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transmission are more relevant than others in terms of potentially contracting an infectious agent. Exposure by way of splashes to the mucous Exam Question 1. Direct transmission refers to an infectious agent that is transferred from a reservoir to a susceptible host by. a. Animate intermediaries (vectors) b. Direct contact or droplet spread c. Inanimate objects (vehicles) d. All of the above 1 Mullins, 24 2 Mayer, 49 3 Davidson & Benjamin Jr., 655 4-15 CDC, Principles of Epidemiology COMMUNICABLE DISEASE AND FUNERAL PROFESSIONALS Funeral Service Academy | 3 membranes, inhalation of aerosolized body fluids, and direct inoculation can result in infectious diseases caused by multiple species of bacteria, viruses, and prions.16 In addition, the routine transport, contact, and embalming of dead human bodies place the funeral professional in a position to be exposed to multiple infectious agents that are transmissible by mucocutaneous contamination (contact or droplet transmission), aerosolization, and direct inoculation.17 Since funeral service professionals rarely know the cause of death or other conditions of the dead human body upon removal or delivery, it is very important to utilize Universal Precautions: treat every body as if it had a communicable disease, and properly utilize personal protective equipment. We will return to Universal Precautions as we address the OSHA Bloodborne Pathogens Standard and Personal Protective Equipment (PPE) Standard, which will be discussed in further detail later in the course. Common Communicable Diseases The three most common pathogenic viruses that funeral service professionals are at risk of exposure to are the Hepatitis B virus, the Hepatitis C virus, and the Human Immunodeficiency virus (HIV). 18 Hepatitis B Hepatitis B is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness.19 Hepatitis B can be defined as either “acute” or “chronic,” and is the result of an infection with the Hepatitis B virus.20 Acute Hepatitis B is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis B virus and can, but does not always, lead to chronic infection.21 Chronic Hepatitis B is a long-term illness that occurs when the Hepatitis B virus remains in a person’s body for an extended period of time.22 In the United States, anywhere from 850,000-2.2 million people are living with Hepatitis B.23 In 2014 alone, the Hepatitis B virus infected an estimated 19,200 people in the United States.24 However, the number of reported cases is often lower: many people do not know they are infected or may not have symptoms, and thus do not seek the attention of medical or public health officials.25 Hepatitis B can be spread through blood, semen, or other body fluids. If these body fluids infected with the Hepatitis B virus enter the body of a person who is not infected, that person is at risk of becoming infected. Activities that may lend to the spread of Hepatitis B include: • the birthing process (spread from an infected mother to her baby) • sex with an infected partner • sharing needles, syringes, or other drug-injection equipment • sharing items such as razors or toothbrushes with an infected person • direct contact with the blood or open sore of an infected person • exposure to blood from needlesticks or other sharps instruments26 According to studies, nearly 10,000 healthcare workers (including funeral professionals) are infected with Hepatitis B every year.27 The route of spread of Hepatitis B to healthcare workers, including funeral professionals, is primarily by needlestick or other sharps injury.28 The approximate incidence rate of contracting the Hepatitis B virus this way is 30%.29 Funeral professionals should also be aware of the possibility of direct contact with blood or open sores during the handling of dead human bodies of infected persons and in the embalming of these dead human bodies. Hepatitis B is still transmittable after death, which causes the dead human body to remain infectious. The Hepatitis B virus can survive outside the body at least 7 days.30 During that time, the virus can still cause infection if it enters the body of a person who is not infected.31 While sterilization is always important, it is critical to properly sterilize all instruments used during the embalming or preparation of a dead human body suspected of being infected with Hepatitis B, as well as all floors and surfaces in the embalming area. A final reminder: infected individuals carrying the virus may be asymptomatic – may never even know that they are infected with the Hepatitis B virus! Exam Question 2. The route of spread of Hepatitis B to healthcare workers, including funeral professionals, is primarily by a. Direct contact with an open sore on an infected body b. Needlestick or other sharps injury c. Sharing embalming equipment d. The birthing process 16-18 Davidson & Benjamin Jr., 655-656 19-26 CDC, Hepatitis B 27 Mullins, 398-399 28-29 Hardin, 76 30-31 CDC, Hepatitis B 4 | Funeral Service Academy COMMUNICABLE DISEASE AND FUNERAL PROFESSIONALS – but are still able to transfer the virus to others.32 Thus, funeral service professionals also may not be aware a deceased is infected with the viruses, even if they have the death certificate with causes of death. According to the Occupational
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