Course Book : #100 - HIV / AIDS For INITIAL FLORIDA Licensure or Endorsement

For Initial Licensure or Endorsement

Meets Florida Requirements

This course is for INITIAL licensure in the State of Florida , and can be used for HIV/AIDS for endorsement if you are applying to Florida. Endorsement HIV/AIDS only requires Three contact hours.

This course exceeds licensure requirements

COURSE # 100

Author: Monica Oram, RN, BSN

This course is intended for the reader to be able to achieve the following objectives:

    Understand difference between HIV and AIDS.

    Know the myths of HIV and AIDS.

    Understand HIV and AIDS Statistics.

    Learn three methods used for HIV Screening.

    Understand Universal Precautions.

    Understand How HIV is transmitted.

    Understand Legal Right associated with HIV/ AIDS.

    Understand Current treatment associated with HIV and AIDS.

    Identify what are blood borne pathogens

    Understand universal precautions

    Understand Hepatitis and the various types

    How to protect yourself from blood borne pathogens

    Learn about the Hepatitis B vaccine

    Understand the Pathophysiology of the disease process of HIV/AIDS and other related Blood-borne pathogens

In the world today, approximately 33.6 million people are estimated to be living with HIV/AIDS. Of these, 32.4 Million are Adults, 14.8 Million are women, and 1.2 million are children under the age of 15. The highest incidence of HIV and AIDS per 100,000 people are found in New York and New York is ranked #1 in the nation for HIV and AIDS cases, followed by California, ranking in at #2, and then Florida at #3, with New Jersey ranking #4 and the little state of Connecticut ranking in at #5.

It is noteworthy to know that Florida, however ranks #2 in Pediatric HIV/AIDS cases in the Nation.

The last cumulative count was done in 1999 by the CDC, and indicates that for every case of AIDS known, there are at least 10 people who are infected with HIV. The most recent estimate of HIV prevalence indicates that there are approximately 1 in 400 people in the world currently living with HIV, and 1 in 250 Americans are currently living with the HIV infection. In Florida, it is estimate that 1 in 150 are infected with the HIV Virus. Florida also ranks SECOND in the nation for HIV Pediatric cases. Alarming statistic for the Dade County Area( Miami, Florida) shows that 1 in every 50-60 people are HIV infected!
Difference Between HIV and AIDS

AIDS is caused by the Human Immunodeficiency Virus (HIV). HIV kills and damages the body’s immune system by destroying the body’s ability to fight off infections and certain cancers. People with AIDS may get life threatening diseases called opportunistic infections, which are caused by viruses and/or bacteria that normal healthy people are able to fight off with out any problems.

HIV is the virus that causes AIDS. A person cannot get AIDS without first having the HIV Virus. HIV attacks the immune system, and weakens the body’s ability to fight off infections. The body becomes so weak it cannot fight off diseases that it comes in contact with. Once the body is infected with the disease of HIV, the virus quickly begins to reproduce inside the blood cells of the infected person. Currently, there is no cure for HIV. There are many medications that are thought to slow down the process of cell reproduction and will allow the infected person to live longer. The best prevention for HIV is by way of community education, and modifying any behaviors that are risky. AIDS is the end stage of HIV infection.
Understanding the Signs and Symptoms

Early AIDS symptoms can include fever, loss of appetite, weight loss, chronic fatigue, and skin rashes. Later on, the person may develop and experience unusual types of cancers or infections, including pneumonia, that the body can no longer fight off. Some people who carry the HIV virus have no symptoms for as long as 10 -15 years. And others may not develop AIDS until many years after they become infected. Researchers are working hard to fight AIDS, and they learn more every day. But, unfortunately there is still no cure.
How The Immune System Is Overpowered

Acquired immunity develops after we are born to help us fight off infections through out life, like colds and flu, ect. The cells in our bodies produce antibodies that can attack and destroy disease causing germs to ward off infections. The immune system is a network of cells and organs that work together to fight off infections. The antibodies try to fight back by signaling out the “Bad Cells” and attaching to them, the phagocytes then try to “eat” them in order to try and destroy them. The T-cells are able to fight infection and are there to also help the body ward off infections. This is how a normal immune system is designed to work.

When HIV invades the body, by entering the blood stream, it uses the immune system against itself in order to reproduce and survive. As the body recognizes the invasion of the “Bad Cells”, some of the HIV is destroyed when the T-Cells try to fight back. The problem arises when the HIV virus compromises the whole immune system. The HIV cells are able to “disguise themselves to appear as “good cells”, and them reproduce at a very fast rate. The body thinks they are the good cells, and accepts them as their own, therefore allowing reproduction to take place in the body. Once HIV is in the body it becomes a retrovirus.

Once inside the T-Cells, it uses reverse transcriptase enzymes to translate its genetic make up of RNA ( (ribonucleic acid ) into t-Cell DNA ( deoxyribonucleic acid) The infected cells become a mass producing factory that produces new viral cells that finally take over and destroy the T Cells.

HIV Infection Cycle

First, there is a window period in which the time a person becomes infected and until the body develops enough antibodies for an accurate positive HIV test to detect presence of HIV in the blood. This is a window period. It can range from 2 weeks to 6 months. The person with HIV is infectious during this window period. Then there is an incubation period. In the incubation period, and HIV infected person normally shows no signs or symptoms and appear to be healthy and not sick. This is particularly a major concern, because it is in this phase that others are becoming infected through unsafe sex, and exposure to blood and body fluids. The person who is infected does not look or feel sick, and therefore usually does not modify any of the identifiable risky behaviors associated with the spread of the disease. The HIV infected person may not develop any signs or symptoms for a period of 5-10 years or more, once infected. The Phase of AIDS, is when symptoms appear and the immune system begins to break down. The person may not be considered to have “full blown AIDS” but they begin to show signs and symptoms. AIDS is confirmed with a positive HIV test , and if found to be positive it is repeated for a confirmation of results. It will also indicate that an HIV person has one or more opportunistic infections, once the symptoms begin to appear. For example, it is not until the person begins experiencing a flu like infection, before they generally seek medical advise and then be tested for HIV. The most common opportunistic infection includes PCP. ( pneumocystis carinii pneumonia), yeast infections primarily in the mouth and esophagus, Kaposi’s Sarcoma

(Blood Cancer). One indicator that a person has AIDS is when it is discovered that the person has a CD4 count below 200. A normal person has about 500-1500 cells per micro liter CD4 count cells.
Myths about HIV and AIDS

Myth: If I am HIV positive, that means I have AIDS

Fact: HIV positive means that your body was exposed to the virus. Since your body was exposed to the virus, there is a good chance that you are infected with the virus. But it does not mean that you have AIDS. AIDS develops over a period of time.

Myth: HIV is the same as AIDS.

Fact: HIV is the virus that causes AIDS. AIDS is a group of symptoms that develop during the last stage of HIV infection.

Myth: I can get HIV from an infected person by shaking hands, hugging, or kissing.

Fact: HIV is not spread through casual contact. There is a slight chance that you could become HIV infected through kissing if you or the infected person both had open bleeding sores in the mouth, and the infected person’s blood gets into yours.

Myth: I can get HIV from telephones, toilet seats, or door knobs.

Fact: The HIV virus cannot live outside of the body. You cannot become infected through saliva, unless there is visible blood and you have an open area for the virus to enter.

Myth: I can get HIV from eating food that was prepared by an infected person.

Fact: HIV dies quickly outside of the body. Once any body fluid is dry, you can be absolutely sure the virus is dead.

Myth: I can become infected with HIV from a mosquito.

Fact: Although it sounds very possible, you can not get HIV infected from a mosquito, fleas, ticks, or lice. For this to happen, the HIV would have to live in the insect’s saliva or salivary glands. HIV is a human virus and cannot survive out of the human body.

Myth: I can get HIV from breathing the same air as an infected person.

Fact: HIV is not airborne, and does not transmit by air. You cannot get HIV by being in the same room with an HIV infected person.
Screening Tests For HIV

The standard method of testing for HIV is by a blood test called the EIA test. The EIA test is the enzyme immunoassay test. It is done by collecting a blood sample, and tested in a lab. A negative screen indicates the person is not infected. A positive test indicates the person is possibly HIV infected, and will be confirmed with a second test to rule out an absolutely positive result. This second test is called the Western Blot to confirm the diagnosis.

A negative test result does not necessarily mean a person is in fact negative, if the person is known to engage in risky behaviors, they could be in the window period, and would not necessarily have a positive test result. These individuals should be retested in 6 months to confirm the outcome of negative or positive.

There is a new rapid test available from the Food and Drug Administration, known as the SUDS test. The suds test is Single Use Diagnostic System. A result can be obtained in 5 to 30 minutes. A positive test is confirmed by the western blot test.

One will also want to remember that an HIV test on an infant could show the HIV status of the mother due to antibodies being transferred from mother to baby.
Methods of Transmission

HIV can be spread through unprotected sex. Unprotected sex refers to having sex without the use of a latex condom or a dental dam for oral sex. HIV is transmitted through blood and body fluids such as blood, semen, vaginal lining and fluids, and breast milk. HIV is transmitted by sexual intercourse, babies born to infected mothers and breast feeding, body fluids and blood, and sharing IV drug needles.

Prevention includes understanding and learning all you can to be safe. Education is a key importance in the spread of HIV. Do not have unprotected sex, know the status of your sexual partners, Do not share needles with anyone, Avoid risky behavior that can expose you to contact with blood or body fluids. Always use latex condoms, and know how to use them correctly.

As far as workplace exposure, it is important to know to never recap any needles. There should always go directly in the sharps box after use. Make certain the sharps box is never over filled more than 2/3 full when disposing needles. Wear gloves at all times when an exposure to any blood or body fluid is a possibility. Use face masks, and eye protection if a fluid splash is possible. Prescription eye glasses will not be adequate protection. Do not expose your skin to soiled equipment or soiled linens. Use resuscitation barriers for Mouth to mouth contact in Cardio- Pulmonary Resuscitation.
Terms To Be Familiar With

Acquired Immunodeficiency Syndrome- AIDS… The severe manifestation of infection with the HIV Virus. The CDC lists a number of opportunistic infections and cancers that, in the presence of HIV infection. Constitutes an AIDS diagnosis. There are also instances of presumptive diagnoses when a person’s HIV status is unknown. This was especially true before 1985. Prior to 1985, the blood supply was not tested, and there was no antibody test available. In 1993, CDC expanded the criteria for an AIDS diagnosis to include CD4 and T cell counts at or below 200 cells per micro liter in the presence of HIV infection.

Acute HIV infection- The four to seven week period of rapid viral replication immediately following exposure. An estimated 30-60% of individuals with Primary HIV infection develop an acute syndrome characterized by fever, malaise, lymphadenopathy, pharyngitis, headache, myalgia, amd sometimes a skin rash. Following primary infection, seroconversion and broad HIV -1 specific immune response occur within 30 - 60 days.

AIDS Dementia Complex- (ADC) A degenerative neurological condition attributed to HIV infection, characterized by a group of clinical presentations including the loss of coordination. Mood swings, and loss of inhibitions, and wide spread common central nervous system complications of HIV infection.

AIDS related Complex- (ARC) A term that is used by some clinicians to describe a variety of symptoms found in some persons living with HIV.

Antibody- Molecule in the blood or secretions that tag, destroy, or neutralizes bacteria, viruses, or harmful toxins in the blood. Antibodies are a class of proteins known as immunoglobulins, which are produced and secreted by B-lymphocytes in response to stimulation by antigens. Antibodies are specific to invading organisms.

CD4+ Cells- A type of T helper cell that is involved in protecting the body against infection. Destruction of CD4 cells is the major cause of immunodeficiency seen in AIDS.

T-Cells- are white blood cells that are derived from the Thymus gland, that participates in a variety of cell mediated immune reactions. Three different types of T cells exist, Helper T’s, Killer T’s, and Suppressor T’s.. They are the body’s “border police” responsible for finding infected or cancerous cells.

Treatment and Medical Management

Currently, there is no cure for HIV or AIDS. There are a variety of medications that will slow down the reproduction phase of the cells. Normally treatment modality will consist of a combination of several types of antiretroviral drugs. The treatment outcome will largely depend upon the compliance of the patient taking these drugs as prescribed. There are many side effects that are often worse than the symptoms, and compliance is a big issue with many HIV positive patients.

Currently some drugs being used include AZT, Dapsone, DDC, DDI, Pentamidine, Saquinavir, to mention a few.

AZT- Azidothymidine, also known as retrovir or zidovudine. The first antiretroviral drug against HIV infection to be introduced by The FDA in 1987. It is a thymidine analog that suppresses replication of HIV virus.

Dapsone- An approved oral antibiotic of the sulfone class used to treat and as prophylaxis of PCP and toxoplasmosis.

DDC- Dideoxycytidine, is a nucleoside analog drug that inhibits the replication of HIV. FDA approved treatment selected for patients with advanced HIV disease.

DDI - Dideoxyinosine, is a nucleoside analog drug that inhibits the replication of HIV. Also prescribed for patients with advanced HIV disease.

Pentamidine- An approved antiprotozoal drug used for the treatment and prevention of PCP. ( pneumocystis Carinii Pneumonia)

Saquinavir- A peptide based, protease inhibitor. FDA approved for combination use with nucleoside analogs for treatment of advanced HIV infection.

Ethical Concerns

The main concern is that the patient requires emotional and psychological support. It is no longer important how he became infected, but how to deal with the disease process at this point. There are laws set in place that protects the patients right to privacy. Consent forms must be obtained in advance before any testing may be done. Only a Doctor or a specially trained individual can deliver test results. They may never be given by phone or in the mail. The individual must undergo pre and post counseling when being tested.

Standard Precautions

The best way as stated by the CDC, is to avoid contracting HIV and developing AIDS, you should follow strict CDC guidelines and standard precautions. The rule of thumb is, “Treat all people as if they have HIV, when providing care” therefore, the use of gloves and personal protective equipment is essential in preventing the spread of HIV. Handwashing is critical, use of vinyl or latex gloves is also essential when in contact with any blood or body fluid.

Let’s look a little deeper

Blood borne pathogens are viruses or bacteria that get into the bloodstream and cause disease. If a person comes in contact with blood infected with a blood borne pathogen, he or she may become infected as well. (For more on infection control in the workplace, refer to course #113.) ( To learn more about OSHA Regulations and how the laws apply in the workplace setting, refer to course #112.)

Other body fluids can contain pathogens that may also spread blood borne diseases. These fluids include:

    Blood products (such as plasma)

    Semen

    Vaginal secretions

    Fluid in the uterus of a pregnant woman

    Fluids surrounding the brain, spine, heart and joints

    Fluids in the chest and abdomen

    Any other fluid that contains visible blood, such as saliva and dental procedures.

Many bloodborne diseases are deadly. The risk of blood borne pathogens in the work place is serious. Yet, you can protect yourself by learning effective ways of minimizing your risk. A good place to start is with your employer’s exposure control plan. A copy should be available for you to consult at your workplace during work at all times.

Always keep in mind that you cannot tell who has a disease just by looking at them. It is impossible to tell who is carrying a blood borne pathogen through medical history or by examination, without the follow up of lab tests.

Bloodborne diseases affect all populations, all ages, all socioeconomic classes, from every state and around the world. Many people carry blood borne diseases without any symptoms. Many people have no idea that they are infected since they are asymptomatic.

We will explore some blood borne pathogens such as HIV, HBV, and HCV. These are the most prevent in a healthcare setting, and put healthcare workers at the greatest risk for exposure.

HIV: the virus that causes AIDS

HBV: Hepatitis B virus, causes serious liver damage

HCV: Hepatitis C causes serious liver disease

There are other blood borne pathogens we should be aware of:
These include

    Hepatitis D

    Diphtheria

    Syphilis

    Herpes

    Ebola (viral hemorrhagic fever)

    Malaria

Blood borne pathogens may be found in OPIM’s.

--- Other Potentially Infected Materials

These include the body fluids listed above, and also blood on any surface of contamination. In a situation where it is hard to tell body fluid from another, all body fluids should be considered infectious.
Universal Precautions

One should know that universal precautions is being replaced with the term, “standard precautions” because standard precautions is implemented through OSHA regulations which covers a BROADER scope of protection for the healthcare worker, and goes a step FARTHER to offer safeguarding measures.

Universal Precautions are the basis of OSHA’s Occupational exposure to blood borne pathogens final rule. For many healthcare workers, following universal precautions and body substance isolation (BSI).

What’s the guiding idea behind Universal Precautions?

Universal precautions require healthcare workers to treat blood and body fluids as if they are infected with a blood borne pathogen. Universal precautions help protect everyone from exposure of blood borne pathogens through guidelines on:

    Proper hand washing

    Use of personal protective equipment

    Dealing with contaminated laundry and regulated waste

BODY SUBSTANCE ISOLATION

Is another infection control strategy that applies to any moist body matter. This means ALL body fluids and substances are treated as infectious. Body Substance Isolation may be used IN PLACE of Universal Precautions , PROVIDED guidelines for OSHA blood borne pathogens standards are met as well.

Universal precautions came about in 1984 in light of the raising concern of the HIV epidemic. The Center For Disease Control (CDC) recognized there was an urgent need to protect healthcare workers from blood and blood borne pathogens. In 1985 the CDC officially introduced Universal Precautions, as we know it today. It took OSHA and CDC another 6 years to put the FINAL PLAN into action to improve working environments and promote safety in healthcare facilities and for healthcare workers. So, in 1991 the rules became final for OSHA laws and regulations regarding Universal Precautions.

Universal Precautions have since been replaced with STANDARD PRECAUTIONS, which goes a step beyond in offering protection to patients and healthcare workers.

What’s the difference between Universal Precautions and Standard Precautions?

Universal precautions has stated that blood and body fluids are to be handled as “potentially infectious”, but also states that certain body fluids are NOT covered by Universal Precautions, and DO NOT REQUIRE UNIVERAL PRECAUTIONS such as:

    Urine

    Feces

    Sweat

    Vomit

    Saliva

    Nasal Drainage

    Tears

WOW!!! We know that all of the above are BODY FLUIDS! So why would we NOT want to include them in UNIVERSAL PRECAUTIONS??

Well, CDC says, that UNLESS THEY CONTAIN VISIBLE BLOOD THEY DO NOT REQUIRE UNIVERSAL PRECAUTONS.

But, Think about this….. If while at work, what do you think would be the types of fluids one would come across in the course of a work day?

ALL OF THE ABOVE ARE VERY LIKELY!! Therefore, why should we be less cautious, because they may not contain VISIBLE BLOOD?

Standard Precautions are CDC recommendations. Standard Precautions are STRONGLY recommended to keep people safe, because they:

COMBINE the main idea from Universal Precautions and Body Substance Isolation.

Standard Precautions apply to blood and body fluid, secretions, excretions, and discharge, WHETHER OR NOT they contain visible blood.

So you see, that by using standard precautions we are protecting ourselves to a much higher degree of safety against coming in contact with blood or body fluids.

Standard Precautions come into play during ANY procedure where there is a chance of exposure to blood, body fluids, secretions and excretions. Standard Precautions apply to the care of ALL patients whether or not they have a confirmed or suspected infection.

Hand Washing

Hand washing is the most important link in the prevention of infections.

It is extremely important to wash you hands:

    Between different patients

    Anytime you remove a pair of gloves

    Whenever you have touched blood or OPIM’s other potentially infectious material)

    Anytime you touch contaminated equipment

    Between performing different procedures on the same patient

    Before and after meals

    And after using the restroom

There are different LEVELS of hand washing…..

The level of hand washing depends upon what job and procedure you are doing.

    Routine or simple hand washing is used to remove dirt and transient (passing) germs from the skin using soap and water.

    Hand antiseptics are used to kill transient germs with antimicrobial soaps or alcohol based hand gels. Remember that hand gels are a temporary solution, until proper hand washing can be done. Hand Gels do not take the place of proper hand washing.

    Surgical scrubs help kill transient germs as well as those that may live on the skin. This may be done with antimicrobial agents and detergents that require a scrub of 5 or more minutes.

Spread of Infection

In order for a blood borne pathogen to gain entry into the body, all four of the following MUST be present:

    A pathogen must be present

    There needs to be a sufficient quantity of the pathogen to cause infection

    The person has to be susceptible to the pathogen

    There has to be a way for the pathogen to get into the body.

Lets look at these…..

It would make good sense that there must be an infectious pathogen present in order to transmit an infectious disease.

It would make sense that a person’s immune system has to be susceptible in order to become infected.

It would make sense that there needs to be a way for the infection to get into the body.

Now, lets look at “sufficient quantity”… How does one determine how much of a pathogen is needed to cause an infection?

Depending on a person’s immunity, what might take only a very small quality to infect one individual, may take a significant amount more for someone else in relatively good health.

So, the bottom line is never take risks, never take chances… when we are told that blood and body fluids are not considered infectious, UNLESS THEY CONTAIN VISIBLE BLOOD, think about the fact that microscopic blood can be present, and since it is unknown how much is a SUFFICIENT QUANITY to cause illness, it definitely makes GOOD SENSE to utilize STANDARD PRECAUTIONS, and treat ALL blood and body fluid as if it IS INFECTIOUS.
Hepatitis Update

There is so much to know and learn about the various types of Hepatitis. We will discuss the most common and give an overview of each.

Most commonly, we deal with Hepatitis A, B, C. (We also see D and E.. not as common) as well as f and g.
What is viral hepatitis?

Viral hepatitis is inflammation of the liver caused by a virus. It is common worldwide. It has since become a world wide epidemic affecting all parts of the globe. Until recently, only two types were known… Hepatitis A and Hepatitis B.. Other types were known as Non A, and Non B. New types such as Hepatitis B and E, and the delta agent ( Hepatitis D) have now been discovered and as research continues more viruses which can cause hepatitis infection are being identified. Viruses such as Epstein-Barr virus, cytomegalovirus ( CMV) and yellow fever virus can also infect the liver and produce hepatitis like symptoms.
How do you catch viral hepatitis?

It can be caught in different ways depending on the type of virus causing the infection. Hepatitis A and E are spread by the consumption of contaminated food or water. Most commonly by fecal-oral route. Hepatitis A is the one we hear about in restaurants where workers use the bathroom, and do not wash hands, therefore, contaminating food products that are ingested. Hepatitis B, C, and D are spread by contact with blood or other body fluids from an infected person. They are all blood borne pathogens.
How is a diagnosis of hepatitis made?

The diagnosis is confirmed by a blood test. The blood levels of liver enzymes are elevated, particularly when the patient has jaundice. These usually return to normal several weeks after the jaundice and other symptoms subside. Additional blood testing is done to identify the virus causing the acute illness. This is important in Hepatitis B and C, as they can persist and cause chronic infection, and even progresses to death if untreated.
What is the treatment for hepatitis?

Most patients do fairly well by being at home and on bed rest. Ample bed rest, together with a light diet and avoiding all alcoholic beverages are recommended. Occasionally the patient is hospitalized due to nausea, vomiting and liver failure. There are no specific anti-viral mediations that are used to treat viral hepatitis. Depending on the cause, certain forms of chronic hepatitis may be treated with steroid therapy, interferon, or other anti-viral agents. A liver transplant may be the only hope in cases of severe chronic hepatitis if the liver becomes so diseased, liver failure develops.

COMPARISON OF THE TYPES OF HEPATITIS ARE SPECIFICALLY OUTLINED IN THE CHART THAT FOLLOWS:

HEPATITIS A

Is an inflammation of the liver. This can be caused by alcohol and some drugs, but is most commonly caused by a viral infection.
    

How it spreads

Hepatitis A virus is a common infection in many parts of the world. It is most commonly transmitted through eating and drinking contaminated food/water.

Hepatitis A is transmitted in feces. It can be passed on even if tiny amounts of feces from a person with Hep A comes in contact with another person’s mouth. The mode is use of the restroom, and not washing hands prior to food preparation. The virus can also be transmitted through anal intercourse.
    

Signs and symptoms

Persons may have no signs and symptoms at all, but they can still pass on the hepatitis virus to others. Symptoms include:

    A short, mild flu like illness

    Nausea and vomiting

    Diarrhea

    Loss of appetite

    Weight loss

    Jaundice

    Itchy skin

    

Tests available

Hepatitis A can be detected with a blood sample test.

A positive blood test may indicate:

1) that the person has come in contact in the past with Hep A, and the body has cleared it. The person now has a natural immunity against future infection with the Hepatitis A virus.

Current infection:

By the time most people have developed symptoms of Hepatitis A they are less infectious to others, but in the weeks prior to developing symptoms, the person will have been a risk for potentially infecting others. Those who have come in contact can be given an injection to reduce the risk of developing symptoms.
    

Diagnosis and Treatment

A person with Hepatitis A sometimes require hospitaliz-ation, and can be fatal if untreated. The vaccine is (IG) (Immuno-globulin)

Persons exposed can receive IG within 2 weeks after exposure. Those who may be traveling to foreign countries should be immunized prior to travel. Two doses are given, 6 months apart, for lasting protection. For hepatitis A, a single injection can give immunity for up to a year. A second booster at 6-12 months after the first, can give protection up to 10 years.

Hepatitis B

Hepatitis B is inflammation of the liver. Those with Hep B need to limit alcohol consumption.

This can be caused by alcohol and drugs, but is usually the result of viral infection.

ACTIVE HEP B: a flu like illness that can last for several months. A Chronic carrier is one that may have no symptoms, but is able to infect others. There IS NO CURE for Hep B. But, with proper care, rest, and diet persons infected can recover completely. Some people develop CHRONIC HBV infection, which means they are infected for life. CDC suggests that over 300 million people are chronic Hep B carriers.
    

How it spreads

Hep B is very common worldwide. It is very infectious. Hep B can be spread by:

    Unprotect-ed sex

    Sharing contam-inated needles

    Non sterile tattoo supplies

    Infected mother to baby

    Through blood transfusion

    Using a razor or toothbrush that is infected by another person

Thousands of healthcare workers get Hep B every year. CDC suggests about 250,000 persons per year become infected!

Hep B is NOT transmitted through casual contact.
    

Signs and symptoms

Many persons may have no signs and symptoms, but they can still pass the virus to others. Symptoms include:

    Flu like illness

    Nausea and vomiting

    Loss of appetite

    Weight loss

    Jaundice

    Itchy skin

Symptoms can take 6 weeks to 6 months to develop. Some people never get symptoms, but can still transmit the virus.
    

Tests available

Most adults infected with Hepatitis B fully recover and develop life long immunity. Between 2%-10% of infected persons will become chronic carriers, which means they will be infectious to others and can develop chronic liver disease. These include chronic hepatitis, liver cirrhosis and liver cancer.
    

Diagnosis and treatment

There is a vaccine available to prevent against Hepatitis B. It is highly suggested that all healthcare workers be immunized due to the risk of exposure on the job to blood and body fluids. The series consists of three injections, and the person is not protected unless all three are received. Once exposed, the person will show positive on a blood test, and has natural immunity against Hep B. Sometimes a liver biopsy needs to be done to find the extent of liver damage.

HEPATITIS C

Hep C is caused by a virus. Hep C causes liver damage. CDC states that about 33% of those who have HIV also have Hep C.

CDC suggests that about 30,000 persons a year become infected with HCV.

CDC states there are approx. 3.9 million infected HCV persons in the U.S. of which 2.7 million are chronically infected.

Hep C is the leading cause of liver cirrhosis, and liver cancer, and is the leading cause for needed liver transplant
    

How it spreads

Hepatitis C is transmitted through blood and body fluids, unsafe sex acts, and contaminated blood transfusions. It was not until 1992, that blood was tested when donated for Hep C. The major risk factors include IV drug use, sexual activity, and blood transfusions prior to 1992. Other risk factors include

Hemophilia, hemodialysis,

Organ transplant, and tattoos.

    

Signs and symptoms

many times a person infected with Hepatitis C have no symptoms, yet are very infectious to others. If there are symptoms, they may be flu like, nausea and vomiting, loss of appetite, weight loss, jaundice and itchy skin. CDC says that about 20% of those infected clear the virus from the body, while 80% remain infectious, and if symptoms persist over a number of years they will most likely develop liver cancer, cirrhosis, and be considered “chronically infected”

CDC states that 80% of those with Hep C have NO signs and symptoms.
    

Tests available

Testing for Hepatitis C has only been available since 1989.The blood test done is a test to detect antibodies to the Hep C virus. Liver function tests are also done to detect the degree of liver damage. Those who clear the infection does NOT mean that they are immune from getting the infection again.
    

Diagnosis and Treatment

There are no vaccines to prevent against HCV. Prevention is the main key to not getting HCV. HCV persons cannot donate blood, organs, or tissue.

Medication management can include the use of interferon. Hepatitis infected people should NOT drink alcohol, as it can make liver disease worse.

HEPATITIS D

Is a defective hepatitis that cannot exist unless the person is infected with Hepatitis B. Hepatitis D is referred to as DELTA HEPATITIS. (HDV) is found in the blood as is all other types of hepatitis.
    

HOW IT SPREADS

Hepatitis D is blood borne, and cannot exist with out a co-infection of Hep B.

Hepatitis D is spread the same way as Hepatitis B.
    

SIGNS AND SYMPTOMS

It is stated that if a Hepatitis B infected person develops Hepatitis D, they are called “super infections” Chronic liver disease is common with those who have both HBV and HDV.
    

TESTS AVAILABLE

The test that is done is the test that detects for HBV through a blood sample.
    

DIAGNOSIS AND TREATMENT

Being Vaccinated against Hepatitis B will prevent the contracting of Hepatitis D.

HEPATITIS E

Hepatitis E is not very common and is rarely found in the USA. It is prevalent in India, Asia, Middle East, and Africa, as well as Mexico.
    

HOW IT SPREADS

Hep. E, (HEV) is transmitted by contaminated water, or contaminated foods. Hep E is transmitted by Fecal-oral route, and is very similar to the data we know about Hep. A.
    

SIGNS AND SYMPTOMS

Signs and symptoms for Hepatitis E are as those for Hepatitis A.
    

TESTS AVAILABLE

There is no vaccine for Hep E. Blood tests for the virus of Hep E are not widely available and so the diagnosis is currently made by excluding other causes of viral hepatitis for which blood tests are available.
    

DIAGNOSING AND TREATMENT

Women should not become pregnant if they have Hep. E, because up to 30% of those pregnant with Hep E have been known to die.

Diagnosis is dependent upon if the person has HBV or not, and treatment is same as HBV .

As you can see, there are many types of Hepatitis… There are also Hepatitis F and G and H and I !!! Incredible!!

Hepatitis F: In 1994 a scientist reported finding viral particles in the stool of post transfusion, non-A, non-B, non-C, non-E, hepatitis cases. Therefore it was labeled as “Hepatitis F” Injection of these particles were given to rhesus monkeys who developed hepatitis. This hepatitis became known as Hepatitis F. There is very little research to support Hepatitis F, and very little is actually known for its existence and modes of transmission, though it is believed to be similar to Hepatitis A in mode of transmission being Fecal-Oral route. In 1993, Japan scientists reported a study that the Hepatitis F virus might actually be a mutant of HBV.

Hepatitis G is also a scientific mystery as well. With little research and little known about Hepatitis G, It is considered the NEWEST form of known Hepatitis. Transmission is believed to be through blood exposure and is seen in IV drug users, individuals with clotting disorders such as hemophilia, and individuals who require hemodialysis for renal failure.

LEARN ABOUT THE HEPATITIS B VACCINE

The HBV vaccine is your best protection against HBV. The vaccine is given in a series of doses. Unless you receive all three doses you will not be protected from the HBV virus. Many people require a booster shot later on.

In order to know if you need a booster shot, you will have to have a blood test, known as a titer drawn to see if you still have antibodies in the blood to ward off HBV pathogens. It is not known how long the series may offer protection, as some studies suggest 5-10 years, when others say “indefinite”. If you have had the Hepatitis series, a booster is recommended every five years. A blood titer should be done to see if there are still immune antibodies present.

Those allergic to yeast cannot take the vaccinations. Those who are pregnant should not be vaccinated.

Keep in mind that there are no vaccines for Hepatitis C or HIV. You must continue to use standard precautions even if you have had the Hepatitis B series of vaccinations, to prevent other types of exposure to other blood borne pathogens.

(Take a deep breathe… Your almost done…. )

Ways to protect yourself

We have learned a great deal about Universal and Standard Precautions. The only way to protect yourself is to take all necessary precautions- NOT CHANCES! Learn all you can about Blood Borne Pathogens.

READ- read your employers exposure control plan, and be familiar with policy and procedure in your place of employment.

RESEARCH- stay up to date and current by staying in contact with the CDC website. www.cdc.org

CONSULT- consult your supervisor, medical director, or infection control department to learn more and stay up to date on diseases and blood borne pathogens.

CONTACT- contact your state’s local health department to obtain valuable materials.

CALL- call the CDC for more information at 1-800-342-2437.

Remember to follow standard precautions, wash your hands, cover wounds, cuts and scrapes or any open sores.

Also important to practice good housekeeping by cleaning up spills and contaminated areas properly and promptly. Dispose of sharps in proper sharps boxes, and dispose of infectious waste and laundry per your facilities protocol.

A final thought.. Keep in mind that “wet” blood on any surface can contain both HIV and HBV, as well as any other blood borne pathogen it may be harboring. Once the blood has dried, it will no longer be able to contain HIV, as HIV requires a wet surface to survive. But, if there is hepatitis present in the blood, it can remain infectious for a period of 30 days regardless if the blood is wet or dry.

Summary

Although the body’s natural defense system defends well against disease, pathogens can still enter the body and cause infections. These pathogens can enter by direct contact, indirect contact, inhaling air exhaled by an infectious person, and through a bite of an infected animal or insect.

OSHA has issued regulations for on-the-job exposure to blood borne pathogens. OSHA has determined that employees face a significant risk to exposure on- the- job. OSHA concludes that your risk can be minimized or even removed using a combination of engineering controls and safe work practices, as well as the use of PPE. ( Personal Protective Equipment)

If you suspect or have come in contact with an exposure, always document the incident fully, notify your supervisor immediately, and seek medical attention without delay to participate in follow up care and procedures.

References:

Occupational Safety Health Administration

www.osha.gov

Preventing Disease Transmission

American Red Cross, 1993 edition

Staywell publications

National Aids Clearinghouse

www.fda.gov

www.muschealth.com

www.olddoc.idv.tw.com

www.aegis.com

For Initial Licensure or Endorsement

Meets Florida Requirements

This course is for INITIAL licensure in the State of Florida , and can be used for HIV/AIDS for endorsement if you are applying to Florida. Endorsement HIV/AIDS only requires Three contact hours.

This course exceeds licensure requirements

COURSE # 100

Author: Monica Oram, RN, BSN

This course is intended for the reader to be able to achieve the following objectives:

    Understand difference between HIV and AIDS.

    Know the myths of HIV and AIDS.

    Understand HIV and AIDS Statistics.

    Learn three methods used for HIV Screening.

    Understand Universal Precautions.

    Understand How HIV is transmitted.

    Understand Legal Right associated with HIV/ AIDS.

    Understand Current treatment associated with HIV and AIDS.

    Identify what are blood borne pathogens

    Understand universal precautions

    Understand Hepatitis and the various types

    How to protect yourself from blood borne pathogens

    Learn about the Hepatitis B vaccine

    Understand the Pathophysiology of the disease process of HIV/AIDS and other related Blood-borne pathogens

In the world today, approximately 33.6 million people are estimated to be living with HIV/AIDS. Of these, 32.4 Million are Adults, 14.8 Million are women, and 1.2 million are children under the age of 15. The highest incidence of HIV and AIDS per 100,000 people are found in New York and New York is ranked #1 in the nation for HIV and AIDS cases, followed by California, ranking in at #2, and then Florida at #3, with New Jersey ranking #4 and the little state of Connecticut ranking in at #5.

It is noteworthy to know that Florida, however ranks #2 in Pediatric HIV/AIDS cases in the Nation.

The last cumulative count was done in 1999 by the CDC, and indicates that for every case of AIDS known, there are at least 10 people who are infected with HIV. The most recent estimate of HIV prevalence indicates that there are approximately 1 in 400 people in the world currently living with HIV, and 1 in 250 Americans are currently living with the HIV infection. In Florida, it is estimate that 1 in 150 are infected with the HIV Virus. Florida also ranks SECOND in the nation for HIV Pediatric cases. Alarming statistic for the Dade County Area( Miami, Florida) shows that 1 in every 50-60 people are HIV infected!
Difference Between HIV and AIDS

AIDS is caused by the Human Immunodeficiency Virus (HIV). HIV kills and damages the body’s immune system by destroying the body’s ability to fight off infections and certain cancers. People with AIDS may get life threatening diseases called opportunistic infections, which are caused by viruses and/or bacteria that normal healthy people are able to fight off with out any problems.

HIV is the virus that causes AIDS. A person cannot get AIDS without first having the HIV Virus. HIV attacks the immune system, and weakens the body’s ability to fight off infections. The body becomes so weak it cannot fight off diseases that it comes in contact with. Once the body is infected with the disease of HIV, the virus quickly begins to reproduce inside the blood cells of the infected person. Currently, there is no cure for HIV. There are many medications that are thought to slow down the process of cell reproduction and will allow the infected person to live longer. The best prevention for HIV is by way of community education, and modifying any behaviors that are risky. AIDS is the end stage of HIV infection.
Understanding the Signs and Symptoms

Early AIDS symptoms can include fever, loss of appetite, weight loss, chronic fatigue, and skin rashes. Later on, the person may develop and experience unusual types of cancers or infections, including pneumonia, that the body can no longer fight off. Some people who carry the HIV virus have no symptoms for as long as 10 -15 years. And others may not develop AIDS until many years after they become infected. Researchers are working hard to fight AIDS, and they learn more every day. But, unfortunately there is still no cure.
How The Immune System Is Overpowered

Acquired immunity develops after we are born to help us fight off infections through out life, like colds and flu, ect. The cells in our bodies produce antibodies that can attack and destroy disease causing germs to ward off infections. The immune system is a network of cells and organs that work together to fight off infections. The antibodies try to fight back by signaling out the “Bad Cells” and attaching to them, the phagocytes then try to “eat” them in order to try and destroy them. The T-cells are able to fight infection and are there to also help the body ward off infections. This is how a normal immune system is designed to work.

When HIV invades the body, by entering the blood stream, it uses the immune system against itself in order to reproduce and survive. As the body recognizes the invasion of the “Bad Cells”, some of the HIV is destroyed when the T-Cells try to fight back. The problem arises when the HIV virus compromises the whole immune system. The HIV cells are able to “disguise themselves to appear as “good cells”, and them reproduce at a very fast rate. The body thinks they are the good cells, and accepts them as their own, therefore allowing reproduction to take place in the body. Once HIV is in the body it becomes a retrovirus.

Once inside the T-Cells, it uses reverse transcriptase enzymes to translate its genetic make up of RNA ( (ribonucleic acid ) into t-Cell DNA ( deoxyribonucleic acid) The infected cells become a mass producing factory that produces new viral cells that finally take over and destroy the T Cells.

HIV Infection Cycle

First, there is a window period in which the time a person becomes infected and until the body develops enough antibodies for an accurate positive HIV test to detect presence of HIV in the blood. This is a window period. It can range from 2 weeks to 6 months. The person with HIV is infectious during this window period. Then there is an incubation period. In the incubation period, and HIV infected person normally shows no signs or symptoms and appear to be healthy and not sick. This is particularly a major concern, because it is in this phase that others are becoming infected through unsafe sex, and exposure to blood and body fluids. The person who is infected does not look or feel sick, and therefore usually does not modify any of the identifiable risky behaviors associated with the spread of the disease. The HIV infected person may not develop any signs or symptoms for a period of 5-10 years or more, once infected. The Phase of AIDS, is when symptoms appear and the immune system begins to break down. The person may not be considered to have “full blown AIDS” but they begin to show signs and symptoms. AIDS is confirmed with a positive HIV test , and if found to be positive it is repeated for a confirmation of results. It will also indicate that an HIV person has one or more opportunistic infections, once the symptoms begin to appear. For example, it is not until the person begins experiencing a flu like infection, before they generally seek medical advise and then be tested for HIV. The most common opportunistic infection includes PCP. ( pneumocystis carinii pneumonia), yeast infections primarily in the mouth and esophagus, Kaposi’s Sarcoma

(Blood Cancer). One indicator that a person has AIDS is when it is discovered that the person has a CD4 count below 200. A normal person has about 500-1500 cells per micro liter CD4 count cells.
Myths about HIV and AIDS

Myth: If I am HIV positive, that means I have AIDS

Fact: HIV positive means that your body was exposed to the virus. Since your body was exposed to the virus, there is a good chance that you are infected with the virus. But it does not mean that you have AIDS. AIDS develops over a period of time.

Myth: HIV is the same as AIDS.

Fact: HIV is the virus that causes AIDS. AIDS is a group of symptoms that develop during the last stage of HIV infection.

Myth: I can get HIV from an infected person by shaking hands, hugging, or kissing.

Fact: HIV is not spread through casual contact. There is a slight chance that you could become HIV infected through kissing if you or the infected person both had open bleeding sores in the mouth, and the infected person’s blood gets into yours.

Myth: I can get HIV from telephones, toilet seats, or door knobs.

Fact: The HIV virus cannot live outside of the body. You cannot become infected through saliva, unless there is visible blood and you have an open area for the virus to enter.

Myth: I can get HIV from eating food that was prepared by an infected person.

Fact: HIV dies quickly outside of the body. Once any body fluid is dry, you can be absolutely sure the virus is dead.

Myth: I can become infected with HIV from a mosquito.

Fact: Although it sounds very possible, you can not get HIV infected from a mosquito, fleas, ticks, or lice. For this to happen, the HIV would have to live in the insect’s saliva or salivary glands. HIV is a human virus and cannot survive out of the human body.

Myth: I can get HIV from breathing the same air as an infected person.

Fact: HIV is not airborne, and does not transmit by air. You cannot get HIV by being in the same room with an HIV infected person.
Screening Tests For HIV

The standard method of testing for HIV is by a blood test called the EIA test. The EIA test is the enzyme immunoassay test. It is done by collecting a blood sample, and tested in a lab. A negative screen indicates the person is not infected. A positive test indicates the person is possibly HIV infected, and will be confirmed with a second test to rule out an absolutely positive result. This second test is called the Western Blot to confirm the diagnosis.

A negative test result does not necessarily mean a person is in fact negative, if the person is known to engage in risky behaviors, they could be in the window period, and would not necessarily have a positive test result. These individuals should be retested in 6 months to confirm the outcome of negative or positive.

There is a new rapid test available from the Food and Drug Administration, known as the SUDS test. The suds test is Single Use Diagnostic System. A result can be obtained in 5 to 30 minutes. A positive test is confirmed by the western blot test.

One will also want to remember that an HIV test on an infant could show the HIV status of the mother due to antibodies being transferred from mother to baby.
Methods of Transmission

HIV can be spread through unprotected sex. Unprotected sex refers to having sex without the use of a latex condom or a dental dam for oral sex. HIV is transmitted through blood and body fluids such as blood, semen, vaginal lining and fluids, and breast milk. HIV is transmitted by sexual intercourse, babies born to infected mothers and breast feeding, body fluids and blood, and sharing IV drug needles.

Prevention includes understanding and learning all you can to be safe. Education is a key importance in the spread of HIV. Do not have unprotected sex, know the status of your sexual partners, Do not share needles with anyone, Avoid risky behavior that can expose you to contact with blood or body fluids. Always use latex condoms, and know how to use them correctly.

As far as workplace exposure, it is important to know to never recap any needles. There should always go directly in the sharps box after use. Make certain the sharps box is never over filled more than 2/3 full when disposing needles. Wear gloves at all times when an exposure to any blood or body fluid is a possibility. Use face masks, and eye protection if a fluid splash is possible. Prescription eye glasses will not be adequate protection. Do not expose your skin to soiled equipment or soiled linens. Use resuscitation barriers for Mouth to mouth contact in Cardio- Pulmonary Resuscitation.
Terms To Be Familiar With

Acquired Immunodeficiency Syndrome- AIDS… The severe manifestation of infection with the HIV Virus. The CDC lists a number of opportunistic infections and cancers that, in the presence of HIV infection. Constitutes an AIDS diagnosis. There are also instances of presumptive diagnoses when a person’s HIV status is unknown. This was especially true before 1985. Prior to 1985, the blood supply was not tested, and there was no antibody test available. In 1993, CDC expanded the criteria for an AIDS diagnosis to include CD4 and T cell counts at or below 200 cells per micro liter in the presence of HIV infection.

Acute HIV infection- The four to seven week period of rapid viral replication immediately following exposure. An estimated 30-60% of individuals with Primary HIV infection develop an acute syndrome characterized by fever, malaise, lymphadenopathy, pharyngitis, headache, myalgia, amd sometimes a skin rash. Following primary infection, seroconversion and broad HIV -1 specific immune response occur within 30 - 60 days.

AIDS Dementia Complex- (ADC) A degenerative neurological condition attributed to HIV infection, characterized by a group of clinical presentations including the loss of coordination. Mood swings, and loss of inhibitions, and wide spread common central nervous system complications of HIV infection.

AIDS related Complex- (ARC) A term that is used by some clinicians to describe a variety of symptoms found in some persons living with HIV.

Antibody- Molecule in the blood or secretions that tag, destroy, or neutralizes bacteria, viruses, or harmful toxins in the blood. Antibodies are a class of proteins known as immunoglobulins, which are produced and secreted by B-lymphocytes in response to stimulation by antigens. Antibodies are specific to invading organisms.

CD4+ Cells- A type of T helper cell that is involved in protecting the body against infection. Destruction of CD4 cells is the major cause of immunodeficiency seen in AIDS.

T-Cells- are white blood cells that are derived from the Thymus gland, that participates in a variety of cell mediated immune reactions. Three different types of T cells exist, Helper T’s, Killer T’s, and Suppressor T’s.. They are the body’s “border police” responsible for finding infected or cancerous cells.

Treatment and Medical Management

Currently, there is no cure for HIV or AIDS. There are a variety of medications that will slow down the reproduction phase of the cells. Normally treatment modality will consist of a combination of several types of antiretroviral drugs. The treatment outcome will largely depend upon the compliance of the patient taking these drugs as prescribed. There are many side effects that are often worse than the symptoms, and compliance is a big issue with many HIV positive patients.

Currently some drugs being used include AZT, Dapsone, DDC, DDI, Pentamidine, Saquinavir, to mention a few.

AZT- Azidothymidine, also known as retrovir or zidovudine. The first antiretroviral drug against HIV infection to be introduced by The FDA in 1987. It is a thymidine analog that suppresses replication of HIV virus.

Dapsone- An approved oral antibiotic of the sulfone class used to treat and as prophylaxis of PCP and toxoplasmosis.

DDC- Dideoxycytidine, is a nucleoside analog drug that inhibits the replication of HIV. FDA approved treatment selected for patients with advanced HIV disease.

DDI - Dideoxyinosine, is a nucleoside analog drug that inhibits the replication of HIV. Also prescribed for patients with advanced HIV disease.

Pentamidine- An approved antiprotozoal drug used for the treatment and prevention of PCP. ( pneumocystis Carinii Pneumonia)

Saquinavir- A peptide based, protease inhibitor. FDA approved for combination use with nucleoside analogs for treatment of advanced HIV infection.

Ethical Concerns

The main concern is that the patient requires emotional and psychological support. It is no longer important how he became infected, but how to deal with the disease process at this point. There are laws set in place that protects the patients right to privacy. Consent forms must be obtained in advance before any testing may be done. Only a Doctor or a specially trained individual can deliver test results. They may never be given by phone or in the mail. The individual must undergo pre and post counseling when being tested.

Standard Precautions

The best way as stated by the CDC, is to avoid contracting HIV and developing AIDS, you should follow strict CDC guidelines and standard precautions. The rule of thumb is, “Treat all people as if they have HIV, when providing care” therefore, the use of gloves and personal protective equipment is essential in preventing the spread of HIV. Handwashing is critical, use of vinyl or latex gloves is also essential when in contact with any blood or body fluid.

Let’s look a little deeper

Blood borne pathogens are viruses or bacteria that get into the bloodstream and cause disease. If a person comes in contact with blood infected with a blood borne pathogen, he or she may become infected as well. (For more on infection control in the workplace, refer to course #113.) ( To learn more about OSHA Regulations and how the laws apply in the workplace setting, refer to course #112.)

Other body fluids can contain pathogens that may also spread blood borne diseases. These fluids include:

    Blood products (such as plasma)

    Semen

    Vaginal secretions

    Fluid in the uterus of a pregnant woman

    Fluids surrounding the brain, spine, heart and joints

    Fluids in the chest and abdomen

    Any other fluid that contains visible blood, such as saliva and dental procedures.

Many bloodborne diseases are deadly. The risk of blood borne pathogens in the work place is serious. Yet, you can protect yourself by learning effective ways of minimizing your risk. A good place to start is with your employer’s exposure control plan. A copy should be available for you to consult at your workplace during work at all times.

Always keep in mind that you cannot tell who has a disease just by looking at them. It is impossible to tell who is carrying a blood borne pathogen through medical history or by examination, without the follow up of lab tests.

Bloodborne diseases affect all populations, all ages, all socioeconomic classes, from every state and around the world. Many people carry blood borne diseases without any symptoms. Many people have no idea that they are infected since they are asymptomatic.

We will explore some blood borne pathogens such as HIV, HBV, and HCV. These are the most prevent in a healthcare setting, and put healthcare workers at the greatest risk for exposure.

HIV: the virus that causes AIDS

HBV: Hepatitis B virus, causes serious liver damage

HCV: Hepatitis C causes serious liver disease

There are other blood borne pathogens we should be aware of:
These include

    Hepatitis D

    Diphtheria

    Syphilis

    Herpes

    Ebola (viral hemorrhagic fever)

    Malaria

Blood borne pathogens may be found in OPIM’s.

--- Other Potentially Infected Materials

These include the body fluids listed above, and also blood on any surface of contamination. In a situation where it is hard to tell body fluid from another, all body fluids should be considered infectious.
Universal Precautions

One should know that universal precautions is being replaced with the term, “standard precautions” because standard precautions is implemented through OSHA regulations which covers a BROADER scope of protection for the healthcare worker, and goes a step FARTHER to offer safeguarding measures.

Universal Precautions are the basis of OSHA’s Occupational exposure to blood borne pathogens final rule. For many healthcare workers, following universal precautions and body substance isolation (BSI).

What’s the guiding idea behind Universal Precautions?

Universal precautions require healthcare workers to treat blood and body fluids as if they are infected with a blood borne pathogen. Universal precautions help protect everyone from exposure of blood borne pathogens through guidelines on:

    Proper hand washing

    Use of personal protective equipment

    Dealing with contaminated laundry and regulated waste

BODY SUBSTANCE ISOLATION

Is another infection control strategy that applies to any moist body matter. This means ALL body fluids and substances are treated as infectious. Body Substance Isolation may be used IN PLACE of Universal Precautions , PROVIDED guidelines for OSHA blood borne pathogens standards are met as well.

Universal precautions came about in 1984 in light of the raising concern of the HIV epidemic. The Center For Disease Control (CDC) recognized there was an urgent need to protect healthcare workers from blood and blood borne pathogens. In 1985 the CDC officially introduced Universal Precautions, as we know it today. It took OSHA and CDC another 6 years to put the FINAL PLAN into action to improve working environments and promote safety in healthcare facilities and for healthcare workers. So, in 1991 the rules became final for OSHA laws and regulations regarding Universal Precautions.

Universal Precautions have since been replaced with STANDARD PRECAUTIONS, which goes a step beyond in offering protection to patients and healthcare workers.

What’s the difference between Universal Precautions and Standard Precautions?

Universal precautions has stated that blood and body fluids are to be handled as “potentially infectious”, but also states that certain body fluids are NOT covered by Universal Precautions, and DO NOT REQUIRE UNIVERAL PRECAUTIONS such as:

    Urine

    Feces

    Sweat

    Vomit

    Saliva

    Nasal Drainage

    Tears

WOW!!! We know that all of the above are BODY FLUIDS! So why would we NOT want to include them in UNIVERSAL PRECAUTIONS??

Well, CDC says, that UNLESS THEY CONTAIN VISIBLE BLOOD THEY DO NOT REQUIRE UNIVERSAL PRECAUTONS.

But, Think about this….. If while at work, what do you think would be the types of fluids one would come across in the course of a work day?

ALL OF THE ABOVE ARE VERY LIKELY!! Therefore, why should we be less cautious, because they may not contain VISIBLE BLOOD?

Standard Precautions are CDC recommendations. Standard Precautions are STRONGLY recommended to keep people safe, because they:

COMBINE the main idea from Universal Precautions and Body Substance Isolation.

Standard Precautions apply to blood and body fluid, secretions, excretions, and discharge, WHETHER OR NOT they contain visible blood.

So you see, that by using standard precautions we are protecting ourselves to a much higher degree of safety against coming in contact with blood or body fluids.

Standard Precautions come into play during ANY procedure where there is a chance of exposure to blood, body fluids, secretions and excretions. Standard Precautions apply to the care of ALL patients whether or not they have a confirmed or suspected infection.

Hand Washing

Hand washing is the most important link in the prevention of infections.

It is extremely important to wash you hands:

    Between different patients

    Anytime you remove a pair of gloves

    Whenever you have touched blood or OPIM’s other potentially infectious material)

    Anytime you touch contaminated equipment

    Between performing different procedures on the same patient

    Before and after meals

    And after using the restroom

There are different LEVELS of hand washing…..

The level of hand washing depends upon what job and procedure you are doing.

    Routine or simple hand washing is used to remove dirt and transient (passing) germs from the skin using soap and water.

    Hand antiseptics are used to kill transient germs with antimicrobial soaps or alcohol based hand gels. Remember that hand gels are a temporary solution, until proper hand washing can be done. Hand Gels do not take the place of proper hand washing.

    Surgical scrubs help kill transient germs as well as those that may live on the skin. This may be done with antimicrobial agents and detergents that require a scrub of 5 or more minutes.

Spread of Infection

In order for a blood borne pathogen to gain entry into the body, all four of the following MUST be present:

    A pathogen must be present

    There needs to be a sufficient quantity of the pathogen to cause infection

    The person has to be susceptible to the pathogen

    There has to be a way for the pathogen to get into the body.

Lets look at these…..

It would make good sense that there must be an infectious pathogen present in order to transmit an infectious disease.

It would make sense that a person’s immune system has to be susceptible in order to become infected.

It would make sense that there needs to be a way for the infection to get into the body.

Now, lets look at “sufficient quantity”… How does one determine how much of a pathogen is needed to cause an infection?

Depending on a person’s immunity, what might take only a very small quality to infect one individual, may take a significant amount more for someone else in relatively good health.

So, the bottom line is never take risks, never take chances… when we are told that blood and body fluids are not considered infectious, UNLESS THEY CONTAIN VISIBLE BLOOD, think about the fact that microscopic blood can be present, and since it is unknown how much is a SUFFICIENT QUANITY to cause illness, it definitely makes GOOD SENSE to utilize STANDARD PRECAUTIONS, and treat ALL blood and body fluid as if it IS INFECTIOUS.
Hepatitis Update

There is so much to know and learn about the various types of Hepatitis. We will discuss the most common and give an overview of each.

Most commonly, we deal with Hepatitis A, B, C. (We also see D and E.. not as common) as well as f and g.
What is viral hepatitis?

Viral hepatitis is inflammation of the liver caused by a virus. It is common worldwide. It has since become a world wide epidemic affecting all parts of the globe. Until recently, only two types were known… Hepatitis A and Hepatitis B.. Other types were known as Non A, and Non B. New types such as Hepatitis B and E, and the delta agent ( Hepatitis D) have now been discovered and as research continues more viruses which can cause hepatitis infection are being identified. Viruses such as Epstein-Barr virus, cytomegalovirus ( CMV) and yellow fever virus can also infect the liver and produce hepatitis like symptoms.
How do you catch viral hepatitis?

It can be caught in different ways depending on the type of virus causing the infection. Hepatitis A and E are spread by the consumption of contaminated food or water. Most commonly by fecal-oral route. Hepatitis A is the one we hear about in restaurants where workers use the bathroom, and do not wash hands, therefore, contaminating food products that are ingested. Hepatitis B, C, and D are spread by contact with blood or other body fluids from an infected person. They are all blood borne pathogens.
How is a diagnosis of hepatitis made?

The diagnosis is confirmed by a blood test. The blood levels of liver enzymes are elevated, particularly when the patient has jaundice. These usually return to normal several weeks after the jaundice and other symptoms subside. Additional blood testing is done to identify the virus causing the acute illness. This is important in Hepatitis B and C, as they can persist and cause chronic infection, and even progresses to death if untreated.
What is the treatment for hepatitis?

Most patients do fairly well by being at home and on bed rest. Ample bed rest, together with a light diet and avoiding all alcoholic beverages are recommended. Occasionally the patient is hospitalized due to nausea, vomiting and liver failure. There are no specific anti-viral mediations that are used to treat viral hepatitis. Depending on the cause, certain forms of chronic hepatitis may be treated with steroid therapy, interferon, or other anti-viral agents. A liver transplant may be the only hope in cases of severe chronic hepatitis if the liver becomes so diseased, liver failure develops.

COMPARISON OF THE TYPES OF HEPATITIS ARE SPECIFICALLY OUTLINED IN THE CHART THAT FOLLOWS:

HEPATITIS A

Is an inflammation of the liver. This can be caused by alcohol and some drugs, but is most commonly caused by a viral infection.
    

How it spreads

Hepatitis A virus is a common infection in many parts of the world. It is most commonly transmitted through eating and drinking contaminated food/water.

Hepatitis A is transmitted in feces. It can be passed on even if tiny amounts of feces from a person with Hep A comes in contact with another person’s mouth. The mode is use of the restroom, and not washing hands prior to food preparation. The virus can also be transmitted through anal intercourse.
    

Signs and symptoms

Persons may have no signs and symptoms at all, but they can still pass on the hepatitis virus to others. Symptoms include:

    A short, mild flu like illness

    Nausea and vomiting

    Diarrhea

    Loss of appetite

    Weight loss

    Jaundice

    Itchy skin

    

Tests available

Hepatitis A can be detected with a blood sample test.

A positive blood test may indicate:

1) that the person has come in contact in the past with Hep A, and the body has cleared it. The person now has a natural immunity against future infection with the Hepatitis A virus.

Current infection:

By the time most people have developed symptoms of Hepatitis A they are less infectious to others, but in the weeks prior to developing symptoms, the person will have been a risk for potentially infecting others. Those who have come in contact can be given an injection to reduce the risk of developing symptoms.
    

Diagnosis and Treatment

A person with Hepatitis A sometimes require hospitaliz-ation, and can be fatal if untreated. The vaccine is (IG) (Immuno-globulin)

Persons exposed can receive IG within 2 weeks after exposure. Those who may be traveling to foreign countries should be immunized prior to travel. Two doses are given, 6 months apart, for lasting protection. For hepatitis A, a single injection can give immunity for up to a year. A second booster at 6-12 months after the first, can give protection up to 10 years.

Hepatitis B

Hepatitis B is inflammation of the liver. Those with Hep B need to limit alcohol consumption.

This can be caused by alcohol and drugs, but is usually the result of viral infection.

ACTIVE HEP B: a flu like illness that can last for several months. A Chronic carrier is one that may have no symptoms, but is able to infect others. There IS NO CURE for Hep B. But, with proper care, rest, and diet persons infected can recover completely. Some people develop CHRONIC HBV infection, which means they are infected for life. CDC suggests that over 300 million people are chronic Hep B carriers.
    

How it spreads

Hep B is very common worldwide. It is very infectious. Hep B can be spread by:

    Unprotect-ed sex

    Sharing contam-inated needles

    Non sterile tattoo supplies

    Infected mother to baby

    Through blood transfusion

    Using a razor or toothbrush that is infected by another person

Thousands of healthcare workers get Hep B every year. CDC suggests about 250,000 persons per year become infected!

Hep B is NOT transmitted through casual contact.
    

Signs and symptoms

Many persons may have no signs and symptoms, but they can still pass the virus to others. Symptoms include:

    Flu like illness

    Nausea and vomiting

    Loss of appetite

    Weight loss

    Jaundice

    Itchy skin

Symptoms can take 6 weeks to 6 months to develop. Some people never get symptoms, but can still transmit the virus.
    

Tests available

Most adults infected with Hepatitis B fully recover and develop life long immunity. Between 2%-10% of infected persons will become chronic carriers, which means they will be infectious to others and can develop chronic liver disease. These include chronic hepatitis, liver cirrhosis and liver cancer.
    

Diagnosis and treatment

There is a vaccine available to prevent against Hepatitis B. It is highly suggested that all healthcare workers be immunized due to the risk of exposure on the job to blood and body fluids. The series consists of three injections, and the person is not protected unless all three are received. Once exposed, the person will show positive on a blood test, and has natural immunity against Hep B. Sometimes a liver biopsy needs to be done to find the extent of liver damage.

HEPATITIS C

Hep C is caused by a virus. Hep C causes liver damage. CDC states that about 33% of those who have HIV also have Hep C.

CDC suggests that about 30,000 persons a year become infected with HCV.

CDC states there are approx. 3.9 million infected HCV persons in the U.S. of which 2.7 million are chronically infected.

Hep C is the leading cause of liver cirrhosis, and liver cancer, and is the leading cause for needed liver transplant
    

How it spreads

Hepatitis C is transmitted through blood and body fluids, unsafe sex acts, and contaminated blood transfusions. It was not until 1992, that blood was tested when donated for Hep C. The major risk factors include IV drug use, sexual activity, and blood transfusions prior to 1992. Other risk factors include

Hemophilia, hemodialysis,

Organ transplant, and tattoos.

    

Signs and symptoms

many times a person infected with Hepatitis C have no symptoms, yet are very infectious to others. If there are symptoms, they may be flu like, nausea and vomiting, loss of appetite, weight loss, jaundice and itchy skin. CDC says that about 20% of those infected clear the virus from the body, while 80% remain infectious, and if symptoms persist over a number of years they will most likely develop liver cancer, cirrhosis, and be considered “chronically infected”

CDC states that 80% of those with Hep C have NO signs and symptoms.
    

Tests available

Testing for Hepatitis C has only been available since 1989.The blood test done is a test to detect antibodies to the Hep C virus. Liver function tests are also done to detect the degree of liver damage. Those who clear the infection does NOT mean that they are immune from getting the infection again.
    

Diagnosis and Treatment

There are no vaccines to prevent against HCV. Prevention is the main key to not getting HCV. HCV persons cannot donate blood, organs, or tissue.

Medication management can include the use of interferon. Hepatitis infected people should NOT drink alcohol, as it can make liver disease worse.

HEPATITIS D

Is a defective hepatitis that cannot exist unless the person is infected with Hepatitis B. Hepatitis D is referred to as DELTA HEPATITIS. (HDV) is found in the blood as is all other types of hepatitis.
    

HOW IT SPREADS

Hepatitis D is blood borne, and cannot exist with out a co-infection of Hep B.

Hepatitis D is spread the same way as Hepatitis B.
    

SIGNS AND SYMPTOMS

It is stated that if a Hepatitis B infected person develops Hepatitis D, they are called “super infections” Chronic liver disease is common with those who have both HBV and HDV.
    

TESTS AVAILABLE

The test that is done is the test that detects for HBV through a blood sample.
    

DIAGNOSIS AND TREATMENT

Being Vaccinated against Hepatitis B will prevent the contracting of Hepatitis D.

HEPATITIS E

Hepatitis E is not very common and is rarely found in the USA. It is prevalent in India, Asia, Middle East, and Africa, as well as Mexico.
    

HOW IT SPREADS

Hep. E, (HEV) is transmitted by contaminated water, or contaminated foods. Hep E is transmitted by Fecal-oral route, and is very similar to the data we know about Hep. A.
    

SIGNS AND SYMPTOMS

Signs and symptoms for Hepatitis E are as those for Hepatitis A.
    

TESTS AVAILABLE

There is no vaccine for Hep E. Blood tests for the virus of Hep E are not widely available and so the diagnosis is currently made by excluding other causes of viral hepatitis for which blood tests are available.
    

DIAGNOSING AND TREATMENT

Women should not become pregnant if they have Hep. E, because up to 30% of those pregnant with Hep E have been known to die.

Diagnosis is dependent upon if the person has HBV or not, and treatment is same as HBV .

As you can see, there are many types of Hepatitis… There are also Hepatitis F and G and H and I !!! Incredible!!

Hepatitis F: In 1994 a scientist reported finding viral particles in the stool of post transfusion, non-A, non-B, non-C, non-E, hepatitis cases. Therefore it was labeled as “Hepatitis F” Injection of these particles were given to rhesus monkeys who developed hepatitis. This hepatitis became known as Hepatitis F. There is very little research to support Hepatitis F, and very little is actually known for its existence and modes of transmission, though it is believed to be similar to Hepatitis A in mode of transmission being Fecal-Oral route. In 1993, Japan scientists reported a study that the Hepatitis F virus might actually be a mutant of HBV.

Hepatitis G is also a scientific mystery as well. With little research and little known about Hepatitis G, It is considered the NEWEST form of known Hepatitis. Transmission is believed to be through blood exposure and is seen in IV drug users, individuals with clotting disorders such as hemophilia, and individuals who require hemodialysis for renal failure.

LEARN ABOUT THE HEPATITIS B VACCINE

The HBV vaccine is your best protection against HBV. The vaccine is given in a series of doses. Unless you receive all three doses you will not be protected from the HBV virus. Many people require a booster shot later on.

In order to know if you need a booster shot, you will have to have a blood test, known as a titer drawn to see if you still have antibodies in the blood to ward off HBV pathogens. It is not known how long the series may offer protection, as some studies suggest 5-10 years, when others say “indefinite”. If you have had the Hepatitis series, a booster is recommended every five years. A blood titer should be done to see if there are still immune antibodies present.

Those allergic to yeast cannot take the vaccinations. Those who are pregnant should not be vaccinated.

Keep in mind that there are no vaccines for Hepatitis C or HIV. You must continue to use standard precautions even if you have had the Hepatitis B series of vaccinations, to prevent other types of exposure to other blood borne pathogens.

(Take a deep breathe… Your almost done…. )

Ways to protect yourself

We have learned a great deal about Universal and Standard Precautions. The only way to protect yourself is to take all necessary precautions- NOT CHANCES! Learn all you can about Blood Borne Pathogens.

READ- read your employers exposure control plan, and be familiar with policy and procedure in your place of employment.

RESEARCH- stay up to date and current by staying in contact with the CDC website. www.cdc.org

CONSULT- consult your supervisor, medical director, or infection control department to learn more and stay up to date on diseases and blood borne pathogens.

CONTACT- contact your state’s local health department to obtain valuable materials.

CALL- call the CDC for more information at 1-800-342-2437.

Remember to follow standard precautions, wash your hands, cover wounds, cuts and scrapes or any open sores.

Also important to practice good housekeeping by cleaning up spills and contaminated areas properly and promptly. Dispose of sharps in proper sharps boxes, and dispose of infectious waste and laundry per your facilities protocol.

A final thought.. Keep in mind that “wet” blood on any surface can contain both HIV and HBV, as well as any other blood borne pathogen it may be harboring. Once the blood has dried, it will no longer be able to contain HIV, as HIV requires a wet surface to survive. But, if there is hepatitis present in the blood, it can remain infectious for a period of 30 days regardless if the blood is wet or dry.

Summary

Although the body’s natural defense system defends well against disease, pathogens can still enter the body and cause infections. These pathogens can enter by direct contact, indirect contact, inhaling air exhaled by an infectious person, and through a bite of an infected animal or insect.

OSHA has issued regulations for on-the-job exposure to blood borne pathogens. OSHA has determined that employees face a significant risk to exposure on- the- job. OSHA concludes that your risk can be minimized or even removed using a combination of engineering controls and safe work practices, as well as the use of PPE. ( Personal Protective Equipment)

If you suspect or have come in contact with an exposure, always document the incident fully, notify your supervisor immediately, and seek medical attention without delay to participate in follow up care and procedures.

References:

Occupational Safety Health Administration

www.osha.gov

Preventing Disease Transmission

American Red Cross, 1993 edition

Staywell publications

National Aids Clearinghouse

www.fda.gov

www.muschealth.com

www.olddoc.idv.tw.com

www.aegis.com

For Initial Licensure or Endorsement

Meets Florida Requirements

This course is for INITIAL licensure in the State of Florida , and can be used for HIV/AIDS for endorsement if you are applying to Florida. Endorsement HIV/AIDS only requires Three contact hours.

This course exceeds licensure requirements

COURSE # 100

Author: Monica Oram, RN, BSN

This course is intended for the reader to be able to achieve the following objectives:

    Understand difference between HIV and AIDS.

    Know the myths of HIV and AIDS.

    Understand HIV and AIDS Statistics.

    Learn three methods used for HIV Screening.

    Understand Universal Precautions.

    Understand How HIV is transmitted.

    Understand Legal Right associated with HIV/ AIDS.

    Understand Current treatment associated with HIV and AIDS.

    Identify what are blood borne pathogens

    Understand universal precautions

    Understand Hepatitis and the various types

    How to protect yourself from blood borne pathogens

    Learn about the Hepatitis B vaccine

    Understand the Pathophysiology of the disease process of HIV/AIDS and other related Blood-borne pathogens

In the world today, approximately 33.6 million people are estimated to be living with HIV/AIDS. Of these, 32.4 Million are Adults, 14.8 Million are women, and 1.2 million are children under the age of 15. The highest incidence of HIV and AIDS per 100,000 people are found in New York and New York is ranked #1 in the nation for HIV and AIDS cases, followed by California, ranking in at #2, and then Florida at #3, with New Jersey ranking #4 and the little state of Connecticut ranking in at #5.

It is noteworthy to know that Florida, however ranks #2 in Pediatric HIV/AIDS cases in the Nation.

The last cumulative count was done in 1999 by the CDC, and indicates that for every case of AIDS known, there are at least 10 people who are infected with HIV. The most recent estimate of HIV prevalence indicates that there are approximately 1 in 400 people in the world currently living with HIV, and 1 in 250 Americans are currently living with the HIV infection. In Florida, it is estimate that 1 in 150 are infected with the HIV Virus. Florida also ranks SECOND in the nation for HIV Pediatric cases. Alarming statistic for the Dade County Area( Miami, Florida) shows that 1 in every 50-60 people are HIV infected!
Difference Between HIV and AIDS

AIDS is caused by the Human Immunodeficiency Virus (HIV). HIV kills and damages the body’s immune system by destroying the body’s ability to fight off infections and certain cancers. People with AIDS may get life threatening diseases called opportunistic infections, which are caused by viruses and/or bacteria that normal healthy people are able to fight off with out any problems.

HIV is the virus that causes AIDS. A person cannot get AIDS without first having the HIV Virus. HIV attacks the immune system, and weakens the body’s ability to fight off infections. The body becomes so weak it cannot fight off diseases that it comes in contact with. Once the body is infected with the disease of HIV, the virus quickly begins to reproduce inside the blood cells of the infected person. Currently, there is no cure for HIV. There are many medications that are thought to slow down the process of cell reproduction and will allow the infected person to live longer. The best prevention for HIV is by way of community education, and modifying any behaviors that are risky. AIDS is the end stage of HIV infection.
Understanding the Signs and Symptoms

Early AIDS symptoms can include fever, loss of appetite, weight loss, chronic fatigue, and skin rashes. Later on, the person may develop and experience unusual types of cancers or infections, including pneumonia, that the body can no longer fight off. Some people who carry the HIV virus have no symptoms for as long as 10 -15 years. And others may not develop AIDS until many years after they become infected. Researchers are working hard to fight AIDS, and they learn more every day. But, unfortunately there is still no cure.
How The Immune System Is Overpowered

Acquired immunity develops after we are born to help us fight off infections through out life, like colds and flu, ect. The cells in our bodies produce antibodies that can attack and destroy disease causing germs to ward off infections. The immune system is a network of cells and organs that work together to fight off infections. The antibodies try to fight back by signaling out the “Bad Cells” and attaching to them, the phagocytes then try to “eat” them in order to try and destroy them. The T-cells are able to fight infection and are there to also help the body ward off infections. This is how a normal immune system is designed to work.

When HIV invades the body, by entering the blood stream, it uses the immune system against itself in order to reproduce and survive. As the body recognizes the invasion of the “Bad Cells”, some of the HIV is destroyed when the T-Cells try to fight back. The problem arises when the HIV virus compromises the whole immune system. The HIV cells are able to “disguise themselves to appear as “good cells”, and them reproduce at a very fast rate. The body thinks they are the good cells, and accepts them as their own, therefore allowing reproduction to take place in the body. Once HIV is in the body it becomes a retrovirus.

Once inside the T-Cells, it uses reverse transcriptase enzymes to translate its genetic make up of RNA ( (ribonucleic acid ) into t-Cell DNA ( deoxyribonucleic acid) The infected cells become a mass producing factory that produces new viral cells that finally take over and destroy the T Cells.

HIV Infection Cycle

First, there is a window period in which the time a person becomes infected and until the body develops enough antibodies for an accurate positive HIV test to detect presence of HIV in the blood. This is a window period. It can range from 2 weeks to 6 months. The person with HIV is infectious during this window period. Then there is an incubation period. In the incubation period, and HIV infected person normally shows no signs or symptoms and appear to be healthy and not sick. This is particularly a major concern, because it is in this phase that others are becoming infected through unsafe sex, and exposure to blood and body fluids. The person who is infected does not look or feel sick, and therefore usually does not modify any of the identifiable risky behaviors associated with the spread of the disease. The HIV infected person may not develop any signs or symptoms for a period of 5-10 years or more, once infected. The Phase of AIDS, is when symptoms appear and the immune system begins to break down. The person may not be considered to have “full blown AIDS” but they begin to show signs and symptoms. AIDS is confirmed with a positive HIV test , and if found to be positive it is repeated for a confirmation of results. It will also indicate that an HIV person has one or more opportunistic infections, once the symptoms begin to appear. For example, it is not until the person begins experiencing a flu like infection, before they generally seek medical advise and then be tested for HIV. The most common opportunistic infection includes PCP. ( pneumocystis carinii pneumonia), yeast infections primarily in the mouth and esophagus, Kaposi’s Sarcoma

(Blood Cancer). One indicator that a person has AIDS is when it is discovered that the person has a CD4 count below 200. A normal person has about 500-1500 cells per micro liter CD4 count cells.
Myths about HIV and AIDS

Myth: If I am HIV positive, that means I have AIDS

Fact: HIV positive means that your body was exposed to the virus. Since your body was exposed to the virus, there is a good chance that you are infected with the virus. But it does not mean that you have AIDS. AIDS develops over a period of time.

Myth: HIV is the same as AIDS.

Fact: HIV is the virus that causes AIDS. AIDS is a group of symptoms that develop during the last stage of HIV infection.

Myth: I can get HIV from an infected person by shaking hands, hugging, or kissing.

Fact: HIV is not spread through casual contact. There is a slight chance that you could become HIV infected through kissing if you or the infected person both had open bleeding sores in the mouth, and the infected person’s blood gets into yours.

Myth: I can get HIV from telephones, toilet seats, or door knobs.

Fact: The HIV virus cannot live outside of the body. You cannot become infected through saliva, unless there is visible blood and you have an open area for the virus to enter.

Myth: I can get HIV from eating food that was prepared by an infected person.

Fact: HIV dies quickly outside of the body. Once any body fluid is dry, you can be absolutely sure the virus is dead.

Myth: I can become infected with HIV from a mosquito.

Fact: Although it sounds very possible, you can not get HIV infected from a mosquito, fleas, ticks, or lice. For this to happen, the HIV would have to live in the insect’s saliva or salivary glands. HIV is a human virus and cannot survive out of the human body.

Myth: I can get HIV from breathing the same air as an infected person.

Fact: HIV is not airborne, and does not transmit by air. You cannot get HIV by being in the same room with an HIV infected person.
Screening Tests For HIV

The standard method of testing for HIV is by a blood test called the EIA test. The EIA test is the enzyme immunoassay test. It is done by collecting a blood sample, and tested in a lab. A negative screen indicates the person is not infected. A positive test indicates the person is possibly HIV infected, and will be confirmed with a second test to rule out an absolutely positive result. This second test is called the Western Blot to confirm the diagnosis.

A negative test result does not necessarily mean a person is in fact negative, if the person is known to engage in risky behaviors, they could be in the window period, and would not necessarily have a positive test result. These individuals should be retested in 6 months to confirm the outcome of negative or positive.

There is a new rapid test available from the Food and Drug Administration, known as the SUDS test. The suds test is Single Use Diagnostic System. A result can be obtained in 5 to 30 minutes. A positive test is confirmed by the western blot test.

One will also want to remember that an HIV test on an infant could show the HIV status of the mother due to antibodies being transferred from mother to baby.
Methods of Transmission

HIV can be spread through unprotected sex. Unprotected sex refers to having sex without the use of a latex condom or a dental dam for oral sex. HIV is transmitted through blood and body fluids such as blood, semen, vaginal lining and fluids, and breast milk. HIV is transmitted by sexual intercourse, babies born to infected mothers and breast feeding, body fluids and blood, and sharing IV drug needles.

Prevention includes understanding and learning all you can to be safe. Education is a key importance in the spread of HIV. Do not have unprotected sex, know the status of your sexual partners, Do not share needles with anyone, Avoid risky behavior that can expose you to contact with blood or body fluids. Always use latex condoms, and know how to use them correctly.

As far as workplace exposure, it is important to know to never recap any needles. There should always go directly in the sharps box after use. Make certain the sharps box is never over filled more than 2/3 full when disposing needles. Wear gloves at all times when an exposure to any blood or body fluid is a possibility. Use face masks, and eye protection if a fluid splash is possible. Prescription eye glasses will not be adequate protection. Do not expose your skin to soiled equipment or soiled linens. Use resuscitation barriers for Mouth to mouth contact in Cardio- Pulmonary Resuscitation.
Terms To Be Familiar With

Acquired Immunodeficiency Syndrome- AIDS… The severe manifestation of infection with the HIV Virus. The CDC lists a number of opportunistic infections and cancers that, in the presence of HIV infection. Constitutes an AIDS diagnosis. There are also instances of presumptive diagnoses when a person’s HIV status is unknown. This was especially true before 1985. Prior to 1985, the blood supply was not tested, and there was no antibody test available. In 1993, CDC expanded the criteria for an AIDS diagnosis to include CD4 and T cell counts at or below 200 cells per micro liter in the presence of HIV infection.

Acute HIV infection- The four to seven week period of rapid viral replication immediately following exposure. An estimated 30-60% of individuals with Primary HIV infection develop an acute syndrome characterized by fever, malaise, lymphadenopathy, pharyngitis, headache, myalgia, amd sometimes a skin rash. Following primary infection, seroconversion and broad HIV -1 specific immune response occur within 30 - 60 days.

AIDS Dementia Complex- (ADC) A degenerative neurological condition attributed to HIV infection, characterized by a group of clinical presentations including the loss of coordination. Mood swings, and loss of inhibitions, and wide spread common central nervous system complications of HIV infection.

AIDS related Complex- (ARC) A term that is used by some clinicians to describe a variety of symptoms found in some persons living with HIV.

Antibody- Molecule in the blood or secretions that tag, destroy, or neutralizes bacteria, viruses, or harmful toxins in the blood. Antibodies are a class of proteins known as immunoglobulins, which are produced and secreted by B-lymphocytes in response to stimulation by antigens. Antibodies are specific to invading organisms.

CD4+ Cells- A type of T helper cell that is involved in protecting the body against infection. Destruction of CD4 cells is the major cause of immunodeficiency seen in AIDS.

T-Cells- are white blood cells that are derived from the Thymus gland, that participates in a variety of cell mediated immune reactions. Three different types of T cells exist, Helper T’s, Killer T’s, and Suppressor T’s.. They are the body’s “border police” responsible for finding infected or cancerous cells.

Treatment and Medical Management

Currently, there is no cure for HIV or AIDS. There are a variety of medications that will slow down the reproduction phase of the cells. Normally treatment modality will consist of a combination of several types of antiretroviral drugs. The treatment outcome will largely depend upon the compliance of the patient taking these drugs as prescribed. There are many side effects that are often worse than the symptoms, and compliance is a big issue with many HIV positive patients.

Currently some drugs being used include AZT, Dapsone, DDC, DDI, Pentamidine, Saquinavir, to mention a few.

AZT- Azidothymidine, also known as retrovir or zidovudine. The first antiretroviral drug against HIV infection to be introduced by The FDA in 1987. It is a thymidine analog that suppresses replication of HIV virus.

Dapsone- An approved oral antibiotic of the sulfone class used to treat and as prophylaxis of PCP and toxoplasmosis.

DDC- Dideoxycytidine, is a nucleoside analog drug that inhibits the replication of HIV. FDA approved treatment selected for patients with advanced HIV disease.

DDI - Dideoxyinosine, is a nucleoside analog drug that inhibits the replication of HIV. Also prescribed for patients with advanced HIV disease.

Pentamidine- An approved antiprotozoal drug used for the treatment and prevention of PCP. ( pneumocystis Carinii Pneumonia)

Saquinavir- A peptide based, protease inhibitor. FDA approved for combination use with nucleoside analogs for treatment of advanced HIV infection.

Ethical Concerns

The main concern is that the patient requires emotional and psychological support. It is no longer important how he became infected, but how to deal with the disease process at this point. There are laws set in place that protects the patients right to privacy. Consent forms must be obtained in advance before any testing may be done. Only a Doctor or a specially trained individual can deliver test results. They may never be given by phone or in the mail. The individual must undergo pre and post counseling when being tested.

Standard Precautions

The best way as stated by the CDC, is to avoid contracting HIV and developing AIDS, you should follow strict CDC guidelines and standard precautions. The rule of thumb is, “Treat all people as if they have HIV, when providing care” therefore, the use of gloves and personal protective equipment is essential in preventing the spread of HIV. Handwashing is critical, use of vinyl or latex gloves is also essential when in contact with any blood or body fluid.

Let’s look a little deeper

Blood borne pathogens are viruses or bacteria that get into the bloodstream and cause disease. If a person comes in contact with blood infected with a blood borne pathogen, he or she may become infected as well. (For more on infection control in the workplace, refer to course #113.) ( To learn more about OSHA Regulations and how the laws apply in the workplace setting, refer to course #112.)

Other body fluids can contain pathogens that may also spread blood borne diseases. These fluids include:

    Blood products (such as plasma)

    Semen

    Vaginal secretions

    Fluid in the uterus of a pregnant woman

    Fluids surrounding the brain, spine, heart and joints

    Fluids in the chest and abdomen

    Any other fluid that contains visible blood, such as saliva and dental procedures.

Many bloodborne diseases are deadly. The risk of blood borne pathogens in the work place is serious. Yet, you can protect yourself by learning effective ways of minimizing your risk. A good place to start is with your employer’s exposure control plan. A copy should be available for you to consult at your workplace during work at all times.

Always keep in mind that you cannot tell who has a disease just by looking at them. It is impossible to tell who is carrying a blood borne pathogen through medical history or by examination, without the follow up of lab tests.

Bloodborne diseases affect all populations, all ages, all socioeconomic classes, from every state and around the world. Many people carry blood borne diseases without any symptoms. Many people have no idea that they are infected since they are asymptomatic.

We will explore some blood borne pathogens such as HIV, HBV, and HCV. These are the most prevent in a healthcare setting, and put healthcare workers at the greatest risk for exposure.

HIV: the virus that causes AIDS

HBV: Hepatitis B virus, causes serious liver damage

HCV: Hepatitis C causes serious liver disease

There are other blood borne pathogens we should be aware of:
These include

    Hepatitis D

    Diphtheria

    Syphilis

    Herpes

    Ebola (viral hemorrhagic fever)

    Malaria

Blood borne pathogens may be found in OPIM’s.

--- Other Potentially Infected Materials

These include the body fluids listed above, and also blood on any surface of contamination. In a situation where it is hard to tell body fluid from another, all body fluids should be considered infectious.
Universal Precautions

One should know that universal precautions is being replaced with the term, “standard precautions” because standard precautions is implemented through OSHA regulations which covers a BROADER scope of protection for the healthcare worker, and goes a step FARTHER to offer safeguarding measures.

Universal Precautions are the basis of OSHA’s Occupational exposure to blood borne pathogens final rule. For many healthcare workers, following universal precautions and body substance isolation (BSI).

What’s the guiding idea behind Universal Precautions?

Universal precautions require healthcare workers to treat blood and body fluids as if they are infected with a blood borne pathogen. Universal precautions help protect everyone from exposure of blood borne pathogens through guidelines on:

    Proper hand washing

    Use of personal protective equipment

    Dealing with contaminated laundry and regulated waste

BODY SUBSTANCE ISOLATION

Is another infection control strategy that applies to any moist body matter. This means ALL body fluids and substances are treated as infectious. Body Substance Isolation may be used IN PLACE of Universal Precautions , PROVIDED guidelines for OSHA blood borne pathogens standards are met as well.

Universal precautions came about in 1984 in light of the raising concern of the HIV epidemic. The Center For Disease Control (CDC) recognized there was an urgent need to protect healthcare workers from blood and blood borne pathogens. In 1985 the CDC officially introduced Universal Precautions, as we know it today. It took OSHA and CDC another 6 years to put the FINAL PLAN into action to improve working environments and promote safety in healthcare facilities and for healthcare workers. So, in 1991 the rules became final for OSHA laws and regulations regarding Universal Precautions.

Universal Precautions have since been replaced with STANDARD PRECAUTIONS, which goes a step beyond in offering protection to patients and healthcare workers.

What’s the difference between Universal Precautions and Standard Precautions?

Universal precautions has stated that blood and body fluids are to be handled as “potentially infectious”, but also states that certain body fluids are NOT covered by Universal Precautions, and DO NOT REQUIRE UNIVERAL PRECAUTIONS such as:

    Urine

    Feces

    Sweat

    Vomit

    Saliva

    Nasal Drainage

    Tears

WOW!!! We know that all of the above are BODY FLUIDS! So why would we NOT want to include them in UNIVERSAL PRECAUTIONS??

Well, CDC says, that UNLESS THEY CONTAIN VISIBLE BLOOD THEY DO NOT REQUIRE UNIVERSAL PRECAUTONS.

But, Think about this….. If while at work, what do you think would be the types of fluids one would come across in the course of a work day?

ALL OF THE ABOVE ARE VERY LIKELY!! Therefore, why should we be less cautious, because they may not contain VISIBLE BLOOD?

Standard Precautions are CDC recommendations. Standard Precautions are STRONGLY recommended to keep people safe, because they:

COMBINE the main idea from Universal Precautions and Body Substance Isolation.

Standard Precautions apply to blood and body fluid, secretions, excretions, and discharge, WHETHER OR NOT they contain visible blood.

So you see, that by using standard precautions we are protecting ourselves to a much higher degree of safety against coming in contact with blood or body fluids.

Standard Precautions come into play during ANY procedure where there is a chance of exposure to blood, body fluids, secretions and excretions. Standard Precautions apply to the care of ALL patients whether or not they have a confirmed or suspected infection.

Hand Washing

Hand washing is the most important link in the prevention of infections.

It is extremely important to wash you hands:

    Between different patients

    Anytime you remove a pair of gloves

    Whenever you have touched blood or OPIM’s other potentially infectious material)

    Anytime you touch contaminated equipment

    Between performing different procedures on the same patient

    Before and after meals

    And after using the restroom

There are different LEVELS of hand washing…..

The level of hand washing depends upon what job and procedure you are doing.

    Routine or simple hand washing is used to remove dirt and transient (passing) germs from the skin using soap and water.

    Hand antiseptics are used to kill transient germs with antimicrobial soaps or alcohol based hand gels. Remember that hand gels are a temporary solution, until proper hand washing can be done. Hand Gels do not take the place of proper hand washing.

    Surgical scrubs help kill transient germs as well as those that may live on the skin. This may be done with antimicrobial agents and detergents that require a scrub of 5 or more minutes.

Spread of Infection

In order for a blood borne pathogen to gain entry into the body, all four of the following MUST be present:

    A pathogen must be present

    There needs to be a sufficient quantity of the pathogen to cause infection

    The person has to be susceptible to the pathogen

    There has to be a way for the pathogen to get into the body.

Lets look at these…..

It would make good sense that there must be an infectious pathogen present in order to transmit an infectious disease.

It would make sense that a person’s immune system has to be susceptible in order to become infected.

It would make sense that there needs to be a way for the infection to get into the body.

Now, lets look at “sufficient quantity”… How does one determine how much of a pathogen is needed to cause an infection?

Depending on a person’s immunity, what might take only a very small quality to infect one individual, may take a significant amount more for someone else in relatively good health.

So, the bottom line is never take risks, never take chances… when we are told that blood and body fluids are not considered infectious, UNLESS THEY CONTAIN VISIBLE BLOOD, think about the fact that microscopic blood can be present, and since it is unknown how much is a SUFFICIENT QUANITY to cause illness, it definitely makes GOOD SENSE to utilize STANDARD PRECAUTIONS, and treat ALL blood and body fluid as if it IS INFECTIOUS.
Hepatitis Update

There is so much to know and learn about the various types of Hepatitis. We will discuss the most common and give an overview of each.

Most commonly, we deal with Hepatitis A, B, C. (We also see D and E.. not as common) as well as f and g.
What is viral hepatitis?

Viral hepatitis is inflammation of the liver caused by a virus. It is common worldwide. It has since become a world wide epidemic affecting all parts of the globe. Until recently, only two types were known… Hepatitis A and Hepatitis B.. Other types were known as Non A, and Non B. New types such as Hepatitis B and E, and the delta agent ( Hepatitis D) have now been discovered and as research continues more viruses which can cause hepatitis infection are being identified. Viruses such as Epstein-Barr virus, cytomegalovirus ( CMV) and yellow fever virus can also infect the liver and produce hepatitis like symptoms.
How do you catch viral hepatitis?

It can be caught in different ways depending on the type of virus causing the infection. Hepatitis A and E are spread by the consumption of contaminated food or water. Most commonly by fecal-oral route. Hepatitis A is the one we hear about in restaurants where workers use the bathroom, and do not wash hands, therefore, contaminating food products that are ingested. Hepatitis B, C, and D are spread by contact with blood or other body fluids from an infected person. They are all blood borne pathogens.
How is a diagnosis of hepatitis made?

The diagnosis is confirmed by a blood test. The blood levels of liver enzymes are elevated, particularly when the patient has jaundice. These usually return to normal several weeks after the jaundice and other symptoms subside. Additional blood testing is done to identify the virus causing the acute illness. This is important in Hepatitis B and C, as they can persist and cause chronic infection, and even progresses to death if untreated.
What is the treatment for hepatitis?

Most patients do fairly well by being at home and on bed rest. Ample bed rest, together with a light diet and avoiding all alcoholic beverages are recommended. Occasionally the patient is hospitalized due to nausea, vomiting and liver failure. There are no specific anti-viral mediations that are used to treat viral hepatitis. Depending on the cause, certain forms of chronic hepatitis may be treated with steroid therapy, interferon, or other anti-viral agents. A liver transplant may be the only hope in cases of severe chronic hepatitis if the liver becomes so diseased, liver failure develops.

COMPARISON OF THE TYPES OF HEPATITIS ARE SPECIFICALLY OUTLINED IN THE CHART THAT FOLLOWS:

HEPATITIS A

Is an inflammation of the liver. This can be caused by alcohol and some drugs, but is most commonly caused by a viral infection.
    

How it spreads

Hepatitis A virus is a common infection in many parts of the world. It is most commonly transmitted through eating and drinking contaminated food/water.

Hepatitis A is transmitted in feces. It can be passed on even if tiny amounts of feces from a person with Hep A comes in contact with another person’s mouth. The mode is use of the restroom, and not washing hands prior to food preparation. The virus can also be transmitted through anal intercourse.
    

Signs and symptoms

Persons may have no signs and symptoms at all, but they can still pass on the hepatitis virus to others. Symptoms include:

    A short, mild flu like illness

    Nausea and vomiting

    Diarrhea

    Loss of appetite

    Weight loss

    Jaundice

    Itchy skin

    

Tests available

Hepatitis A can be detected with a blood sample test.

A positive blood test may indicate:

1) that the person has come in contact in the past with Hep A, and the body has cleared it. The person now has a natural immunity against future infection with the Hepatitis A virus.

Current infection:

By the time most people have developed symptoms of Hepatitis A they are less infectious to others, but in the weeks prior to developing symptoms, the person will have been a risk for potentially infecting others. Those who have come in contact can be given an injection to reduce the risk of developing symptoms.
    

Diagnosis and Treatment

A person with Hepatitis A sometimes require hospitaliz-ation, and can be fatal if untreated. The vaccine is (IG) (Immuno-globulin)

Persons exposed can receive IG within 2 weeks after exposure. Those who may be traveling to foreign countries should be immunized prior to travel. Two doses are given, 6 months apart, for lasting protection. For hepatitis A, a single injection can give immunity for up to a year. A second booster at 6-12 months after the first, can give protection up to 10 years.

Hepatitis B

Hepatitis B is inflammation of the liver. Those with Hep B need to limit alcohol consumption.

This can be caused by alcohol and drugs, but is usually the result of viral infection.

ACTIVE HEP B: a flu like illness that can last for several months. A Chronic carrier is one that may have no symptoms, but is able to infect others. There IS NO CURE for Hep B. But, with proper care, rest, and diet persons infected can recover completely. Some people develop CHRONIC HBV infection, which means they are infected for life. CDC suggests that over 300 million people are chronic Hep B carriers.
    

How it spreads

Hep B is very common worldwide. It is very infectious. Hep B can be spread by:

    Unprotect-ed sex

    Sharing contam-inated needles

    Non sterile tattoo supplies

    Infected mother to baby

    Through blood transfusion

    Using a razor or toothbrush that is infected by another person

Thousands of healthcare workers get Hep B every year. CDC suggests about 250,000 persons per year become infected!

Hep B is NOT transmitted through casual contact.
    

Signs and symptoms

Many persons may have no signs and symptoms, but they can still pass the virus to others. Symptoms include:

    Flu like illness

    Nausea and vomiting

    Loss of appetite

    Weight loss

    Jaundice

    Itchy skin

Symptoms can take 6 weeks to 6 months to develop. Some people never get symptoms, but can still transmit the virus.
    

Tests available

Most adults infected with Hepatitis B fully recover and develop life long immunity. Between 2%-10% of infected persons will become chronic carriers, which means they will be infectious to others and can develop chronic liver disease. These include chronic hepatitis, liver cirrhosis and liver cancer.
    

Diagnosis and treatment

There is a vaccine available to prevent against Hepatitis B. It is highly suggested that all healthcare workers be immunized due to the risk of exposure on the job to blood and body fluids. The series consists of three injections, and the person is not protected unless all three are received. Once exposed, the person will show positive on a blood test, and has natural immunity against Hep B. Sometimes a liver biopsy needs to be done to find the extent of liver damage.

HEPATITIS C

Hep C is caused by a virus. Hep C causes liver damage. CDC states that about 33% of those who have HIV also have Hep C.

CDC suggests that about 30,000 persons a year become infected with HCV.

CDC states there are approx. 3.9 million infected HCV persons in the U.S. of which 2.7 million are chronically infected.

Hep C is the leading cause of liver cirrhosis, and liver cancer, and is the leading cause for needed liver transplant
    

How it spreads

Hepatitis C is transmitted through blood and body fluids, unsafe sex acts, and contaminated blood transfusions. It was not until 1992, that blood was tested when donated for Hep C. The major risk factors include IV drug use, sexual activity, and blood transfusions prior to 1992. Other risk factors include

Hemophilia, hemodialysis,

Organ transplant, and tattoos.

    

Signs and symptoms

many times a person infected with Hepatitis C have no symptoms, yet are very infectious to others. If there are symptoms, they may be flu like, nausea and vomiting, loss of appetite, weight loss, jaundice and itchy skin. CDC says that about 20% of those infected clear the virus from the body, while 80% remain infectious, and if symptoms persist over a number of years they will most likely develop liver cancer, cirrhosis, and be considered “chronically infected”

CDC states that 80% of those with Hep C have NO signs and symptoms.
    

Tests available

Testing for Hepatitis C has only been available since 1989.The blood test done is a test to detect antibodies to the Hep C virus. Liver function tests are also done to detect the degree of liver damage. Those who clear the infection does NOT mean that they are immune from getting the infection again.
    

Diagnosis and Treatment

There are no vaccines to prevent against HCV. Prevention is the main key to not getting HCV. HCV persons cannot donate blood, organs, or tissue.

Medication management can include the use of interferon. Hepatitis infected people should NOT drink alcohol, as it can make liver disease worse.

HEPATITIS D

Is a defective hepatitis that cannot exist unless the person is infected with Hepatitis B. Hepatitis D is referred to as DELTA HEPATITIS. (HDV) is found in the blood as is all other types of hepatitis.
    

HOW IT SPREADS

Hepatitis D is blood borne, and cannot exist with out a co-infection of Hep B.

Hepatitis D is spread the same way as Hepatitis B.
    

SIGNS AND SYMPTOMS

It is stated that if a Hepatitis B infected person develops Hepatitis D, they are called “super infections” Chronic liver disease is common with those who have both HBV and HDV.
    

TESTS AVAILABLE

The test that is done is the test that detects for HBV through a blood sample.
    

DIAGNOSIS AND TREATMENT

Being Vaccinated against Hepatitis B will prevent the contracting of Hepatitis D.

HEPATITIS E

Hepatitis E is not very common and is rarely found in the USA. It is prevalent in India, Asia, Middle East, and Africa, as well as Mexico.
    

HOW IT SPREADS

Hep. E, (HEV) is transmitted by contaminated water, or contaminated foods. Hep E is transmitted by Fecal-oral route, and is very similar to the data we know about Hep. A.
    

SIGNS AND SYMPTOMS

Signs and symptoms for Hepatitis E are as those for Hepatitis A.
    

TESTS AVAILABLE

There is no vaccine for Hep E. Blood tests for the virus of Hep E are not widely available and so the diagnosis is currently made by excluding other causes of viral hepatitis for which blood tests are available.
    

DIAGNOSING AND TREATMENT

Women should not become pregnant if they have Hep. E, because up to 30% of those pregnant with Hep E have been known to die.

Diagnosis is dependent upon if the person has HBV or not, and treatment is same as HBV .

As you can see, there are many types of Hepatitis… There are also Hepatitis F and G and H and I !!! Incredible!!

Hepatitis F: In 1994 a scientist reported finding viral particles in the stool of post transfusion, non-A, non-B, non-C, non-E, hepatitis cases. Therefore it was labeled as “Hepatitis F” Injection of these particles were given to rhesus monkeys who developed hepatitis. This hepatitis became known as Hepatitis F. There is very little research to support Hepatitis F, and very little is actually known for its existence and modes of transmission, though it is believed to be similar to Hepatitis A in mode of transmission being Fecal-Oral route. In 1993, Japan scientists reported a study that the Hepatitis F virus might actually be a mutant of HBV.

Hepatitis G is also a scientific mystery as well. With little research and little known about Hepatitis G, It is considered the NEWEST form of known Hepatitis. Transmission is believed to be through blood exposure and is seen in IV drug users, individuals with clotting disorders such as hemophilia, and individuals who require hemodialysis for renal failure.

LEARN ABOUT THE HEPATITIS B VACCINE

The HBV vaccine is your best protection against HBV. The vaccine is given in a series of doses. Unless you receive all three doses you will not be protected from the HBV virus. Many people require a booster shot later on.

In order to know if you need a booster shot, you will have to have a blood test, known as a titer drawn to see if you still have antibodies in the blood to ward off HBV pathogens. It is not known how long the series may offer protection, as some studies suggest 5-10 years, when others say “indefinite”. If you have had the Hepatitis series, a booster is recommended every five years. A blood titer should be done to see if there are still immune antibodies present.

Those allergic to yeast cannot take the vaccinations. Those who are pregnant should not be vaccinated.

Keep in mind that there are no vaccines for Hepatitis C or HIV. You must continue to use standard precautions even if you have had the Hepatitis B series of vaccinations, to prevent other types of exposure to other blood borne pathogens.

(Take a deep breathe… Your almost done…. )

Ways to protect yourself

We have learned a great deal about Universal and Standard Precautions. The only way to protect yourself is to take all necessary precautions- NOT CHANCES! Learn all you can about Blood Borne Pathogens.

READ- read your employers exposure control plan, and be familiar with policy and procedure in your place of employment.

RESEARCH- stay up to date and current by staying in contact with the CDC website. www.cdc.org

CONSULT- consult your supervisor, medical director, or infection control department to learn more and stay up to date on diseases and blood borne pathogens.

CONTACT- contact your state’s local health department to obtain valuable materials.

CALL- call the CDC for more information at 1-800-342-2437.

Remember to follow standard precautions, wash your hands, cover wounds, cuts and scrapes or any open sores.

Also important to practice good housekeeping by cleaning up spills and contaminated areas properly and promptly. Dispose of sharps in proper sharps boxes, and dispose of infectious waste and laundry per your facilities protocol.

A final thought.. Keep in mind that “wet” blood on any surface can contain both HIV and HBV, as well as any other blood borne pathogen it may be harboring. Once the blood has dried, it will no longer be able to contain HIV, as HIV requires a wet surface to survive. But, if there is hepatitis present in the blood, it can remain infectious for a period of 30 days regardless if the blood is wet or dry.

Summary

Although the body’s natural defense system defends well against disease, pathogens can still enter the body and cause infections. These pathogens can enter by direct contact, indirect contact, inhaling air exhaled by an infectious person, and through a bite of an infected animal or insect.

OSHA has issued regulations for on-the-job exposure to blood borne pathogens. OSHA has determined that employees face a significant risk to exposure on- the- job. OSHA concludes that your risk can be minimized or even removed using a combination of engineering controls and safe work practices, as well as the use of PPE. ( Personal Protective Equipment)

If you suspect or have come in contact with an exposure, always document the incident fully, notify your supervisor immediately, and seek medical attention without delay to participate in follow up care and procedures.

References:

Occupational Safety Health Administration

www.osha.gov

Preventing Disease Transmission

American Red Cross, 1993 edition

Staywell publications

National Aids Clearinghouse

www.fda.gov

www.muschealth.com

www.olddoc.idv.tw.com

www.aegis.com