Infection Prevention Marie Kassai, RN, BSN, MPH, CIC

Goal and Objectives Discuss current information on Hepatitis C, MDRO and current outbreaks State the latest related to Eye Wash Stations State the important facts and OSHA requirements related to Zika

Infection Prevention - Issues/Concerns Wisconsin Outbreak- Increase in cases of Elizabethkingia – 61 cases - 18 deaths Infects those 65 and over who are compromised Varicella Outbreak – New York Post Oral Surgery Klebsiella Endocarditis Scope related infections and deaths – new information ongoing

Infection Prevention - Issues/Concerns 5 Year Trail of stolen drugs and thousands of patients at risk Surgical tech – fired repeatedly 4 states – Over 6000 patients notified Switched dirty saline syringes for Fentenyl Denver lawyer suing all hospitals on behalf of infected patients Hospitals failed to do background checks or verification of employment. History of being fired after 1 to 2 months.

Hepatitis C

More Specific Factors/Infection Prevention – Hepatitis C – New Definition of the disease - CDC Successful treatment available New emphasis on testing and treatment by CDC Recent blame on medical practice – use of glass and metal syringes – Transplants – new policy Resistant Microorganisms Colistin resistant – a major concern worldwide Resistant Gonorrhea – MSM the biggest risk HIV Prevention – new plan

Eye Wash – New Requirements ANSI Z358 – January 2015 Changes – check ANSI document Tepid Water – 60 to 100 degrees F – mixer valves Eye wash and Shower should work at the same time Other Requirements Personal wash/Bottled Eye wash – use as alternate only – Visibly check weekly Comply with installation requirements Install in well – lit areas Do not install in locked areas Weekly Testing - Why Employees at risk should be educated There is a risk assessment

Zika Virus Today

What is Zika virus (Zika)? Viral infection caused by the bite of an infected mosquito Linked to serious birth defects and other poor pregnancy outcomes in babies of mothers who were infected with Zika while pregnant Outbreaks typically occur in tropical Africa, Southeast Asia and the Pacific Islands

Zika background Initially discovered in mosquitoes in Uganda in 1948 Detected in humans in Nigeria in 1954 Regularly found in Africa and Asia First outbreak outside Africa and Asia occurred in the Federated States of Micronesia in 2007

As of June 01, 2016 (5 am EST) Zika virus disease and Zika virus congenital infection are nationally notifiable conditions. This update from the CDC Arboviral Disease Branch includes provisional data reported to ArboNET for January 01, 2015 – June 01, US States Travel-associated cases reported: 618 Locally acquired vector-borne cases reported: 0 Total: 618 Sexually transmitted: 11 Guillain-Barré syndrome: 1 US Territories Travel-associated cases reported: 4 Locally acquired cases reported: 1,110 Total: 1,114 Guillain-Barré syndrome: 8 Zika in the US

June 2016

Symptoms 1 in 5 people develop symptoms (usually mild) Symptoms usually begin 2-7 days after being bitten by an infected mosquito and last several days to a week Hospitalization and deaths from Zika are rare The most common symptoms of Zika: Fever Rash Joint pain Conjunctivitis (red eyes) Other common symptoms include: Muscle pain Headache

How do people get Zika? Usually spreads to people through the bite of an infected Aedes mosquito Same mosquito that spreads dengue and chikungunya Virus has also been found in semen and person-to-person sexual transmission has been documented (uncommon) Spread of the virus through blood transfusion has also been reported (uncommon) – Deferral of donors – 28 days

ZIKA IS NOT AN AIRBORNE DISEASE AND CANNOT BE SPREAD BY COUGHING, SNEEZING OR TALKING. IMPORTANT FACT!

What is an incubation period? The time from when a person was infected with the virus to the time symptoms begin to show For Zika it is typically 2-7 days

What is microcephaly? Microcephaly is a condition where a baby’s head is much smaller than expected It can occur because a baby’s brain has not developed properly during pregnancy or has stopped growing after birth The data to provide evidence linking Zika and babies born with small heads and potential brain damage are conclusive.

Pregnant women (in any trimester): Women trying to become pregnant: Postpone travel to any area where Zika virus transmission is ongoing If you must travel to one of these areas, talk to your doctor first and strictly follow steps to prevent mosquito bites during your trip Before you travel, talk to your doctor about your plans to become pregnant and the risk of Zika virus infection Strictly follow steps to prevent mosquito bites during your trip Current recommendation is DO NOT TRAVEL to THESE AREAS Zika and pregnancy: special precautions

ZIKA TESTING IS CURRENTLY ONLY BEING PERFORMED ON CERTAIN POPULATIONS. Weekly information from the state on testing and follow up. IMPORTANT FACT!

Preventing Zika infection Currently no vaccine/preventive drug Best prevention method is to avoid mosquito bites when traveling: EPA-registered insect repellent Air conditioning, window screens, mosquito netting Routinely emptying or changing standing water Wearing long sleeves and pants (weather permitting)

IF YOU HAVE ZIKA, AVOID MOSQUITO BITES FOR THE FIRST WEEK OF YOUR ILLNESS. IMPORTANT FACT!

Who is at highest risk for getting infected with Zika? Anyone living in or traveling to an area where Zika is found, who has not already been infected with Zika. Note: Must check before travel. Spread is evident Includes pregnant women

What should I know about Aedes mosquitoes? Aedes mosquitoes transmit Zika, chikungunya and dengue Bite outdoors and indoors during the day Strongly attracted to bite humans Use natural habitats (tree holes) and artificial containers (pet dishes) with water to lay eggs

What is the difference between Zika, chikungunya and dengue? ZikaChikungunyaDengue Higher Fever More Severe Muscle Pain More Intense Joint Pain Skin Rash Conjunctivitis (Red Eyes)

How is Zika treated? No FDA-approved vaccine or medicine (e.g., antiviral drug) is available for Zika Symptoms of Zika are treated as they appear and include rest, fluids and medicines such as acetaminophen or paracetamol Aspirin and other non-steroidal anti- inflammatory drugs (NSAIDs), like ibuprofen and naproxen, should be avoided until dengue can be ruled out to reduce risk of increased bleeding

Can I travel to countries affected by the outbreak? Everyone who travels to areas with ongoing transmission of Zika should protect themselves from mosquito bites Women who are pregnant (in any trimester) should consider postponing travel to any area where Zika transmission is ongoing If you are pregnant and must travel to one of these areas, talk to your doctor first and strictly follow steps to prevent mosquito bites during travel Women who are trying to become pregnant should talk to their doctor about plans to become pregnant and the risk of Zika before travel and strictly follow steps to prevent mosquito bites during travel

Wait Time Before Trying to Get Pregnant After Exposure If Zika symptoms Women wait at least 8 weeks after symptoms started Men –wait 6 months after symptoms started If no Zika symptoms – Women wait at least 8 weeks after exposure Men wait at least 8 weeks after exposure

Can Zika be spread through breastfeeding? No reports of infants getting Zika through breastfeeding to date Mothers are encouraged to breastfeed even in areas where Zika is found Mothers who breastfeed in areas where Zika is found should practice mosquito prevention measures

What is CDC doing about Zika? Laboratories trained to test for chikungunya and dengue have prepared these labs for Zika testing CDC is working with international public health partners and state health departments CDC is working to: Alert healthcare providers and the public about Zika Provide state health laboratories with diagnostic tests Detect and report cases, helping prevent further spread

What is NJ doing about Zika? NJDOH is communicating with LHDs and health care providers to increase awareness: - Health alert messages - Conference calls Updated information is posted to NJDOH website Mosquito Control – Bats

Where to learn more CDC website: CDC hotline: CDC INFO ( ) TTY: NJ Department of Health website: OSHA – Interim Guidance for Protecting Workers from Occupational Exposure to Zika Virus

Questions