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CDM 2280
PROFESSOR
INTERNAL MEDICINE (DERMATOLOGY)
COLLEGE OF OSTEOPATHIC MEDICINE • Blood-borne Pathogens
– Hepatitis
NOVA SOUTHEASTERN UNIVERSITY
3200 SOUTH UNIVERSITY DRIVE – HIV And AIDS
FORT LAUDERDALE, FLORIDA 33328-2018 • Tuberculosis
PHONE: 954-262-4309 • OSHA And AWDA
E-MAIL: masiegel@nova.edu
BLOOD-BORNE OCCUPATIONAL
PATHOGENS (BBP) EXPOSURE
• Needles, Blades, Other Sharps
• Splash To Mucosa Of Eye, Nose, Mouth, • Exposure Is A Needlestick Or Cut With A
Skin Contaminated Sharp Object
• Viruses, Prions? • Splash Of Blood Or Body Fluids Into Eyes, Nose,
Mouth
– Hepatitis B,C,D,E,F,G,TT, SENV, YoBin?
• Blood, Body Fluids (Cerebrospinal, Synovial,
– HIV
Pleural, Peritoneal, Pericardial, Amniotic,
• Blood Or Body Fluids Contaminated Vaginal), Semen **Not Saliva**
With Blood
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VIRAL HEPATITIS HEPATITIS B
HEPATITIS C HEPATITIS C
• Estimated 36,000 New Cases/Year In US
• 2.7 Million Chronic Cases In US (Who?)
•4 Million Cases In US (4x HIV) – Blood Supply Safe After 1992
•85% Carrier Or Chronic • No Vaccine
•#1 Cause For Liver Transplant • Treatment 30% Successful, Weekly Injections And
•8,000-10,000 Deaths/Year Daily Pills, $$$$$$
• LONG Time From Infection To Manifestation Of
Disease
2
HIV EPIDEMIOLOGY AIDS CASES DATA FOR
U.N. ESTIMATES AS OF 12/03 2002
New HIV+ Cases* 5.0 Million • Florida #3 In US AIDS Cases
Deaths* 3.1 Million – 90,233 56% Have Died
– Miami #4 Metro Area 24,800
(*In 2003)
• #2 In Pediatric And Female
Total Deaths 29.8 Million • 12% Of New Cases In The US
People Living W/HIV,AIDS 40.0 Million – 5,058 Adults, 34 Pedo
• Approximately 900,000 HIV+ In US
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TRENDS IN HIV TRANSMISSION DYNAMICS OF HIV INFECTION
SPECTRUM OF DISEASE
More Than 90% Of The Transmission Of Time Of Initial
HIV Is By Sexual Intercourse, With A Infection With HIV
Steadily Increasing Proportion Due To
Heterosexual Intercourse
Less Than 10% Of Cases Result From
Blood Transfusion Or Injection Drug Abuse 8 -12 Years AIDS
– 30% Of Entire Viral Population • The Vast Majority Of Plasma HIV Is From Newly
Infected Lymphocytes
– Half-life Of Viral Population Is 2 Days
4
TESTING FOR HIV CLASSIFICATION OF HIV DISEASE,
ARC, AND AIDS
• Rapid HIV Test Takes 5-30 Minutes CDC System (Modified In 1993)
• EIA (Enzyme Immunoassay Takes 1-2 Weeks
– Test Is Repeated If Positive
Aids-Defining Illness
– Western Blot Test Used To Confirm CD4+ Lymphocyte Count
• ***About 25 Days From Infection To Antibody Production***
Viral Load
5
COMMON ORAL FINDINGS Common Oral Findings
VIRAL INFECTIONS Oral Ulcers
Hairy Leukoplakia And Herpes HIV Patients May Suffer From
Lesions Are Commonly Found In Painful, Aggressive Oral Ulcers
The HIV Patient Appearance
Appearance Management
Management
6
TB TREATMENT TB HIGH RISK
7
TB MORBIDITY REPORTED TB CASES
UNITED STATES, 1998-2002 UNITED STATES, 1982-2002
No. of Cases
26000
20000
No. of Cases
20
15000
10000 10
5000
0
0 1993 1994 1995 1996 1997 1998 1999 2000 2001
1992 1994 1996 1998 2000 2002
All Ages Aged 25 - 44
U.S.-born Foreign-born Note: Minimum estimates based on reported HIV-positive status
among all TB cases in the age group. All 2001 cases from California
have an unknown HIV status.
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OCCUPATIONAL SAFETY AND
HEALTH ADMINISTRATION
OSHA REGULATIONS
STANDARD PRECAUTIONS
PROVEN & PRACTICAL INFECTION CONTROL MEASURES STANDARD PRECAUTIONS...
...
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NEW INFORMATION
JANUARY 2004
OCCUPATIONAL RISK
• CDC 2003
• More Scientific Evidence
– Articles Are Referenced
• Patient To HCW
– Weighted Values • HCW To Patient
• Added Hand Washing, Water Lines,
Dental Devices, Immunizations, Etc.
• Occupational Exposure
OCCUPATIONAL RISK
HIV IN HEALTH CARE
As Of 12/31/2001, The CDC Reported:
CDC - THROUGH 12/31/01
23,951 HCWs With HIV/AIDS Occupation # with AIDS
57 Documented Occupational Physician 1,760
Exposures To HIV Surgeon 119
Nurse 5,211
138 Cases Under Investigation As
Dental worker 486
Possible Occupational Exposures
Paramedic 463
Technician 3,086
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OCCUPATIONAL RISK
OCCUPATIONAL RISK 57 OCCUPATIONAL EXPOSURES TO HIV:
57 OCCUPATIONAL EXPOSURES TO HIV:
11
NSU STUDENTS NSU STUDENTS
• Report Incident
• All NSU HPD Students Are Required To
– Infection Control Officer
Have Health Insurance
– Faculty
• All Bills For Post-exposure Follow-up Will
• Follow Up Immediately With Be The Responsibility Of The Student.
Appropriate Medical Facility • *Exception Exists
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PRIVATE PRACTICE MORAL, ETHICAL & LEGAL ISSUES
CONFIDENTIALITY
ISSUES
EMPLOYEES…
EMPLOYEES…
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