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Biosafety and

Infectious Disease

Awareness:Health and Safety

Essentials for Workers

Instructor

Location

Date

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This guidance was created by the National Clearinghouse for Worker Safety and Health

Training under a contract with the NIEHS Worker Training Program (WTP).

Additional materials pertaining to worker health and safety are available at

http://tools.niehs.nih.gov/wetp.

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This awareness level course is not a substitute for a hands on operations level course for

personnel who have potential for occupational exposure to

infectious materials.

CAUTION!

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COURSE GOALS:

LEARNING OBJECTIVES:

Increase awareness about health and safety for a broad spectrum of workers who work in industries with potential exposure to infectious material.

1. Understand key elements of the chain of infection2. Recognize basic facts about selected infectious diseases3. Identify how workers in affected occupations may be exposed 4. Define key steps in worker protection and infection control5. Understand relevant government standards, regulations, and

guidelines

Biosafety and Infectious Disease Awareness:

Health and Safety Essentials for Workers

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MODULE 1INFECTIOUS MATERIAL & MEANS OF TRANSMISSION

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In this module, we will…

• Describe the association of infectious agents to disease

• Describe the chain of infection

• Describe what is meant by contact, droplet, and airborne transmission

• Describe the potential routes of exposure

• Describe the concept of risk categorization

• Illustrate the concepts using EVD as an example

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Why learn about infectious diseases?

As health care workers and first responders:

• Exposure in your work setting is possible every day

• Exposure can change your life forever

• You need to take precautions

• You need to know where to go if exposed

• Your awareness decreases the infection risk for you and your family

Content adapted from International Association of Fire Fighters

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Infectious Agents & Disease

Agent Type Examples of specific agents

Disease produced by

example agent

Bacteria Mycobacterium tuberculosis Tuberculosis

Virus Hepatitis C virus (HCV) Hepatitis C

Rickettsia Coxiella burnetii Q fever

Fungi Trychophyton species Ringworm

Protozoa Plasmodium falciparum Malaria

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How are infectious agents spread?

• Contact Transmission

– Direct contact

– Indirect contact

• Droplet Transmission

– Sprays

– Splashes

• Airborne Transmission

– Inhalation of airborne pathogen

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Contact Transmission

• Occurs when a health care worker, first responder, or other worker comes in contact with blood or body fluids and then touches their own nose, mouth, or eyes.

– The contact can be direct contact with an infected person, or

– The contact can be indirect contact with a contaminated surface or instrument.

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Droplet Transmission• Coughing, sneezing and vomiting allow droplets to

travel (in sprays or splashes).

• These droplets can contact mucosa of eyes, nose, or mouth.

• Certain precautions are recommended for infections that are spread by inhalation of droplets.

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Airborne Transmission

• Occurs with inhalation of airborne pathogens.

• Certain precautions are recommended for infections

that are spread by airborne agents.

CDC Continuing Education Activities: Self-Study Modules on TB https://www.cdc.gov/tb/education/corecurr/pdf/chapter2.pdf

Transmission of Tuberculosis (TB): TB is spread from person to person through the air. The dots in the air represent droplet nuclei containing tubercle bacilli.

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What happens after transmission?

• The incubation period is the time period between exposure (and transmission) and the occurrence of signs and symptoms of the disease.

• Symptoms are the effects of the disease reported by the patient, such as nausea or pain.

• Signs are the effects of the infection observed or detected by others, such as vomiting or diarrhea.

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Risk Categorization

• Risk for occupational exposure to an infectious agent varies depending on:

– Specific pathogen

– Mode of transmission

– Nature of job tasks

– Work environment

• Level of risk may be categorized (for example, high versus low) based on results of an occupational exposure assessment.

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1. Will job tasks include potential exposure to blood and body fluids?

2. What is the proximity of workers to the contagious individual or contaminated waste?

3. Will workers be potentially exposed through contact, inhalation, ingestion, or injection?

4. Will job tasks, work environment, fatigue, and related factors increase risk of exposure?

Considerations for an Occupational Exposure Assessment

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Basic Risk Categories

• CDC and OSHA have not developed specific risk categories for safety & health purposes.

• Many workplace guidelines include two risk categories:

• High risk where blood and body fluid exposure exists.

• Low risk where workers are in close proximity to suspect or known cases without blood or body fluids (low grade fever).

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Prevent Skin Contact!

• People touch their eyes, nose, and mouth frequently.

• The eyes, nose, and mouth are known as the transmission zone.

• In one study of physicians offices, healthcare workers touched their faces 10 times per hour!*

*Elder, Nancy C., et al. "Hand hygiene and face touching in family medicine offices: a Cincinnati Area Research and Improvement Group (CARInG) network study."

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What is “The 3 foot rule?”

CDC defines “close contact” as being within 3 feet or within a patient’s room/care area while not

wearing PPE.

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INFECTIOUS MATERIAL & MEANS OF TRANSMISSIONEBOLA VIRUS DISEASE EXAMPLE

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Ebola Virus Disease (EVD)

• Ebola, also known as Ebola virus disease (EVD), is a rare and deadly disease caused by infection with one of the Ebola virus strains.

• Detailed information can be found on the CDC website: https://www.cdc.gov/vhf/ebola/

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U.S. Cases in 2014

• September 2014: First travel associated case– 42 year old Male, deceased

• October 2014: First transmission in U.S.– Healthcare workers treating first patient

– 26 year old female nurse, recovered

– 29 year old female nurse, recovered

• Multiple individuals working to combat EVD in West Africa brought to the U.S. for treatment.

http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/united-states-imported-case.html

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Incubation Period

• When is someone able to spread the disease to others?

Ebola only spreads when people are sick

A patient must have symptoms to spread the disease to others

After 21 days, if an exposed person does not develop symptoms, he or she will not become sick with Ebola

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Signs & Symptoms

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Case Fatality Rate & Treatment

40%

60%

2014 West Africa Case Fatality Rate = 60% at

Height of Outbreak

Non-fatal Fatal

Treatment

• Supportive care, especially hydration

• Investigational therapies

• No currently approved vaccines

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How is Ebola spread?

Body Fluids

• Blood, vomit, urine, fecal matter

• Sweat, semen, spit, breast milk

• Dead bodies

Contaminated Objects

• Needles, medical equipment, sheets

• Clothing, PPE, others

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Is EVD spread through the air?

• Droplets (splashes and sprays) of respiratory or other secretions from a person who is sick with Ebola could be infectious, and therefore certain precautions are recommended.

• It is not considered an airborne infectious disease.

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How long does Ebola survive outside of the body?

• Dried surfaces such as doorknobs and countertops

– Several hours

• Body fluids such as blood

– Several days

• It is killed with EPA-approved cleaners labeled as effective against non-enveloped viruses

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END OF MODULE 1