Infectious &
Communicable
Diseases
Chemeketa Community College
1
Are we at risk?
Patient
contact
Co-workers
Hygiene
Hazardous
scenes
2
Overview
Infectious diseases affect entire
populations
Important to understand population
demographics
Their ability to move internationally
Age distributions
Socioeconomic considerations
Genetic factors
Study of an infectious disease cluster is
regional; consequences may be
international.
Think of consequences of person-toperson contacts
3
World map according to land mass
World According To Global Population
World Map Showing People With HIV
Reflections of Health Care Spending
Public Health Agencies
Local – that’s YOU!
State
Health dept
Federal
US DHS CDC & P
• Monitors
• Studies & researches
• Manages
OSHA
8
Agency responsibility relative
to isolation from exposure
Exposure plan
Maintenance and surveillance
Appointing a DO
Schedule of standards implemented
PPE
•
•
•
•
•
gloves
protective eyewear
face shields
masks
gowns
9
BSI
Procedures for evaluation of
circumstances and counseling
Personal, building, vehicular, equipment
disinfection and storage
Correct handling
Correct disposal
After action analysis
10
Guidelines,
Recommendations,
Standards, Laws
PPE must be available
to all employees at high
risk
All employees must be
offered HB vaccine
All high risk employees
must be offered
protection from
bloodborne pathogens
including TB testing,
measles vaccination.
11
Host Defense
Mechanisms
Nonspecific and surface defense
mechanisms
Flora
Enhances effectiveness of surface barrier by
interfering with establishment of agents
Can be responsible for infection
Skin
Intact skin defends against infection by:
• Maintaining an acidic pH level
• Preventing infection
12
Host Defense Mechanisms
Gastrointestinal (GI) System
Resident bacterial flora
provides competition between
colonies of microorganisms for
nutrients and space; helps
prevent proliferation of
pathogenic organisms
Stomach acid may destroy
some microorganisms
Eliminates pathogens through
feces
13
cont.
Host Defense Mechanisms
Upper Respiratory
system
Turbinates
Mucous
Mucociliary escalator
Normal bacterial flora
Lymph tissues of tonsils
and adenoids permit
rapid local
immunological
response
14
cont.
Host Defense Mechanisms
Genitourinary (GU) tract
Natural process of urination
and bacteriostatic properties
of urine help prevent
establishment of
microorganisms in GU tract
Antibacterial substances in
prostatic fluid and vaginal
fluid help prevent infection in
GU system.
15
cont.
Host Defense Mechanisms
Internal Barriers
Protect against
pathogenic agents
when external lines of
defense are breached.
Include
Inflammatory response
Immune response
16
cont.
Inflammatory response
A local reaction to cellular injury
Generally protective and beneficial
May initiate destruction of the body’s
own tissue
17
Three separate stages
Cellular response to injury
Decreasing energy stores
Cell membrane deteriorates, begin to leak
Vascular response to injury
Capillary permeability increases, = edema
Leukocytes collect
Phagocytosis
Leukocytes engulf, digest, destroy invaders
18
Immune response
Possesses self-non-self
recognition
Produces antibodies------Some lymphocytes
become memory cells
Is self-regulated to
activate only with
invading pathogens
IgG
IgM
IgA
IgD
IgE
19
Immune response
cont.
B-cells
Produces antibody
T-cells
Processes antigen for B-cell,
Killer T cells are stimulated to multiply by
presence of antigens on abnormal cells
Helper T cells turn on activities of killer cells
Suppressor T cells turn off action of helper and
killer T cells
Inflammatory T cells stimulate allergic reactions,
anaphylaxis, autoimmune reactions
20
Approach to a call
Wear appropriate PPE
Patient Assessment:
Focused history and physical
History of present illness
•
•
•
•
•
•
Onset - gradual or sudden?
Fever
Antipyretic usage (ASA, APAP)
Neck pain or rigidity?
Difficulty swallowing, secretions?
How did sx change over time?
21
Approach to a call
cont.
Past medical history
Chronic infections, inflammation
Use of steroids, antibiotics
Organ transplant and associated
medicines
Diabetes or other endocrine disorders
COPD or respiratory complications
22
Detailed History and
Physical
Assess skin for temperature, hydration,
color, mottling, rashes, and petechiae
Assess sclera for icterus
Assess patient reaction to neck flexion
Assess for lymphadenopathy in neck
Assess digits and extremities for purulent
lesions
23
After the Call
Upon disposition of patient, dispose
of supplies, bag linen, disinfect
ambulance and equipment
Reprocessing methods for EMS durable
equipment
•
•
•
•
Sterilization
High-level disinfection
Intermediate-level disinfection
Low-level disinfection
24
Stages of an infectious
disease
Stage of
Disease
Begins
Ends
With invasion
When agent can
be shed
Communicable
period
When latent
period ends
Continues as
long as agent is
present
Disease period
Follows
Of variable
incubation period duration
Latent period
25
The Ryan White Act
Ryan Wayne White 1971 – 1990
Dx - Hemophilia at 3 days
old
Tx - Factor VIII and blood
transfusions
1984 – Dx - AIDS
1990, 1996, 2000, 2006 –
Ryan White law passed
26
What does it mean?
Funding for HIV/AIDS
treatment
Health care provider
employees must be notified
within 48 hours if an exposure
is found to have occurred.
Employers must name a
DICO to coordinate
communications between
hospital and agency
27
Ryan White Act - 2006
Staffers removed provisions of bill
dealing with Emergency Responders
Hospitals no longer required to test or
reveal results within 48 hours
Efforts to reinstate underway
28
Individual
Responsibilities
Be familiar with laws, regulations
Proactive attitude – infection control
Maintain personal hygiene
Attend to wounds
Effective hand washing after every
patient contact
Remove or dispose of work
garments- handle uniforms properly
29
Individual
Responsibilities
Handle and launder soiled work clothes
properly
Prepare food and eat in appropriate areas
Maintain general and psychological
health
Dispose of needles and sharps
appropriately
Don’t wipe face and/or rub eyes, nose,
mouth etc.
30
Pathophysiology
Infectious Agent
•Virulence
•Dosage
Means of
Transmission
Host
•Host Resistance
•Protective Measures
•Direct
•Indirect
Routes of Exposure
•Airborne
•Bloodborne
•Foodborne
(Fecal/Oral)
What’s That Mean
Exposure does not necessarily equal
infection
The chain of elements must be intact
Transmission can be controlled
32
We’ll talk about...
HIV
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis non-ABC
Tuberculosis
Meningococcal
meningitis
Pneumonia
Rabies
Hantavirus
Chicken pox
Mumps
33
And these too
Rubella
Measles
Whooping cough
Influenza
Mononucleosis
Herpes simplex
Syphilis
Gonorrhea
Chlamydia
Scabies & Lice
Lyme disease
Gastroenteritis
1&2
34
Infectious agents
Bacteria
Prokaryotic
• Nuclear material is not contained within a
distinctive envelope
Self-reproducing
without host cell –
BUT require host for
food, support
S/S depend on cells
and tissues infected
35
Toxins - often more lethal
than bacterium
Endotoxins
Exotoxins
Can be localized or
systemic infection
36
Viruses
Eukaryotic
• Nuclear
material
contained
within a
distinct
envelope
Must invade host cells to reproduce
Can’t survive outside of host cell
37
Other Microorganisms
Prions
Slow viruses – particles of protein
• Accumulate in nervous tissue and brain tissue
Mad Cow Disease
Fatal familial insomnia
Alzheimers Disease
Parkinsons’ Disease
38
Fungi
Protective capsules surround the cell
wall and protect fungi from
phagocytes
Broad-spectrum antibiotics can cause
fungal infections
• Pneumonia
• Yeast infections
39
Protozoans
Single-celled microorganisms
More complex than bacteria
Live in soil – opportunistic
infections – fecal-oral or
mosquito bites
Malaria
Some forms of Gastroenteritis
Trichomoniasis (STD)
40
Parasites –
Helminths (worms)
Roundworms
Live in intestinal mucosa
S/S – abdominal cramping, fever, cough
Pinworms
Common in US
• 20% of children in temperate
climates are infected
Live in distal colon
S/S – anal itching
Hookworms
25% world population – rare in US
• Walking barefoot in contaminated area
• S/S – epigastric pain, anemia
41
Human Immunodeficiency Virus
(HIV) - Slim Disease
Present in blood and
serum-derived body
fluids
Directly transmitted
person-person
Indirectly transmitted via
Blood transfusion, organ
transplant, contaminated
needles
42
Adults and children estimated to be living
with HIV/AIDS as of end 2006
2002
North America
1,200,000
980
000
Caribbean
440 000
540,000
Latin America
2,000,000
1.5
million
Eastern Europe
Western Europe & Central Asia
1.2 million
570 000 1,800,000
East Asia & Pacific
North Africa
1.2 million
1,800,000
South
& Middle East
& South-East Asia
600,000
550
000
8,000,000
6 million
700,000
Sub-Saharan
Africa
30,000,000
29.4
million
Total: 44
42 million
00002-E-4 – 1 December 2002
Australia
& New Zealand
15 000
750,000
45
46
Spread of AIDS in Africa
Various stats about Africa:
- Sub-Saharan Africa has 10 percent of the world’s population but is home to
more than 60 percent of all people living with HIV and AIDs
- In 2005, 3.2 million people in the region became newly infected, while 2.4
million adults and children died of AIDs
Likelihood of contacting the HIV virus per 10,000 exposures:
Blood Transfusion 9,000 - 90% chance, Childbirth 2,500 - 25% Chance, Needlesharing injection drug use 67 - 0.67% Chance, Percutaneous needle stick 30 0.3% Chance, Anal intercourse 50 - 0.5% Chance, Penile-vaginal intercourse 10 0.1% Chance, Oral intercourse 1 - 0.01% Chance
Many countries have over 15% of their adult population carrying the virus.
Swaziland - People Living with HIV/Aids: 220,000 - Population with
HIV/Aids: 38.8%
Botswana - People Living with HIV/Aids: 350,000 - Population with
HIV/Aids: 37.3%
Lesotho - People Living with HIV/Aids: 320,000 - Population with HIV/Aids:
28.9%
Zimbabwe - People Living with HIV/Aids: 1,800,000 - Population with
HIV/Aids: 24.6%
South Africa - People Living with HIV/Aids: 5,300,000 - Population with
HIV/Aids: 21.5%
Namibia - People Living with HIV/Aids: 210,000 - Population with HIV/Aids:
21.3%
Zambia - People Living with HIV/Aids: 920,000 - Population with HIV/Aids:
16.5%
Malawi - People Living with HIV/Aids: 900,000 - Population with HIV/Aids:
14.2%
United States - People Living with HIV/Aids: 984,000 - Population with
HIV/Aids: 0.6%
48
Statistics
US- >1,185,000 through 2003
Most 25-49 y/o
24-27% undiagnosed HIV
2005- est. 45,669 AIDS dx
Oregon – 5,855 through 2005
2005 – 284 new cases (AIDS primary Dx)
New York, California, Florida leading
49
As of the end of 2006…

44 million people worldwide were living with
HIV/AIDS.

3.5 million of these are children

Approx. 50% of adults living with HIV/AIDS worldwide are
women.

6.5 million HIV infections worldwide occurred in
2005 alone - 18,000 day.

40,000 new HIV infections/yr in the U.S, half are
younger than 25 years of age (70% men, 30% women).
50
By the end of 2006…

30 million people have
died of AIDS
worldwide.

14 million orphans
have been left behind.
51
AIDS Origins - First Reports

In Africa - First known case!
Man in Republic of Congo died in
1959, had his blood frozen for an
immunology experiment.

In the U.S: A 15-yr old male
prostitute died of Kaposi’s
Sarcoma in 1969.
Frozen tissue sample had HIV
antibodies - not reported until 1999.

In Europe: A Danish surgeon
who had worked in Zaire. She
died mysteriously in 1976.
52
First reports, cont….

June 1981: reports of new
disease in male homosexual
community in U.S.

5 men in LA area diagnosed with
PCP (pneumocystis carinii
pneumonia), a type of pneumonia
carried by birds.

Very unusual, since PCP is
usually only found in profoundly
immune-suppressed patients.
53
First Reports (Cont.)

July 1981: reports of
Kaposi’s sarcoma (KS),
a very uncommon cancer,
found in 26 gay men in
NYC and California.

Very unusual, since KS had
only been seen in older men
of Jewish or Italian ancestry
(mostly in lower legs).
54
At the same time…

1982: Similar cases outside the U.S.
(Zambia, Uganda).

1983: Zaire.

Soon cases were identified in all
Western European countries and in
Australia, New Zealand, and parts of
Latin America (Brazil, Mexico).
55
Origins of AIDS - What we know

There are two types of the virus:
HIV-1 and HIV–2.

HIV-1 appears to have spread
from Central Africa.

HIV-2 has so far been confined
mainly to West Africa.

9 of the 11 known sub-types
are found in the Republic of
Congo  probable origin.
56
Causative agent - HIV-1 & HIV-2
Seeks cell receptor CD4+ T cells
Found on surface of T helper cells
Both types are seriologically distinct
but share similar characteristics
HIV infected T-cell
57
Origin of HIV-1

Cross-species transmission
from chimpanzee (Pan
troglodytes troglodytes).

Simian virus closely related to
HIV jumped from monkeys to
humans, later mutated into
current form SIVcpz.

Genetic evidence (75-85%).
Several species of monkey
carry HIV-like simian viruses.
Believe virus jumped at least 8
times from ape to human.

58
Origin of HIV-1, cont.
 Consumption of “bushmeat”
 The slaughter and selling of monkey
body parts provides families with meat and
income.
 This is a long-standing practice - but has
decreased in the past few decades due to:
Commercial logging driving out
animals.
Bans on hunting/trading simian body
parts
Better roads, easier access to other
food.
The blood-to-blood contact of killing these animals
is a prime suspect in humans acquiring the HIV virus.
59
HIV-1 is far more pathogenic; most cases
world-wide are HIV-1, Group M
First case in US of HIV-1, Group O, identified in
6/96
HIV-antibody tests in US detect HIV-1
Group M, with 99% accuracy; HIV-1 Group
O with 50-90%.
HIV-2 – milder symptoms, slower
development – mainly in West Africa. US
cases: 79
60
Why The Rapid Spread?
International Travel
'Patient Zero‘ - Gaetan Dugas
Analysis of several of the early cases of AIDS infected individuals were either direct or indirect
sexual contacts of the flight attendant.
The Blood Industry
In some countries such as the USA paid donors
were used, including intravenous drug users.
• This blood sent worldwide.
• Also, in the late 1960's hemophiliacs benefit from
Factor VIII. To produce the coagulant, blood from
thousands of individual donors had to be pooled.
61
Why The Rapid Spread?
Drug Use
The 1970s - increase in availability of heroin
following the Vietnam War and other conflicts in
the Middle East,
The development of disposable syringes and the
establishment of 'shooting galleries' provided
another route.
What other theories have there been about
the origin of HIV?
Conspiracy theories - manufactured by the CIA vs
genetically engineered.
62
Occurrence highest:
High-risk sexual behavior
IV drug and steroid abuse
Transfusion recipient between 1978-1985
Hemophilia or other coagulation disorders
requiring blood products
Infant born from HIV-positive mother
Other factors
Coexisting STD’s (esp. with ulceration)
Penile foreskin
63
Why all the fuss over AIDS?
AIDS is killing over 3 million people
each year worldwide. No other
disease is spreading at this rate.
64
Why all the fuss over AIDS?


It has an extraordinary capacity for change
and rapid global spread. Hard to make a
vaccine.
There is a long asymptomatic period
between infection and illness. Can be
passed on during this period. Many people
with disease seem outwardly healthy.
65
Why all the fuss over AIDS?


HIV/AIDS is more serious than
many common diseases
because of the age groups it
attacks.
Mainly kills people in their 20s
to 40s  society’s most
productive group.



40% increase in 14-22 age group
70% are unknown carriers
Death of these young people
has left behind 14 million
AIDS orphans.
66
Why all the fuss over AIDS?
Therapy:
HIV/AIDS requires the use of some of
the most EXPENSIVE and TOXIC drugs
in medical history.
 $2,000 - 4,000 per month


Need to be 98% compliant to be effective
67
Initial case definition established by
CDC in 1981.
1987 & 1993; s/s include
tuberculosis, recurrent pneumonia,
wasting syndrome, HIV dementia,
sensory neuropathy.
68
69
Classifications &
Categories
Category A
Acute retroviral infection
2-4 weeks after exposure
Mono-like illness; lasts 1 – 2 weeks
• Fever
• Adenopathy
• Sore throat
70
Transient decrease in CD4+T cell
counts
Seroconversion; 6-12 weeks after
transmission
• CD4+T cell count return to normal
levels
Asymptomatic infection; persistent
generalized lymphadenopathy;
gradual decline in CD4+T cell
count
71
Category B
Early symptomatic HIV
Decreased CD4+T cell count
Common complications
• Localized Candida infections
• Oral lesions
• Shingles
• PID
• Peripheral neuropathy
• Fever/Diarrhea lasting more than one
month
72
Category C
Late symptomatic HIV
Represents all AIDS-defining diagnoses
CD4+T cell count 0 to 200 per uL
Severe opportunistic infections
• Bacterial pneumonia (Pneumocystis Carinii
Pneumonia)
• Pulmonary tuberculosis
• Debilitating diarrhea
• Tumors in any body system, including
Kaposi’s sarcoma
• HIV-associated dementia
Advanced HIV: CD4+T cell counts 0-50
per uL.
73
Nervous system - toxoplasmosis of
CNS
Immune system - major site of
compromise
Respiratory system pneumocystis carinii pneumonia
Integumentary system - Karposi’s
sarcoma
74
13-30% transmission to infants born to
HIV-infected mothers
Breast feeding can result in HIV
transmission
Virus has occasionally been found in
saliva, tears, urine, bronchial secretions.
Vector transmission has not been known
to occur.
Risk of oral sex is not quantified; believed
low.
75
Patient management
Out-of-hospital care - supportive.
BSI as appropriate
Effective hand washing
Use of eye protection, masks and
gowns highly recommended when
exposure to large volumes of body
fluids.
76
HCW infection:
Non-intact skin exposure (6/2000)
– 56 + 138 ?
Susceptibility and resistance
Infectiousness may be high during
initial period after infection and at endstage
Race and gender are not risk factors for
susceptibility.
77
Care in use of medical equipment
mandatory
Disinfection of equipment
mandatory
Early diagnosis, treatment,
counseling for health-care
providers is mandatory.
78
HIV testing
OraQuick Rapid HIV 1 / 2 test
Oral fluid, plasma, whole blood
20 – 40 minutes
Accuracy
• Positive – 99.3%
• Negative – 99.8%
79
80
Post-exposure
prophylaxis
< 72 hours non-occupational exposure
Highly active antiretroviral therapy (HAART)
• PMPA (tenofovir) – 28 days
Repeat testing 4-6 weeks after exposure;
again at 3 months, 6 months, 1 year
81
WHO Recommendations for a First Line
Regimen in Adults and Adolescents
• d4T+3TC+NVP
• ZDV+3TC+NVP
• d4T+3TC+EFZ
• ZDV+3TC+EFZ
d4T (NRTI) alternative name Stavudine
ZDV (NRTI) alternative names Zidovudine or
AZT
EFZ (NNRTI) alternative name Efavirenz
NVP (NNRTI) alternative name Nevirapine
3TC (NRTI) alternative name Lamivudine
82
Hepatitis
A viral disease
Produces pathologic alterations in the
liver
83
Hepatitis-A
Causative agentHepatitis A virus
Most common type of
viral hepatitis
Once infected, person
is immune to HAV for
life
84
Statistics
Oregon 2005 – 1.3/100,000 (49 new cases)
 1955 – 86.7/100,000
Marion County: 632
Multnomah County: 1,512
National – 1/3 of Americans show past
infection (immunity)
85
Many infections asymptomatic
Liver may be affected
Often occurs without jaundice,
esp. children
Only recognizable by liver
function studies
Only hepatitis virus that does
not lead to chronic liver
disease or chronic carrier
state.
87
Routes of transmission
Stool of infected person
Contaminated water, ice or food
Sexual and household contact can
spread virus
Can survive on unwashed hands for 4
hours
88
Susceptibility and
resistance
No clearly defined populations at
increased risk.
75% of people with H-A have sx.
In developing nations with poor
sanitation, infection is common
In developed nations, often associated
with day care, nursing homes
89
S/S
Onset is abrupt with fever, weakness,
anorexia, abdominal discomfort, nausea
and darkening of urine, sometimes
followed w/in a few days by
jaundice/icterus.
Mild severity lasting 2-6 weeks.
Rarely serious.
90
Patient management
Care is supportive for fluid intake
and prevention of shock.
Person is most infectious during first
week of symptoms
BSI mandatory.
91
Immunization
Prophylactic IG may be administered
within two weeks after exposure
If traveling to Africa, the Middle East,
Central and South America, Asia - get
immunized.
92
Hepatitis A vaccine available for 2 y/o
or older
Close contact with people who live in
areas with poor sanitary conditions
Male-male sex
Illicit drugs
Children in populations with repeated
epidemics
Chronic liver disease or clotting factors
disorders
93
Hepatitis-B
Causative agent - H-B
virus.
Potential secondary
complication - liver
necrosis
HBV usually lasts < 6
months
Carrier state may
persist for years
94
Statistics
National – 60,000 new infections
(2004)
Oregon – 2005; 99 cases acute HB
404 cases chronic carriers
Marion County: 195
Multnomah County: 556
95
Routes of transmission
Blood, semen, vaginal fluids,
saliva, blood transfusion,
dialysis, needle and syringe
sharing, tattooing, sexual
contact, acupuncture,
communally-used razors and
toothbrushes.
HBV stable on environmental
surfaces > 7 days
Transmission by insects
and fecal-oral route not
demonstrated.
97
S/S
Within 2-3 months, infected persons
gradually develop non-specific
symptoms such as anorexia, n/v, fever,
joint pain, generalized rashes,
sometimes jaundice.
Risk of developing chronic infection
varies inversely with age.
98
1% of patients develop full-blown
liver crises and die with mortality
increasing > 40 y/o.
5-10% infected people become
asymptomatic carriers.
99
Patient management
Out-of-hospital - supportive
BSI
Effective handwashing
Care in use of equipment.
Careful handling of sharps
High-level disinfection of
equipment esp.
laryngoscopy blades is
mandatory.
100
Immunizations:
Recombivax HB and
Engerix B are effective.
Vaccines: initial, onemonth, six-month provide
long-lasting immunity in
95-98% of cases.
Postexposure
prophylaxis
HBV vaccine
HB IG
101
Hepatitis C
Causative agent - H-C virus.
Organ affected - liver.
Most frequent infection secondary to
needlestick & sharp injury
85% infected healthcare workers
become chronic carriers
102
Health care workers - 2.7 - 10%
probability of infection when
exposed to contaminated blood.
Transmission by household and
sexual contact low.
Can’t occur from food and water.
103
Statistics
Oregon: 2005; newly reportable; 1,337
July-Dec. (chronic) – 50 acute cases
Marion County: 4
Multnomah County: 17
National – new infections per year
has declined (240,000 in 1980’s –
24,000 in 2004)
104
S/S
Same as for HBV but less
progression to jaundice
Chronic liver disease common with
>80% developing chronic liver
disease.
Apparent association between HCV
infection and liver cancer
106
Patient management
Same as for HBV
Immunization:
Prophylactic administration of IG not
supported by current data
Post exposure testing important
Vaccine may be available
107
Hepatitis non-ABC
Hepatitis D; infects a cell
with other hepatitis virus
When virus active in HBV
patients, resulting disease
extremely pathogenic
Hepatitis E not
bloodborne; is spread like
H-A
108
Hepatitis G - newly identified
Major epidemics documented in
young adults.
Women in 3rd trimester
especially susceptible to liver
disease
109
S/S
Onset abrupt with s/s resembling HBV
Always associated with HBV
Patient management
Same as for HBV
Immunization
HB vaccine can indirectly prevent H-D,
but has no effect on H-E.
110
Tuberculosis
Causative agent mycobacterium
tuberculosis
8 million new TB/yr
worldwide
3 million die of
disease
111
TB Epidemic in US
Immigration
Transmission in high-risk environments
• Prisons, homeless shelters, hospitals,
nursing homes
• National – 1953; 84,350 – 19,707 deaths
 2005; 14,097 – 662 deaths
Oregon: 106/100,000 (11/03)
103 - 2005
112
Rate of TB for HIV patients 40x rate
of TB for non-HIV persons
Routes of transmission:
Airborne droplet
Prolonged exposure to infected person
Reservoirs include some cattle,
badgers, swine
114
Susceptibility and
resistance
Period of incubation 4-12 weeks.
Period for development of disease 6-12
months after infection.
Risk of developing disease highest in
children < 3, lowest in later childhood and
high among adolescents, young adults
and elders.
High in immuno-compromised patients;
HIV-infected, underweight,
undernourished.
115
S/S:
First infection usually subclinical
These bacteria lie dormant but can reactivate into
secondary TB
Most common site of reactivation TB is in apices
of lungs.
Patients present with
chronic productive/non-productive cough (persistent for
2-3 weeks),
low-grade fevers,
night sweats,
weight loss, fatigue
Hemoptysis common.
116
Body systems affected;
Indirectly affects respiratory system including
larynx
Left untreated, TB can spread to other organ
systems and cause other sx.
Cardiovascular; pericardial effusions may
develop
Skeletal:
Generally affects thoracic and lumbar spine,
destroying intervertebral discs
Chronic arthritis of one joint is common
CNS
Causes a subacute meningitis and forms
granulomas in brain
117
Patient care
Primarily supportive
Prevent shock
118
Routine evaluation of Health
care workers
PPD (purified protein derivative)
• Positive reaction indicates past
infection
CXR
Sputum stain and culture
Remember; TB is communicable
with prolonged exposure to
droplet infection.
119
Drug therapy
Prophylactic INH; recommended
routinely for persons <35 y/o who are
PPD positive; not recommended > 35
due to hepatic complic.
Therapeutic: Isoniazid, Rifampin,
Pyrazinamide, Streptomycin
Side effects of INH
Paresthesias, seizures, orthostatic
hypotension, N/V, Hepatitis
120
Meningococcal
meningitis
Causative organism: Neisseria
meningitidis, meningococcus
Tissues affected:
Colonize lining of throat and spread
easily through respiratory secretions
Est. 2-10% of population carriers, but
are prevented from illness by throat’s
epithelial lining.
121
Statistics
Oregon – 2005: 56 cases
Oregon – 1994 – 2003: 887
Marion County: 111
Multnomah County: 182
122
Modes of transmission: direct
contact w/ secretions during
intubation, suctioning, CPR etc.
123
S/S:
Onset is rapid;
Fever
Chills
Joint pain
Neck stiffness or nuchal rigidity
Petechial rash
Projectile vomiting
Headache
124
~10% may develop septic shock;
acute adrenal insufficiency, DIC,
coma may result. Death may occur in
6-8 hours.
125
Pediatric patients; infants 6 mo - 2 y/o
esp. susceptible; maternal antibodies
protect neonates to 6 mo.
Infants display nonspecific s/s:
Fever,
Vomiting,
Irritability,
Lethargy,
Bulging fontanelle
High-pitched cry
126
Patient
management:
Protective
measures with
surgical masks to
patient.
Prophylactic tx
available; rifampin,
etc.
Immunizations:
especially for older
children and adults.
127
Other infectious agents
cause meningitis:
Streptococcus pneumoniae
(bacterial)
2nd most common cause in adults
Most common cause of pneumonia in
adults and OM in children
Spread by droplets, prolonged contact
or soiled linen.
128
Hemophilus influenza type B
(bacterial)
Gram negative rods. Prior to 1981,
leading cause of meningitis in
children 6 mo-3 y/o.
Although tx with antibiotics very
effective, >50% infected children
have long-term neurological
deficits.
Implicated in epiglottitis, septic
arthritis, generalized sepsis.
129
Viruses (aseptic meningitis)
A variety known to cause
meningitis
Not considered communicable
130
Pneumonia
Causative organisms
Bacterial
Viral
Fungal
131
Pneumonia
(cont)
Systems affected
Respiratory - pneumonia
CNS - meningitis
ENT - otitis, pharyngitis media
Routes of transmission
Droplet, Direct contact, Soiled linen
132
Susceptibility
Pulmonary edema
Flue
Exposure to inhaled toxins
Chronic lung disease and aspiration
Geriatrics
Pediatrics with low birth weight and
malnourishment
133
Other high-risk groups
Sickle cell disease
Cardiac disease
Diabetes
Kidney disease
Hiv
Organ transplants
Hodgkins disease
Asplenia
134
Statistics
2005 (Tri-county area) – 165 cases
Death highest in > 84 y/o
135
S/S
Sudden onset chills, high-grade
fevers, chest pain with respirations,
dyspnea.
PEDS: fever, tachypnea, chest
retractions are ominous.
Purulent exudates may develop in
one or more lobes.
Patient may have productive cough
with yellow-green phlegm.
136
Patient management
Several antibiotics effective to treat
bacterial pneumonia
Protective measures for health-care
workers.
Immunizations:
Vaccine exists for some causes
137
Tetanus
Causative organism;
Clostridium tetani
Live mainly in soil
and manure
Also found in
human intestine
138
Statistics
500,000 cases/year worldwide
45% mortality
100 cases/year in U.S.
Patients > 50 y/o
Oregon: 1992-2001; 6
Marion County – 1997: 1
139
Affects musculoskeletal system
Mode of transmission
Wounds, burns, other disruptions in
skin.
Puncture wounds introducing soil,
street dust and animal or human feces.
Dead or necrotic tissue favorable
environment.
140
S/S
Muscular tetany
Painful contractions, esp.
trismas or lockjaw and neck
muscles; secondarily of
trunk muscles.
PEDS: abnormal rigidity may
be first sign.
Painful spasms with risus
sardonicus
Can lead to respiratory
failure.
141
Patient
management:
Support vital functions
Valium for muscle spasms
Consider paralytics
Magnesium sulfate
Narcotics
Antidysrhythmics
Administration of antitoxin
- TIG
142
Post exposure of tetanus immune
globulin - keep immunizations UTD.
Immunizations: Booster before
elementary school, every ten years
thereafter.
143
Rabies - hydrophobia
Acute viral infection of the
CNS
Causative organism - rabies
virus
Affects nervous system
Route of transmission
Saliva from bite or scratch of
infected animal.
Person-person transmission
theoretically possible.
Airborne spread in bat caves rare
144
Statistics
Oregon; 1994 – 2003; 77
Marion County:
1996 – 2
1998 – 2
2001 – 1
2007 – 4 animals (bats)
145
Hawaii is only area in US
that is rabies-free.
Wildlife rabies (in us)
common in
Skunks
Raccoons
Bats
Foxes
Dogs
Wolves
Jackals
Mongoose
Coyotes.
146
Susceptibility: Mammals highly
susceptible.
Incubation period usually 3-8 weeks
(rare; 9 days - can be as long as 7
years).
147
S/S:
Sense of apprehension
H/A
Fever
Malaise
Poorly defined sensory changes.
Progresses to weakness or paralysis
Spasm of swallowing muscles (causes
hydrophobia)
Delirium
Convulsions
W/O medical care, disease lasts 2-6 days;
often results in death.
148
Patient
management:
EMS workers; transmission never
documented.
After bite:
Thorough debridement of wound
Free bleeding and drainage.
Vigorously clean wound with soap and water
and irrigate with 70% alcohol.
Prophylactic Tetanus vaccine
Administration of human rabies immune
globulin
Over several weeks
149
Hantavirus
Known to be associated with
hemorrhagic fever with renal
syndrome; occurs in Asia.
Also associated with a
syndrome of severe respiratory
distress & shock in
Southwestern U.S.
Deermouse
Transmitted via inhalation of
aerosols of rodent urine and
feces
150
Statistics
Oregon: 1993 – 2003; 5 cases
• 2006 – 7 cases
NM – 2006 – 68 cases
151
S/S
Typically healthy adults
Onset of fever and malaise – 1 – 5 weeks
later
Followed several days later by respiratory
distress
Fever,
Chills
H/A
GI upset
Capillary hemorrhage
Kidney failure, hypotension, severe infection
may ensue
Death from poor cardiac output
153
Severe HPS
Evolution of HPS
1
2
Large effusion assoc. w/ HPS
3
154
Patient management
Supportive
BSI
155
Chickenpox
Causative agent;
variella-zoster virus
(member of the
Herpes virus group).
System affected;
primarily
integumentary
156
Statistics
4 million/yr in US
Most 1 – 4 y/o
• Associated with Daycare
157
Shingles is a local manifestation of
reactivation of latent viral infection
Mainly airborne
Soiled linen implicated.
Incubation period 10-21 days
158
S/S: Chickenpox
More severe in adults
Begins with respiratory symptoms, malaise,
low-grade fever.
Rash begins as small red spots that become
raised blisters on a red base. Eventually dry
into scabs. Rash is profuse on trunk
Itching
Patient management:
Isolation until all lesions are crusted and dry.
159
Disease self-limited
Complications
Secondary bacterial infections
Aseptic meningitis
Mononucleosis
Reye syndrome
160
Mumps
Causative agent:Mumps virus
Acute, communicable systemic
viral disease
Glands most commonly
affected:
Parotid
Testes
Pancreas
161
S/S:
Mode of transmission; droplet spread,
direct contact
Incubation period; 12-25 days.
Immunity general after recovery
30% asymptomatic
Fever, swelling and tenderness of
salivary glands, esp. parotid.
After onset of puberty;
• Orchitis
• Testicular atrophy
162
Patient management:
EMS workers - MMR immunity
Patients wear masks
Caution with soiled linen
163
Rubella (German
measles)
Causative agent - rubella
virus
Mild, febrile, highly
communicable disease
Systems affected;
Integumentary,
Musculoskeletal,
Lymph nodes
164
Mode of transmission
Maternal transmission
gravest risk:
Congenital heart
diseases, eye
inflammations,
retardation,
Deafness (90% of
neonates born to
mothers infected in
first trimester develop
congenital rubella
syndrome).
165
Congenital anomalies; death from
heart disease, sepsis in first 6 month
Mental retardation
Deafness
Person-person contact via mucous
secretions
166
S/S:
Generally mild; fever,
flue sx, red rash that
spreads from
forehead to face to
torso to extremities
and lasts 3 days.
Serious
complications do not
occur in Rubella.
167
Patient management:
BSI including mask.
All EMS workers,
especially females
should be screened
for immunity.
No specific
treatment.
Immunizations:
known to be 98-99%
effective
168
Measles (rubeola,
hard measles)
Causative organism - measles virus
Highly communicable
Systems affected: respiratory, CNS, pharynx, eyes,
systemic
Mode of transmission - air droplets, direct contact.
169
170
S/S:
Prodrome - conjunctivitis, swelling of
eyelids, photophobia, high fevers to
105 degrees, hacking cough, malaise
171
A day or two before rash, patients
develop small, red-based lesions
with blue-white centers in the mouth
(Koplik’s spots) sometimes
disappearing with generalized skin
rash.
Rash is red, slightly bumpy and
spreads from forehead to face, neck,
torso, to feet by 3rd day.
172
Rash usually lasts for 6 days, initially
appears thicker over head and
shoulders, clears up and follows that
pattern toward feet.
Pneumonia, eye damage and
myocarditis are all possible but most
life-threatening is subacute
sclerosing panencephalitis
Progressive deterioration of mental
capacity, muscle coordination
173
Patient management:
BSI, including mask
EMS workers should be immunized
No specific treatment.
174
Pertussis (Whooping Cough)
The 100-day cough
Causitive organism - Bordetella
pertussis
Mainly affects infants and young
children
Affects oropharynx
Mode of transmission; direct contact
with airborne droplets.
175
S/S:
Insidious onset of cough which becomes
paroxysmal in 1-2 weeks, lasts 1-2
months.
Paroxysms are violent, inspiratory whoop.
Whoop often not present in infants < 6
mo., adults
Before pertussis vaccine in 1950’s,
disease killed more children in U.S. than
all other infectious diseases combined
176
Patient management:
EMS workers be cautious about handling
linens, supplies etc. on all patients with hx
of recent onset of paroxysmal cough
Transport patient with mask.
Communicable period thought to be greatest
before onset of coughing.
Incubation period 6-20 days.
Erythromycin decreases period of
communicability, but only reduces sx if given
during incubation period.
177
Influenza – the flu
Causative organisms; influenza
viruses types A, B, C
Affects respiratory system
primarily
Mode of transmission:
airborne, direct contact
Virus can persist for hours,
especially in low humidity and
cold temp.
Incubation period 1-3 days.
178
S/S:
URI- type symptoms which
last 2-7 days.
Chills
Fever
Headache
Muscle aches
Anorexia
Fatigue
Cough often severe,
protracted.
179
Patient management:
Supportive
Immunizations:
Health care workers should be
immunized by mid-Sept. (flu
season Nov.-Mar. in US).
180
Avian Flu
Lots of media coverage
In most bird populations
More of an issue when in domestic birds
Chickens
Turkeys
Ducks
Rarely transmitted to humans
Not known to transmit human to human
50% death rate when acquired
181
27 February 2009
Cumulative Number of Confirmed Human Cases of
Avian Influenza A/(H5N1) Reported to WHO
2003
Country
C
2004
D
C
2005
D
C
2006
D
C
2007
D
C
2008
D
C
2009
D
C
Total
D
C
D
Azerbaijan
0
0
0
0
0
0
8
5
0
0
0
0
0
0
8
5
Bangladesh
0
0
0
0
0
0
0
0
0
0
1
0
0
0
1
0
Cambodia
0
0
0
0
4
4
2
2
1
1
1
0
0
0
8
7
China
1
1
0
0
8
5
13
8
5
3
4
4
7
4
38
25
Djibouti
0
0
0
0
0
0
1
0
0
0
0
0
0
0
1
0
Egypt
0
0
0
0
0
0
18
10
25
9
8
4
4
0
55
23
Indonesia
0
0
0
0
20
13
55
45
42
37
24
20
0
0
141
115
Iraq
0
0
0
0
0
0
3
2
0
0
0
0
0
0
3
2
Lao People's
Democratic
Republic
0
0
0
0
0
0
0
0
2
2
0
0
0
0
2
2
Myanmar
0
0
0
0
0
0
0
0
1
0
0
0
0
0
1
0
Nigeria
0
0
0
0
0
0
0
0
1
1
0
0
0
0
1
1
Pakistan
0
0
0
0
0
0
0
0
3
1
0
0
0
0
3
1
Thailand
0
0
17
12
5
2
3
3
0
0
0
0
0
0
25
17
Turkey
0
0
0
0
0
0
12
4
0
0
0
0
0
0
12
4
Viet Nam
3
3
29
20
61
19
0
0
8
5
6
5
2
2
109
54
Total
4
4
46
32
98
43
115
79
88
59
44
33
13
6
408
256
C = Cases
D = Deaths
West Nile Virus
Symptoms
Usually mild or no symptoms
May have fever
Headache
Body aches
Skin rash
Swollen lymph glands
May cause encephalitis
183
2005
2008
West Nile Virus
Treatment
Prevention
• Insect repellent
Supportive
Most return to normal
status within 1 year
186
Mononucleosis
Causative organism Epstein-Barr virus or
cytomegalovirus (both
herpes virus family)
Body regions
affected: oropharynx,
tonsils
187
Modes of
transmission
Person-to-person
spread by saliva
Kissing
Care providers to
young children is
common
188
S/S:
Appear gradually
Fever
Sore throat
Oropharyngeal discharges
Lymphadenopathy
Splenomegaly
Recovery usually in a few weeks, but
may take months
189
Patient management
No specific treatment
No immunization available.
190
Herpes simplex virus
type 1
Causative organism:
HSV 1
Affects: oropharynx,
face, lips, skin, fingers,
toes, CNS in infants
Mode of transmission:
Saliva
Skin – skin contact
191
S/S:
Cold sores, fever
blisters
Tx with acyclovir
(Zovirax) helpful.
192
Patient management:
BSI, including mask
Lesions are highly contagious
193
Herpes simplex virus
type 2
Causative organism HSV 2
Mode of transmission sexual activity
S/S - Males:
Lesions of penis, anus,
rectum, and/or mouth
194
S/S - Females:
Sometimes
asymptomatic; lesions
of cervix, vulva, anus,
rectum and mouth;
recurrent disease
generally affects vulva,
buttocks, legs, perineal
skin.
195
Syphilis
Causative organism;
Treponema pallidum, a
spirochete
Affects:
Skin,
CNS,
Eyes,
Joints,
Skeletal system,
Kidneys,
Cardiovascular
196
Mode of transmission:
Direct contact with
exudates from moist,
early, obvious or
concealed lesions of skin
and mucous membranes
Semen,
Blood,
Saliva,
Vaginal discharges,
Blood transfusions,
Needle sticks
Congenital transmission
197
S/S: Occurs in 4 stages
Primary stage - painless
lesion develops at point of
entry called a chancre, 1090 days after initial
contact.
Lesion heals spontaneously
within 1-5 weeks
Highly communicable at
this stage
198
Secondary stage - bacteremia stage
begins 2-10 weeks after appearance
of primary lesion
H/A
Malaise
Anorexia
Fever
Sore throat
Lymphadenopathy
Rash, (small, red, flat lesions) on palms
and soles of feet, lasts about 6 weeks.
199
Condyloma latum - painless wart-like
lesion found on moist, warm sites
like inguinal area. Extremely
infectious, lasts @ 6 weeks.
Skin infection in areas of hair growth
results in bald spots and/or loss of
eyebrows.
CNS - eyes, bone and joints or
kidneys may become involved.
201
Third stage - latent syphilis 1 – 40
years
25% may relapse and develop
secondary stage symptoms again.
After 4 years, there are generally no
more relapses
33% of patients will progress to tertiary
syphilis; the rest will remain
asymptomatic.
202
Tertiary (Late) Syphilis
Granulomatous lesions
(gummas) found on skin and
bones; skin gummas are
painless with sharp borders;
bone lesions cause a deep,
growing pain.
Cardiovascular syphilis; occurs
10 years after primary infection;
generally results in dissecting
aneurysm of ascending aorta or
aortic arch. Antibiotics don’t
reverse this disease process.
203
Neurosyphilis; asymptomatic, develop
menengitis,
Spinal cord disease that results in loss
of reflexes and loss of pain and
temperature sensation.
Tabes dorsalis; spinal column
degeneration; wide gait and ataxia
Spirochetes attack cerebral blood
vessels and cause CVA.
Psychosis, Insanity
204
Late Stage Syphilis
205
Syphilis can do a number
on your genitalia:
Secondary syphilis w/gross disfiguration
Patient management:
BSI
Causative agent extremely fragile
and is easily killed by heat, drying,
or soap and water.
Treatment is effective with
penicillin, erythromycin,
doxycycline.
207
US Syphilis Rates by State, 2004
2.4
0.4
0.2
0.0
0.8
0.5
1.8
0.5
0.0
0.6
3.8
0.2
1.0
0.4
1.8
0.6
3.8
3.1
1.4
2.8
0.9
0.7
4.4
1.0
2.1
0.2
1.6
1.6
1.1
1.7
2.8
2.0
3.7
0.2
0.4
1.8
2.4
1.3
1.7
1.1
6.9
2.3
2.2
Guam 0.0
6.3
Rate per 100,000
population
3.7
7.4
1.2
VT
NH
MA
RI
CT
NJ
DE
MD
1.9
4.3
<=0.2
0.21-4.0
>4.0
0.6
Puerto Rico 4.7
Virgin Is. 4.6
(n= 7)
(n= 39)
(n= 7)
Statistics
Oregon: 2005 – 57 cases reported
• 2004 – 58 cases reported
115% increase over 2001
209
Gonorrhea
AKA “The Clap”
Causative agent;
Neisseria gonorrheae
Affect genital organs
and associated
structures
Mode of transmission:
direct contact with
exudates of mucous
membranes;
unprotected sex.
210
S/S - Males:
Initial inflammation of urethra with
dysuria and purulent urinary
discharge . Left untreated, can
progress to epididymitis, prostitis,
and strictures of urethra.
211
Typical Gonorrheal penile discharge
212
S/S - Females:
Dysuria and purulent vaginal
discharge may occur.
Most females have no pain and
minimal urethral discharge.
213
Infection of uterus can progress to
PID; fever, lower abdominal pain,
abnormal menstrual bleeding,
cervical motion tenderness.
Menstruation allows bacterial spread
from cervix to upper genital tract 50% of PID occurs within 1 week of
onset of menstruation.
214
Females at increased risk for sterility,
ectopic pregnancy, abscesses of
fallopian tubes, ovaries, peritoneum,
and peritonitis.
215
Males and females:
In rare cases, systemic bacteremia
Septic arthritis with fever, pain, swelling
of 1 or 2 joints can occur.
Patient management:
BSI
Antibiotics
216
Statistics
Oregon:
1980 – 11,162
1995 – 854
2001 – 1,039
2005 – 1,562
217
Gonorrhea Rates by State, 2004
45.8
9.6
16.1
17.4
36.6
58.4
7.5
92.3
39.8
11.8
97.6
172.4
42.4
90.9
65.9
137.3
85.0
67.1
72.8
179.0
162.8 110.6
25.6
69.7
93.3
126.8
49.3 116.0
161.6
67.0
151.8
221.1
Guam 69.7
182.3
181.7
Rate per 100,000
population
110.2
234.4
87.4
13.9
10.3
47.5
75.8
82.2
77.5
109.4
150.6
180.7
145.1
248.6
VT
NH
MA
RI
CT
NJ
DE
MD
109.2
<=19.0
19.1-100.0
>100.0
94.9
Puerto Rico 6.9
Virgin Is. 68.9
(n= 8)
(n= 25)
(n= 20)
Chlamydia
Causative organism;
Chlamydia
trachomatis
Affects; eyes, genital
area and associated
organs, respiratory
system
219
Mode of transmission sexual activity, sharing
contaminated clothing or
towels.
S/S: similar to gonorrhea
Conjunctivitis may
occur; leading cause of
preventable blindness
in the world.
Infant pneumonia
known to occur.
Healthy Cervix
Chlamydia
Statistics
Most common reported STD in
Oregon
2005 – 9,018
222
US Chlamydia Rates by State, 2004
287.6
284.2
161.8
285.6
244.1
229.3
203.8
351.2
331.3
215.9
308.0
409.2
236.3
307.5
301.2
298.5
372.9 297.6
164.0
344.4
311.0
300.8
482.0
275.1
295.2
344.3
152.3 292.9
373.7
157.1
288.5
444.2
Guam 457.2
295.8
394.7
Rate per 100,000
population
317.5
485.7
609.4
183.6
134.8
205.8
319.8
274.2
202.0
361.3
362.2
344.5
385.4
654.7
VT
NH
MA
RI
CT
NJ
DE
MD
250.0
(n= 2)
<=150.0
150.1-300.0 (n= 25)
(n= 26)
>300.0
422.0
Puerto Rico 92.5
Virgin Is. 278.5
Scabies
Scabies; a mite; a parasite
Female burrows into epidermis to lay
eggs; remains in burrow for 1 month.
Affects skin
Modes of transmission; skin-skin
contact
Bedding only if within 24 hours.
Mite can burrow into skin in 2.5 minutes.
224
S/S:
Intense itching, esp. at night with
vesicles, papules, linear burrows.
Males; lesions prominent around finger
webs, anterior surfaces of wrists and
elbows, armpits, belt line, thighs,
external genitalia
Females; lesions prominent on nipples,
abdomen, lower portion of buttocks.
Infants; head, neck, palms, soles.
225
Patient management:
BSI
Personal - launder everything used in
last 48 hours in hot water. Treatment
with Kwell
226
Lice
Infesting agents:
Head louse, body louse
Responsible for outbreaks of
epidemic typhus & trench
fever in WWI
Modes of transmission:
Head lice and body lice - direct
contact
Body lice - indirect contact,
esp. shared clothing
Crab lice - sexual contact
227
Head Louse infestation
228
3 stage life cycle; eggs, nymphs,
adults
Eggs hatch in 7-10 days
Nymph stage lasts @ 7-13 days
Egg-egg cycle lasts 3 weeks.
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S/S: Itching
Infestation of Head
lice is of hair,
eyebrows,
eyelashes,
mustache, beards.
Infestation of body
lice is of clothing,
especially along
seams of inner
surfaces.
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Patient management:
Personal treatment - Kwell, etc.
repeat in 7-10 days.
Wash all bedding, clothing, etc. in hot
water, or place in dryer on hot cycle.
EMS workers - clean patient area well.
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Lyme Disease
Causative organisms;
Borrelia burgdorferi
Affects skin, CNS,
cardiovascular system,
joints
Mode of transmission;
tick borne with reservoirs
in mice and deer
Western Black-legged
Tick
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Statistics
Oregon – 2005 - 24 Cases
Tillamook: 5
Hood River: 7
May - August
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S/S:
Early, localized
stage with
painless skin
lesion at site
of bite (starts
out as red, flat,
round rash
which spreads
out.
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Border remains
bright red, center
becomes clear, blue
or necrose and
black, flu-like
syndrome with
malaise, myalgia,
stiff neck.
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Early disseminated stage; invades
skin, nervous system, heart, joints
Skin - multiple lesions
Nervous system - meningitis, Bell’s
palsy, peripheral neuropathy
Cardiac; AV block, Myocarditis
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Joint and muscle pain - can occur 6
months after bite
Late stage:
~10% develop chronic arthritis
Encephalopathy can develop; cognitive
deficits, depression, sleep disorders.
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Almost time to go….
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Body fluids to which universal
precautions apply
Blood, other body fluids containing blood
Semen, vaginal secretions
Human tissue
Human fluids
CSF
Synovial
Pleural
Peritoneal
Pericardial
Amniotic
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Body fluids to which universal
precautions do not apply
In the absence of blood
Feces
Nasal secretions
Sputum
Sweat
Tears
Urine
Vomitus
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Precautions for other body
fluids in special settings
Human breast milk if mother HIV
positive
Saliva if person HBV or HIV positive
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Remember!
Prepare food and eat in
appropriate areas
Maintain general and
psychological health
Dispose of needles and
sharps appropriately
Don’t wipe face and/or
rub eyes, nose, mouth
etc.
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Bye Bye now...
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