Unit F: Infectious Diseases
Bioterrorism
Agents and Containment
BT 06.05
Bioterrorism
• Terrorism is defined as violent acts or acts
dangerous to human life that appear to be
intended to:
1. Intimidate or coerce a civilian population
2. Influence the policy
of a govt
1. Affect the conduct of
a govt
Bioterrorist Agents
• Bacterial – like Anthrax and Plague
• Viral – like smallpox
• Toxins – like Botulism and Ricin
ANTHRAX
• Acute infectious disease caused by bacillus
anthracis
• Infection in humans:
– Skin contact – cutaneous, ingestiongastrointestinal, inhalation-pulmonary
– Person-to-person transmission of inhalation
disease does not occur.
Pulmonary Anthrax S/S
• Flu-like symptoms that may
briefly improve 2-4 days
after initial symptoms
• Abrupt onset of respiratory
failure
• Hemodynamic collapse
• Thoracic edema
• Widened mediastinum on
xray
• Positive blood culture in 2-3
days of illness
• Incubation Period: 2-60
days
Pulmonary Anthrax cont:
• Prognosis is good only if treated early.
• Increased mortality rate if treated after
respiratory onset.
Cutaneous Anthrax S/S
• Local skin involvement with
direct contact
• Commonly seen on head,
forearms, or hands
• Localized itching followed by
papular lesion that turns
vesicular within 2-6 days –
develops into depressed black
eschar.
• Incubation period: 1-7 days
• Prognosis good if treated with
antibiotics.
Gastrointestinal Anthrax
• S/S:
– Abdominal pain, nausea, vomiting, & fever
– Bloody diarrhea, hematemesis
– Positive culture after 2-3 days
– Incubation period: 1-7 days
• Prognosis:
– If progression to toxemia and sepsis, prognosis is
poor
Anthrax overview
• Modes of Transmission
– Inhalation of spores
– Skin contact
– Ingestion of contaminated food
• Incubation Periods:
– Pulmonary: 2-60 days
– Cutaneous: 1-7 days
– Gastrointestinal: 1-7 days
• Transmission: Anthrax IS NOT airborne person to
person. Direct contact with infectious skin lesions
CAN transmit infections.
• Prevention: Vaccine available – quantities limited
BOTULISM
• Potent neurotoxin caused by an anaerobic bacillusclostridium botulinum
• Transmission
– Contaminated food
– inhalation
• S/S
–
–
–
–
GI symptoms
Drooping eyelids
Weakened jaw clench
Difficulty swallowing or
speaking
– Blurred vision
– Respiratory distress
Botulism Cont:
• Incubation period:
– Neurological S/S for food borne
botulism – 12-36 hours after ingestion
– Neurological S/S for inhalation
botulism – 24-72 hours after exposure
• Prevention:
– Vaccine is available
Botulism CANNOT be
transmitted from person
to person
PLAGUE
• Plague is an acute bacterial disease caused by
yersinia pestis.
• S/S
– Fever - Chest pains - Hemoptysis - Watery sputum
– Cough - Bronchopneumonia on xray
• Mode of Transmission:
– Plague normally transmitted form an infected flea
(that has bitten an infected rat!)
– Can be aerosol-probably use in bioterrorism
– Can be transmitted person to person
Plague Cont:
• Incubation period:
– Flea bite – 2-8 days
– Aerosol – 1-3 days
• Prognosis:
– Good if treated with antibiotics early.
RICIN
• Ricin is a potent
protein toxin
derived from
Castor beans. The
toxin is fairly easily
produced.
• Can be used as a
biological weapon
with relative ease.
Ricin Cont:
• Infections in Humans:
– Aerosol
– Ingestion
• Incubation period:
– 8-18 hours
• S/S:
– Within 18-24 hours:
•
•
•
•
Weakness
Fever
Cough
Pulmonary edema
Ricin Cont:
• S/S continued:
– Within 36-72 hours:
• Severe respiratory distress
• Death from hypoxemia
• Prognosis:
– Poor – No vaccine available
– You’re GOING TO DIE!
Ricin DOES NOT spread easily from person to person
SMALLPOX
• Smallpox is an acute viral illness caused by the
variola virus.
• Mode of transmission:
– Airborne :droplets (sneeze, cough, drip, or exhale)
• S/S:
– Flu like symptoms – fever, myalgia
– Skin lesions quickly progressing from macules to
papules to vesicles
– Rash scabs over in 1-2 weeks
– Rash occurs in all areas at once, not in crops
Smallpox Cont.
• Incubation Period:
– From 7-17 days, average is 12 days
– Contagious when the rash is apparent and remains
infectious until scabs separate (appx 3 weeks)
• Prognosis:
– Vaccine available and effective post-exposure
– Passive immunization is also available in the form of a
vaccina immune globulin (Vig) antibody transfer
Smallpox has a high mortality rate.
CONTAINMENT OF BIOTERRORISM
AGENTS
1. Isolation Precautions
– All pts in healthcare facilities, including
symptomatic pts with suspected or confirmed
bioterrorism-related illnesses, should be managed
utilizing STANDARD PRECAUTIONS
– Standard precautions include things like:
• Handwashing - after touching blood, body flds, etc
• Wearing gloves – clean gloves, exchange b/w tasks and
procedures. Remove gloves and wash hands B4 leaving
a pt care area.
Standard Precautions Cont.
• Gowns
– Worn to protect skin and prevent soiling of clothes
– Soiled gowns are promptly removed and hands
are washed when finished
• Masks/ Eye protection or Face Shields
– Worn to protect mucus membranes
– Prevent splashes of blood, body fluids
Containment of bioterrorism agents
2. Patient placement
• Normal infection control
practices should be
followed if numbers allow.
• With large numbers, group
affected patients together
into designated ward or
floor (possibly even a
separate building)
• Consult with engineering
staff (airflow and
ventilation, plumbing and
waste disposal, and
capacity)
Containment of bioterrorism agents
3. Patient Transport
• Most bioterroristic agents cannot be
transmitted from patient to patient.
• Transport and movement of pts should be
limited to movement that is essential to
provide pt care.
• This SHOULD reduce the opportunities for
transmission of microorganisms within
healthcare facilities.
Containment of bioterrorism agents
4. Cleaning, disinfection, and sterilization of
equipment & environment
• Standard precautions should be followed.
• All facilities have in place procedures.
• Cleaning agents should be available for spills
and disinfecting equipment.
• Contaminated equipment – wear gloves
• Sterilize all instruments
Containment of bioterrorism agents
5. Discharge management
• Pts will not be discharged until they are
deemed non-infectious
• Home care instructions should include barrier
precautions, handwashing, waste mgmt, and
cleaning and disinfection.
Containment of bioterrorism agents
6. Post-mortem care
• Pathology depts and labs should be informed!
• All autopsies should be performed carefully
using PPE and standard precautions.
• Instruct funeral directors of diagnosis
Containment of bioterrorism agents
7. Handwashing
• Push sleeves and watch 4-5 inches up on arms
• Stand back from sink and adjust water temperature until warm
• Wet wrists and hands without splashing and with fingertips pointed
downward
• Apply soap using friction
• Later well, keeping hands lower than elbows
• Rush hands together in circular motion, being sure
to wash between fingers and two inches above wrists
• Clean under nails by rubbing against palms
• Wash for at least 15 seconds or longer if contaminated
• Rinse wrists and hands with running water
• Dry hands thoroughly with paper towel and discard towel into trashcan
• Turn faucets off with a new paper towel and discard into trash can
Response to bioterrorism agents
• Internal reporting requirements (within a
facility)
a.
b.
c.
d.
Infection control personnel
Epidemiologist (local and state)
Administration (health care facility)
Office of public affairs (media coverage)
Response to bioterrorism agents
• External contacts (outside of facility)
a.
b.
c.
d.
e.
f.
Local health department
State health department
FBI
CDC
Local police
EMS