Airborne Pathogens

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Airborne Pathogens

  1. 1. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Airborne Pathogens JCAHO Mandatory Annual Competency Chesapeake Medical Staffing
  2. 2. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Content Tuberculosis SARS Avian Influenza
  3. 3. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Introduction Airborne pathogens differ from bloodborne pathogens in that they are spread by inhaling a pathologic microorganism. An infectious person's coughing or sneezing can send tiny droplets of moisture into the air that contain the pathogen. Depending on the environment, these contaminants can remain airborne for several hours.
  4. 4. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Types of Airborne Pathogens There are three types of airborne pathogens: • viral • bacterial • fungal
  5. 5. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Illnesses caused by Airborne Pathogens Examples of diseases transmitted through the air include: • meningitis • influenza • pneumonia • Tuberculosis • SARS
  6. 6. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Exposure If an airborne pathogen is inhaled, the pathogen may be transmitted to a receptive host. Exposure to airborne pathogens, however, does not always result in infection. Those individuals who are around an infectious person on a regular basis, such as family members and coworkers, are more susceptible to airborne pathogens than someone who experiences a single isolated exposure.
  7. 7. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Risk for Health Care Providers According to the CDC, heath care workers face a greater risk of exposure to airborne pathogens than the general Public. Standard Precautions and Droplet Precautions should be used when caring for any patient with symptoms of respiratory illness.
  8. 8. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Respiratory Protection OSHA requires healthcare settings that use respiratory protection to prevent the inhalation of infectious droplet nuclei to develop, implement, and maintain a personal respiratory protection program. All healthcare workers who use respiratory protection must be included in the program. The two most critical elements of a personal respiratory protection program are: • training of healthcare workers • selection of appropriate, well-fitting respirators (CDC, 2004).
  9. 9. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. N-95 Respirators (Masks) Anyone working in an area where there is a possibility of exposure to tuberculosis, must be fitted for a respirator hepa-filter mask. • Fit-testing must be done by an Infection Control Practitioner, Clinical Nurse Specialist or trained designee. • A NIOSH (National Institute for Occupational Safety & Health) approved N95 respirator is the only appropriate respiratory protection to be used when caring for a patient with possible active tuberculosis.
  10. 10. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Tuberculosis Tuberculosis (TB) is an airborne disease caused by Mycobacterium tuberculosis (M. tuberculosis). It is spread primarily by droplet nuclei—tiny airborne particles— expelled by an individual who has infectious TB disease (CDC, 2004). If another person inhales air containing these droplet nuclei, transmission may occur.
  11. 11. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Likelihood of Transmission When a susceptible individual inhales droplet nuclei containing the tubercle bacilli, TB transmission may occur. The probability that TB will be transmitted depends on the: • infectiousness of the individual with TB disease • environment in which exposure occurred • duration of exposure • virulence of the organism
  12. 12. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. TB Infection Control Program An effective TB infection control program comprises the following three-level hierarchy of controls: • administrative controls, to reduce the risk of exposure to individuals with potentially infectious TB • environmental controls, to prevent the spread and reduce the concentration of infectious droplet nuclei • individual respiratory protection use in situations that pose a relatively high risk for exposure to TB (CDC, 2004)
  13. 13. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Effective TB Infection Control Effective TB infection control depends on: • early detection • airborne infection • isolation • treatment of individuals with infectious TB
  14. 14. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Symptoms of TB People with TB infection often have no symptoms and do not feel sick. If the infection advances to TB disease, however, the person's symptoms may include: • weight loss • fever/chills • night sweats • feeling weak • cough (> 3weeks) • chest pain • hemoptysis (coughing up blood)
  15. 15. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Annual TB Testing All healthcare workers who have patient contact are required to receive a PPD annually (some hospitals may require more frequent PPD testing). The PPD or purified protein derivative is a tuberculin skin test that has been the traditional method of demonstrating infection with the bacteria that causes TB. The purpose of the TB skin test or PPD is to determine whether an individual has been exposed to TB and has a TB infection.
  16. 16. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. TB Exposure Like an exposure to a bloodborne pathogen, any exposure to a known TB source should be reported to CMS. Following an exposure you should be medically evaluated and tested for TB. A baseline skin test (PPD) should be performed, followed by a second test in eight to twelve weeks after exposure. Under the direction of the CMS medical director, CMS offers annual PPD testing at no cost for all associates.
  17. 17. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Current Facts Although current activities to control TB are yielding significant results nationwide, TB elimination will require sustained effort, long-term commitment, new tools, and strong partnerships with other federal health agencies and state and local health departments (CDC, 2004). Even though the 2005 TB rate was the lowest recorded in the United States since national reporting began in 1953, the average annual decline has slowed during the past three Years. MDR (multi-drug resistant) TB remains a threat, and disparate rates of TB persist among certain racial,ethnic, and foreign-born populations (CDC, 2006a).
  18. 18. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. SARS Severe acute respiratory syndrome (SARS) is a viral respiratory illness caused by a coronavirus, called SARS-associated coronavirus (SARS-CoV). SARS was first reported in Asia in February 2003. Over the next few months, the illness spread to more than two dozen countries in North America, South America, Europe, and Asia before the SARS global outbreak of 2003 was contained.
  19. 19. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. SARS Outbreak in 2003 In 2003, an outbreak of severe acute respiratory syndrome (SARS) in some parts of the world caused a new concern. SARS is primarily an infectious disease, transmitted when an infected person coughs or sneezes within close proximity of others. During the 2003 epidemic, almost 10% of the approximately 8000 known SARS victims in the world died. Only 7 people in the U.S. were known to have contracted SARS after international travel to epidemic areas. The U.S. Centers for Disease Control and Prevention continues to monitor the risks of SARS and will issue updates and warnings if new outbreaks occur.
  20. 20. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Symptoms of SARS In general, SARS begins with a high fever (temperature greater than 100.4°F [>38.0°C]). Other symptoms may include headache, an overall feeling of discomfort, and body aches. Some people also have mild respiratory symptoms at the outset. About 10 percent to 20 percent of patients have diarrhea. After 2 to 7 days, SARS patients may develop a dry cough. Most patients develop pneumonia.
  21. 21. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. How SARS Spreads The main way that SARS seems to spread is by close person-to- person contact. The virus that causes SARS is thought to be transmitted most readily by respiratory droplets (droplet spread) produced when an infected person coughs or sneezes. Droplet spread can happen when droplets from the cough or sneeze of an infected person are propelled a short distance (generally up to 3 feet) through the air and deposited on the mucous membranes of the mouth, nose, or eyes of persons who are nearby. The virus also can spread when a person touches a surface or object contaminated with infectious droplets and then touches his or her mouth, nose or eye(s). In addition, it is possible that the SARS virus might spread more broadly through the air (airborne spread) or by other ways that are not now known.
  22. 22. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. “Close Contact” In the context of SARS, close contact means having cared for or lived with someone with SARS or having direct contact with respiratory secretions or body fluids of a patient with SARS. Examples of close contact include: • kissing or hugging • sharing eating or drinking utensils • talking to someone within 3 feet • touching someone directly
  23. 23. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. CDC Update on SARS CDC continues to work with other federal agencies, state and local health departments, and healthcare organizations to plan for rapid recognition and response if person-to-person transmission of SARS-CoV recurs. CDC has developed recommendations and guidelines to help public health and healthcare officials plan for and respond quickly to the reappearance of SARS in a healthcare facility or community. These are available in the document Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS). CDC provides the latest information on SARS on the SARS website.
  24. 24. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Avian Influenza Avian influenza is an infection caused by avian (bird) influenza (flu) viruses. These influenza viruses occur naturally among birds. Wild birds worldwide carry the viruses in their intestines, but usually do not get sick from them. However, avian influenza is very contagious, and some domesticated birds—including chickens, ducks, and turkeys—can become infected and even die.
  25. 25. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Risk from Avian Influenza The risk from avian influenza is generally low for most people because the viruses occur mainly among birds and do not usually infect humans. However, more than 200 human cases of avian influenza infection have been reported since 1997. Most cases of avian influenza infection in humans have resulted from direct or close contact with infected poultry (eg, domesticated chicken, ducks, and turkeys) or surfaces contaminated with secretion/excretions from infected birds.
  26. 26. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Risks to Human Health Two main risks to human health from avian influenza are: • The risk of direct infection when the virus passes from the infected bird to humans, sometimes resulting in severe disease • The risk that the virus—if given enough opportunities—will change into a form that is highly infectious for humans and spreads easily from person to person.
  27. 27. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Symptoms of Avian Influenza in Humans Symptoms of avian influenza in humans have ranged from typical human influenza-like symptoms (fever, cough, sore throat, and muscle aches) to eye infections (conjunctivitis), pneumonia, acute respiratory distress, viral pneumonia, and other severe and life- threatening complications. The symptoms of avian influenza may depend on which specific virus subtype and strain caused the infection.
  28. 28. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Diagnosis of Avian Influenza A laboratory test is needed to confirm avian influenza in humans. Studies done in laboratories suggest that the prescription medicines approved in the United States for human influenza viruses should work in treating avian influenza infection in humans. However, influenza viruses can become resistant to these medications, so they may not always work.
  29. 29. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Drug Resistant Organism The H5N1 virus that has caused human illness and death in Asia is resistant to amantadine and rimantadine, two antiviral medications commonly used for influenza. Two other antiviral medications, oseltamivir (Tamiflu) and zanamivir (Relenza), may work to treat influenza caused by H5N1 virus, but additional studies are needed to demonstrate their effectiveness.
  30. 30. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Increased Resistance Because of increased resistance to the adamantanes, the CDC issued a Health Alert Network (HAN) notice in January of 2006, recommending against the use of adamantanes (amantadine and rimantadine) for the treatment or prophylaxis of flu for the duration of the 2006 flu season. Healthcare practitioners should ensure that the appropriate person(s) at their agencies are subscribed to both the CDC Health Alert Network and their state’s HAN, and that information from those networks is distributed as deemed appropriate.
  31. 31. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. No H5N1 Vaccine Available There currently is no commercially available vaccine to protect humans against the H5N1 virus being seen in Asia and Europe. However, vaccine development efforts are under way. Research studies to test a vaccine to protect humans against H5N1 virus began in April 2005, and a series of clinical trials is ongoing. More information is available from the National Institutes of Health vaccine website and the World Health Organization avian flu website.
  32. 32. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Additional Precautions Needed The rationale for the use of additional precautions for avian influenza as compared with human influenza include the following: • The risk of serious disease and increased mortality from highly pathogenic avian influenza may be significantly higher than from infection by human influenza viruses. • Each human infection represents an important opportunity for avian influenza to further adapt to humans and gain the ability to transmit more easily among people. • Although rare, human-to-human transmission of avian influenza may be associated with the possible emergence of a pandemic strain.
  33. 33. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Vaccination of Healthcare Workers Healthcare workers involved in the care of patients with documented or suspected avian influenza should be vaccinated with the most recent seasonal human influenza vaccine. In addition to providing protection against the predominant circulating influenza strain, this measure is intended to reduce the likelihood of a healthcare worker’s being co-infected with human and avian strains where genetic rearrangement could take place, leading to the emergence of potential pandemic strain.
  34. 34. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Pandemic Risk A pandemic is a global disease outbreak. A flu pandemic occurs when a new influenza virus emerges for which people have little or no immunity, and for which there is no vaccine. The disease spreads easily person-to-person, causes serious illness, and can sweep across a country and around the world in very short time.
  35. 35. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Difficult to Predict It is difficult to predict when the next influenza pandemic will occur or how severe it will be. Wherever and whenever a pandemic starts, everyone around the world is at risk. Countries might, through measures such as border closures and travel restrictions, delay arrival of the virus, but they cannot stop it.
  36. 36. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Potential Human Pandemic Health professionals are concerned that the continued spread of a highly pathogenic avian H5N1 virus across eastern Asia and other countries represents a significant threat to human health. The H5N1 virus has raised concerns about a potential human pandemic because: • it is especially virulent • it is being spread by migratory birds • it can be transmitted from birds to mammals and in some limited circumstances to humans • like other influenza viruses, it continues to evolve
  37. 37. This material is the private property of Chesapeake Medical Staffing. Any duplication or use by anyone other than an employee of Chesapeake Medical Staffing is prohibited. Preparation Education and outreach are critical to preparing for a pandemic. Understanding what a pandemic is, what needs to be done at all levels to prepare for pandemic influenza, and what could happen during a pandemic helps people to make informed decisions. Well-informed healthcare professionals may help others in their communities in this endeavor.

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