• personal protective equipment (gloves) to suit the
specific task.
64
Reporting Requirements
Report any exposure you may have by
• notifying your supervisor immediately and
• completing an Incident and Injury report and faxing it
to Risk Management (Debie Martin) within one (1)
hour of the incident
• faxing a copy of your Incident and Injury report to
Human Resources (HR) within twenty-four (24) hours
of the incident.
65
Importance of Hand-Washing
Hand washing is the single most effective way to
prevent the spread of infections.
The use of gloves is not a substitute for hand washing.
66
Importance of Hand-Washing
For effective hand washing, follow these steps
• remove any rings or other jewelry
• use warm, running water and wet your hands thoroughly
• use soap plenty of soap and lather very well
• scrub your hands, between your fingers, wrists, and
forearms with soap for 10 seconds or longer if your hands
are visibly soiled. (to wash your hands long enough sing a
short song such as "Happy Birthday")
(continued)
67
Importance of Hand-Washing
• scrub under your nails
• rinse thoroughly
• turn off the faucets with a paper towel
• dry your hands with a single use towel or air dryer
• protect your hands from touching dirty surfaces as you
leave the bathroom
68
Times for Hand-Washing
Different situations where you can pick up "germs" and should wash your
hands include
• before starting your job
• after contact with blood, blood-contaminated or any body fluids and
soiled items
• when hands are visibly soiled
• after changing diapers
• after assisting with toileting
• between contact with different consumers
• before handling or serving food
• before assisting others with eating & drinking
• before medication supervision and administration
(continued)
69
Other Times for Hand-Washing
• before going off duty
• after sneezing in your hands
• after using the bathroom (this reduces disease transmission of the
stomach "flu," which is really not a "flu" but a gastrointestinal infection)
• before and after eating, drinking or smoking
• after blowing your nose
• before and after visiting or caring for people who are sick
• after handling garbage
• after touching raw meat, poultry, or fish
• after handling pets, animals or animal waste
70
Antibacterial Soaps
and Waterless Hand Scrubs
When there is no soap or water available, waterless hand scrubs
can be used. StarCare provides Prevacare, made of ethyl alcohol
mixed with emollients (skin softeners) and other agents.
Dispensers are located in all Center buildings. Portable bottles are
also provided for staff who work in the community where hand
washing facilities are not available.
However, Prevacare is not effective when your hands are heavily
contaminated with dirt, blood, or other organic materials.
71
Prevacare Use
You should use Prevacare
• every time you enter a building
• every time you leave a building
• anytime that you should wash your hands and a
hand washing facility is not available
72
Other Tips to Reduce Infections
Other ways to reduce infections include:
• cover cuts with band aides or bandages and wear gloves for added
protection (cuts are very vulnerable to infections)
• clean your nails properly
• keep your nails short (artificial nails and chipped nail polish also have
been associated with an increase in the number of bacteria)
• keep your hands away from your eyes, nose and mouth
• assume that contact with any human body fluids is infectious
• use liquid soap in disposable containers, if possible
73
Cleaning Guidelines
In most workplaces and homes, cleaning floors,
walls, doorknobs, etc., with soap and water is
adequate.
74
Cleaning Guidelines
In some workplaces, further cleaning can be done with the
following two methods.
Method #1
Ten percent bleach solution (10 part bleach in 90 parts tap
water). This solution is effective for material contaminated
with blood and body fluids. It should be used in well
ventilated areas while wearing gloves. Do not mix bleach
with ammonia or soaps containing ammonia (will react and
form chlorine gas). Bleach is corrosive to metals.
75
Cleaning Guidelines
Method #2
Alcohol (70% ethanol) can be used on smooth metal surfaces
(tabletops, etc) where bleach cannot be used. Use with care
as it is flammable and toxic. Follow safe procedures as listed
on the manufacturers instructions. Keep away from heat
sources, electrical equipment, flames and hot surfaces. Allow
to completely dry.
76
How to Help Stop the Spread
of Infections
Ways you can reduce or slow the spread of infections include
• get the appropriate vaccine (Flu and
Hepatitis B)
• wash your hands frequently
• stay home if you are sick (so you do not spread it to other
people)
• use single-use tissues for wiping your nose
(continued)
77
How to Help Stop the Spread
of Infections
• cover your nose and mouth when sneezing and coughing
(or cough into your elbow)
• wash your hands after coughing, sneezing or using tissues
• if working with children, have them play with hard surface
toys that can be easily cleaned
• do not touch your eyes, nose or mouth (viruses can transfer
from your hands and into the body)
• do not share cups, glasses, dishes or cutlery
78
How StarCare Helps Stop
the Spread of Infections
The Center:
• has an infection control plan
• trains staff in the facts about diseases
• trains staff in infection prevention including the use of
Standard Precautions
• provides clean hand washing facilities with single-use
towels
• provides Prevacare
79
Employee Responsibilities
It is your responsibility as an employee of StarCare to protect
yourself and others against illnesses by
• always washing your hands as recommended,
• always using Prevacare as recommended,
• avoiding unprotected sex
(continued)
80
Employee Responsibilities
• avoiding illegal substance use
• carefully considering getting the Hepatitis B Vaccine and the
annual Flu shot
• getting a TB test or chest x-ray annually
• following all policies and procedures
of the Center
81
Conclusions
You have now completed the course on diseases,
Standard Precautions, and general infection controls.
Using this information is vital to your health, as well as,
the health of other employees and consumers. You
should use the precautions whether you are in the
office, in the community or at home.
By using the information you have regarding infections
you can better protect yourself and others.
82