National Nurses United

3 National Nurses United How Can Nurses be Exposed to Infectious Diseases? Nurses provide the majority of hands-on patient care in hospitals and other health care settings. This physical proximity and contact with patients is vital to nurses' abilities to assess and care for patients, but can also present exposure scenarios that employers must address. These exposures can include: • Direct contact with blood and other bodily fluids that may contain pathogens. Direct contact may occur while providing patient care, through splashes or sprays, needlestick or other sharps injuries, and direct contact with nonintact skin. • Indirect exposure may occur via fomites, or objects that have become contaminated with pathogens. Fomites can include equipment, clothing, beds, cur- tains, tables, and door handles, among other objects and surfaces. • Droplet exposure may occur when a patient with an infectious disease that can be transmitted via droplets coughs, sneezes, talks, laughs, and in some cases via breathing. Intubation, spirometry, CPR, suction, and other procedures may increase the droplets released and thereby increase exposure. Many droplets stay in the air for a limited amount of time or travel a limited distance before settling onto the floor and other sur- faces. For some diseases, droplets may also introduce indirect exposure via contaminated surfaces. • Airborne or aerosol exposure can occur for certain diseases that can be transmitted in very small aero- sols. These microscopic particles can be generated during certain procedures such as ventilation, bronchoscopy, and CPR as well as during vomiting, flushing of an uncovered toilet, and other situations. Some Disease of Concern in Hospitals and Other Health Care Settings Nurses may be exposed to a wide variety of infectious diseases. Employers should protect nurses from exposure to infectious diseases, including in situations where it may not be known or suspected that a patient has an infectious disease. Some diseases that nurses may encounter include: Hepatitis B: This vaccine-preventable disease causes a million deaths worldwide each year. In 2016, 3,218 cases of acute hepatitis B were reported to the CDC in the U.S. Because many hepatitis B infections are asymptomatic, the CDC estimates that the actual number of 2016 cases in the U.S. was closer to 20,900. Hepatitis B used to be called the "health care workers' disease" before the vaccine was developed and disseminated in the 1980's. Hepatitis B is transmitted through contact with blood and other bodily fluids from a person with a hepatitis B infection. Employers in the U.S. are required to provide the hepatitis B vaccine at no charge to employees who may have exposure to blood or other potentially infec- tious material while at work. Hepatitis C: Viral infection with hepatitis C results in a chronic infection 75-85% of people who are infected. In 2016 in the U.S., 2,967 cases of acute hepatitis C were reported to the CDC. Because many hepatitis C infections may go undiagnosed or unreported, the CDC estimates that the actual number of hepatitis C cases in 2016 was closer to 41,200. Hepatitis C is transmitted through contact with blood and other bodily fluids from a person with a hepatitis C infection. HIV: The World Health Organization (WHO) estimates that over 36 million people are living with HIV world- wide. The CDC reports that there were 39,782 people diagnosed with human immunodeficiency virus (HIV) in the U.S. in 2016. HIV can be transmitted through contact with blood and other bodily fluids from a person with an HIV infection. Zika: The Zika virus became a nationally notifiable condition in 2016. Infection with Zika virus may be asymptomatic or cause mild to moderate, self-limited symptoms in adults. The virus is most often transmitted by mosquitoes, but transmission through blood and other bodily fluids, such as sexual transmission, has also been documented. Zika virus infection in pregnant women can result in lifelong injuries to the fetus, including develop- mental delay, microcephaly, seizures, and other impacts. Most cases of Zika virus in the U.S. are acquired during travel—5,723 symptomatic Zika cases were reported between 2015 and 2018. Over 300 of these cases were acquired through local mosquito-borne transmission, primarily in Florida and Texas, sexual transmission, and other routes. MRSA: Methicillin-resistant Staphylococcus aureus (MRSA) is a bacteria that can cause a variety of problems and that is resistant to many antibiotics. MRSA is a common and concerning health care-acquired infection among patients. MRSA can be transmitted via direct con- tact as well as through contaminated objects or fomites. The CDC estimates that two in every 100 people carry MRSA on or in their bodies, usually without any illness. C diff: Infection with Clostridium difficile is a common health care-acquired infection and can result in diarrhea, fever, nausea, and can cause death in some patients. C. diff often recurs in patients after treatment with antibiot- ics and can continue to cause severe illness. The bacteria is transmitted via contact with contaminated surfaces, where it can live for long periods of time. The CDC esti- mates that almost a half a million C. diff infections were reported in the U.S. in 2011 and that 29,000 of these patients died within 30 days of diagnosis. S aureus: About 30% of people carry Staphylococcus aureus in their nose without any harm. Sometimes, however, S. aureus can infect other parts of the body and cause sepsis, pneumonia, endocarditis, and other conditions. When S. aureus has developed antibiotic resistance, it can be challenging to treat.

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