# Presentation: 236099

## Slide 1

## Anthrax - A Review for      Mail Handling Personnel

- Katherine West,BSN,MSEd,CIC
- Infection Control Practitioner

## Anthrax

- An acute bacterial infection

##  Disease Origin

- Livestock
- cows
- sheep
- goats
- pigs

## Anthrax 

- U.S. low/rare cases in past 30+ years due to vaccine programs
- Vaccine program focus on animal handlers
- Still large number of cases: South and Central America, Asia, Africa, Middle East (third world countries)

- Medicine Journal, October, 2001

## Types

- Many strains - some are man made
- Used In U.S. for research

## Formula for Infection

**Organism**

**Dose**

**Virulence**

**Mode of**
**Entry**

**Host**
**Resistance**

## Bacteria

- Bacteria- Organisms that need certain conditions for growth, reproduction and maintenance of life.

## Dose - Anthrax

- Thousands of bacteria need to cause infection (very large dose required)
- Infectious dose -Greater than 3,000 bacteria

- Anthrax in a Biowar Environment, 1990

## “Spore”

- Defense mechanism
- Makes organism resistant to environmental changes

## Mode of Entry

- _Direct contact_ ( actual physical contact with   infective organisms)_ _

**Mode of**
**Entry**

## Cutaneous (skin)

- Skin is not intact - open cut or sore
- itching of exposed area
- edema
- Pustule
- sore with black center ( 2-6 days)
- 95% of infections

## Body’s Natural Defenses - Skin

- Unbroken skin is the body’s first line of defense
- Organisms can _**not**_ pass through
- Some of the skin’s  normal secretions are bactericidal

## CDC/OSHA

-  Workers with non-intact skin should have the area covered with a dressing, if the area is too large to cover, then the individual should not perform patient care activities that pose a risk

## Inhalation

- Inhaling organism into the respiratory tract
- cough, chills, fever, and aches
- mid chest pain
- respiratory distress

## Body’s Natural Defenses -  Lungs

-  Moist mucous membranes
- Cilia
- Complex arrangement of nasal passages
- Cough mechanism

## Ingestion  

- Eating contaminated meat
- Less than 1% of the cases
- Symptoms
- abdominal distress
- bloody vomiting or diarrhea followed by fever

## Immune System

- _Antibody_ - a protein produced by the body in response to presence of an antigen (pathogen)

## Not Spread Person to Person

## Exposure Does Not Mean Infection

## Handling Suspect Items

## Approach to Protection

**Facility Design**

**Engineering Controls**

- Personal Protective Equipment

## Engineering Controls

- Mail Processing Sites
- industrial vacuum with HEPA filter for cleaning high speed, mail sorting machinery
- HEPA filters in HVAC systems if possible
- local exhaust hoods at
- pinch roller areas
- mail sorting machines

- CDC, October 31, 2001

## Administrative Issues

-  Limit number of persons working=
- high speed sorting machines
- unloading mail bags
- limit access to area
- Emergency Contact Number/Procedures
- Personal Protective Equipment

## Housekeeping

- Avoid dry sweeping or dusting
- Use wet-clean and vacuum with HEPA filter

- CDC, October 31, 2001

## General Guidelines

- Establish isolation/segregation of suspect packages
- Limit staff responsible for opening
- Frequent and through washing of hands and forearms

## General Rule

- No eating, drinking smoking is permitted in the work or mail handling area

##   Get Suspicious! 

**  ****Get Suspicious!**

**No Return Address**
** ****Excessive Postage**
** ****Postmark does not match return address**
**Misspelled Words**
** ****Marked personal,confidential**
**Badly Typed of Written**

##  Get Suspicious! 

** ****Get Suspicious!**

**Protruding Wires**
** ****Powdery substance noted**
** ****Lopsided/uneven**
**Oily Stains or Discoloration**
**Crystallization on Wrapper**
** **

## Safe Handling and Opening of Mail 

**Treat mail gently**
** ****Open over a table**
**Use letter openers**
**Don’t blow envelopes open**
**Do not carry to show others**

- CDC, October 31, 2001

## Immediate Action: If powder or other materials spill out 

**Put on table**
**Do not feel, smell or taste the substance**
** ****Evacuate everyone from the area**
**Turn off air handling equipment**

- CDC, October 31, 2001

## Notify

- Supervisor
-  Emergency phone number

## Personal Protective Equipment

## Glove Issues

- Potential for developing latex allergy/sensitivity- avoid latex gloves
- Proper removal - contaminated gloves
- Disposal

- CDC, October 31, 2001

## Occlusion

-  Gloves are worn for too      long a period of time

## Dermatitis - Contract (Non- Allergic)

**Acute**
** ****Red**
** ****Scalded appearance**

**Chronic**
-  **Dry**
** ****Thick Skin**
** ****Crusty**
** ****Papules**

## Handwashing after glove removal!

**Use plain soap & water**

## Personal Protection

- Forearm protection - arm guards or long sleevesLong pants
- Aprons

## Masks

- P 100, N95, or HEPA Respirators
-  ? Effectiveness
- Fit testing
- Asthma/Respiratory Problems
- Medical Surveillance

- CDC, October 31, 2001

## Cleaning/Disinfection

**Bleach solution (1:10 dilution)**
**Hydrogen peroxide**
**Chlorine dioxide**
** ****Steam**
- Decon is Not your responsibility !

- Microtextbook

## Treatment

- Penicillin
- Cipro*
- Amoxicillin
- Doxycycline*
- Tetracycline

## Side Effects

- State allergies
- Medications you are all ready taking
- Medical history
- Pregnancy

## World Health Organization Warning

- Do not self medicate with antibiotics
- May cause resistance

## Proper Perspective

- Acknowledge there is fear of the unknown
- Education = fear reduction

## Perspective

- Flu deaths annually
-  over 12,000
- Anthrax Cases
- 17 diagnosed
- over 10,000 tested

## Proper Perspective

-  Easily treated with antibiotics
- News  Media often spins and hypes information- focus on science

## Questions