ch. 16 blood-borne pathogens CMA review

*A disease caused by the gram-negative coccobacillus Brucella.* It is most prevalent in rural areas among farmers, vegetarians, meat packers, and livestock producers. The ingestion of unpasteurized milk from infected stock also can cause brucellosis.

Brucellosis

a type of pneumonia caused by the parasite pneumocystis carinii, usually seen in patients with HIV infection. Its symptoms include fever, tachypnea, cough, and cyanosis. the diagnosis is not easy to make. the mortality rate in untreated patients is approximately 100%.

Pneumocystitis carinii pneumonia

an infection caused by toxoplasma gondii, transmitted in cat feces. Pregnant women and AIDS patients should not handle cat litter boxes. During pregnancy, the mother may pass the infection to her fetus through the placenta. Can result in spontaneous abortion, mental retardation, and malformation. It also can cause blindness, deafness, and brain damage.

Toxoplasmosis

the human immunodeficiency virus that causes AIDS. -passed from one person to another through *blood-to-blood and sexual contact. * -infected pregnant women can *pass to infant thru breast feeding and birthing* -not spread through causal contact -HIV infects and *destroys T lymphocytes* (T cells) of the immune system

HIV

recommendations issued by the CDC (centers for disease control and prevention) have called for coluntary testing of people who are at high risk for HIV infection. It is also federally mandated for military applicants and organ donators.

HIV antibody testing

inflammation of the liver caused by the hepatitis A virus, which is transmitted through *fecal-oral contamination*. Hepatitis A is generally not considered to be an important risk to health-care workers. it is also known as acute infective hepatitis.

Hepatitis A

a malignancy of the skin and lymph nodes that often occurs in AIDS patients. It is the most common HIV-related cancer and usually appears as painless nodules and reddish purple to dark blue colors on the body.

Kaposi's Sarcoma

also referred to as clean technique. it is used for the destruction of organisms after they leave the body, to maintain cleanliness in order to prevent the spread of microorganisms. it ensures that there are as few microorganisms in the medical environment as possible.

Medical Asepsis

a disease that is often curable when treatment regiments are followed exactly and completely. however, there has been a rise in the number of cases in recent years as a result of single largest risk factor for the development of tuberculosis and antibiotic resistance.

tuberculosis

used to sanitize delicate instruments and those with moving parts. it involves placing the instruments in a special bath that generates sound waves through a cleaning solution

ulrasonic cleaning

an approach to infection control, in which all human blood and certain other human body fluids are treated as if they were known to be infectious for HIV, HBV, and other blood-borne pathogens. applies to blood, blood products, semen, human tissue, vaginal secretions, saliva from dental procedures, cerebrospinal fluid, and all other body fluids if visibly contaminated with blood or from questionable origin in body. *Only used in medical office settings*

universal precautions

wash your hands, cover the injury, report and document the injury, and get the injury treated.

what are the proper steps to reacting to a needlestick injury?

Hepatitis B virus (HBV) and Human immunodeficiency virus (HIV)

what are the two most common blood-borne pathogen?

inflammation and infection of the liver that may be caused by several factors, such as drugs, toxins, and microorganisms. There are six known hepatitis viruses, designated A, B, C, D, E, and G.

what is hepatitis and what can it be caused by?

The most common cause of hepatitis is a virus.

what is the most common cause of hepatis?

The lungs

what is the most commonly affected organ in AIDS due to opportunistic infections?

opportunistic infections

what plays a major role in the diagnosis of AIDS?

controls that reduce the likelihood of exposure by altering the manner in which a task is performed, such as prohibiting recapping of a needle using two hands

work place controls

one of the most common infections. As many as 80% of adults have been exposed to it. In AIDS patients it may cause severe lung disease. Pregnant women may transmit this infection to the fetus through the placenta, which results in brain damage, mental retardation, blindness, deafness, or death.

cytomegalovirus

cleaning procedures that reduce or eliminate infectious organisms on instruments or equipment. common disinfectants are chemical germicide, household bleach, boiling water, and steam. ten percent bleach solution reduces or eliminates infection agents for 24 hours.

disinfectants

the process of destroying infectious agents by chemical or physical means. it is used for instruments that do not penetrate a patient's skin or that come in contact only with a patient's mucous membranes or other surfaces not considered sterile.

disinfection

There is no cure for HIV or AIDS; however, a growing number of drugs are available for treatment of these diseases.

drug treatments

used on items that would be damaged by immersion in chemical solution or by exposure to steam

dry heat sterilization

controls, such as sharps disposal containers and self-sheathing needles, that isolate or remove the hazard or blood-borne pathogens

engineering controls

a part of a safety plan used by medical facility, or stand-alone document, that must cover all OSHA-required elements. the plan must detail which tasks employees perform that involve a risk of exposure to blood, and classify jobs according to their potential for blood exposure. a hazardous materials communication must be included, which explains how to handle spills or exposures involving hazardous substances.

exposure control plan

characterized by the presence of opportunistic infections and unusual cancers. a severe pneumonia caused by pneumocystis carinii is commonly seen in AIDS patients, and Kaposi's sarcoma, a rare type of cancer, frequently occurs.

final stage of AIDS

uses ethylene oxide, a hazardous gas. it may be performed only in hospital and manufacturing environments

gas sterilization

germ-killing additives. the use of soap in the process of disinfection is less important than scrubbing and rinsing steps, but germicides may increase the effectiveness of soap.

germicides

one of the most important methods of medical asepsis is washing your hands -at the beginning of day -after breaks -before and after using the restroom -before and after lunch -before and after any patient contact, including taking vital signs -before and after using gloves -before and after handling specimens or waste -before and after handling clean or sterile supplies -before and after performing any procedures -after blowing nose or coughing -before leaving for the day

hand-washing

each hazardous chemical should be identified by a hazard warning label that displays the following information: -a statement requirement that the chemical be kept in its original container -a color code (blue for health hazard, red for flammability, yellow for reactivity, and white for specific hazards such as radioactivity -a numerical rating superimposed on each colored area of the label indicating a level of hazard from 0 (no hazard) to 4 (extreme hazard)

hazard warning label

a chemical that is explosive, unstable, flammable, carcinogenic, or irritating or that contains toxic agents.

hazardous chemicals

*an acute infectious disease caused by the spirochete leptospira interrogans*, transmitted in the urine of wild or domestic animals, especially dogs and rats. Human infections arise directly from *contact with an infected animal's urine or tissue or indirectly from contact with contaminated water or soil*.

leptospirosis

a severe infectious disease caused by one or more of four species of the protozoan genus Plasmodium. The disease is transmitted by mosquitoes. It also can be spread by blood transfusion from an infected patients or by the use of infected hypodermic needle.

malaria

the fastest method, using low-pressure steam with radiation

microwave sterilization

liquid or semiliquid blood or other potentially infectious materials, contaminated items that would release blood or other potentially infectious materials in a liquid or semiliquid state if compressed, items that are caked with blood or other potentially infectious matierals and are capable of releasing these materials during handling, contaminated sharps, and pathological and microbiological wastes containing blood or other potentially infectious materials

regulated waste

a manufacturer's printed document that contains basic information about chemical or product. a SDS must be on file for all chemicals used in the facility. OSHA requires chemical manufacturers to make these sheets available, usually as package inserts.

safety data sheet (SDS)

a cleansing process that reduces the number of microorganisms to a safe level, via washing and scrubbing equipment to remove body tissue, blood, and other bodily fluids

sanitization

*the only readily available method to detect evidence of HIV infection*. there are three serological tests used to detect antibodies to HIV: enzyme-linked immunosorbent assay (ELISA), western blot technique, and the immunoflourescent antibody (IFA) test.

serological tests

a person who is HIV-positive without any symptoms for months or even years is known as a carrier of HIV. the AIDS virus infection cycle has four stages: acute HIV infection, asymptomatic latency period, AIDS-related complex (ARC), and full-blown AIDS

stages of AIDS

the means by which transmission of pathogens in infected materials is prevented. standard precautions apply to blood, other body fluids, secretions, excretions (except sweat), non--intact skin, and mucous membranes. *used in hospitals for the care of all patients.*

standard precautions

a destruction of ALL living microorganisms and spores. it is required for all instruments and supplies that penetrates a patient's skin or come in contact with any normally sterile areas of the body. it is also required for instruments that will be use in a sterile field. EX: Curettes, needle drivers/holders, forceps, and hemostats.

sterilization

tags, strips, tapes, or tubes that confirm that items in the autoclave have been exposed to the correct volume of steam at the correct temperatures in a steam autoclave

sterilization indicators

have separate refrigerators in separate rooms for food and for biohazardous materials. refrigerators used for specimens should be clearly labeled with biohazard stickers.

storing biohazardous materials

also referred to as the sterile technique, used to create a completely sterile environment without the presence of any microorganisms, or their spores. This procedure is used for invasive or surgical techniques.surgical asepsis is used to destroy pathogenic organisms before they enter the body.

surgical asepsis

similar to aseptic hand washing except for the following differences: -a sterile scrub brush is used instead of a nail brush -hands and forearms are washed -hands are held above the elbows so that water cannot run from the arms down onto washing areas -sterile towels are used instead of paper towels -sterile gloves are put on immediately after the hands are dried

surgical scrub

perform procedures in a way that avoids cross-contamination.

cross-contamination

at least one week.

How long is the HBV capable of surviving on a dried state on environmental surfaces?

acquired immunodeficiency syndrome, caused by HIV. -it is a fatal disease that attacks the immune system and is characterized by severe opportunistic infections and rare cancers. - approx. 70% of HIV patients develop AIDS within 10 years.

AIDS

approx. 1/3 of all patients are asymptomatic. the initial symptoms, if present, last from 2 to 14 days.* no specific treatment or drug kills the hepatitis virus. about 90% of patients recover fully after the acute phase.*

Acute Hepatitis B

A syndrome resulting from HIV infection but lacking an opportunistic infection or Kaposi's sarcoma. patients with ARC often have chronic systemic symptoms, including enlarged lymph nodes, fever, diarrhea, weight loss, fatigue, and dementia. most people with ARC progress to having full-blown AIDS

AIDS-related complex (ARC)

an infection that lasts from 3 days to a month. symptoms are often mistaken for those of other viral infections and include fever, sweats, fatigue, loss of appetite, diarrhea, pharyngitis, myalgia, arthralgia, and adenopathy.

Acute HIV infection

-separate areas in the waiting room for well and sick patients - maintenance of well-lit, well-ventilated, draft-free office with a room temperature of approx. 72 degrees F. -prohibition of eating and drinking in the office -disposal of trash as oftern as needed -elimination of insects from the office -signs asking patients to use tissues, put waste in the trash cans, report safety or health hazards, and tell the receptionist if they are nauseated or need to use the restroom -keeping hand sanitizing agents in all areas

Aseptic precautions: OFFICE PROCEDURES

inflammation of the liver caused by the hepatitis B virus. it is the *main blood-borne hazard* for health-care workers. HBV can be transmitted through contaminated serum and plasma; contaminated needlesl cuts caused by contaminated sharps; sexual contact with an infected person; and splashes of contaminated material onto the eyes, mouth, nose, or broken skin. *HBV is also transmitted from mother to newborns. it is a severe infection that may cause a prolonged illness and become a chronic disease* resulting in destruction of liver tissues, cirrhosis, or death. *Also known as serum hepatitis.*

Hepatitis B

approximately *90% effective in providing immunity for at least 7 years*. The vaccine is recommended as a *series of three intramuscular doses* in infants, children, adolescents, and adults. Employers must offer this vaccine within 10 days of employments

Hepatitis B vaccine

a chronic disease transmitted largely by *blood transfusion or intravenous drug use. diagnosis is made by detecting HCV antibodies. there is no cure.*

Hepatitis C

also called delta hepatitis, a form of viral hepatitis that *occurs only in patients infected with hepatitis B*; consequently it *can be prevented by hepatitis B vaccine*. the Hepatitis D virus is *transmitted by sharing needles and sex*. it is not common in the U.S.

Hepatitis D

a *common acute infection of the liver*, similar to hepatitis A, seen mainly in southeast Asia, south America, and Africa. Hepatitis E is frequently seen in rainy season of after natural disasters because of* fecal contaminated water or food*. there is *no serological test available for the detection*. the disease is most *dangerous in pregnant women* and increases the mortality rate among them.

Hepatitis E

inflammation of the liver caused by the single-stranded RNA Flavivirus. *Mode of spread is usually blood and possibly semen*. incubation period of hepatitis G may be weeks. *there is no vaccine and the symptoms are usually mild*. Viremia may be persistent for months or years.

Hepatitis G

the U.S. department of Labor's occupational safety and health administration, which requires basic safety practices, including infection control, and develops federal regulations that aim to protect health-care workers from health hazards on the job, particularly from accidentally acquiring infections

OSHA

a set of regulations to protect health-care workers, patients, and other visitors from health hazards.

OSHA Blood borne pathogens standard of 1991

three forms are now primarily used to document accidents, injuries, and illnesses related to the workplace: -Form 300 is the log of work-related injuries and illnesses -form 301 is the injury and illness incident report, which must be completed for each entry in form 300 - form 300A is the summary of work-related injuries and illness.

OSHA record keeping regulations

a sexually transmitted disease caused by the spirochete Treponema pallidum. The incubation period is 10 to 90 days. There are three stages. -first stage (primary syphilis) is marked by a single lesion, called chancre. -syphilis can be treated with penicillin

Syphilis

cleaning products used on human tissues as anti-infection agents

antiseptics

removes accumulated dirt and microorganisms that could cause infection. -remove all jewelry, except plain gold wedding bands -use a paper towel to turn on faucets and adjust the temperature to moderately warm -wet hands and apply liquid soap -work the soap into a lather, make sure that both hands are covered in lather. rub vigorously in circular motions for at least 2 minutes. keep hands lower than your forearms so that dirty water flows into sink instead of back onto your arms. interlace fingers and clean the palms and between fingers. wash wrist as well -use nailbrush or orange stick to dislodge dirt from cuticles and nails -rinse hands well, keeping hands lower than forearms and not touching sink or faucets -with water still running, dry your hands with clean, dry paper towels, and then use clean, dry paper towel to turn off faucet. discard paper towels.

aseptic hand washing

a long incubation period, sometimes lasting for years. during this period, HIV antibodies are produced but it will not be able to destroy the virus. HIV tests may fail to detect presence of the virus for as long as 3 to 6 months after an individual has been infected.

asymptomatic latency period

a device that forces the temperature of steam above the boiling point of water in order to sterilize instruments and equipment. distilled water is used for autoclaving.

autoclave

1. wrap sanitized and disinfected instruments and equipment, and label each pack 2. clean and preheat the autoclave 3. perform quality control procedures 4. load the instruments and equipment, allowing adequate space around the items 5. set the autoclave for the correct time 6. run the autoclave through the cycle, including the drying time 7. remove the instruments and equipment 8. store the instruments and equipment for the next use 9. clean the autoclave and the surround work area

autoclave procedures

anything that poses a risk to the human body or other living organism, such as blood chemical materials, or ionizing radiation.

biohazard

a leak-proof, puncture resistant container that is color coded red or labeled with a biohazard symbol and is used to store and dispose of contaminated supplies and equipment. the lid must be replaced each use and it is used for disposable of gowns, table covers, items contaminated with blood and body fluids, dressings, gloves, needles, and sharp objects.

biohazard container

disease-causing microorganisms that spread from one person to another via blood.

blood-borne pathogens

tasks that expose a worker to blood, body fluids, or tissues, such as assisting with removal of a cyst, and tasks that have a chance of spills or splashes. these tasks always require special protective measures

category 1 tasks

tasks that usually do not involve a risk of exposure but that may involve exposure in certain situations. ex: mouth to mouth resuscitation

category 2 tasks

tasks that involve no exposure to blood, body fluids, or tissues and therefore do not require special protection

category 3 tasks

used on instruments that would be damaged by prolonged exposure to high temperatures in a steam autoclave

chemical sterilization

about 10% of patients who do not recover from the acute phase go on to develop chronic hepatitis. these patients face an increased risk of liver damage, cirrhosis of the liver, liver cancer, or liver failure.

chronic hepatitis B

a term used by OSHA to describe the use of physical or chemical means to remove, inactivate, or destroy blood borne pathogens on surface or item to the point at which they are no longer capable of transmitting infection and the surface of item is rendered safe for handling, use, or disposal.

decontamination

by incineration, chemical treatment, steam sterilization, and other safe, equivalent methods that inactivate the waste before it is placed in a landfill.

how are biohazard materials disposed of?

when it is 3/4 full.

how full does a biohazard container have to be before it should be moved to a locked storage area until pickup?

HIV is readily destroyed by heat treatment and exposure to disinfectants. the most common disinfectant is 10% NaClO (sodium hypochlorite, the active ingredient in household bleach)

inactivation of HIV

OSHA revised its blood-borne pathogens standard to comply with the 2000 needstick safety act. employers must involve employees when selecting needle safety devices. in the medical facility, a needlestick and sharps injury log must be kept and must include the description of the incident, the type (and brand) of devices involved, the location, and sharp injuries must be reported and documents.

needlestick safety and prevention act

any microorganism that causes a disease

pathogen

OSHA requires the following steps: -decontaminate all exposed work surfaces with bleach or a germ-killing solution -replace protective coverings on surfaces and equipment that have bee nexposed -decontaminate receptacles -pick up broken glass with tongs -discard all potentially infectious waste materials in appropriate biohazardous waste containers

postprocedure cleanup

body fluids visibly contaminated with blood; seminal and vaginal secretions; cerebrospinal, mucous, amniotic, and other body fluids; and tissue cultures.

potentially infectious body fluids

to prevent spoiling or deterioration of testing kits and specimens, the temperature of the lab frig should be maintained between 36 and 46 degree F. (2 and 8 degree C)

refrigerators