Week 9 Flashcards
1
Q
what are the foundational concepts of communicable diseases (7)
A
- infections
- epidemiological triangle
- classification of communicable diseases
- types of transmission
- lvls of prevention
- prophylaxis
- PHNs role
2
Q
define: infection
A
- the invasion and multiplication of microorganisms in body tissues, which may be cliically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response
3
Q
infection is caused by… (5)
A
- bacteria
- viruses
- fungi
- parasites
- protozoa
4
Q
common pathogens (just review)
A
5
Q
what is typically involved in tx for viruses
A
- treat symptoms
- sometimes antivirals or immunization
6
Q
define acute
A
- resolving in a few days or weeks
- very ill
7
Q
define chronic
A
- lasting >12 weeks
- may be incurable
- may become a carrier
- can develop from acute
8
Q
define: localized
A
- limited to a specific body area
9
Q
define: disseminated
A
- spread to other parts of body
ex. syphilis
10
Q
define: systemic
A
- spread throughout the body
11
Q
define: sepsis
A
- pathogens throughout blood and tissues
12
Q
what is the difference between primary and secondary infection
A
- different stages
13
Q
what are examples of hospital acquired infection (3)
A
- pneumonia
- MRSA (both hospital and community)
- Cdiff
14
Q
what is an example of a community acquired infection
A
- pneumonia
15
Q
what are some examples of infections that are antibiotic resistant
A
- TB
- some types of STI
16
Q
what contributes to antibiotic resistance
A
- not completing full dose of abx
17
Q
antibiotic resistance leads to… (2)
A
- longer treatment
- different treatment
18
Q
interaction of host, pathogen, and enviro
A
19
Q
interaction of host, pathogen, and enviro
A
20
Q
what host behaviors reduce the risk of infection (6)
A
- hand hygeine
- condoms
- intact skin
- good health
- avoid contact
- immunization
21
Q
what is an environmental change that reduces the risk of infection (4)
A
- monitoring air quality
- water supply
- sanitation
- weather (winter v summer)
22
Q
describe the epidemiological trainge
A
- for an infectious disease to be acquired, 3 elements are needed:
–> an infective agent
–> a susceptible host
–> a supportive enviro
23
Q
the epidemiological triangle is a simple way to classify…
A
- communicable disease by examining the relationship between the host, agent, and enviro
24
Q
to disrupt the epidemiological triange, we disrupt…
A
- the interaction between host, enviro, and pathogen
25
define herd immunity
- we want 95% of population immunized to achieve herd immunity
- for the group, not the individual
26
localized outbreaks can be the result of...
- low herd immunity
27
what is included in assessment r/t infection (4)
- history of present illness (when did it start)
- symptoms (when, what, who)
- examination (physical, observation, mostly self report)
- diagnostics
28
what kind of diagnostics are used w infection (3)
- lab (CBC, elevated WBC)
- C&S (throat, genital, mucus membranes
- radiological for TB (sputum, CXR)
29
what are examples of ways to classify communicable diseases (5)
- clinical presentation
- the microbe causing it
- how its transmitted
- the reservoir
- public health classification
30
what are examples of diseases classified based on clinical symptoms (5)
- diarrheal
- resp
- central nervous
- cvs
- sepsis
31
what are examples of diseases classified based on microbiologic classification (5)
- bacterial
- viral
- fungal
- parasitic
- prion
32
what are examples of diseases classified based on means of trasmission classification (5)
- contact
- food or water bprne
- vector borne
- perinatal
- airborne
33
what are examples of diseases classified based on reservoir in nature classification (4)
- human
- animals (zoonones)
- soil
- water
34
what are examples of diseases classified based on public health programs (5)
- vaccine preventable
- resp
- enteric, food borne, water borne
- sexually transmitted and blood borne
- zoonotic and vector borne
35
describe: zoonotic transmission
- transmissable between humans & animals
36
what are examples of zoonotic infections (6)
- ebola
- rabies
- ecoli
- avian flu
- bovine TB
- BSE/CJ
37
describe vector borne infections
- caused by viruses, bacteria, and parasites that arthropods carry and pass on
38
what are examples of vector borne infections
- lyme disease and RMSF
- malaria
- west nile
39
describe enteric infections
- enters the body thru the mouth and GI tract
- consumption of contaminated food
40
what are examples of enteric infections
- salmonellosis
- ecoli
- glardiasis (beaver fever)
- hep A
41
describe respiratory infections
- often caused by viruses, sometimes bacteria
42
what are examples of resp infections (6)
- pneumococcal pneumonmia (droplet)
- chicken pox
- group A strep (large droplet)
- pulmonary TB
- measles
- influenza
43
describe fomite infections
- caused by used tissues
- doorhandles
- atm buttons
- debit machines
44
describe sexual infections
- enter thru penis, vagina, mouth, anus (ie. mucus membranes)
- also vertical transmission
- consider transmission to babies
45
what are examples of sexually transmitted infections (5)
- chylamydia
- syphilis
- gonorrhea
- HIV
- hep B
46
describe blood borne infections
- thru infected blood
- injection drug use
- vertical transmission
- think of transmission to babies
47
what are examples of blood borne transmitted infections
- hep C
- HIV
48
describe healthcare and iatrogenic infections
- result of being admitted to or attending a healthcare facility
49
what is an example of a healthcare or iatrogenic infection
- c diff
50
what is one of the most highly communicable diseases? what else is?
- most highly = measles
- also fomite
51
what are lvls of prevention for infection (4)
- premordial
- primary
- secondary
- tertiary
52
what is the focus of primordial prevention
- health promotion
- high lvl interventions that effect everyone
53
what is an example of primordial prevention
- safe water supply
- water water screning
- swabbing floors for evidence of covid
54
what is the focus of primary prevention
- prevent diseases
- requirement for individual to do something
55
what are examples of primary prevention (8)
- immunization
- handwashing
- standard precautions
- PPE
- notifying contacts
- pre-exposure prophylaxis prep
- infection control (ex. cleaning services, sharps)
- public education
56
what is the focus of secondary prevention
- detect disease so we can diagnose and treat
57
what are examples of secondary prevention (7
(C:) how are outbreaks of hep a and meningitis managed
- screening and testing (who is at risk, often done when foodborne)
- case finding
- isolation (infected)
- quarantine (well but (possibly) exposed)
- prophylaxis (passive = immunoglobulin, and active = vaccines)
- hep A outbreak = hep A antibiotics
-meningococcal outbreak = all in contact get cipro
58
what is the focus of tertiary prevention
- reduce severity and illness and complications
59
what are examples of tertiary prevention
- directly observed therapy (ex. TB)
60
define: prophylaxis
- action taken to prevent disease, especially by specified means or against a specified disease
61
what are examples of prophylaxis (2)
- antibiotics prior to dental work
- HIV: pre-exposure prophylaxis
62
describe pre-exposure prophylaxis for HIV
- using certain antiretroviral medications by HIV uninfected persons who are at high, ongoing risk of HIV acquisition, beginning before and continuing after potential HIV exposure
63
describe prophylaxis post-exposure
- when you have been exposed (or potentially exposure) to an antigen
64
what are examples of times when prophylaxis post-exposure is used(3)
- HIV postexposure
- hep A postexposure
- after needlestick
65
what is involved in post-exposure needlestick prophylaxis
- wash location
- post-exposure protocol --> history, take med, serology, blooddraw from other individual
66
describe HIV postexposure prophylaxis
- involves 28 days of antiretroviral medications immediately after a specific HIV exposure
67
describe hep A postexposure prophylaxis
- involves hep A vaccine or immune globulin (IG) to prevent infection
- administered within 2 weeks of exposure
68
what are guiding principles for STBBIs (6)
- diversity
- cultural safety
- health equity
- population health approach
- harm reduction approach
- evidence informed and use of best practices
69
when diagnosing syphilis, what should you look for? (3)
- chancres on the genitals, anus, and mouth
- serology
- dacron-tipped, rayon-tipped, and/or flocked swab of the genital or extra genital lesions to cadham provincial labratory in viral transport medium
70
what is the preferred treatment for syphilis
- bicillin LA
71
with syphilis, you should be aware of... (2)
- symptoms of secondary and tertiary syphilis
- symptoms of complications
72
When should sexual contacts of known syphilis cases be treated
- treated immediately for syphilis without waiting for test rests
73
due to primarily heterosexual outbreaks in the north, who should be tested?
- test pregnant pts who reside in the northern health region at:
--> first prenatal visit
--> 28-32 weeks
--> again on delivery
74
regardless of location of residence, test pregnant pts...
- more frequently for syphilis if risk for infection is identified
75
76
the re-emergence of syphilis is due to...
- drug resistance
77
describe congenital syphilus
- as the baby is born, it can get infected
78
what are risks associated with congenital syphilus (4)
- neuro consequences
- blindness
- deafness
- problems w learning
79
can the infection be cleared w congenital syphilis
- yes, but damage can already by done
80
50% of cases of congenital syphilis had..
- no prenatal care
81
what organism causes syphilis
- treponema pallidum
82
what is transmission of syphilis
- direct contact w syphilitic sore
83
what is the incubation period of syphilis
21 days average
84
what are complications of syphilis
- neuro complications
85
when is screening for syphilis done
- people w risk factors
86
what are diagnostics for syphilis
- serology
87
what is included in treatment for syphilis
- antibiotics
88
what is included in followup for syphilis
- post treatment serologic testing at intervals
89
describe partner notification w syphilis, trace back period depends on...
- test & treat sexual or perinatal contacts
- trace back period depends on the stage of infection of the index case
90
what are symptoms of syphilis (8)
- fever
- swollen lymph nodes
- sore throat
- patchy hair loss
- headaches
- weight loss
- muscle aches
- fatigue
91
what is included in prevention of syphilis (5)
- safer sex
- rigorous contact tracing of infectious cases
- screening of high-risk groups
- routine blood test w STI screen and during pregnancy and on immigration
- local outreach to MSM via bathhouse clinics, park outreach, internet outreach, GLBT health coalition
92
what are examples of high risk groups for syphilis (4)
- if have other STI
- multiple contacts
- pregnant women
- gay men
93
is syphilis curable
- yes
94
the # of new HIV cases per year in Manitoba increased by __% between 2014 to 2016
25%
95
among transmission events occurring Manitoba for HIV, the most commonly reported risk activity is...
- heterosexual sex
96
an estimated __% of Canadians who have HIV do not know it
21%
97
if you do not know the HIV status of the pt in front of you, what do you do?
- offer testing --> risk based screening is not recommended
98
the manitoba HIV program has endorsed...
- the BC testing guidelines which include recommended testing frequency
99
describe prevention of HIV
- still do not know alot about how to prevent it (many people know that they have it)
100
what are examples of ways to prevent HIV (6)
- condoms
- lube
- HIV tx
- PrEP
- PEP
- not sex sharing toys
- choosing oral sex, masturbation and forms of sexual stimulation that pose little or no risk of HIV
101
what is universal HIV testing
- bloodwork
102
describe condom and use for prevention of HIV
- use a new condom every time you have sex
- use only water or silicone based labricants --> oil based can make a condom break
103
if a person has HIV and is not on HIV treatment, what should they do?
- talk to their doctor about starting HIV treatment
104
what is the purpose of HIV treatment (3)
- not a cure
- protect your health
- prevent HIV transmission --> when a person is on HIV treatment and have suppressed viral load, they do not pass HIV during sex
105
what might make you a candidate for HIV PrEP
- if you are HIV negative and at higher risk for HIV
106
HIV PrEP involves...
- an HIV negative person taking certain HIV drugs to reduce the risk of getting HIV
107
when does a person start HIV PrEP
- before being exposed to HIV
108
what might make you a candidate for HIV PEP
- if you are HIV negative and may have been exposed to HIV
109
when should you start PEP? how long is it taken for?
- asap after being exposed --> within 72 hrs of exposure
- taken for 28 days
110
what is the transmission of AIDS (4)
the exchange of a variety of body fluids from infected people, such as:
- blood
- breast milk
- semen
- vaginal secretions
111
what is the incubation period of AIDS
1-3 months for it to be visible on tests
112
complications from AIDS depend on...
- progression
113
who should receive screening for AIDS (7)
- anyone requesting
- anyone w symptoms or signs
- individuals w illnesses associated weakned immune system
- shared drug equipment
- unprotected intercourse
- pregnant or planning pregnancy
- victim of sexual assault
114
what diagnostics are used for AIDS
- rapid hiv test kits
115
describe gonorrhea rates in males vs females
- both are affected
- but over the last 5 years, rates have been consistently higher in females
116
what are testing tips for gonorrhea
- in addition to testing genitals through urine or swabs, also consider taking throat and anal swabs using a red or black topped culture tubeb
117
how is gonorrhea treated (2)
- cephalosporin
- azithromycin
118
what should be avoided when taking azithromycin
- monotherapy
119
what organism causes chlamydia
- chlamydia trachomatis
120
describe transmission of chlamydia (3)
- vaginal
- anal
- oral sex with someone with the infection
121
what is the incubation period of chlamydia
5-14 days
122
what are potential complications of chlamydia (6)
- pelvic inflammatory disease
- ectopic pregnancy
- infertility
- chronic pelvic pain
- epidymo-orchitits
- reiter syndrome
123
who should be screened for chlamydia (4)
- all asymptomatic sexually active people under 25
- all pregnant people
- neonates born to mothers w chlamydia
- people with risk factors
124
what are diagnostics for chlamydia (3)
- NAAT
- swabs
- first void urine
125
what is treatment for chlamydia
- abx
126
escribe follow up for chlamydia
- test of cure 3 weeks after complement of treatment
127
what partner notifications should be done for chlamydia
- any sexual partners 60 days prior
128
what are symptoms of chlamydia (5)
- painful urination
- discharge in women & men
- painful intercourse in men
- bleeding between periods in women
- testicular pain
129
what is included in prevention for chlamydia
- safer sex
130
what health promotion strategies can be used for chlamydia and GC prevention (5)
- healthy sexuality
- healthy childhood development
- school health curriculum
- social marketing
- education on how to prevent infection in the first place
131
what primary prevention strategies can be done for chlamydia and GC prevention (4)
- educating on condom use
- vaccinate again hep B (and A)
- school health curriculum
- social marketing
132
what secondary preventions can be done for chlamydia and GC prevention (5)
- screening at risk groups
- contact tracing and notification of exposure
- treating exposed individuals
- routine testing (ex. during pregnancy)
- pap test
133
what is included in tertiary prevention for chlamydia and GC prevention
- recovering
134
what are symptoms of hep B (6)
- abdominal pain
- loss of appetite
- jaundice
- NV
- fatigue
- 50-70% asymptomatic in adults
135
describe the transmission of hep B (4)
- blood
- sexual fluids
- salvia
- breast milk
136
what is treatment of hep B (3)
- high protein diet
- maintain fluid intake
- rest
137
what is included in prevention of hep B (5)
- immunization
- safer sex
- universal precautions
- household precautions
- retractable needles as prevention for healthcare workers
138
what is the transmission of hep A? hep B? hep C?
- hep A = fecal/oral
- hep B = blood/body fluids
- hep C = infected blood
139
is there a vaccine for hep A? hep B? hep C?
- yes to hep A and B
- no for hep C
140
what is the transmission of HPV
- sex w someone who has the virus
141
what is a complication of HPV
- cancer
142
who should be screened for HPV (4)
- sexual behavior
- under 25 yo
- co-infection with HIV
- smokers
143
what are symptoms for HPV (4)
- warty growth on genital skin or mucus membrane
- usually painless
- may recur
- may ahve no symptoms
144
what is the testing for HPV (3)
- aceto-whitening
- direct exam
- PAP smear (over 95% of cervical cell dysplasi)
145
what is treatment for HPV (6)
- trichloroacetic acid
- electroautery
- cyrotherapy
- laser therapy
- Aldara
- surgery to remove condylomata
146
what is included in prevention for HPV (3)
- safer sex
- universal precautions
- household precautions
147
what is a distinction between HPV and HSV
- herpes = painful lesions
- HPV = not painful
148
what are main messages r/t STBBI testing
- do you know the STBBI status of the pt in from of you? if not, offer testing
- if testing for STBBI, test for all
- all STBBIs have asymptomatic phases = do not wait for symptoms to test
149
150
what is included in the general physical exam for STBBIs (3)
- fever
- lymphadenopathy
- wasting
- oral mucosa exam
- external genital exam
- perianal exam
151
what is included in the female physical exam for STBBIs (3)
- speculum exam to visualize cervix and vaginal walls
- evaluate vaginal/cervical discharges
- bimanual pelvic exam (cervical motion tenderness, adnexal tenderness)
152
what is included in the male physical exam for STBBIs (3)
- scrotal palpation (epididymal tenderness)
- "milk" urethra to check for urethra discharge
- retract foreskin & inspect glans
153
what is included in testing for STBBIs (4)
- urine
- blood
- swabs (affected oriffces)
- pelvic exam
154
what should be assessed r/t sexual health history (5)
- presenting concern
- symptoms
- risk assessment
- HIV pre-test counselling
- risk reduction counselling
155
what should be assessed r/t presenting concern (4)
- routein screening
- named as contact
- symptomatic
- new partner --> test in between partners
156
what should be assessed r/t risk assessment (9)
- number of sex partners (lifetime, last 12 months), type of sex, with M/F/both
- use of condoms
- sexual route
- IDU/substance use
- sex trade
- history of STIs
- last HIV test
- MSM, LGBTQ2S
- women: pregnancy, LNMP, last pap
157
describe what is included in interviewing for sexual contacts (10)
- types of sexual exposure
- last sexual encounter
- name, birthday, year of birth
- place of meeting/exposure
- physical description
- address, cell #, email address, school, employer
- ongoing partner?
- will case notify?
- interview period varies based on infection or stage at infection
- blood contacts followed up for HIV and hep C
158
what role do the CNHC standards of practice play? (7)
- describe scope of practice
- describe criteria & expectations for practice
- provide criteria for measuring performance
- support ongoing development of CHN
- promote CHN as a speciality
- inspire excellence and commitment
- set a benchmark
159
what is the purpose of the standards of practice (7)
- define the scope & depth of community nursing practice
- establish criteria and expectations for acceptable nursing practice and safe, ethical care
- provide criteria for measuring actual performance
- support ongoing development of community health nursing
- provide community health nursing as a specialty and provide the foundation for certification of CHN by the CNA
- inspire excellence in and comittment to community nursing practice
- set a benchmark for new community health nurses
160
who is at the greatest risk for foodborne illnesses
- elderly
- young children
(less immune response, easily dehydrated)
161
what are sources of data for foodborne illness (3)
- population & public health branch, health canada
- public health agency of canada
- control of communicable diseases manual
162
what agent causes botulism
- bacteria
- spores in soil and GI tracts of animals
163
what is the transmission of botulism (2)
- contaminated food
- home canning
164
what are the S&S of botulism (3)
- GI
- neuro
- can be fatal
165
what diagnostics are used for botulism
- culture --> stool, serum, gastric aspirate
166
what is included in treatment for botulism (2)
- antitoxin
- ICU
167
what is included in prevention for botulism (4)
- wash hands
- safe food handling
- check your cans
- good canning practices
168
what agent causes salmonella
- bacteria
169
what is the transmission of salmonella
- contaminated food & water
170
what are 2 types of salmonella
- enteric fever
- gastroenteritis
171
enteric fever salmonella is r/t?
- sanitation
172
gastroenteritis salmonella is r/t (7)
- GI tract of animals
- fresh meat
- seafood
- poultry
- eggs
- milk (low chance)
- food contaminated w animal feces
173
what are S&S of salmonella (8)
- entercolitis
- diarrhea
- bloody stool
- fever
- chills
- abdominal cramps
- HA
- HV
174
what diagnostics are used for salmonella (2)
- culture (stool)
- suspect food sample
175
what is treatment of salmonella (2)
- antitoxin
- ICU
176
what is included in prevention of salmonella (6)
- refrigeration slows growth
- heat kills it
- sanitation
- pasteurizing milk
- food handling
- no raw cookie dough (boo)
177
what agent causes e. coli
- bacteria
178
what is the transmission of e. coli (5)
- undercooked ground beef
- contaminated food and water
- unpasteurized milk
- contaminated surfaces
- contaminated soils (ex. manure runoff)
179
what are S&S of e.coli (7)
- abdominal cramps
- diarrhea
- NV
- dehydration
- bloody stool
- hemolytic uremic syndrome
- kidney complications
180
what diagnostics are used for e. coli
- culture (stool)
- suspect food sample
181
what is treatment for e. coli
- symptomatic
- elderly & children often end up in ICU
182
what is included in prevention of e.coli (3)
- food safety
- cooking food properly
- drinking water safety --> rural get tested
183
what agent causes listeria
- bacteria
184
what is the transmission of listeria
- contaminated food and food processing equipment
- can be shed from bowel for several months
- vertical transmission after birth
185
what are S&S of listeria (8)
- enterocolitis
- diarrhea
- bloody stool
- fever
- chills
- abdominal cramps
- headache
- NV
186
what is the treatment for listeria
- antitoxin
- ICU
187
what is included in prevention of listeria
- sanitation
- sterilizing equipment
- inspection of facilities where meat is process
188
what 4 federal regulatory bodies are involved in the primary prevention of foodborne infections
- health canada
- canadian food insepction agency
- public health agency of canada
-canadian institutes of health research
189
describe the role of health canada in the primary prevention of foodborne illness
- regulate the safety of food, health products, consumer products, and pesticides
190
describe the role of Canadian Food Inspection Agency in the primary prevention of foodborne illness
- inspect and enforce activities related to food safety and food borne illness investigations
191
describe the role of Public Health Agency of Canada in the primary prevention of foodborne illness (2)
- food borne illness surveillance and investigation
- helps w prevention and control
192
describe the role of Canadian Institutes of Health Research in the primary prevention of foodborne illness
- research
193
what are other factors involved in primary prevention of foodborne infections (3)
- public education
- regulations and policies
- structural
194
describe the role of public education in primary prevention of foodborne infections
- educate on handwashing
195
describe the role of regulations and policies in primary prevention of foodborne infections (4)
- cleaning
- cooking throughly
- chilling --> refigerate at 0.5C
- cross contamination, equipment, work surfaces
196
describe the role of structural factors in primary prevention of foodborne infections (2)
- uncontaminated food sources
- uncontaminated water supply
197
what is involved in secondary prevention of foodborne infections (3)
- systematic surveillance and inspection programs
- contact tracing
- proper treatment of index case and contacts
198
define: surveillance
- the process of systematic, orderly consolidation, analysis, and evaluation of pertinent data with prompt dissemination of the results to those who need to know, particularly those who are in position to take action
199
define: active surveillance
- the collection of data utilizing screening tools, interviews, and sentinel systems to identify disease occurrence in the community when individual present with suggestive symptoms.
200
define: passive surveillance
- occurs when a health care provider must contact the local health authority to notify it of an identified case of a “reportable” disease.
201
define: isolation
- separation of an infectious person for a period of time to prevent or limit the direct or indirect transmission of the infectious agent.
202
define: quarantine
- restriction of activities for a well person who has been exposed to an infectious agent
203
define: active immunization
- vaccines that stimulate the immune system to create antibodies
204
define: active immunization
- vaccines that stimulate the immune system to create antibodies
205
define: passive immunization
- immunizing w antibodies
206
define: vector-borne infections
- are caused by viruses, bacteria, and parasites that living creatures carry and pass on to other living creatures. Disease carriers are called vectors i.e. mosquitoes, tickes, mammals.
206
define: vector-borne infections
- are caused by viruses, bacteria, and parasites that living creatures carry and pass on to other living creatures. Disease carriers are called vectors i.e. mosquitoes, tickes, mammals.
207
define: acquired resistance
- when a bacteria changes in a way that protects it from antibiotics
208
define: contact tracing
- the action or process of identifying individuals who have been in the proximity of a person diagnosed with an infectious disease, in order to isolate, test, or treat them.
209
define: incubation period
- The incubation period is the time it takes for an infection to develop after a person has been exposed to a disease-causing organism (such as bacteria, viruses, or fungi). The incubation period ends when the first signs or symptoms of the disease appear.
210
define: communicable period
- The time during which an infectious agent may be transferred directly or indirectly from an infected person to another person, from an infected animal to humans, or from an infected person to animals, including arthropods.
211
what are diseases that require contact notification the same day? (14)
- botulism
- cholera
- diphtheria
- measles
- meningococcal invasive disease
- mumps
- pertussis
- plague
- polio
- rabies
- rubella
- SARI
- small pox
- viral hemorrhagic fever
212
what are diseases that require contact notification within 5 days (7)
- acids
- congenital rubella infection/syndrome
- creutzfeldt-jakob disease
- leprosy
- tetanus
- TB
- yellow fever
213
does a PHN have any "special powers" under the Public Health Act
- A public health nurse has the powers of a medical officer under subsection (1) if authorized to exercise them by a medical officer, either orally or in writing. In the authorization, the medical officer may give the public health nurse authority to exercise all or some of the powers under subsection (1)
214
what are populations at risk for infection
- age (immature infant immune system)
- socioeconomic status (un or underinsured leading to insufficient preventive healthcare)
- geographic location
215
what are individual risk factors for infection (4)
- Immunodefiency
- Chronic disease
- Exposure frequency
- Environmental conditions (unsafe sanitary conditions. Crowded living conditions, access to clean food and water, ventilation, food preparation)
216
TB usually affects...
- the lungs
217
Tb can also affect other organs such as: (5)
- brain
- spine
- bones
- kidneys
- lymph nodes
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describe reporting of TB
- is a legally reportable disease in every province and territory of Canada
- cases must be reported to the corresponding provincial and territorial department of health
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of people infected w TB:
- how much develop active TB within 18 ot 24 months?
- latent? how many latent will never develop active? how many will later develop active?
- 5% = active within 18 to 24 months
- 95% = latent
- 90% of latent will never develop active
- 5% of latent will have reactivation and develop active TB later
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latent TB, if not treated, can turn into...
- active TB
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what symptoms of TB occur due to general infection & immune response? (3)
- fever
- night sweats
- weight loss
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what symptoms of TB occur due to resp/pulmonary TB (8)
- cough (espeically if lasting for 3 weeks or longer)
- with or without sputum --> white, grey, green, red
- chest pain
- loss of appetite
- unexplained weight loss
- night sweats
- fever
- fatigue
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what symptoms of TB occur due to direct damage with non-resp/extrapulmonary TB (10)
- just about anything, depends on site
- blood in urine (kidney)
- headache or confusion (meningitis)
- back pain (spine)
- hoarseness (larynx)
- loss of appetite
- unexplained weight loss
- night sweats
- fever
- fatigue
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describe symptoms of TB in people w HIV
- develop symptoms late and are less likely to present w coughing
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describe the diagnostics of latent TB (5)
- visible in lungs
- lays dormant
- won't get sick but might if something gets triggered
- positive skin test
- cXR --> spot on lungs
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how long does someone have to get TB treatment for to prevent abx resistance
entire 270 days
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how is TB diagnosed? (2)
- by finding mycobacterium TB bacteria in a clinical specimen taken from the pt
- sputum also tells us about the person's lvl of infectivity
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what is the gold standard for diagnosing TB
3 morning sputum samples
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TB is often diagnosed clinically, until microbiology results are confirmed, by... (4)
- taking risk social factors
- TB hx
- radiology
- symptoms
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what does an acid-fast bacilli smear of +1, +2, +3, and +4 mean
- greater then number = more infectious
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what equipment is needed for smears (3)
- microscope
- glass slides
- special dyes
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what equipment is needed for cultures (4)
- incubators
- safety cabinet
- culture plates or tubes
- culture media, biochemicals for tests
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how much time is needed to make a report for smears
- 1 day
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how much time is needed to make a report for cultures
- 4 days to 12 weeks (depending on method used and how quickly the organism grows)
235
what is the basis of procedure for smears
- looking for acid-fast bacilli on slide under microscope
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what is the basis of procedure for cultures
- growth and identification of tubercibacilli or other mycobacteria on culture media in incubator
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what is the significance of a negative report for smears
- pt is probably not infectious
- does not rule out TB disease (culture may be positive)
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what is the significance of a negative report for cultures
- no live tuberci bacilli found in specimen
- does not rule out TB disease (live tubercli bacilli may be in other specimens or body sites)
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what is the significance of a positive report with smears
- pt is more likely to be infectious (if acid-fast bacilli are tubercle bacilli)
- acid-fast bacilli could be nonTB mycobacteria
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what is the significance of a positive report with cultures
- confirms diagnosis of TB disease
241
what are important for assessing the pt's infectiousness and response to therapy (TB)
- bacteriologic exams
242
with TB, specimens should be obtained how often and for how long?
- at monthly intervals until 2 consecutive specimens sent for culture are reported as negative
243
how is TB diagnosed when the culture is pending (3)
- look at results of sputum
- CXR
- symptoms
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what is the role of the public health TB nurse (9)
- Find individual and move to hospital to initiate treatment (2wks of abx treatment), then no longer infectious but stays on abx longer
- Adherence with therapy and monitoring, including Directly Observed Therapy
- Discharge planning
- Follow up
- Home isolation and community therapy
- Outpatient assessments
- Resource
- Contact investigation: The PHN will conduct TB contact investigation for all cases of TB who are or who may be infectious.
- Visit address, call shelter, hotel etc. Follow up on old address.
245
someone admitted to the hospital with TB should be in what type of room?
- negative pressure isolation room
246
what happens is 1 dose of TB medications are missed? two?
- 1 = can be added at the end
2 = higher risk of resistance and becoming infectious again
247
describe the infectious period of TB
- onset of symptoms (particularly cough)
- continues for at least 2 weeks after start of treatment
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describe the infectiousness of non-resp TB
- generally not infectious
249
how is TB transmitted
- airborne droplet nuclei via resp (coughing, sneezing, sining, or speaking) or air currents, duct systems, elevator shafts (due to slow setting rate)
250
how many droplet nuclei are necessary for establishing TB infection
1
251
most TB bacilli die quickly thru... (3)
- drying
- heat
- sunlight
252
period of inefectivity for TB
253
describe how to prioritize contacts r/t TB
- prioritize who has highest risk of adverse events from infection
ex. baby (undrer 5yo), people who are HIV positive, people in close conditions (hotel, shelter), cumulative exposure
254
describe contact investigation for TB
- the PHN will conduct TB contact investigation for all cases of TB who are or who may be infectious
255
256
how long does someone with TB have to stay on resp isolation
- until sputum sample is no longer infection
257
is fomite transmission a risk with TB?
- not a risk
258
to find out who was exposed to TB, what do you have to do?
- track backwards
259
For smear positive or symptomatic infections, the period of communicability may start...
- up to 3 months before respiratory symptom onset
260
for Smear negative, asymptomatic cases with no evidence of cavities, the person may be considered infectious for up to...
- 4 weeks prior to date of diagnosis.
261
what does "clinical pulmonary" mean
- CXR may be +ve, but culture is -ve
262
clinical pulmonary TB cases, who needs to be screened>
- only household contacts
263
with TB, which household exposures are considered high risk?
- everyone in household (initial and repeat TST)
- for rooming/basement apartments with forced air --> consider all floors as household
264
with TB, which close non-household exposures are considered high risk?
- contacts >5 years old with >96 hrs cumulative exposure (initial and repeat TST)
- contacts <5 years old or immunosuppressed contacts w >36 cumulative exposure (initial & repeat TST)
265
with TB, which exposures in shelters/groups/home/drop-ins are considered high risk?
- contacts >5 years old who spent >3 nights sleeping in same room (TST >8 weeks BIC)
- staff and others with >96 hrs cumulative exposure (TST >8 weeks)
- contacts <5 years old or immunosuppressed contacts w >36 hrs cumulative exposure (initial & repeat TST)
- if infectious case spent >60 hrs in facilities w drop-in services, consider holding site based screening in addition to the above
266
Certain populations are at increased risk of TB infection and are often at increased risk of developing TB disease once infected. Risk factors may overlap in those who: (3)
- crowded housing
- substance use
- HIV infection
267
for people living with HIV, what is priority? (3)
- early detection
- diagnosis
- treatment
268
why is early detection, diagnosis, and treatment of TB priority for people living with HIV
- HIV is the biggest risk factor for LTB turning into active TB
- people living with HIV with LTBI have a compounding 10% risk of developing TB disease each year
269
define: latent TB
- a state of persistent immune response to stimulation by mycobacterium tubercolosis antigens without evidence of chronically manifested active TB
- Someone has latent TB if they are infected with the TB mycobacteria but do not have signs of active TB disease.
270
when is DOT used
- DOT is used only for those who are treated for active TB disease and DOPT with children who are treated for LTBI.
271
what is DOT
- A trained health care worker monitors the patient taking each dose of anti-TB medications
- The standard of care in Manitoba for all patients receiving treatment for active TB disease
272
what are the benefits of DOT
- improved outcomes
- reduces development of resistant strains of TB
273
in addition to the TB risk factors among homeless individuals, what also plays a role in the spread of TB? how?
- shelter enviro
- inadequate ventilation systems
- clients in close quarters for long periods of time at night
- many shelters do not screen people for TB symptoms
274
what is the PHNs role r/t syphilis (8)
- Case and contact follow-up of reportable infections
- Prevention initiatives and education
- Street outreach (e.g. Street Connections)
- Community development, DOH
- Interdisciplinary approach
- Some infections are reportable under the Public Health Act
- Results from provincial laboratory are sent to Manitoba Health, then forwarded to specific public health direct service region (RHA)
- PHN follows up with the patient and the testing practitioner to ensure treatment and contact tracing
275
how does the PHN get involved r/t syphilis (3)
- Some infections are reportable under the Public Health Act
- Results from provincial laboratory are sent to Manitoba Health, then forwarded to specific public health direct service region (RHA)
- PHN follows up with the patient and the testing practitioner to ensure treatment and contact tracing
276
what questions should be asked r/t syphilis (7)
- sexual health history
- presenting concern
- last STBBI testing
- symptoms? *genital sores, discharge, dysuria)
- sexual practices
-individual risk (# of partners, use of condoms, sexual route, IDU, sex trade, pregnancy, last pap)
- may be appropriate to complete HIV pre-test education at this time +/- risk reduction counselling
277
what is included in the general physical exam for syphilis (6)
- fever
- lymphadenopathy
- wasting
- oral mucosa exam
- external genitalia
- peri-anal exam
278
what is included in the female physical exam for syphilis (3)
- speculum exam to visualize cervix and vaginal walls
- evaluate vaginal/cervical discharges
- bimanual pelvic exam (cervical motion tenderness, adnexal tenderness)
279
what is included in the male physical exam for syphilis (3)
- scrotal palpation (epididymal tenderness)
- retract foreskin, inspect glans
- examine urethra to determine presence of urethral discharge
280
what does a "positive" or "reactive" test result for antibody hepBsag mean?
- a person is protected against the hep B virus
281
what does a "positive" or "reactive" test result for GBsAG (hep B surface antigen) mean?
- the person is infected with hep B
282
what is syphilis RPR
- A rapid plasma reagin (RPR) test to screen for syphilis
- It works by detecting the nonspecific antibodies that your body produces while fighting the infection
- Combined with specific antibody testing, the RPR test can confirm the diagnosis of active infection.
283
what is Syphilis TPPA Syphilis Antibody, Treponema pallidum Particle Agglutination, Serum
- This test is not recommended for general screening purposes for syphilis.
284
what is included in routine STBBI testing
- throat and urine = gonorrhea & chlamydia
- blood testing = HIV, syphilis, hep A, hep B
285
what is treatment for sylphilis (3)
- penicillin
- IM bicillin
- hep A vaccination
286
what does a rash mean r/t syphilis
- second stage
287
describe followup for syphillis (3)
- repeat serology at 1, 3, 6, and 12 months
- HIV testing repeated in 3 months
- second hep A vaccine in 6 months
288
what contacts should be contacted r/t syphilis
- sexual contacts in the last 6 months
289
what info should be gathered rlt contacts fr syphilis (8)
- Name, address, phone, email, alias
- DOB or month of birth, gender
- Relationship
- Place of meeting/ contact
- Physical description
- Last sexual contact, type of contact
- Frequency of contact
- Social / sexual network contacts
290
1 contact is HIV+
--> Already received a negative test for HIV = will test again in 3 months
(apparently supposed to know this for the exam but idrk what this is saying?? )
291
describe targeted screening r/t syphilis case study
- A PHN and an outreach worker speak to the bar owner who agrees to have posters put up in the bathrooms encouraging people to be tested for syphilis.
- They also negotiate a weekly STI clinic outside the bar in the Street Connections van.
- The GLBTTQ2+ coalition installs condom dispensers in the bathrooms
292
HIV testing looks for anti-bodies which may take how long to be produces?
3-6 months (we use the 3 month timeline)
293
if a client reports any high risk exposures over the past 3 months, or is unsure about risk, testing should be offered...
- 2 weeks post exposure
- and repeated at the end of the antibody window period (generally 3 months)
294
In the context of a new relationship, a couple should be advised ....
- to be tested together at the start of a relationship, and to use condoms at least until testing is repeated 3 months later.
295
There can be legal implications for putting others at risk for HIV. Criminalization has resulted in ...
- magnified stigma, rather than reduced prevention
296
describe what is included in syphilis cluster/outbreak investigation
- Map all cases and contacts visually
- Engage a team to review the epidemiological information and response (Epidemiologist, Medical Officer of Health, Outreach Worker, Public Health Nurse, Communicable Disease Coordinator)
- Engage in community needs assessment to determine other potential interventions:
- Is education an issue, service access, or perceived risk?
- How is public health perceived?
- What are the priorities of the population you are targeting?
- Communication to service providers – possibly media engagement.
- Use multiple lenses to try to understand the ‘problem’
- Try to find the superspreaders
297
what are population measures for syphilis (3)
- Monitor trends – have rates increased? Are there clusters/outbreaks? Map the cases
- Does a population need more interventions?
- Media engagement, social marketing
