Download Standard Precautions and Bloodborne Pathogens

Standard Precautions and
Bloodborne Pathogens
• Nurses play an integral role in preventing
infection and creating a biologically safe
environment for their patients.
• Many diseases are considered to be infectious
or communicable. Infectious diseases are the
result of microorganisms known as pathogens
that enter the body and cause disease.
An infection is an invasion of the body by a disease causing organism called
an infectious agent. Once an infection occurs, the signs and symptoms are
distinct. Disease causes the body to function differently. Some pathogens
are stronger than others in their ability to cause disease and this is known
as virulence. Infections also differ in their ability to be communicated to
another person. The common cold or flu can be spread readily through
coughing, sneezing, etc; whereas, Hepatitis B or HIV are much more
difficult to transmit as they require blood to blood transmission.
A communicable or infectious disease is a disease that
can be transmitted from one person to another through
direct or indirect contact. The mode by which a infectious
disease can move from one to another is known as a
vector.
Types of Microorganisms
*Bacteria are the most common type of
microorganism . They can live and be
transported in the air, food, water, soil,
inanimate objects as well as be
transported in body tissues and body
fluids.
*Viruses can also cause infections but are
the smallest disease-causing agent.
*Fungi are either yeast or molds.
*Parasites live on other living organisms.
Chain of Infection
Infectious Agent
Able to cause infection.
Carrier has ability to cause
infection but no signs or
symptoms.
Eliminated or controlled
through disinfection or
sterilization
Reservoir
Where the organism normally
lives.
Includes humans, animals,
plants, insects, birds, or
food/water.
Proper handling of food,
blood, and body fluids.
Portal of exit
The way the organism leaves the reservoir.
May be a body fluid.
Proper handling prevents organism from exiting the
reservoir
Portal of Entry
Usually the same as portal of
exit.
Intact skin and mucous
membranes provide a barrier.
Transmission
The way the organism gets to the
host.
Direct contact
Organism passes directly from one
person to the other.
Indirect contact
Organism passed via contaminated
equipment or hands.
Airborne
Organism passed through dust or
droplets.
Prevention
Barrier devices such as masks, gowns,
gloves.
Proper hand hygiene and cleaning
contaminated equipment.
Susceptible Host
Cannot cause infection if host
is not susceptible.
Factors that increase
susceptibility:
Age
Nutrition
Diseases
Heredity
Medications
Stress
Prevention: minimize factors
that increase susceptibility.
Risk Factors for Increased Susceptibility
Age
Genetics
Stress
Nutrition
Medical therapies/diseases
Medications
Smoking
Culture/ethnicity/socioeconomics
Nosocomial Infections
Definition: Infections that occur after
hospital admission (Hospital-acquired).
Proper hand hygiene: Essential to prevent
the spread of infection.
Correct technique with medical devices:
Proper use of supplies and equipment.
Resistant organisms: MRSA/VRE, etc.
Prevention of Infection
Infection can be prevented if one link in the chain is disrupted.
Standard Precautions
All clients in all facilities: Standard Precautions are the same at every facility with every
client.
Proper hand hygiene: Proper hand washing is essential in breaking the chain of infection.
Barrier devices: Proper and appropriate use of PPE.
Disposal of contaminated equipment: Disposal in accordance with the facility to which
you are assigned.
Disinfection of reusable equipment and linen: Disinfect in accordance with the facility to
which you are assigned.
Placement of infected clients: Per infection control guidelines for the facility to which you
are assigned.
Standard Precautions
Transmission Based Precautions
Clients with known or suspected infections:
Precautions should be taken if any communicable or
infectious disease is known or suspected.
Tailored to the mode of transmission:
Appropriate isolation measures should be taken.
Personal protective equipment: Use the
appropriate level of PPE for the care you will be
providing and the anticipated risk of exposure.
Transporting the client: Transporting of clients with
communicable/infectious diseases outside of their room should be
done only if necessary to carry out care for the client. The client must
adhere to isolation precautions such as wearing a mask outside of the
room.
Reverse Isolation: May be placed on isolation precautions to protect the
client who may have had an organ transplantation, bone marrow
transplant, etc that makes them more susceptible to infection.
Removal of contaminated items :Removal of all equipment and supplies that
have been contaminated is essential to infection control. Ensure these items
have been cleaned per the recommendations of the CDC and the in accordance
with the policies of the facility to which you have been assigned.
Hand Hygiene
Adjust the Water Flow
Some sinks will have knee or foot pedals that control the water,
while others will be the more traditional sink.
Interlace Fingers
Figure 9-6 Interlacing the fingers during hand hygiene.
(Photographer: Elena Dorfman.)
Figure 9-8 The hands are held higher than the elbows during hand
hygiene before a sterile technique
.
Figure 9-7 Using a paper towel to grasp the
hand-operated faucet to turn off the water if
foot pedals are not available. (Photographer:
Elena Dorfman.)
Personal Protective Equipment
Gloves
Gowns
Eyewear
Masks
It is essential to utilize the appropriate level of PPE when
providing care for the client with a communicable or infectious
disease.
Disposal of Soiled Items
Disinfection
Disposal
Bagging
Use only facility approved solutions for the disinfecting of equipment.
Disposal of items that cannot be cleaned thoroughly or disposal of items
that are not for re-use should be done according the facility’s policy to
which you are assigned.
WHAT IS HEPATITIS?
Hepatitis means an inflammation, or swelling, of the liver. Viruses can cause hepatitis. Alcohol,
drugs (including prescription medications), or poisons can also cause hepatitis. So can
opportunistic infections such as Mycobacterium Avium Complex (MAC, see fact sheet 514) or
Cytomegalovirus (CMV, see fact sheet 504).
Hepatitis is a very common disease. It can affect people even if their immune systems are healthy.
Hepatitis can lead to serious scarring (cirrhosis) of the liver and liver failure, which can be fatal.
Many cases of hepatitis aren’t treated because people either don’t feel sick at all, or think they have
the flu. The most common symptoms are loss of appetite, fatigue, fever, body aches, nausea and
vomiting, and stomach pain. Some people may have dark urine, light-colored bowel movements,
and a yellowing of the skin or of the eyes (jaundice).
Hepatitis A and E are both acute diseases. They are spread by contact with fecal matter, either directly or from water that has
sewage in it, or through food handled by someone with contaminated hands. Hep A and Hep E do not cause chronic illness.
Hepatitis B is the most common hepatitis virus. It can be transmitted from mother to infant, through sexual contact, or through
contact with infected blood. Globally, about 10% of people with HIV also are infected with hepatitis B (HBV.) People with HIV are
much more likely to develop chronic HBV. Hepatitis B is more serious in people with HIV, but some HIV drugs (3TC, tenofovir,
emtricitabine) fight HIV and HBV. For more information, see the Treatment Action Group's Guide to Hepatitis B at
http://www.treatmentactiongroup.org/hcv/publications/2009/hbv-guide
Hepatitis C is usually spread by direct contact with blood, usually through sharing needles and other injection equipment. Although it
doesn’t happen as often, some people—especially HIV+ MSM—have gotten HCV from unprotected sex. About 75-85% of people
infected with HCV develop chronic hepatitis. Hepatitis C can be very mild or show no symptoms, but over 15-50 years, can cause
serious liver damage in about 20% of people. .HIV worsens hepatitis C. See Fact Sheet 507 for more information on hepatitis C and
HIV.
Hepatitis D only shows up in people who get hepatitis B. People who get type D get sicker than people who just have type B.
The best way to prevent viral hepatitis is through cleanliness and by avoiding contact with blood. You may not know if someone else
is infected. Condoms can help prevent transmission of hepatitis B and C. Also, there are vaccines that can protect you against
developing hepatitis A and B, even if you’ve already been exposed to them. These vaccines may not work for people with CD4
counts below 350.
There are no treatments for hepatitis A and E, but they usually only last a couple of weeks. Pegylated interferon and three drugs used
against HIV - lamivudine (3TC), tenofovir (TDF) and emtricitabine (FTC) - help treat hepatitis B and D. In September 2002, adefovir
dipivoxil (Hepsera) was approved in the US to treat hepatitis B, Tenofovir was approved in August of 2008 and is a better treatment
for hepatitis.
Fact sheet 507 has more information on drug treatments for hepatitis C. Several drugs are being developed to treat HCV.
Hepatitis C Virus (HCV)
Structure of Hepatitis C Virus
The Hepatitis C virus (HCV) is a major cause of acute hepatitis and chronic liver disease, including
cirrhosis and liver cancer. According to estimates from the Centers for Disease Control and
Prevention, an estimated 3.9 million Americans (1.8%) have been infected with HCV, and 2.7 million
are chronically infected. The number of new infections per year has declined from an average of
240,000 in the 1980s to about 30,000 in 2003. Illegal injection drug use is the primary cause of
infection. Approximately 80% of the persons infected with Hepatitis C have no signs or symptoms.
Those that have symptoms and signs may exhibit the following:
•Jaundice
•Fatigue
•Dark Urine
•Abdominal Pain
•Loss of Appetite
•Nausea
HIV is the human immunodeficiency virus. It is the virus
that can lead to acquired immune deficiency syndrome, or
AIDS. CDC estimates that about 56,000 people in the United
States contracted HIV in 2006. There are two types of HIV,
HIV-1 and HIV-2. In the United States, unless otherwise
noted, the term “HIV” primarily refers to HIV-1. Both types
of HIV damage a person’s body by destroying specific blood
cells, called CD4+ T cells, which are crucial to helping the
body fight diseases. Within a few weeks of being infected
with HIV, some people develop flu-like symptoms that last
for a week or two, but others have no symptoms at all.
People living with HIV may appear and feel healthy for
several years. However, even if they feel healthy, HIV is still
affecting their bodies. All people with HIV should be seen
on a regular basis by a health care provider experienced
with treating HIV infection. Many people with HIV, including
those who feel healthy, can benefit greatly from current
medications used to treat HIV infection. These medications
can limit or slow down the destruction of the immune
system, improve the health of people living with HIV, and
may reduce their ability to transmit HIV. Untreated early
HIV infection is also associated with many diseases including
cardiovascular disease, kidney disease, liver disease, and
cancer. Support services are also available to many people
with HIV. These services can help people cope with their
diagnosis, reduce risk behavior, and. find needed services.
AIDS is the late stage of HIV infection, when a person’s immune system is severely
damaged and has difficulty fighting diseases and certain cancers. Before the
development of certain medications, people with HIV could progress to AIDS in
just a few years. Currently, people can live much longer - even decades - with HIV
before they develop AIDS. This is because of “highly active” combinations of
medications that were introduced in the mid 1990s.
No one should become complacent about HIV and AIDS. While current medications can
dramatically improve the health of people living with HIV and slow progression from
HIV infection to AIDS, existing treatments need to be taken daily for the rest of a
person’s life, need to be carefully monitored, and come with costs and potential side
effects. At this time, there is no cure for HIV infection. Despite major advances in
diagnosing and treating HIV infection, in 2007, 35,962 cases of AIDS were diagnosed
and 14,110 deaths among people living with HIV were reported in the United States.
HIV is spread primarily by:
Not using a condom when having sex with a person who has HIV.
All unprotected sex with someone who has HIV contains some risk.
However:
Unprotected anal sex is riskier than unprotected vaginal sex.
Among men who have sex with other men, unprotected receptive anal sex is riskier than
unprotected insertive anal sex.
Having multiple sex partners or the presence of other sexually transmitted diseases (STDs) can increase the
risk of infection during sex.
Unprotected oral sex can also be a risk for HIV transmission, but it is a much lower risk than anal or vaginal
sex.
Sharing needles, syringes, rinse water, or other equipment used to prepare illicit drugs for injection.
Being born to an infected mother—HIV can be passed from mother to child during pregnancy, birth, or breastfeeding.
Less common modes of transmission include:
Being “stuck” with an HIV-contaminated needle or other sharp object. This risk pertains mainly to healthcare
workers.
Receiving blood transfusions, blood products, or organ/tissue transplants that are contaminated with HIV. This risk
is extremely remote due to the rigorous testing of the U.S. blood supply and donated organs/tissue.
HIV may also be transmitted through unsafe or unsanitary injections or other medical or dental practices. However,
the risk is also remote with current safety standards in the U.S.
Eating food that has been pre-chewed by an HIV-infected person. The
contamination occurs when infected blood from a caregiver’s mouth mixes with food
while chewing. This appears to be a rare occurrence and has only been documented
among infants whose caregiver gave them pre-chewed food.
Being bitten by a person with HIV. Each of the very small number of cases has
included severe trauma with extensive tissue damage and the presence of blood.
There is no risk of transmission if the skin is not broken.
Contact between broken skin, wounds, or mucous membranes and HIV-infected
blood or blood-contaminated body fluids. These reports have also been extremely
rare.
There is an extremely remote chance that HIV could be transmitted during “French”
or deep, open-mouth kissing with an HIV-infected person if the HIV-infected person’s
mouth or gums are bleeding.
Tattooing or body piercing present a potential risk of HIV transmission, but no cases of HIV transmission from
these activities have been documented. Only sterile equipment should be used for tattooing or body piercing.
There have been a few documented cases in Europe and North Africa where infants have been infected by
unsafe injections and then transmitted HIV to their mothers through breastfeeding. There have been no
documented cases of this mode of transmission in the U.S.
HIV cannot reproduce outside the human body. It is not spread by:
Air or water.
Insects, including mosquitoes. Studies conducted by CDC researchers and others have shown no evidence of
HIV transmission from insects.
Saliva, tears, or sweat. There is no documented case of HIV being transmitted by spitting.
Casual contact like shaking hands or sharing dishes.
Closed-mouth or “social” kissing.
All reported cases suggesting new or potentially unknown routes of transmission are thoroughly investigated
by state and local health departments with assistance, guidance, and laboratory support from CDC.
What are bloodborne pathogens?
Bloodborne pathogens are microorganisms in human blood or certain body fluids that
cause disease in humans. The most common ones are the hepatitis B virus (HBV),
which causes a severe form of Hepatitis in some or acts as a carrier in others, and the
human immunodeficiency virus (HIV), which causes AIDS.
How do you become infected?
Bloodborne pathogens may be passed on when the microorganisms enter the body
through mucus membranes, through breaks in the skin or through needle sticks. In
non-medical occupations, exposure is most common when an injured worker’s blood
contacts a co-worker rendering first aid. Practicing universal precautions and wearing
the proper personal protective equipment will prevent exposure.
What are universal precautions?
Universal precautions are methods of preventing infection by treating all human body
fluids as if they were contaminated and using proper personal protective equipment
whenever you are required to come into contact with these fluids. Qualified, trained
first-aid providers should be knowledgeable of these precautions.
What should I do to protect myself?
Personal protective equipment (PPE) includes latex gloves, gowns, mouth pieces,
resuscitation bags,
face masks and foot protection. Proper use can significantly reduce the health risks for
exposed workers.
Utilizing the proper PPE and being
cautious about Bloodborne Pathogens,
you can avoid making yourself and your
clients ill.