OSHA/HIV Barry
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| Who regulates purity of medical gases? | FDA: US pharmacopia.
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| Who regulates chemical germicides? | FDA.
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| Who regulates disinfection/sterilization devices and procedures? | FDA/EPA.
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| Who regulates gas containers and cylinders? | DOT(department of transportation).
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| Who regulates safety and health of employees/employee exposures? | Department of Labor-->OSHA.
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| What does ATSM stand for? | American Society for Testing and Materials.
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| The ATSM does not enforce compliance, but many of its standards are mandatory. What does it regulate? | Tracheal tubes.
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| This organization Offers broad recommendation for infection transmission and prevention. Does NOT regulate only makes recommendations. | The CDC.
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| What does OSHA stand for? | The Occupational Safety & Health Administration.
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| OSHA is a part of the US Department of... | Labor.
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| Congress created OSHA in 1970 as a part of what legislation? | Occupational Safety and Health Act.
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| “To assure the safety and health of America’s workers by setting and enforcing standards; providing training, outreach, and education; establishing partnerships; and encouraging continual improvement in workplace safety and health.” | OSHA's mission statement.
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| True or false: OSHA can write standards and conduct inspections but has no powers of enforcement? | False. OSHA can enforce with fines.
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| What does NIOSH stand for? | National Institute for Occupational Safety and Health.
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| NIOSH is part of the US Department of... | Health and Human Services.
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| True or false: NIOSH helps assure safe and healthful working conditions for working men and women by providing research, information, education, and training in the field of occupational safety and health. | True.
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| Exposure to trace amounts of anesthetic gas in the air can cause increased... | Spontaneous abortions, involuntary sterility, birth defects, cancer rates, kidney/liver failure.
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| Anesthesia providers can come down with impaired performance ability, decreased B12 synthesis, and impaired bone marrow DNA from exposure to what? | Air pollution from excess anesthesia gas in the air.
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| What are some factors associated with waste gas concentration? | 1. Length of anesthetic 2. Equipment used for measurement 3. Cuff vs uncuffed ETT 4. Ambu bag vs anesthesia machine circuit 5. Effectiveness/proper fx of scavenging system 6. Technique.
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| How is trace gas measured? | Parts per million.
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| What's the maximum trace N2O allowed in the air? | 25ppm.
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| What's the maximum trace N2O with volatile agent allowed in the air? | 0.5 ppm.
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| What's the maximum trace halogenated agents alone allowed in the air? | 2ppm.
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| Hospital biomed dept or external contractors samples air for trace gas how often? | Every 3-6 months.
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| What are 4 ways we control gas levels? | 1. Scavenging system, 2. Work practices, 3. Soda lime, 4. Rebreathing of exhaled gases.
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| What are some work practices we can employ to help control gas levels? | 1. Proper mask fit/technique, 2. check N2O briefly, 3. 100% O2 at end of case, 4. avoid liquid spills, 5. low-flow technique, 6. control leaks, 7. OR ventilation system
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| How does administering 100% O2 at the end of the case help control gas levels? | To wash out anesthetic (prevent diffusion hypoxia).
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| About how many people in the US are HIV positive? | Just over 1 million.
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| About how many new HIV infections each year? | 40,000 +.
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| About how many people worldwide are HIV positive? | 42 million.
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| What are the types of HIV? | HIV-1 and HIV-2.
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| What type of HIV is most common in the US? | HIV-1.
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| What type of HIV is less common and found mainly in West Africa? | HIV-2.
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| True or false? American HIV tests currently test for both forms of HIV? | True.
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| HIV is a Retrovirus. What does this mean? | RNA and reverse transcriptase structure.
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| HIV binds to what kind of immune cells? | CD4 T-helper cells.
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| What happens as a result of HIV binding to CD4 T-helper cells when it replicates RNA and takes over cell? | Cell mediated immunodeficiency.
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| When can HIV seroconversion be detected? | Only after the HIV infected person's immune system recognizes the virus as foreign and produces antibodies.
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| What does ELISA stand for? | Enzyme-linked immunosorbent assay.
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| ELISA is highly sensitive for HIV-1, however we need one more test to confirm... | Western blot assay.
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| What is HIV's primary target? | CD4 T-helper cell.
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| How low does the CD4 count have to be for HIV to be classified as AIDS? | Below 200 cells per cubic millimeter.
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| We start treatment for HIV when the plasma HIV RNA level reaches what? | 100 or greater.
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| What do we need to do before testing for HIV? | Obtain consent(written or verbal--document).
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| True or false: it is mandatory to inform the county health department of all positive HIV results. | True.
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| True or false: anonymous HIV testing is available. | True.
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| True or false: pre-test counseling is required before testing for HIV. | False.
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| True or false: if you get stuck with a dirty needle, you can test a patient's blood which has already been drawn for HIV without his consent. | True.
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| If you've been stuck with a dirty needle and the patient refuses HIV testing and there is no available blood in the lab to test, how can he be tested? | Blood can only be drawn against a patient's consent with a court order.
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| What body fluids are considered infectious even if there is no visible blood? | Cerebrospinal, synovial, pleural, peritoneal, pericardial and amniotic fluids.
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| What body fluids are NOT considered infectious if there is no visible blood. | Feces, nasal secretions, saliva, sputum, sweat, tears, urine, and vomitus.
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| If an employee is exposed to a potentially infectious substance, what should he immediately be tested for? | Baseline HIV status.
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| Post-exposure prophylaxis(PEP) for HIV exposure is most effective if given within what time frame? | Within the first 24-36 hours.
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| Post exposure prophylaxis with either a 2- or 3-drug antiretroviral regimen as outlined in the CDC recommendations is indicated to be given for how many days? | 28 days.
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| Post-exposure to potentially infectious substance, how often should the employee be tested for HIV? | 6 weeks, 3 months, and 6 months.
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| What else should the employee be tested for after exposure to HIV? | Hep B and C.
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| What is the risk for seroconversion after needle-stick exposure to HIV? | 0.3%.
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| What are the risks for conversion to Hep B and C after needle-stick exposure? | HepB ~30%/HepC ~4%.
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| What is the risk for seroconversion after mucous membrane exposure to HIV? | Approximately 0.09%.
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| Most common HIV treatment is a combination of 3-4 agents known as HAART. What does this stand for? | Highly active antiretroviral therapy.
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| What are the reverse transcriptase inhibitors? | AZT, didanosine, zalcitabine, stavudine, lamivudine.
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| What are the protease inhibitors? | Saquinavir, ritonavir, indinavir, nelfinavir.
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| What are some of the SE of HIV treatment? | Anemia, n/v, diarrhea, hepatitis, peripheral neuropathy, bone marrow supression.
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| Protease inhibitors increase levels of what drugs? | Opioids and Benzos.
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| What cardiac drug is contraindicated when pt is on Protease inhibitors? | Amiodarone.
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| AZT increases levels of these four drugs: | 1. Benzodiazepines 2. Ca channel blockers 3. Quinidine 4. Methadone
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| What is one particular medication that should not be mixed with HIV drugs? | Midazolam(Versed).
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| What are some airway complications as a result of HIV? | Candida, Kaposi’s sarcoma.
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| What are some common pulmonary complications you can find in a patient with HIV? | P. carinii, TB, Other pneumonias
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| What are some common CNS complications found in the HIV positive patient? | Infections, tumors, dementia, electrolyte/blood glucose imbalances.
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| What are some CV complications found in the HIV patient? | Infection (myocarditis), arrythmias.
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| What organ is particularly prone to failure in the HIV patient? | Kidney.
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| HIV patients are prone to these two liver problems: | Failure, hepatitis.
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| What hematological problems do HIV patients often have? | Anemia, thrombocytopenia.
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| How do you kill blood-borne pathogens on surfaces? | 1:10 bleach solution, 70% isopropyl alcohol.
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| How long does OSHA recommend that we leave the surface wet with disinfectant before wiping? | 30 seconds for HIV-1 and 10 minutes for HBV.
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