Blood Borne Pathogens

Bloodborne andAirborne pathogens

Ruth Weiscarger, BSN, RN 10 points per question 1-9. 1Pathogen

A pathogen is any agent that causes diseaseBloodborne PathogensDisease causing microorganisms (viruses, bacteria, or parasites) carried in human blood.

Common bloodborne pathogens include: Hepatitis A Hepatitis B HIV

Pathogens may be transmitted through unprotected contact with human blood or body fluids.Blood borne pathogens are disease-causing . Microorganisms (viruses, bacteria, or parasites) carried in the human blood. May be transmitted by blood splashes, or sprays, handling or touching contaminated items or surfaces, and infection under the skin by puncture wounds or cuts from contaminated sharps. Example: Needle sticks. Most occupational transmission of HIV has occurred through puncture injuries from contaminated sharps.3Airborne PathogensAirborne pathogens are disease-causing agents that spread infection through droplets or dust.Eg. Coughing, sneezing.

For example the common cold is moved from person to person by coughing and sneezingCombining the strategies of respiratory hygiene and cough etiquette helps minimize the transmission of air borne pathogens. 4Chain of Transmission Several elements must exist for a pathogen to cause illness or disease:Source-infected person or animalRoute of Transmission-contact, air, etc.Portal of entry-cut, nose etc.Susceptible host

Several elements must exist for a pathogen to cause illness or disease. These elements are referred to as the chain of transmission. The chain includes

SourceRoutePortal of entrySusceptible host Common portals of entry are mucous membranes, the respiratory tract, and non-intact skin open cuts. 5OSHAUS Department of Labors Occupational Safety and Health Administration (OSHA)

Regulations issued to protect employees of certain jobs from BLOODBORNE/AIRBORNE pathogens.

Regulations are known as OSHA Bloodborne Pathogen Standard

Employee safety is insured by training, education, safety measures and exposure control.Blood Borne Pathogens and the LAW: Because certain jobs may involve contact with blood or body fluids, the US DEPT of Labor Occupational Safety and Health Administration (OSHA) issued regulations to protect employees from blood borne pathogens. The regulations are known as the Bloodborne pathogen standards.6OSHA RegulationsOSHA Bloodborne Pathogen Standard was first issued in 1991 to protect employees from occupational exposure to bloodborne pathogens.

Respiratory Protection Standard are designed to promote employee safety through proper training, education, prevention and exposure control methods. 7OSHA Regulations Regulations require employers to use a combination of engineering and work practice controls such as protective clothing and equipment, safety precautions in the workplace.

Go over slide: These are also referred to as Protective barriers. Examples gowns, gloves, goggles. Needles devices. Sharps containers. Employees required to receive training related to the Barriers they should wear when taking care of a patients universally, what protective barriers they may need for patient in specific isolation or what they should use for a specific procedure. Talk about examples of what they will see at some of the clinical sites.

8Engineering ControlsControls/products protective barriersdesigned/developedto create a saferworking environment.

Ex. Needleless systems, sharps containers, eye stations.

Most hospitals have needless IV systems, needles that when used properly protect the needle. Engineering controls are simply barriers and products put in place to protect you the health care worker. If you dont wear THE PROTECTIVE EQUIPMENT OR USE THE EQUIPMENT AS INTENDED you are putting your self at risk FOR EXPOSURE THAT COULD BE PREVENTED. In addition when you go from room to room patient to patient need good hand hygiene and utilize appropriate barriers.9OSHA TrainingGoal of training is to educate employees regarding bloodborne pathogen issues and how to minimize or eliminate the exposure to bloodborne pathogens by using a combination of standard precautions, personal protective equipment (PPE) , work practice controls, and engineering controlsTraining is initiated upon hire and must be done within the first year of employment. Standards must be updated yearly and when new standards are implemented.

The scope of the standards addresses not only employees who may have direct contact with blood or body fluids but the potential for exposure. Example even secretaries, receptionists in clinical areas. Employees who are required to handle blood or Education Examples: using appropriate engineering controls depending on the procedure, or type of isolation involved. The barriers required are identified on policy and procedures and in nursing references. Disvcuss what you can find at WBGH: Mosby, Clinical Policies. 10OSHA EXPECTATIONS

Objective is to minimize or eliminate the hazard posed by the exposure.

Prevent infection by immunization when possible.

Knowledge of symptoms of infection.

Counseling after exposure incident.

Post exposure treatments and follow-up.WHO NEEDS OSHA TRAININGAnyone who has the potential for exposure to blood or other potentially infectious materials (OPIMs).

Ex. Physicians, nurses, physicians assistants, nurse practioners, other healthcare employees.

Anyone who has potential . ER admission or intake person. Employees of clinical and diagnostic laboratories, housekeepers in health care facilities. Employees in hospital or laundries tissue bank personnel, blood banks, plasma center, freestanding clinics urgent centers.

12ROUTE OF TRANSMISSIONContactDroplet FoodAir vector Contact is the most common means of transmission. Direct contact occurs when a pathogen is passes from person to person. Example someone has an open cut on their hand and fails to wear gloves when rendering care to a patient with an open bleeding wound. Indirect contact occurs when a person is exposed to pathogens (contaminated items ) such as bed linens, contaminated objects or soiled dressings.

Droplet transmission occurs when droplets contaminated with infectious pathogens are expelled during coughing or sneezing, talking, aerosol generating procedures such as suctioning are transferred into the air through the hosts mucous membranes with in 3 to 6 feet of the infected person. In some circumstances Pathogens considered to be transmitted by droplets may also be transmitted by droplets. Example common cold. Most well known airborne-transmitted disease is TB, which affects the respiratory system as well as other organ systems. Vector ( nonhuman transmission) occurs when animals or insects ( fleas, mosquitoes, birds, rodents, malaria, or West Nile virus.)13Hierarchy of controlsBoth OSHA and the CDC believe that preventing pathogen exposures requires a comprehensive program of strategies:Administrative controls: Providing vaccinations and promptingInfection prevention and control training programsEngineering controls eg, needless devices, plastic capillary tubesWork practice controls: Hand hygiene, no needle recapping

Administrative controls are polices and programs that manage and support the infection prevention control program. These programs may include vaccination programs. Some offer flu and pneumonia vaccinations, hepatitis B free of charge. Tetanus DPT, chicken pox. An example of a work place control /Administrative control are designated areas. Nurses stations are clean areas and there should be no food or drink in theses areas. 14Engineering Controls Hand washing stationsEye wash stationsSharps containersBiohazard labelsNeedless devices and self sheathing needles

Examples of what would be considered engineering controls.Hand hygiene/hand washing is one of the most effective methods of preventing transmission of pathogens/infection. Wash hands between patients.It is required that you wash your hands before and after taking care of a patient. Wash hands after removal of gloves. PPE Personal Protection Equipment. Gloves, gowns, masks ect..goggles, face masks, masks on patients traveling with droplet or air borne processes.

15Contaminated Sharps Any contaminated object that can penetrate skin, including but not limited to needles, scalpels, broken capillary tubes, exposed ends of dental wires.

A sharps is any contaminated objectsee slide16Contaminated Sharps Contaminated needles or sharps must NOT be bent, recapped, or removed unless no alternative is feasible.

Reusable sharps must be placed in clearly labeled, puncture-resistant, leak-proof containers immediately or as soon as possible after use.

Reusable sharps must be decontaminated before reuse. 17Sharps ContainersThe Federal Food and Drug Administration (FDA) regulates sharps disposal containers as Class II Medical devices.

OSHAs Bloodborne Pathogens Standard establishes minimum design performance elements for sharps disposal containers.

A sharps container must have a biohazard label.According to the standard the sharps container must meet four criteria to be considered acceptable. Must having a warning labeled, color coded, it must be closable, puncture resistant, leak proof on the sides and the bottom.18Sharps ContainersA sharps container must meet certain criteria to meet the Standard:Must be closablePuncture resistantLeak proof on sides and bottomLabeled or color coded

Discuss location, patient rooms, dirty utility rooms, med rooms. Emptied when full. Some hospitals remove and empty by them selves others have companies come in 1-2 times per week to change them. Laboratory personal and IV therapy staff have small ones in baskets. See examples, needles devices, IV catheter, and needleless systems. 19Sharps ContainersDuct tape may be used to secure a lid but may not be used to serve as a lid.

Sharps containers must be maintained in an upright position and not be overfilled.

Whatever goes into a sharps container stays in the sharps container, do not attempt to remove it.

Transmission of pathogensTransmission occurs when blood or other potentially infected materials come in contact with mucous membranes or non-intact skin.

The needlestick safety prevention act became effective April 2001. Required employers to implement new developments in control technology. (Needles systems).Involve non-managerial employees with direct patient contact for input and on committees to look at and evaluate the selection of devices (engineering controls). Maintain a log of percutaneous injuries from contaminated sharps. (employee Health is required to report at Infection Control meeting.Annual meeting and review with staff representation and all disciplines to participate. Identify priority areas, areas with increase in needlestick or sharps injuries. Staff has to evaluate, participate in safety audits.21Transmission of pathogensMay also be transmitted by blood splashes, handling contaminated items and injection by a contaminated needle.

Needle stick and other sharps injuries are primarily associated with the following activities: disposing of needles, administering medications, injections, drawing blood, recapping needles, or handling linens and trash. Give examples.22Respiratory HygieneRespiratory hygiene/Cough etiquette helps to minimize the transmission of aerosol-transmissible pathogens, these include:Covering mouth/nose during coughing and sneezing using tissues or masks to contain secretions.Disposing of tissues/masks contaminated with secretions properly.Hand hygieneEnsuring spatial-separation of at least 3 from others when coughing.IN many organizations, hand hygiene devices are available by the elevators, entrance to patient room, strategic areas in hall, near rest rooms. Ect.Many organizations have posters that demonstrated respiratory etiqutte. Masks if cold. Or no flue shot. 23Clean Work SurfacesThe term work area indicates an area in which you work involving exposure or potential exposure to Blood or Body fluids, along with the contamination of surfaces.The employer will identify which areas may become contaminated with blood or body fluids. For example: Nurses station, lab stations, ER triage areas. Central supply, OR., recover. Discuss nurses station.

No food or drinks in the nurses station. Eatting, drinksin, applying lip balm or, or handling contacts are prohibted in work areas where there is reasonable expecation og exposure to blood or body fluids. T

Talk about specimen collection.

Tube stations, and urine specimens. 24Standard PrecautionsAn aggressive standardized approach to infection control.

These infection control practices apply to all patients and animals in the research setting regardless of suspected or confirmed infection status.

Treats all bodily substances as if they contain pathogens.IN the past referred to as universal precautions. Wear gloves with any potential blood or body fluids. 25Standard PrecautionsStandard precautions are a combination of Universal precautions and body substance isolation.

Standard Precautions recommend:Hand hygieneRespiratory hygiene, cough etiquette, safe injection practices, use of gown, glove, mask, eye protection, If you refer to your resources before you do a procedure they will usually detail barriers to use.

Example trach care /suctioning. Give examples gloves with blood or body fluids, expect coughing spitting gowns and or mask and goggles. 26Hand HygieneA general term that applies to any one of the following

Hand washing with plain soap and waterAntiseptic hand washAntiseptic hand rubSurgical hand antiseptics

Hand hygiene is the first line of prevention of infection. Hand hygiene before you go into a patient room, hand hygiene on way out, any contact with patient, in between patients. Soap and water when in contact with blood or body fluids. After going to bathroom, coughing and or sneezing. 27Substances requiring standard precautionsBloodSalivaMucousSweatSemanVaginal secretionsCerebrospinal fluidSynovial fluidPleural fluidAny body fluid with visible blood

Transmission-based precautionsRecommended to provide additional precautions beyond standard precautions to interrupt the transmission of pathogens.

All healthcare personnel must adhere strictly to the isolation precautions that are ordered for patients in the healthcare facility.

The following precautions should be used in addition to standard precautions.Referred to as Isolation Protocol.29Contact PrecautionsContact precautions are used to protect and prevent the spread of infection. Protect from infections spread by skin-to-skin contact or contact with other surfaces such as linen, doorknobs, counters. Example: staphylococcus aureus

Contact precautions: Isolation type will be indicated, many hospitals or facilities have caddies with supplies need upon entering that room. Private rooms, or cohorting patients with identical organisms.

Hand hygiene Gloves, Gowns, entering MRSA, Chicken Pox, ESBL, VRE, CDIFF. You will see in your clinical areas a lot of isolations. Reasons, patients are screened for MRSA if they are coming in from a nursing home, or from another health care facility. All patients screened if admitted to ICU, screened for MRSA. Many hospitals have polices if they had MRSA or others on a previous admission are always isolated when readmitted. Exiting removal of above and hand hygiene. 30Droplet PrecautionsDroplet precautions are used for infectionscaused by large droplets. They can be spread bycoughing, talking, or sneezing such asinfluenza.

Practice good hand hygiene on the way in to every room. Between each patient, hand hygiene on the way out of the room. Hand hygiene on the way in to room, gloves, gowns, mask, potentially eye wear, and hygiene after removal of barriers.Flu, MRSA sputum, TB. Most patients in Droplet isolation are also considered contact isolation.Isolation Read sings they will tell what you need to put on.31Airborne PrecautionsAirborne precautions are used for infections that spread small particles in the air such as chickenpox, and tuberculosis. Many times you will see patients in isolation, DROPLETT, and CONTACT

Droplet precautions32Reporting If exposure to blood or OPIM occurs, the incident must be documented.

Information should include: name, job, classification, location of incident, engineering controls in use at time of incident, procedure being done, protective equipment, training.

You would immediately report any occurrences' to your clinical instructor. The goal of reporting is to ensure that you as an individual receives timely access to medical services and to identify methods for future prevention. 33Hepatitis Hepatitis is an inflammation of the liver caused by drugs, poisons, toxins or blood borne pathogens.

Viral hepatitis is the leading cause of liver cancer and liver transplants in the United States.

Hepatitis BCan affect anyone.It is estimated that 1 to 1.4 million persons in the U.S. are chronically infected with HBV.There has been a decline since the implementation of the Hepatitis B vaccine.Persons at higher risk for HBV are infants of mothers with HBV, those who engage in risky behaviors, have a preexisting health condition, and healthcare workers.

Common sense things. If you have an exposure to blood or body fluids, immediately wash the exposed area with warm water and ASAPIf your exposed area was you mouth rinse your mouth with water or mouthwash.Eyes flush with warm water.Report incident.35Clinical FeaturesSymptoms generally last from 4 to 6 weeks.Jaundice (yellowing of eyes and skin).FatigueAbdominal painLoss of appetiteIntermittent nauseaVomitingFever Joint painGray colored stools

36Hepatitis BIncubation period from time of exposure averages 12 weeks with a range of 4 weeks to 6 months.

No cure, vaccination is the best protection

Approximately 90% of HBV cases resolve without further complication, about 6% to 10% will progress to chronic HBV.

Hepatitis B

PreventionStandard Precautions protective barriers are key in preventing the spread of HBV.Vaccination is the best protection against contracting HBV THE CDC Reports:An unvaccinated person has the risk of contracting HBV from a single needle stick post exposure to a HBV infected blood ranges 6%-30 %.Vaccinated person who has developed immunity there is virtually no risk.Vaccinate39HBV VaccineImmunization is required for all health care workers at no cost to the employee.

Series of 3 injections: first injection second injection one month later third injection 5 months after the second one.Treatment Supportive care treat symptomsChronic Hepatitis B, liver transplantation may be a treatment optionHepatitis CMost common chronic bloodborne infection in the US.It is estimated that 3.9 million Americans have been infected with HCV 2.7 million are chronically infected.Fortunately in the last 5 years the incidence has declined.

Transmitted primarily through large or repeated direct percutaneous exposures to blood.

No vaccine for Hepatitis C.

Prevention is directed toward the use of engineering and work practice controls, and personal protective equipmentThere is no vaccine for HepatitisInjectable drug abuse accounted for a substantial portion of HCV infection. Accounts for 60 % of the transmission in the US. Others at high risk are infants born to mothers with HEP C. Those who share personal items, shavers, toothbrushes, preexisting health conditions. Tattooing if unclean needles were used. Unprotected sex. THE CDC has reported that the prevalence of HCV infection among health care workers id no greater than the greater population, averaging 1-2 % and is 10 times lower than HBV amonst health care workers.Aneedlestick injury id the nly occupational risk factor that has been associated with HCV infection.

42Clinical Features70% to 75% of patients with hepatitis C are asymptomatic.

Symptoms may include:JaundiceFatigueAbdominal painLoss of appetiteIntermittent nauseavomitingTreat the symptoms.43Clinical FeaturesIncubation period averages 7 weeksBut can be between 3-20 weeks.

Chronic infection is common, affecting more than 85% of people infected.

Chronic liver disease may occur in 70% of those infected with HCV.

8,000 to 10,000 deaths occur each year as a result of HCV-associated liver disease.Treatment44Treatment HCV is best addressed through supportive careAntiviral medications may have some benefit in the early stages of the disease and may be used as a treatment option for chronic infection If the liver damage is severe, a liver transplant may be a treatment option.Human Immunodeficiency VirusAcquired immunodeficiency syndrome (AIDS) HIV is a condition in which the body is unable to fight off infection or destroy mutated cells.

The body is vulnerable to opportunistic infections and cancer.Routes of transmissionPersons at higher risk include:Infants of mothers with HIVThose who engage in risky behaviors such as drug abuse, unprotected sexual encounterspre-existing health conditionsExposure to HIV

47Clinical PresentationNight sweatsWeight lossFever fatigueGland painSwellingMuscle painJoint pain

Post ExposureTesting done ASAP and periodically for at least 6 months.

Antibodies usually become detectable within 3 months of infection.

99.7% of exposures do NOT lead to infection.

If treatment with antiviral medications plus a protease inhibitor is recommended, treatment should begin within hours of the exposure.PreventionThere is no vaccinationStandard Precautions/Protective barriers are keys to prevention in a occupational/clinical setting

Airborne PathogensDiseases that can be transmitted by droplet or airborne routes.

Airborne transmission occurs when droplet particles from an infected person enter a susceptible host.

InfluenzaInfluenza or flu is an illness that is easily spread from person to person.

Primarily effects the respiratory system.

Epidemics occur in late fall to early spring.

Rates of flu are usually higher in children andadults older than 65 years of age.Typical flu season is Oct 1, through March 31.

52InfluenzaSeveral strains of the influenza may exAirborne pathogens are transmitted through droplets or dust.

Large droplets can travel short distances and cause direct transmission.

Small droplets can turn into an aerosol and can float in the air for long distances.

Sneezing can transmit disease through direct contact and airborne routes.

InfluenzaIncubation period is approximately 1 to 3 days.

Only considered immune if vaccinated.

Centers for Disease Control and Prevention (CDC) states that it is effective between 70% and 90%.

Effectiveness also depends on age, disease, and immune status.

No vaccine is 100% effective. Implement preventive strategies.

Clinical PresentationPrimary Symptoms:FeverMalaiseMuscle achesBody achesSore throatRunny nosecough

Other possible symptoms:DiarrheaEye infectionsPneumoniaRespiratory distress

This is how you feel

Post exposure TreatmentPrescription antiviral medications may be indicated, must be administered within 48hrs to be effective.

Proper Hand washing.

Standard droplet precautions for suspected and confirmed cases.FYI Viral cultures are collected yearly, these cultures provide information about influenza strains and subtypes.

This information is used to guide formulation of vaccines for the next flu season.

Swine FluIn 2009, a new strain of influenza began to spread. Also known as (H1N1).

Origin of strain was found to be from the pig, (swine).

Reached pandemic proportions in the US.

Currently under control due to preventative precautions.

Avian FluAlso known as (H5N1).

Caused by influenza type A subset that is normally found in birds and crossed over to humans.

Symptoms are similar to seasonal influenza.

Prevention includes, avoid contact with poultry and other birds suspected of being infected.Tuberculosis (TB) TB is caused by mycobacterium tuberculosis.

Approximately 85% occurs in the lungs.

Other 15% may occur in central nervous system, kidneys, lymph nodes, and skeletal system.

TB is serious and often fatal if left untreated.

TuberculosisAfter infected, the bacteria can live inside the human host in a dormant state for years without causing health effects.

This is known as latent TB infection (LTBI).

The only sign of LTBI is a positive reaction to the tuberculin skin test.

Cannot spread the disease to others but have a 5% to 10% risk of developing active TB.

Active TuberculosisOccurs when the bodys immune system cannot stop the bacteria from multiplying.

People with active TB can spread the disease to others.

TB is primarily spread from person to person through droplet nuclei suspended in the air by coughing, sneezing, or talking.Most health care employers will require a TB test on hire and annually. Nursing programs require for admissison.63Active TuberculosisIncubation period is at least 6 weeks.

Anyone is susceptible to TB.

Higher risk: immunocompromised long term corticosteroids HIV cancers

64Clinical PresentationCoughProduction of sputumWeight lossLoss of appetiteWeaknessFeverNight sweatsMalaiseChest painHemoptysis (coughing up blood) later in disease

Postexposure If TB is confirmed before you become ill, preventative therapy is almost 100% effective. Usually patient will be medicated with a daily dose of isoniazid and this will prevent the development of infection.

CDC has TB Guidelines with recommended controls to minimize TB transmission. TB screeningHealthcare workers are at risk for TB, testing should be provided free of charge from employer.

Mantoux test which uses an intradermal injection of purified protein derivative (PPD) is the test used for screening.

Forearm is usually used, very small amount of PPD is injected intradermally until a small bleb is made. The bleb will disappear.TB Testing Injection site is checked for reaction in 48 to 72 hours.

A positive reaction is usually hard, red and bumpy swelling at injection site.

TB TestA positive skin test means that an infection with M tuberculosis has occurred.

Does not prove that individual has TB.

TB TestingIf someone had had close contact with a person who has TB and has a negative reaction, they should be retested in 10 weeks.

If a person has had a positive reaction in the past , they should have a chest x-ray to confirm a diagnosis.MeningitisMeningitis is the inflammation of the protective membranes (meninges) covering the brain and spinal cord.

Meningitis can be caused by bacteria, fungi, viruses and other organisms.

Bacterial form is highly contagious and more serious than viral meningitis.

Viral meningitis is the most common form.MeningitisPrevention: One vaccine can prevent four variants of meningitis.

Transmission occurs through direct contact and airborne (droplet) routes.

Incubation period is 2 to 10 days.

Anyone is susceptible to meningitis.

Infants and toddlers are at highest risk for bacterial meningitis, other high-risk groups include preteens and adolescents, persons living in close quarters such as dorms or barracks.

Clinical PresentationFeverNausea/vomitingPetechial rashStiff neckPhotophobiaHeadacheAltered mental statusTreatmentDepend on the type of meningitis

Post exposure management

Symptomatic treatment

Early use of antibiotics

Airborne precautions should be utilized PertussisPertussis(whooping cough) is a highly communicable bacterial respiratory infection caused by Bordetella pertussis.

Affects people of all ages, infants and children are at higher risk.

Recognized by a characteristic paroxysmal whooping cough followed by vomiting.

The whoop may not always be present.

Diagnosis is made by sputum specimen. PertussisRoute of transmission is from person to person with direct contact to the infected secretions or mucous membrane of infected person.

Average incubation is 9 to 10 days.

Unimmunized individuals are at higher risk for contracting pertussis.Clinical presentationShortness of breathHypoxiaMuscle achesBody achesSeizuresPneumonia cough

TreatmentAntibiotic such as erythromycin to lessen the severity of the symptoms.

Vaccination

People exposed to an active case may take antibiotics to prevent the development of the disease.Severe Acute Respiratory SyndromeSARS-first appeared in China in 2002.

Viral respiratory illness spread by close person to person contact.

Most likely respiratory droplets spread by coughing or sneezing.

Incubation period is 3 to 10 days.

Clinical PresentationFeverHeadache Body achesCough may develop 2 to 7 days after the onset of the illnessDiarrhea in up to 20% of patientsShortness of breathSevere pneumonia

TreatmentPost exposure management principles.

Advise exposed persons to watch for development of fever and respiratory symptoms for 10 days after exposure.

Contact and airborne precautions.

Use of N95 or higher respiratory mask.

No vaccine currently exists for SARS.Varicella (chicken pox)Highly contagious disease caused by the varicella-zoster virus.

Most cases occur in children younger than 15 years, most commonly seen in the spring.

Transmitted via direct contact (touching of vesicles) or exposure to airborne droplets.

May be transmitted indirectly by coming in contact with articles recently contaminated by the vesicles or discharge from mucous membrane. VaricellaIncubation period is approximately 2 to 3 weeks.

Anyone not protected by vaccination is susceptible.

Infection usually confers lifelong immunity.Clinical PresentationFeverMalaiseItchy rash of blistersRash appears as fluid-filled blisters, first appears on trunk and face then other areasComplications may include pneumonia, encephalitis and secondary bacterial infection

TreatmentIf exposed person is vaccinated, report exposure and watch for signs of infection for a minimum of 21 days.

In not immunized and no history of chickenpox, perform serological testing.

Vaccinated person still has a 15% to 20% of developing a mild form of the disease.Prevention: Vaccination ShinglesChickenpox virus also causes shingles.Shingles causes numbness, itching and severe pain followed by a cluster of blisters.Usually occur in people over the age of 50.

ShinglesShingles may persist for months, pain may remain after rash is gone.

Antiviral medication may be used for treatment.

Prevention: Vaccination is available.MeaslesViral disease that is highly contageous, 90% chance of contracting the disease if a person is exposed and not immunized.

Virus is found in the mucous of the nose and the throat in the infected person.

Virus can live on objects for up to 2 hrs.

197,000 deaths are attributed to measles annually.MeaslesTransmission is by airborne droplets expelled during breathing, coughing, or sneezing.

Incubation period is 7 to 21 days.

Measles is still a significant cause of vaccine-preventable deaths in pediatrics worldwide.Clinical PresentationFeverRunny noseRash (3 to 5 days after respiratory and fever start)CoughRed watery eyes (conjunctivitis)General malaiseWhite spots with bluish center(kopliks spots) inside mouth

RubellaA vaccine-preventable viral disease sometimes referred to as German measles.

Harmful to pregnant women, can cause birth defects.

Transmission occurs through airborne contact or through droplets from respiratory secretions of the infected person.

Direct contact with fomites of the infected person.

RubellaIncubation period ranges from 12 to 23 days.

A person should be considered infectious from 7 days prior to the rash to 7 days after onset.

Immunocompromised and nonimmunized persons are at a higher risk for contracting rubella.Cancer patients who have low white counts, or are receiving chemo.92Clinical PresentationEnlarged tender lymph nodesMuscle achesGeneral malaiseHeadacheFeverStuffy/runny noseInflamed red eyesPink rash beginning on the face and spreading to trunk and extremities

TreatmentPost exposure prophylaxis

Symptomatic

Vaccination for preventionMumpsA vaccine-preventable viral disease.

Transmission occurs by airborne contact or through contact with infected saliva or respiratory droplets of infected person.

Incubation period is 14 to 25 days.

Immunocompromised and nonimmunized individuals are at the highest risk for contracting mumps.Clinical PresentationUnilateral or bilateral facial swelling (jaws & neck)Muscle achesGeneral malaiseHeadacheFeverEaracheTenderness in facial areaMeningitisStiff neckencephalitis

TreatmentSymptomatic

Vaccination to prevent disease

Droplet precautions Exposure Control PlanGuidelines for employees to know what to do if an exposure occurs.

OSHA Bloodborne Pathogens Standard requires facilities to have an exposure control plan.

OSHA defines an exposure as a specific eye, mouth, other mucous membrane, nonintact skin, or parenteral contact with blood or other potentially infectious materials that result from the performance of an employees duties.Exposure Control Plan

ConclusionThe best way to prevent the spread of diseases is to always follow your regulations in your institution where you are employed.

Keep yourself healthy.

Get vaccinated for any preventable diseases.

Educate patients and family members on prevention of spread of disease.Practice good hand Hygiene and respiratory etiquette.100