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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. 20 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