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//-->.pos {position:absolute; z-index: 0; left: 0px; top: 0px;}Respiratory Viruses: Roles of Surfaces, Fomites, and HandsDr. Lynne Sehulster, Centers for Disease ControlA Webber Training TeleclassRespiratory Viruses:Roles of Surfaces, Fomites,and HandsLynne Sehulster, PhD, M(ASCP)Division of Healthcare Quality PromotionCenters for Disease Control and PreventionHosted by Paul Webberpaul@webbertraining.comObjectives for TodayThis presentation will briefly address:Seasonal respiratory viruses and theirmodes of transmissionSurvival of these viruses on hands andenvironmental surfacesStrategies to interrupt transmissionCommon Respiratory VirusesInfluenza virusCoronavirusRespiratory Syncytial virusElectron micrographs source: CDC, Public Health Image LibraryParainfluenza virusHosted by Paul Webberpaul@webbertraining.comwww.webbertraining.comPage 1Respiratory Viruses: Roles of Surfaces, Fomites, and HandsDr. Lynne Sehulster, Centers for Disease ControlA Webber Training TeleclassViruses as Healthcare-Associated PathogensIn 2001, 5% of all healthcare asociated- sinfections were attributed to viruses(viewed as an underestimation)Pediatric and geriatric patients particularlyvulnerableSpread in health care mirrors transmissionunderway in communitiesAsymptomatic infections a problemValenti WM, et al.Infect Control1980; 1: 33-37; Aitken C, Jeffries DJ.Clin Microbiol Rev2001; 14: 528-546.Respiratory Syncytial Virus>95% of children seropositive by age 2Repeat infections are commonWinter or spring outbreaks in the U.S.Major agent isolated from children admitted withacute lower respiratory tract infection (89%)– Bronchiolitis: 43-90% due to RSV– Pneumonia: 5-40%– Tracheobronchitis: 10-30%Acquired immunity is not complete or durableFrom: Hall CB, McCarthy CA. Respiratory Syncytial Virus.in:Mandel, Bennett, Dolin eds. Principles andPractices of Infectious Diseases, 6thEdition. 2005. Elsevier, Churchill, LivingstoneInfluenza VirusInfluenza A, B, and CHigh mortality rates (10,000 – 51,000 peryear)– Pneumonia & Influenza mortality statisticsare estimateAttack rates highest among the young,mortality high among the elderlyAntigenic drift, antigenic shiftFrom: Treanor JJ. Influenza Virus.in:Mandel, Bennett, Dolin eds. Principles and Practices of Infectious Diseases, 6thEdition. 2005. Elsevier, Churchill, LivingstoneHosted by Paul Webberpaul@webbertraining.comwww.webbertraining.comPage 2Respiratory Viruses: Roles of Surfaces, Fomites, and HandsDr. Lynne Sehulster, Centers for Disease ControlA Webber Training TeleclassTransmission of RespiratoryVirusesLarge or small (< 5µm mediandiameter) droplets– Large droplets in close person-to-person contact• mucous membrane contact– Small droplets in coughs,sneezes, talkingHand contamination andtransferral from surfaces,fomitesAirborne/Droplet Transmission ofPathogens from Healthcare Personnelto PatientsPathogenInfluenza virusVaricella-zoster virusMycobacteriumtuberculosisBordetella pertussisStaphylococcus aureusCircumstanceLack of vaccinationDisseminatedinfectionCavitary diseaseUndiagnosedprolonged coughViral URI (“cloud”healthcare provider)Sherertz RJ et al.Emerg Infect Dis2001; 7: 241-244Chain of InfectionVirulent pathogenSufficient number of the pathogen (i.e.,infectious dose)Susceptible hostMode of transmissionCorrect portal of entryHosted by Paul Webberpaul@webbertraining.comwww.webbertraining.comPage 3Respiratory Viruses: Roles of Surfaces, Fomites, and HandsDr. Lynne Sehulster, Centers for Disease ControlA Webber Training TeleclassEnvironmental SurfacesEnvironmental surfaces (e.g., walls, floors)are not directly involved in infectiousdisease transmissionThese surfaces, however, may serve asreservoirs of microorganisms that maypotentially cause infection when transferredfrom the surface to patients via hands oraerosol-producing activitiesThe Spaulding ClassificationCategories are based on the potential for a surface totransmit infection should contamination be present attime of useMedical instruments:– Critical, Semi-critical, Non-criticalEnvironmental surfaces– CDC modification– Surfaces with minimal potential for diseasetransmission– Medical equipment surfaces and housekeepingsurfaces“How Long Does It Live?!?”<1 – 5 days:Bacteria:Neisseria meningitidis, Mycoplasmapneumoniae, Hemophilus influenzae,Pseudomonas aeruginosa, BurkholderiapseudomalleiViruses: Rubeola virus (measles), mumps virus,parainfluenza viruses, RSV, VZV, rubella virus,rhinoviruses, SARS-CoV, hepatitis C virus (HCV)Hosted by Paul Webberpaul@webbertraining.comwww.webbertraining.comPage 4Respiratory Viruses: Roles of Surfaces, Fomites, and HandsDr. Lynne Sehulster, Centers for Disease ControlA Webber Training Teleclass“How Long Does It Live?!?”< 1 monthBacteria:Bordetella pertussis, Streptococcuspneumoniae, Yersinia pestisViruses: Influenza viruses, norovirus, hepatitis Bvirus (HBV)** Note: HBV survival studies indicate the virus canpersist on environmental surfaces for at least 7days; long term survivability not determinedResistance Levels of MicroorganismsBacterial Spores↓Mycobacteria↓Non-lipid or small viruses↓Fungi↓Vegetative bacteria↓Lipid or medium-sized virusesChoosing a DisinfectantProcedureNature of the item to bedisinfectedConcentration ofmicroorganisms presentInnate resistance ofthose microorganismsAmount of organic soilType andconcentration ofgermicide usedDuration andtemperature ofgermicide contactOther factors if using aproprietary productHosted by Paul Webberpaul@webbertraining.comwww.webbertraining.comPage 5
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