Bloodborne Virus Transmission from Healthcare Worker to Patient血源性传播病毒的医护人员对病人.ppt

Bloodborne Virus Transmission from Healthcare Worker to Patient B. Lynn Johnston, MD FRCPC June 17, 2003 Teleconference Objectives Gain an appreciation of the risk for transmission of a bloodborne pathogen from infected HCW to patient Understand those situations which appear to pose a risk for transmission of a bloodborne pathogen from infected HCW to patient Become familiar with the Canadian guidelines for bloodborne pathogen infected HCWs Hepatitis B Small double-stranded DNA virus 3 major antigens: “s”, “e”, and “c” Incubation 60-110 days Areas of endemicity 10% chronic carriers Hepatitis C Single stranded RNA virus Incubation 6-7weeks Acute symptoms unusual ~75% develop chronic disease Diagnosed by positive HCV serology confirmed by positive pcr HIV Enveloped RNA retrovirus Targets cells with CD4 receptor molecules Diagnosed by positive serology (EIA confirmed by WB) Monitored by CD4 counts and HIV viral load Occupational Bloodborne Pathogen Infections Occupational Bloodborne Pathogen Infections Risk for transmission related to ? host susceptibility ? nature of the injury ? magnitude of the inoculum ? source viremia level ? availability/effectiveness of PEP Estimated prevalence of BBP among US HCWs performing invasive procedures Sources of Information on Risk of BBP Transmission from HCWs to Patients Surveillance data; investigations of clusters of cases linked to infected HCWs Prospective studies of contacts of infected HCWs Studies of patients with no identified risk factors for infection Mathematical models HCW to Patient HBV - Dentistry HCW to Patient HBV – Obs/Gyn HCW to Patient HBV- CV Surgery HCW to Patient HBV - Other HCW to Patient HBV – Prospective Surveillance 228 contacts of HBsAg + HCWs tested negative for HBV (N Engl J Med 1975) 213 patients exposed to 6 chronic carriers (including 2 surgeons, 1 eAg+) tested HBV negative (Hepatology 1986) No transmissions in 30 of 49 tested patients exposed to orthopedic resident with acute