Streptococcal infections are important in healthcare. Streptococcus is a gram positive bacteria. The two varieties of Streptococcus you should be familiar with are Group A Streptococcus (GAS) and Streptococcus pneumonea This brief article will discuss these two important bacterial pathogens.

Group A Streptococcus (GAS)

• Commonly found in the throat and skin
• Causes infection such as strep throat and impetigo. In rare cases, invasive GAS can cause necrotizing fasciitis (flesh eating bacteria) and streptococcal toxic shock syndrome. There are 2000 deaths associated with GAS infection.
• Streptococcus can be passed from one person to another. Antibiotic treatment for 24 hours eliminates contagiousness.
• Early signs of GAS infection include fever, sever pain, swelling and redness at a skin wound site.
• Prevention may be reduced by good handwashing, covering coughs and sneezes.
• All wounds should be kept clean and observed for signs of infection.

Streptococcus pneumonae

• Causes infections such as pneumonia, bacteremia and meningitis.
• Infection can be prevented through vaccination. The pneumococcal vaccine is protective against most pneumococcal infections.
• Everyone over age 65 should be vaccinated. Anyone with chronic illness, such as diabetes, heart or lung disease should be vaccinated, regardless of age.
• Streptococcal pneumonia is the most common community acquired pneumonia and a major cause of pneumonia in residents of long term care facilities.
• Residents who become ill may need to be transfered to the acute hospital for traetemnt, resulting in lost revenue for the facility.
• The Surgeon General has set a goal of at least 60% of people at risk should be vaccinated by 2000. The goal for 2010 is 80%.

HIV and AIDS review

It has been twenty years since AIDS was first reported. Since that time, there has progress toward prevention and treatment. In 1985, Human Immunodeficiency Virus (HIV) was identified and tests were developed to detect the presence of HIV antibody. Since then, the nations blood supply has been screened and HIV related transfusions have almost been eliminated.

By far the greatest risk of HIV transmission is human behavior. Sexual transmission is still the primary route. However, healthcare workers (HCW) are at risk through exposure to blood and other body fluids that contain HIV. Body fluids that do not transmitted HIV are: urine, feces, sweat, tears, respiratory secretions unless they contain visible blood.

After exposure to HIV, the HCW can be offered medication (chemoprohylaxis). This is currently recommended for high risk, high blood volume exposures. Unless your facility has a program for patients known to have HIV, you probably will not need a Rapid Response procedure. The Rapid Response is a program which will screen and initiate chemoprohylaxis within 2 hours of the exposure. This is important for clinics and hospice that have an HIV positive patient population.

The diagnosis of AIDS usually made when the patient is HIV + (antibody blood test) and has a T-helper cell count less than 200. At this time, the patient may appear healthy and have no signs of immundeficiency. DS is reportable to the county health department. HIV infection is usually not reportable. Check with you county health department.

The illnesses that patients with HIV disease get are opportunistic. That means they do not effect people with a healthy immune system. Opportunistic infections include pneumocystis pneumonia, fungal infections and non-infectious diarrhea. Only pulmonary tuberculosis can be transmitted to otherwise health people. People with AIDS will sometime take prophylactic antibiotics to prevent opportunistic infections. In addition they may also take anti-viral medications. There are now may anti-viral medications, which seem to prolong the time from infection until there are signs of opportunistic infections.

Prevention of HIV transmission to the health care worker include the use of safety syringes (required in California after July 1); availability of sharps containers; work practices that prohibit recapping used needles; and use of personal protective equipment such as gloves, gowns and mask/goggles. The facility needs to identify those at risk of bloodborne pathogen exposure through the facility's Exposure Control Plan