1 PowerPoint ® to accompany Second Edition Ramutkowski  Booth  Pugh  Thompson  Whicker Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Medical Assisting Chapter 21

2 Objectives: 21-1 Describe ways in which blood-borne pathogens can be transmitted Explain why strict adherence to Universal Precautions is essential in preventing the spread of infection Describe the symptoms of hepatitis and AIDS List and describe the blood tests used to diagnose HIV infections. HIV, Hepatitis, and Other Blood-borne Pathogens

3 Objectives (cont.) 21-5 Identify chronic disorders often found in patients who have AIDS Compare and contrast drugs used to treat AIDS/HIV infection Describe the symptoms of infection by other common blood-borne pathogens. HIV, Hepatitis, and Other Blood-borne Pathogens

4 Objectives (cont.) 21-8 Explain how to educate patients about minimizing the risks of transmitting blood-borne infections to others Describe special issues you may encounter when dealing with patients who have terminal illnesses. HIV, Hepatitis, and Other Blood-borne Pathogens

5 Introduction  What you will learn: HIV, hepatitis, and other blood-borne infections Expansion on OSHA blood-borne pathogen standards and how to reduce your risk of exposure to blood-borne pathogens. Issues associated with terminal illnesses such as AIDS

6 Transmission of Blood-borne Pathogens  Blood-borne pathogens are disease-causing microorganisms carried in the host’s blood.  Transmission from one host to another through contact with infected blood, tissue, body fluids, or mucous membranes.

7 Transmission Agents  Blood  Blood products  Human tissue  Semen  Vaginal secretions  Saliva from dental procedures.  Cerebrospinal fluid  Synovial fluid  Pleural fluid  Peritoneal fluid  Pericardial fluid  Amniotic fluid The Centers for Disease Control and Preventions has identified specific substances that can serve as transmission agents for blood-borne diseases.

8 People at Increased Risk  People who come in contact with substances that may harbor the pathogens.  Health-care professionals  Law enforcement officers  Mortuary or morgue attendants  Firefighters  Medical equipment service technicians  Barbers  Cosmetologists

9 Universal Precautions  The most effective means of preventing the spread of HIV, hepatitis and other blood-borne pathogens is avoid contaminations.  Universal Precautions is required by OSHA.

10 Disease Profiles  Keep up-to-date on developments to perform your job effectively.  Knowledge needed: Of symptoms that may indicate the patient has the disease. To provide education to patients to limit risks of contracting disease. To identify habits of your patients that increase risk of spreading the disease.

11 Hepatitis Viral infection of the liver that can lead to cirrhosis and death  Hepatitis A – spread by fecal-oral route  Hepatitis B – blood borne that spreads with contact with contaminated blood or body fluids or sexual contact

12 Hepatitis (cont.)  Hepatitis C (non A, non B)- spread through contact with contaminated blood or body fluids and sexual contact.  No cure  Many people are carriers  Causes immediate symptoms like flu  Damages liver, causing liver failure and death

13 Hepatitis cont.  Hepatitis D (delta agent hepatitis) – occurs when people are infected with HBV.  May make symptoms of hepatitis B but more severe  Associated with liver cancer  Hepatitis E – caused by hepatitis E virus (HEV)  Transmitted by fecal – oral route

14 Risk Factors  Risk of contracting HIV from a single needle stick is approximately 0.5%  Risk for contracting Hepatitis B from single needle stick is 6% to 33%. The primary risk factor for HBV and HCV infection is occupational exposure to the virus.

15 Infection Progression  Prodromal -general malaise, maybe nausea or vomiting, or no symptoms  Icteric or jaundice – yellowing of the skin, eyes, mucous membranes – Appears 5-10 days after initial infection  Convalescent – can last 2 to 3 weeks

16 Preventive Measures  Avoiding contact with contaminated substances  A vaccine is available to prevent HBV infections Will not protect you from other strains of hepatitis Recommended for high risk medical personnel, dialysis patients, homosexual men, and IV drug users.

17 Apply Your Knowledge A patient is diagnosed with Hepatitis E. What caused it, and what was the most likely route of transmission?

18 Answer Apply Your Knowledge - Answer Hepatitis E is caused by hepatitis E virus (HEV) and is transmitted by fecal – oral route. A patient is diagnosed with Hepatitis E. What caused it, and what was the most likely route of transmission?

19 AIDS/HIV Infection  Virus that infects and destroys components of the immune system.  HIV infection develops into AIDS.  Pathogen destroys helper T cells (white blood cells component of immune system).

20 Risk Factors for AIDS/HIV  People who have unprotected sexual activity  IV drug users who share needles  Mother to fetus during pregnancy  Health care workers exposed to blood- borne pathogens because of a needle stick (percutaneous exposure)

21 Progress of the Infection  Three main stages Initial infection –can occur years after exposure  Virus enters cell and makes copies-helper T cells die.  Body immune system responds, cleaning the blood supply of the virus, and the virus enters an inactive phase.

22 Progress of the Infection (cont.) Incubation period  Virus incorporates its genetic material into the genetic material of the helper T cells  Incubation period can be 8 to 15 years Full blown AIDS  During the incubation period HIV becomes active again and continues to attack and kill helper T cells  200 or fewer helper T cells/mL blood indicates full blown AIDS

23 Diagnosis of HIV/AIDS  Enzyme-linked immunosorbent assay (ELISA) Confirms presence of antibodies in response to HIV  Western Blot Test or immunofluorescent antibody (IFA)

24 Symptoms of HIV/AIDS  Systemic  Respiratory  Oral  Gastrointestinal  Peripheral nervous system  Skin- related  Kaposi’s sarcoma

25 Preventive Measures  Prevention and sexual contract Use protection during sexual contract Avoid multiple sexual partners Avoid concurrent sexual transmitted infections  Prevention and IV drug users Avoid sharing or reusing needles  Prevention and medical procedures Universal Precautions Wash hands

26 AIDS Patients  No one is immune to AIDS  December 1966, 22.6 million men, women and children were HIV infected worldwide.  In 2000 there were 200 million  Homosexual men  IV drug users  Women

27 Chronic Disorders of the AIDS Patient  Impaired immune system permits opportunistic infections  Pneumocystis carinii pneumonia  Kaposi’s Sarcoma  Non-Hodgkin’s lymphoma  Tuberculosis Kaposi’s Sarcoma

28 Chronic Disorders of the AIDS Patient (cont.)  Mycobacterium Avium Complex (MAC) infections  Meningitis  Oral candidiasis  Vaginal candidiasis  Herpes Simplex  Herpes Zoster

29 Opportunistic Infections of AIDS 1.Herpes simplex 2.Pneumocystis carinii 3.Kaposi’s sarcoma 4.Tuberculosis 5.Meningitis 6.Mycobacterium avium complex (MAC) 7.Non-Hodgkin’s lymphoma 8.Oral candidiasis 9.Herpes zoster 10.Tuberculosis Identify where these opportunistic infections affect the body.

30 Opportunistic Infections of AIDS (cont.) 1.Herpes simplex – mouth, lips, genitalia 2.Pneumocystis carinii – lungs 3.Kaposi’s sarcoma – arms, legs, chest, neck, face, conjunctiva, palate 4.Tuberculosis – lungs 5.Meningitis – brain 6.Mycobacterium avium complex (MAC) – systemic 7.Non-Hodgkin’s lymphoma – neck, armpits, groin 8.Oral candidiasis – mouth, tongue, mucous membranes 9.Herpes zoster – skin over ribs, neck, arms; nerves 10.Tuberculosis – lungs

31 Treating Opportunistic Infections  Drug side effects pose major problems for the AIDS patient.  Repeated episodes of infection can leave patient allergic to treatment or intolerance to medications.

32 Testing Regulations  CDC does not require mandatory HIV testing for health care workers.  Health care workers chances of being infected by a patient are greater than a patient being infected by a health care worker.

33 Treatment for AIDS  Drugs More than 20 drugs available See table 21-2 in text  Treatment Guidelines Developed by Panel of Clinical Practices for Treatment of HIV Infections  Initialing Therapy Must be made by patient and physician  Delayed Treatment Postponement of drug related adverse affects  Early Treatment Suppresses viral replication Reduces risk of transmitting to others

34 Other Blood-Borne Infections  Cytomegalovirus Extremely common infection Pregnant women can pass to newborns.  Erythema Infectiosum Parvovirus B19 Fifth disease  Human T-Cell Lymphotropic Virus HTLV-1 Appears in IV drug users  Listeriosis Caused by listeria monocytogenes Fever, shock, rash, and aches

35 Other Blood-Borne Infections (cont.)  Malaria Enters bloodstream through mosquito’s bite  Syphilis Caused by treponema pallidum Three stages  Toxoplasmosis Caused by toxoplasma gondii in cat feces

36 Reporting Guidelines  Each state formulates requirements for reporting HIV infections and AIDS  Verify the specific guidelines in the state you are employed.

37 Patient Education  Patient education is one of the most effective means of preventing disease transmission.  You can assess the patient’s understanding of their risk for infection and provide information about preventions and treatments.

38 Patients with Special Concerns  Teenagers Educate them about dangers of HIV and AIDS  Patients about to be discharged Make sure that the patient comes for follow-up, reports any adverse reactions, and knows signs and symptoms to watch for.

39 Apply Your Knowledge What guidance could you give a patient with AIDS or Hepatitis that would like more information about the disease?

40 Answer Apply Your Knowledge - Answer What guidance could you give a patient with AIDS or Hepatitis that would like more information about the disease? Suggest the patient contact government agencies such as the CDC or the Consumer Information Center by mail or by the Internet. In addition local support groups and resource organizations may be available in your area.

41 Summary Medical Assistant Use Universal Precautions, watch for signs of infectious disease and education patient about risk factors associated with blood-borne diseases. You are to help prevent the spread of infectious diseases.

42 End of Chapter