Hiv Aids Bloodborne Pathogens

1. HIV/AIDS
and other Bloodborne Pathogens
Orlando Tech
Practical Nursing Program

2. Course Objectives
• What is HIV / AIDS?
• How is it spread?
• How can it be prevented?
• What happens to people with AIDS?
• Distinguish fact from fiction regarding HIV / AIDS

3. Definition of HIV
Human
Immunodeficiency
Virus
HIV is the virus that causes AIDS

4. Definition of AIDS
Acquired
Something a person gets from someone else
Immune
Your defense system for fighting off diseases
Deficiency
Below normal levels
Syndrome
Group of signs and symptoms that occur together

5. When the HIV Virus Attacks
It infects the helper T cells, first blocking their ability to
recognize foreign substances, then changing the T
cells into AIDS-virus factories
Because the T cells no longer perform their infection
fighting role, invading viruses can roam free.
Meanwhile, the damaged T cells produce AIDS virus,
which invades other T cells

6. HIV Virus Structure

7. HIV Attack on a T Cell

8. For AIDS to be Transmitted
• Virus must be present in an infected person
• Infected body substance must enter the
bloodstream of another person

9. Body Substance Carriers
• Blood
• Semen
• Vaginal Secretions
• Breast Milk
• Body substances that contain blood cells
• Cerebrospinal fluid, synovial fluid, amniotic fluid

10. Sexual Transmission
• Semen, vaginal fluids, menstrual blood can
carry the AIDS virus
• These fluids can enter the bloodstream through
microscopic tears or sores in the tissue of vagina, penis,
anus or mouth

11. Nonsexual Transmission
• Sharing IV drug needles passes blood from
one user to another
• Infected mothers can infect unborn children or babies
who are breastfed
• Blood transfusions of infected blood

12. Blood Transmission
• An HIV-infected drop of human blood contains
1 to 100 live virus particles
• Methods of blood transmission
• Blood / blood product
• Needle sharing
• Occupational Exposure

13. HIV is not transmitted through…
Shaking hands Hugging
Casual kiss Drinking fountain
Food Door knobs
Insects Hot tubs
Pets Swimming pools
Sneezing Dishes
Coughing Toilet seat

14. General Precautions
• Don’t share razors, toothbrushes, dental floss,
tattoo or ear piercing needles
• Clean body fluid spills with a 1:10 bleach:H20 solution
• Wear disposable gloves when cleaning blood spills
• Dispose of waste materials in proper containers
• Wash hands with soap and water

15. Personal Prevention
Autologous Transfusion
The collection and storage of blood or blood
components from a patient for subsequent
transfusion to that same person is recommended
prior to elective surgery

16. Personal Prevention
An infected person may show no outward
sign of being infected…
• Know your partner’s health status
• Practice safer sex
• Abstinence
• Monogamy

17. Occupational Exposure Transmission
The risk of contracting HIV after one occupational exposure
is about 0.3%
Health care worker exposure can occur from:
• Needlesticks
• Blood splashes to the oral mucosa

18. Universal Precautions
• Approach every body fluid as if
it was infected with HIV
• Put a barrier between you and
everyone’s body substances!

19. Infection Control Practices
• Wear PPE – Personal Protective Equipment
masks, gloves, eyewear
• Wash hands frequently for at least 15-30 sec.
• Use puncture proof containers / Biohazard bags
• Tie / close securely
• Clean work areas with tuberculocidal solution or fresh
1:10 (bleach to water) solution

20. HIV Testing
Florida Statute 381.004
• Informed Consent
• Anonymity
• Results reported to DOH
• Counseling
• Confidentiality

21. HIV Testing
• HIV testing must be performed by a lab
licensed by the Department of Health
• All reactive tests must be retested using another
confirmatory test such as a Western blot test.
• Confirmation must be done before releasing results

22. HIV Screening Testing
• HIV ELISA, sometimes called an HIV enzyme
immunoassay (EIA) is the first test to determine
if an individual is positive for the HIV pathogen.
• Detects either the presence of
• antigen or antibody in your blood.

23. HIV Western Blot Testing
• Lupus, Lyme disease, and Syphilis may give a
false positive ELISA screening.
• More specific Western Blot is used to confirm if
someone is truly HIV positive.

24. Pathogenesis
The Development of
HIV into AIDS

25. Pathogenesis
Sero-conversion
HIV positive

Symptomatic AIDS

26. T Cells
Lymphocyte subset responsible for
cell-mediated immunity
• Killer T cells  macrophages
• Helper T cells “CD4”  activate and direct other
immune cells and are the target of the HIV virus
• Regulatory T cells  maintain immunity homeostasis

27. Classification System of HIV Infection
Clinical Categories
A B C
CD4+T-cell categories Asymptomatic, Symptomatic, AIDS-indicator
acute HIV not A or C conditions
1. ≥ 500/µL A1 B1 C1
2. 200-499/µL A2 B2 C2
3. <200/µL
A3 B3 C3
AIDS indicator -Tcell count

28. Category A Conditions
• Asymptomatic HIV infection
• Persistent generalized lymphadenopathy
• Primary acute HIV infection with
accompanying illness

29. Category B Conditions
One of the following criteria must be met
• The conditions are attributed to HIV infection
or defective cell mediated immunity
• The conditions have a clinical management
that is complicated by HIV infection.

30. Opportunistic Infections
• An infection caused by an organism that does
not usually trouble people with healthy immune
systems.
• Opportunistic infections (OIs) are primarily responsible
for the morbidity and mortality associated with HIV
disease

31. Category B Conditions
• Candidiasis
• Cervical dysplasia
• Cervical carcinoma in situ
• Fever, diarrhea lasting longer than a month
• Oral leukoplakia
• Herpes zoster at least 2 distinct episodes
• Idiopathic thrombocytopenic purpura
• Pelvic Inflammatory Disease
• Peripheral neuropathy

32. Cervical Dysplasia

33. Leokoplakia

34. Herpes Zoster

35. Category C Conditions
• Candidiasis • Kaposi’s Sarcoma
• Invasive cervical cancer • Tuberculosis
• Cytomegalovirus • Pneumocystis carinii pneumonia
• Herpes simplex • Salmonella septicemia
• Histoplasmosis • Toxoplasmosis of brain
• Lymphoma • Encephalopathy

36. Oral Herpes Simplex

37. Genital Herpes Simplex
Vaginal Herpes
Penile Herpes

38. Kaposi’s Sarcoma

39. Tuberculosis

40. HIV Warning signs
• Profound and unexplained fatigue
• Chills or drenching night sweats
• Weight loss 10% in less than 60 days
• Lymphadenopathy
• Dry cough
• Blotches on or under skin, in mouth, nose, eyelids
• Dementia, memory loss, tremors, depression

41. AIDS Reported Cases
New York
California
Florida
Texas
New Jersey
Puerto Rico
Illinois
Georgia
Pennsylvania
Massachusetts

42. Other Bloodborne Pathogens
Hepatitis

43. The Functions of the Liver
• Detoxify everything you eat, breathe, and absorb
through the skin
• Convert nutrients in food into proteins, energy,
hormones, clotting and immune factors
• Store certain vitamins, minerals
• Neutralize and destroy poisonous substances
• Regulate fat stores
• Remove bacteria from the blood stream

44. Viral Hepatitis
Acute Hepatitis
• Infection following entrance of virus into the body
• Symptoms may or may not be present
• Disease develops in a 4 week period; then recovery
• Rarely results in liver failure

45. Viral Hepatitis
Chronic Hepatitis
• Acute hepatitis persisting > than 6 months
• Only acute hepatitis B, C and D can become chronic
• Results in a persistent liver injury
• May lead to cirrhosis, and primary liver cancer

46. Types of Hepatitis
• Hepatitis A • Hepatitis D
• Hepatitis B • Hepatitis E
• Hepatitis C • Hepatitis G

47. Transmission of Hepatitis
• Enteral
• Parenteral

48. Enteral-Acquired Hepatitis
Hepatitis A, Hepatitis E
Transmission from stool-contaminated…
• Water, ice cubes
• Food shellfish, vegetables, fruits

49. Hepatitis A
• No chronic infection
• Once you have had HAV you cannot get it again
• 15% of infected people have prolonged or relapsing
symptoms over a 6-9 month period
• Epidemics both community-wide and nationwide
• 1/3 Americans have evidence of past infection immunity

50. Hepatitis A
• Found in the feces of persons with hepatitis A
• Spread from person to person by putting
something in the mouth that has been
contaminated with the stool of a person with hepatitis
A...oral-fecal route

51. HAV Signs and Symptoms
Adults are more symptomatic than children
• Jaundice
• Fatigue
• Abdominal pain
• Loss of appetite
• Nausea
• Diarrhea
• Fever

52. HAV Prevention and Treatment
• Hepatitis A vaccine
• Immune globulin given before and within 2 weeks after
coming in contact with HAV
• Always wash your hands with soap and water after using
the bathroom, changing a diaper, and before preparing and
eating food

53. Parenteral-acquired Hepatitis
Hepatitis B, C, D, G
• Blood to blood
Transfusion, tattoo, body piercing, needles,
organ transplants, hemodialysis
• Sexual intercourse
• Mother to child
• Household contact of infected persons

54. Hepatitis B
• Can exist on almost any surface outside the body for
more than a month
• Found in the blood, semen, and vaginal
secretions of infected people
• Low concentrations can be found in saliva
• Blood concentration is 100 times greater than HIV
• Can cause cirrhosis, liver failure, liver cancer

55. HBV Statistics
• HBV infects 1 out of every 20 people living in the US
• ½ of HBV infected persons are symptomatic
• Infected persons can spread with HBV, whether they have
symptoms or not
• 6% of infected adults will carry HBV in their bodies for
years or for life and remain contagious

56. HBV Signs and Symptoms
• Extreme tiredness
• Joint pain
• Loss of appetite
• Nausea, vomiting
• Fever
• Dark-colored urine
• Ascites
• Yellowish tinged skin and eyes

57. HBV Transmission
• Unprotected anal or vaginal sex
• Needles used for drugs, body piercing, tattooing,
• Contact with open sores
• Sharing toothbrushes, razors, nail clippers, washcloths
• Living with a person with ongoing HBV infection
• Human bites

58. Hepatitis C
• Blood or body fluids from an infected person
enters the body of a person who is not infected
• IV drug users
• Needlesticks or sharps exposures on the job
• Infected mother to her baby during delivery

59. HAC Statistics
• 3.9 million people have been infected
• 15-45% clear HCV naturally
• 55-85 % retain the HCV virus and are infectious
• 20 % of carriers develop cirrhosis and/or cancer
• 3 % will die of complications related to Hepatitis C

60. HAC Signs and Symptoms
Most patients have no symptoms because
the liver is a non-complaining organ
Symptomatic patients may experience:
• Fatigue • Jaundice
• Nausea • Abdominal Pain
• Diarrhea • Extreme Fatigue
• Vomiting • Muscle and Joint Pain

61. HAC Treatment
• There is no vaccine for Hepatitis C
• Drug treatment with interferon
• Alcohol abstinence
• Healthy low fat diet
• Avoid NSAID medications
• Avoid greater than 2 gm acetaminophen /day

62. Healthcare Workers Risks
Any healthcare worker
that may come in contact
with blood is at risk

63. Healthcare Workers Risks
• Contact with infected body fluids by not using
PPE can lead to transmission through skin
and mucous lesions
• Needle stick injury or other sharps
• Tying wires to close sternum may cause glove tearing and
finger cuts

64. Healthcare Workers Risks
• HBV is transmitted more efficiently than HIV
• HBV needlestick injury is 20 times more likely
to transmit than a HIV needlestick injury
• A single drop of contaminated blood has
100 million to 1 billion organisms

65. Biohazard Labels and Signs
•BIOHAZARD symbol must be clearly visible any
where there is potentially infectious material
•BIOHAZARD signs must be posted at the
entrance of potentially hazardous work areas

66. Laundry Practice
• Laundry workers must wear PPE
• Contaminated linens should be treated as if it were
HBV/HIV infectious
• Contaminated linen should be bagged on-site
• Contaminated laundry should be transported in leak
proof biohazard bags

67. Hepatitis Prevention
• Immunization for HBV
• Avoid sharing personal items like needles,
razors, scissors, toothbrush, pierced earrings
that may be contaminated with blood
• Cover open wounds
• Disinfect / sterilize medical reusable devices
• Use disposable needles, syringes, lancets

68. Hepatitis Vaccination
• Vaccine offers 85-95% prevention
with inoculation series of 3 doses
• There is no cure once infected
• No cost to employees

69. Personal Protective Equipment
Employer Provided
• Different sizes and readily accessible areas
• Cleaning or disposal of PPE
• Repair or replacement of PPE as needed
Employee Guidelines
• Replace surgical gloves when torn, soiled or punctured
• Replace surgical gloves when integrity is compromised
• Utility gloves may be cleaned and disinfected for re-use

70. Recordkeeping
• ID employees
• HBV vaccination status
• Examination, testing results and follow-up
• Information regarding exposure follow-up
• Training session dates
• Program summary
• Name & Qualification of Trainer
• Name & job titles of attendees
• Records must be available to employees and OSHA

71. For More Information
Centers for Disease Control
www.cdc.gov
National Library of Medicine
www.nlm.nih.gov
The Hepatitis Foundation
www.hepfi.org
Occupational Safety & Health Administration
www.osha.gov