protocols involving mrsa infection lice & scabies tuberculosis influenza hiv, hepatitis b...

Protocols InvolvingProtocols Involving MRSA Infection MRSA Infection Lice & Scabies Lice & Scabies

TuberculosisTuberculosisInfluenzaInfluenza

HIV, Hepatitis B & C HIV, Hepatitis B & C Presented By:Presented By:

Stephen W. Munday, MD, MPH, MSStephen W. Munday, MD, MPH, MSSharp Rees-Stealy Medical Group, Inc.Sharp Rees-Stealy Medical Group, Inc.

Occupational MedicineOccupational Medicine

MRSAMRSA

Spread by direct contact/fomitesSpread by direct contact/fomites

30% of general public is colonized with SA30% of general public is colonized with SA

Now most common type of SA isolated in all settings (greater than Now most common type of SA isolated in all settings (greater than 50% of isolates)50% of isolates)

Most cases similar to MSSA clinicallyMost cases similar to MSSA clinically

Certain strains are more virulent and are more likely to cause severe Certain strains are more virulent and are more likely to cause severe diseasedisease

Presumptive for Firefighters/Police 01/01/2009Presumptive for Firefighters/Police 01/01/2009

(methicillin-resistant (methicillin-resistant Staphylococcus Staphylococcus aureusaureus) )

For MRSA photos, click here: http://www.staph-infection-resources.com/mrsa-pictures.html

Head LiceHead Lice•Adult head lice are 2.1-3.3 mm in length. Head lice infest the head and neck and attach their eggs to the base of the hair shaft. Lice move by crawling; they cannot hop or fly.•Head lice infestations (pediculosis, pronounced peh-DICK-you-LO-sis) are spread most commonly by close person-to-person contact. Dogs, cats, and other pets do not play a role in the transmission of human lice.•Both over-the-counter and prescription medications are available for treatment of head lice infestations. •Treatments include use of pyrethrins (OTC), malathion (Rx), •2nd treatment is often necessary after 7-10 days

Body LiceBody Lice•Adult body lice are 2.3-3.6 mm in length. Body lice live and lay eggs on clothing and only move to the skin to feed.•Body lice are known to spread disease. (i.e. louse-borne typhus)•Body lice infestations (pediculosis, pronounced peh-DICk-you-LO-sis) are spread most commonly by close person-to-person contact but is generally limited to persons who live under conditions of crowding and poor hygiene (for example., homeless, refugees, etc.). Dogs, cats, and other pets do not play a role in the transmission of human lice.•Improved hygiene and access to regular changes of clean clothes is the only treatment needed for body lice infestations.

Pubic LicePubic Lice•Adult pubic lice are 1.1-1.8 mm in length. Pubic lice typically are found attached to hair in the pubic area but sometimes are found on coarse hair elsewhere on the body (for example, eyebrows, eyelashes, beard, mustache, chest, armpits, etc.).•Pubic lice infestations (pthiriasis, pronounced THIR-i-a-sus) are usually spread through sexual contact. Dogs, cats, and other pets do not play a role in the transmission of human lice.•Both over-the-counter and prescription medications are available for treatment of pubic lice infestations.•Treatments include use of pyrethrins (OTC), malathion (Rx), •2nd treatment may be necessary after 7-10 days

ScabiesScabies

•Treatment is by Rx only

•Topical treatment is usually done with permethrin crème 5% or crotamiton can be used; a 2nd treatment is sometimes necessary if symptoms persist more than 2-4 weeks

•Oral ivermectin can be used but a 2nd dose Must be given 2 weeks later

TuberculosisTuberculosis

Spread by aerosol droplets / air-borne Spread by aerosol droplets / air-borne transmissiontransmission11//33 – ½ of household droplets infected – ½ of household droplets infected

Drug resistance increasingly commonDrug resistance increasingly common

Treatment is complicated and lengthy Treatment is complicated and lengthy requiring multiple drugs for a minimum of requiring multiple drugs for a minimum of 6 months6 months

TuberculosisTuberculosisWork-related exposure still common in San Work-related exposure still common in San Diego – not just healthcare workersDiego – not just healthcare workers

New blood tests (eg, Quantiferon) available and New blood tests (eg, Quantiferon) available and will likely eventually replace PPDwill likely eventually replace PPD

Persons infected but not ill have LTBIPersons infected but not ill have LTBI– They have a ~10% chance of developing acute TB They have a ~10% chance of developing acute TB

in futurein future

Treatment with INH for 9 months or Rifampin for Treatment with INH for 9 months or Rifampin for 4 months greatly decreases risk of later 4 months greatly decreases risk of later developing acute TBdeveloping acute TB

H1N1H1N1

First cases identified were two Southern California First cases identified were two Southern California children in April 2009children in April 2009

Currently over 1 million Americans have been infected Currently over 1 million Americans have been infected and many more worldwideand many more worldwide

Predominant flu circulating in North AmericaPredominant flu circulating in North America

Spread by direct contact and respiratory dropletsSpread by direct contact and respiratory droplets

Not sure how much is by airborne transmissionNot sure how much is by airborne transmission

ILI defined as fever (100ILI defined as fever (100) and cough but nasal and GI ) and cough but nasal and GI symptoms can also occursymptoms can also occur

H1N1H1N1Limit spread by social distancing and good hygieneLimit spread by social distancing and good hygiene

– Hand washing! (soap & water or alcohol-based hand Hand washing! (soap & water or alcohol-based hand sanitizers)sanitizers)

– Stay home if sick!Stay home if sick!

– Use a fit tested N-95 respirator (IOM) to limit exposure in Use a fit tested N-95 respirator (IOM) to limit exposure in appropriate settingsappropriate settings

– General work setting: may return 24 hours after cough General work setting: may return 24 hours after cough andand fever have resolvedfever have resolved

– Healthcare setting: 7 days after onset Healthcare setting: 7 days after onset andand 24 hours after 24 hours after fever fever andand cough resolved cough resolved

– Use an antiviral (Tamiflu) for exposures or illness in high-risk Use an antiviral (Tamiflu) for exposures or illness in high-risk personspersons

H1N1 Flu (Swine) AND SEASONAL FLU VACCINE

2009-2010 is a confusing year. There will be two kinds of flu vaccines available - seasonal and H1N1. It is recommended that everyone be vaccinated against both. The supply of H1N1 flu vaccine may be limited at first, but eventually there will be enough vaccine for anyone who wants protection from H1N1 flu.

H1N1 Flu Vaccine H1N1 Flu Vaccine Seasonal Seasonal Influenza Vaccine Influenza Vaccine

What types of flu What types of flu vaccine are vaccine are available? available?

Both vaccines will be available either Both vaccines will be available either as shots (inactivated, injectable as shots (inactivated, injectable vaccine) or as a nasal spray (live, vaccine) or as a nasal spray (live, attenuated virus vaccine). ). The attenuated virus vaccine). ). The nasal spray vaccine can only be used nasal spray vaccine can only be used in healthy individuals between the in healthy individuals between the ages of 2 and 49 years. Everyone ages of 2 and 49 years. Everyone else should receive the injectable else should receive the injectable vaccines (shots). Both vaccines are vaccines (shots). Both vaccines are manufactured the exact same way manufactured the exact same way and are equally safe .and are equally safe .


How many doses How many doses will I need? will I need?

Everyone will Everyone will need 2 doses need 2 doses separated by at separated by at least 3 weeks least 3 weeks

Everyone needs Everyone needs one doseone dose

Children under Children under age 9 may need 2 age 9 may need 2 doses – ask your doses – ask your doctor doctor


Who should be Who should be vaccinated and vaccinated and when?when?

H1N1 flu vaccine H1N1 flu vaccine should go should go firstfirst to to those in groups those in groups who are at who are at highest risk for highest risk for more severe more severe disease.disease.

Seasonal flu Seasonal flu vaccine can go to vaccine can go to anyone who anyone who wants protection wants protection starting as early starting as early as September.as September.

Seasonal Influenza VaccineSeasonal Influenza VaccineTarget Groups (September –March)Target Groups (September –March)(order of target groups does not indicate priority)(order of target groups does not indicate priority)

all children age 6 months through 18 yearsall children age 6 months through 18 yearspregnant womenpregnant womenpersons age 50 years and olderpersons age 50 years and olderpersons persons who have chronic underlying medical conditions (such who have chronic underlying medical conditions (such as asthma) or weakened immune systems as asthma) or weakened immune systems residents of long-term care facilities residents of long-term care facilities health care personnel health care personnel household contacts and caregivers of children aged <5 years household contacts and caregivers of children aged <5 years and adults aged and adults aged >>50 years, with particular emphasis on 50 years, with particular emphasis on vaccinating contacts of children aged <6 months; andvaccinating contacts of children aged <6 months; andhousehold contacts and caregivers of persons with medical household contacts and caregivers of persons with medical conditions that put them at higher risk for severe complications conditions that put them at higher risk for severe complications from influenzafrom influenza

H1N1 Flu VaccineH1N1 Flu Vaccine

Priority 1 (October - March):Priority 1 (October - March): (order of target groups does not indicate priority)(order of target groups does not indicate priority)

Pregnant women Pregnant women Persons who live with or provide care for infants aged <6 Persons who live with or provide care for infants aged <6 months (e.g. parents, siblings, & childcare providers)months (e.g. parents, siblings, & childcare providers)Health-care & emergency medical services personnel who Health-care & emergency medical services personnel who have direct contact with patients or infectious material have direct contact with patients or infectious material Children aged 6 months – 4 yearsChildren aged 6 months – 4 yearsChildren & adolescents aged 5 – 18 years who have medical Children & adolescents aged 5 – 18 years who have medical conditions that put them at higher risk for influenza-related conditions that put them at higher risk for influenza-related complications complications


Priority 2 (November - March):Priority 2 (November - March):

(order of target groups does not indicate priority)(order of target groups does not indicate priority)

All other health-care and emergency medical services All other health-care and emergency medical services personnelpersonnel

All persons aged 6 months-24 years All persons aged 6 months-24 years

Persons aged 25-64 years who have medical conditions that Persons aged 25-64 years who have medical conditions that put them at higher risk for influenza-related complicationsput them at higher risk for influenza-related complications


Priority 3 (December - March):Priority 3 (December - March):

(order of target groups does not indicate priority)(order of target groups does not indicate priority)

All persons aged 25 and olderAll persons aged 25 and older

Anyone else wanting protection from H1N1Anyone else wanting protection from H1N1


Can I get H1N1 Can I get H1N1 and Seasonal Flu and Seasonal Flu vaccine at the vaccine at the same time? same time?

Yes. It is fine to receive seasonal flu Yes. It is fine to receive seasonal flu vaccine and H1N1 vaccine at the vaccine and H1N1 vaccine at the same time. However, if you choose same time. However, if you choose to receive the nasal spray vaccine for to receive the nasal spray vaccine for both H1N1 and seasonal flu both H1N1 and seasonal flu protection, they must be given three-protection, they must be given three-four weeks apart from each other.four weeks apart from each other.

Estimates indicate that 600,000 – 800,000 Estimates indicate that 600,000 – 800,000 needlestick injuries occur yearly in the needlestick injuries occur yearly in the USAUSA

Only about 50% are reportedOnly about 50% are reported

An average hospital has approximately 30 An average hospital has approximately 30 needlestick injuries per 100 bed-yearsneedlestick injuries per 100 bed-years

Nursing staff have the highest riskNursing staff have the highest risk

Blood-borne PathogensBlood-borne Pathogens

Hepatitis B Clinical FeaturesHepatitis B Clinical Features

Incubation period: 6 weeks - 6 monthsIncubation period: 6 weeks - 6 months

May have prodrome of fever, malaise, May have prodrome of fever, malaise, headache, myalgiaheadache, myalgia

Jaundice may persist for days or weeksJaundice may persist for days or weeks

Symptoms not specific for hepatitis BSymptoms not specific for hepatitis B

At least 50% of infections asymptomaticAt least 50% of infections asymptomatic

Chronic CarriageChronic Carriage

Chronic viremiaChronic viremia

Responsible for most mortalityResponsible for most mortality

Overall risk: 10%Overall risk: 10%

Higher risk with early infectionHigher risk with early infection

Annual Disease Burden from Annual Disease Burden from Hepatitis B Virus InfectionHepatitis B Virus Infection

Total infections = 150,000Total infections = 150,000

Symptomatic infections =Symptomatic infections = 50,000 50,000

Hospitalized = 8,000Hospitalized = 8,000

DeathDeath

– Fulminant Hepatitis = 200Fulminant Hepatitis = 200

– Liver Cancer = 1,500Liver Cancer = 1,500

– Cirrhosis = 4,000Cirrhosis = 4,000

Hepatitis BHepatitis BEpidemiologyEpidemiology

Reservoir:Reservoir: Human; EndemicHuman; Endemic

Transmission:Transmission:Bloodborne; Subclinical Bloodborne; Subclinical cases transmitcases transmit

Communicability:Communicability: 1-2 months before 1-2 months before and and after onset of symptoms; after onset of symptoms;

Chronic carriersChronic carriers

Risk Factors for Risk Factors for HepatitisHepatitis B B

HeterosexualHeterosexual

HomosexualHomosexual

Drug AbuseDrug Abuse

UnknownUnknown

HouseholdHouseholdContactContact

Health CareHealth CareOtherOther

Hepatitis B VaccineHepatitis B Vaccine

Composition:Composition: Recombinant HBsAg Recombinant HBsAg

Efficacy:Efficacy: 95% (Range, 80%-100%) 95% (Range, 80%-100%)

Duration of immunity:Duration of immunity: >15 years >15 years

Schedule:Schedule: 3 doses at least 1 month apart and repeat 3 doses at least 1 month apart and repeat Titer at least 1 month after last doseTiter at least 1 month after last dose

Booster doses not routinely recommended, however non-Booster doses not routinely recommended, however non-responders should receive 3 additional doses at least 1 responders should receive 3 additional doses at least 1 month apart and repeat titermonth apart and repeat titer

Hepatitis B High-Risk PopulationsHepatitis B High-Risk Populations

Clients in institutions for developmentally Clients in institutions for developmentally disableddisabled

Immigrants/refugees from areas of high Immigrants/refugees from areas of high HBsAg endemicityHBsAg endemicity

Patients of hemodialysis unitsPatients of hemodialysis units

Intravenous drug usersIntravenous drug userscont’d...cont’d...

Hepatitis B High-Risk PopulationsHepatitis B High-Risk Populations

Homosexual malesHomosexual males

Household contacts of HBV carriersHousehold contacts of HBV carriers

Recipients of certain blood productsRecipients of certain blood products

Alaskan Natives, Pacific IslandersAlaskan Natives, Pacific Islanders

Hepatitis BHepatitis BIntermediate-Risk PopulationsIntermediate-Risk Populations

Male prisonersMale prisonersHealth care workers with frequent blood contactHealth care workers with frequent blood contactStaff of institutions for developmentally disabledStaff of institutions for developmentally disabled

Risk of Transmission Infectious Material Percutaneous

Injury Mucosal

contact or contact with

injured/broken/skin

Bite wound Documented Possibles Unlikely

2-40% Not quantified (transmission by this route has been documented; the magnitude of risk is probably high relative to that for HCV and HIV)

Not quantified (transmission by this route has been documented)

Blood, blood products

Semen, vaginal fluid, bloody fluids, saliva

Urine, feces

Hepatitis BHepatitis B

Recommendations for hepatitis B Recommendations for hepatitis B prophylaxis following prophylaxis following

percutaneous or permucosal percutaneous or permucosal exposureexposure

Exposed person Treatment when source is found to be: HBsAg “+” HBsAg “-” Source not tested or unknown Unvaccinated HBIG x 11 and initiate HB

vaccine Initiate HB vaccine

Initiate HB vaccine

Previously vaccinated:

Test exposed for anti-HBs No treatment No treatment

Known Responder

2. If adequate2, no treatment

2. If inadequate, HB vaccine booster dose

Known nonresponder

HBIG x 2 or HBIG x 1+1 dose HB vaccine

No treatment If known high-risk source, may treat as if source were HBsAg ”+”

Response unknown

2. If inadequate2, HBIG x 1 + HB vaccine booster dose

No treatment Test exposed for anti-HBs 1. If inadequate2, HBIG x 1 + HB vaccine booster dose

2. If adequate, no treatment

2. If adequate, no treatment

1 = HBIG dose is 0.06 ml/kg IM 2 = Adequate anti-HBs is1 = HBIG dose is 0.06 ml/kg IM 2 = Adequate anti-HBs is>>10 SRU by RIA or positive by EIA10 SRU by RIA or positive by EIA

Hepatitis CHepatitis C

Transmission is similar to Hep B but the risk is Transmission is similar to Hep B but the risk is much lower due to low levels of virus outside the much lower due to low levels of virus outside the liverliverSeroconversion can be delayed up to 6 months Seroconversion can be delayed up to 6 months after exposure therefore evaluate patient for after exposure therefore evaluate patient for seroconversion with Hep C RNA and Hep C seroconversion with Hep C RNA and Hep C antibody testingantibody testingCauses chronic infection in 70-85% of those Causes chronic infection in 70-85% of those infected who are not treated acutelyinfected who are not treated acutely

cont’d…cont’d…

Hepatitis C Hepatitis C ((cont’dcont’d))

Interferon and Ribavirin have been Interferon and Ribavirin have been demonstrated to give clinical remission in demonstrated to give clinical remission in a minority of those treateda minority of those treated

Treatment of acute infection in order to Treatment of acute infection in order to prevent chronic infection is effectiveprevent chronic infection is effective

There is no vaccine that will likely become There is no vaccine that will likely become available in the foreseeable future.available in the foreseeable future.


Injury Mucosal contact or contact with injured/broken/skin


3-10% Not quantified (transmission by this route has not been documented but is plausible)*

Not quantified (transmission by this route has not been documented)

Blood Blood products, bloody fluids, semen, vaginal fluid

Saliva, urine, feces

Hepatitis CHepatitis C

HIVHIVAs of June 2000, 56 documented and 138 As of June 2000, 56 documented and 138 possible cases of occupational HIV possible cases of occupational HIV transmissions to US health care workers were transmissions to US health care workers were reported to the CDCreported to the CDCMost involved nurses and laboratory Most involved nurses and laboratory technicianstechniciansPercutaneous injuries (“needlesticks”) were Percutaneous injuries (“needlesticks”) were associated with 89% (49) of the documented associated with 89% (49) of the documented casescases


HIV HIV ((cont’dcont’d))

44 of the 49 involved hollow-bore needles, the 44 of the 49 involved hollow-bore needles, the majority of which were used for blood majority of which were used for blood collection or insertion of an IV cathetercollection or insertion of an IV catheter

Based on data collected prospectively from 20 Based on data collected prospectively from 20 studies worldwide, 21 of 6498 (0.3%) health studies worldwide, 21 of 6498 (0.3%) health care workers with percutaneous exposure to care workers with percutaneous exposure to HIV developed infectionHIV developed infection



Based on a case-control study of health care Based on a case-control study of health care workers, transmission risk is increased by: workers, transmission risk is increased by: – A visibly bloody deviceA visibly bloody device– A procedure which placed a needle in the A procedure which placed a needle in the

source’s vein or arterysource’s vein or artery– A deep injuryA deep injuryThis same study estimated that use of AZT This same study estimated that use of AZT decreased the risk of HIV infection from a decreased the risk of HIV infection from a percutaneous exposure by 79%percutaneous exposure by 79%



Studies of perinatal transmission have shown Studies of perinatal transmission have shown that AZT can decrease the risk by two-thirds.that AZT can decrease the risk by two-thirds.

There are no human data regarding optimal There are no human data regarding optimal timing of post-exposure prophylaxis.timing of post-exposure prophylaxis.

There are 21 cases in which transmission There are 21 cases in which transmission occurred despite almost immediate institution occurred despite almost immediate institution of antiviral prophylaxisof antiviral prophylaxis


HIVHIV

Animal data suggest that optimal protection occurs if Animal data suggest that optimal protection occurs if the prophylaxis is given within 1-2 hours of the prophylaxis is given within 1-2 hours of exposure.exposure.There is no evidence of benefit after 24-36 hoursThere is no evidence of benefit after 24-36 hoursCombination therapy, while theoretically sound, Combination therapy, while theoretically sound, remains unprovenremains unprovenToxicity may be increased with combination therapyToxicity may be increased with combination therapy– 2 cases of progressive fatal neurologic disease associated with 2 cases of progressive fatal neurologic disease associated with

ZDV and 3TC used for perinatal protectionZDV and 3TC used for perinatal protection– Fatal lactic acidosis has been reported in pregnant women Fatal lactic acidosis has been reported in pregnant women

treated with d4T and DDItreated with d4T and DDI


Injury Mucosal

contact or contact with

injured/broken/skin


0.2-0.5% Not quantified (transmission by this route has been documented; pooled risk estimate: 0.1%)

Not quantified (possible route of transmission in 2 cases of non-occupational exposure)

Blood, blood products, bloody fluids

Semen, vaginal fluid, cerebro-spinal fluid, breast milk, exudates, serosal fluids, amniotic fluid, saliva (during dental procedures)

Saliva, urine, feces, tears, sweat

HIVHIV

Regimen Category

Application Drug Regimen

Basic Occupational HIV Exposures for which there is a recognized transmission risk

2 drugs

Expanded Occupational HIV exposures that pose an increased risk for transmission (e.g., larger volume of blood and/or higher virus titer in blood)

3 drugs

Putting it all together…Putting it all together…

Exposed patient Day 0 1 week 4 weeks 16 weeks 24 weeks Hep B Vaccine Responder (prior “+” Hep B sAb at any time)

HIV Hep C Ab/ALT

- HIV HIV HIV Hep C Ab/ALT

Hep B Vaccine Nonresponder or No prior vaccine

HIV Hep C Ab/ALT Hep BsAg Hep BsAb HBIG 0.06ml/kg Hep B vaccine #1

- HIV *Hep B vaccine #2

HIV *Hep B vaccine #3

HIV Hep C Ab/ALT *Hep BsAb titer

Hep B Vaccine Response Unknown

HIV Hep C Ab/ALT Hep BsAb

*Hep BsAg *HBIG 0.06ml/kg *Hep B vaccine #1

HIV *Hep B vaccine #2

*Hep B vaccine #3

HIV Hep C Ab/ALT *Hep BsAb

* Unnecessary if Hep BsAg or sAb is positiveArchive blood for 90 days if HIV testing is declined

Prevention of Exposure toPrevention of Exposure toBlood-born PathogensBlood-born Pathogens

Universal precautions –Universal precautions –

– Assume everyone is potentially infectiousAssume everyone is potentially infectious

– Use appropriate barrier protection, especially Use appropriate barrier protection, especially glovesgloves

Case StudyCase Study

After performing phlebotomy on a patient with After performing phlebotomy on a patient with AIDS, a health care worker sustained a deep AIDS, a health care worker sustained a deep needlestick with the used phlebotomy needle. needlestick with the used phlebotomy needle. Blood from the collection tube also spilled into Blood from the collection tube also spilled into the space between the wrist and cuff of the the space between the wrist and cuff of the health care worker’s gloves, contaminating her health care worker’s gloves, contaminating her chapped hands. The health care worker chapped hands. The health care worker removed the gloves and washed her hands removed the gloves and washed her hands immediately.immediately.

Cont’d…Cont’d…

Case Study Case Study ((cont’dcont’d))

She had a negative baseline HIV test and She had a negative baseline HIV test and refused zidovudine prophylaxis. Because the refused zidovudine prophylaxis. Because the source patient was not known to have HCV source patient was not known to have HCV infection and did not have clinical evidence of infection and did not have clinical evidence of liver disease, the health care worker did not liver disease, the health care worker did not receive baseline testing for exposure to HCV. receive baseline testing for exposure to HCV. Eight months after the incident, the health care Eight months after the incident, the health care worker was hospitalized with acute hepatitis.worker was hospitalized with acute hepatitis.


Case Study Case Study ((cont’dcont’d))

She was found to be seropositive for HIV 9 She was found to be seropositive for HIV 9 months after the incident. 16 months after the months after the incident. 16 months after the incident, she tested positive for anti-HCV incident, she tested positive for anti-HCV antibodies and was diagnosed with chronic antibodies and was diagnosed with chronic HCV infection. Her clinical condition continued HCV infection. Her clinical condition continued to deteriorate, and she died 28 months after to deteriorate, and she died 28 months after the needlestick injury [Ridzon et al. 1997].the needlestick injury [Ridzon et al. 1997].

Occupational Exposure to Occupational Exposure to Bloodborne PathogensBloodborne Pathogens

Post-TestPost-Test

The average rate of HIV transmission The average rate of HIV transmission from an infected source during a from an infected source during a

needle stick is?needle stick is?

3/100,0003/100,0003/10,0003/10,0003/10003/10003/1003/100

AZT has been shown to decrease the AZT has been shown to decrease the risk of HIV transmission from a risk of HIV transmission from a

needlestick in a single case/control needlestick in a single case/control study. The magnitude of this decrease study. The magnitude of this decrease

was closest to:was closest to:20%20%

40%40%

60%60%

80%80%

The risk of HIV transmission is The risk of HIV transmission is greater for a solid-bore than for a greater for a solid-bore than for a

hollow-bore needlehollow-bore needle

TrueTrue

FalseFalse

Combination antiretroviral treatment Combination antiretroviral treatment has been demonstrated in controlled has been demonstrated in controlled trials to be better than AZT alone in trials to be better than AZT alone in preventing HIV transmission from a preventing HIV transmission from a

needlestick.needlestick.TrueTrue

FalseFalse

The risk of Hepatitis B transmissions The risk of Hepatitis B transmissions from an infected source is closest to from an infected source is closest to

0.1%0.1%

1%1%

6-30%6-30%

60-80% 60-80%

In general, Hep B virus is more likely In general, Hep B virus is more likely to be transmitted by a needlestick to be transmitted by a needlestick

than HIVthan HIV

TrueTrue

FalseFalse

Based on currently available data, a Based on currently available data, a healthcare worker who has completed healthcare worker who has completed all 3 doses of Hep B vaccine and has all 3 doses of Hep B vaccine and has

a positive Hep B surface antibody a positive Hep B surface antibody titer, should have a repeat titer (or titer, should have a repeat titer (or

“booster shot”) after 5 years“booster shot”) after 5 years TrueTrue

FalseFalse

Hep B virus more commonly causes Hep B virus more commonly causes chronic infection than Hep C viruschronic infection than Hep C virus ? ?

TrueTrue

FalseFalse

Hep C transmission after a needlestick Hep C transmission after a needlestick exposure from an infected source exposure from an infected source

occurs ____% of the time on average occurs ____% of the time on average

1.8%1.8%

15%15%

18.5%18.5%

27.2% 27.2%

Serum immune globulin has been Serum immune globulin has been shown to decrease the risk of Hep C shown to decrease the risk of Hep C infection after needlestick exposureinfection after needlestick exposure

TrueTrue

FalseFalse

Hep C and HIV transmission have Hep C and HIV transmission have occurred from a single needlestick occurred from a single needlestick

injuryinjury

TrueTrue

FalseFalse

protocols involving mrsa infection lice & scabies tuberculosis influenza hiv, hepatitis b...

Documents