Florida Funeral Ebook Continuing Education

This interactive Florida Funeral Ebook contains 12 hours of continuing education. To complete click the Complete Your CE button at the top right of the screen.

Elite Learning

FLORIDA Funeral Continuing Education

Includes mandatory topics required for license renewal.

ELITELEARNING.COM/BOOK Complete this book online with book code: FFL1223 12-hour Continuing Education Package $64.95


THIS COURSE FULFILLS THE HIV/AIDS REQUIREMENT Chapter 1: HIV/AIDS - Communicable Disease Education (Mandatory)


[1 CE hour] Communicable diseases pose a significant risk to those within the funeral profession. It is important for funeral industry professionals to be aware of these risks and be reminded of best practices to employ to avoid exposure and/or transmission of bloodborne pathogens that could lead to disease or death.

Chapter 2: Aftercare - Extending a Helping Hand All Year Round


[1 CE hour] Funeral homes offer different aftercare services, these services are to help with the process of grief. These services are based on the customers and community and what is best for the families needing your guidance. Chapter 3: COVID-19: The Complete Guide for Funeral Directors and Embalmers [2 CE hours] SARS-CoV-2, also known as COVID–19, is a novel coronavirus that has become a worldwide pandemic. It is essential that funeral directors and embalmers take on a proactive approach to eliminate the spread of this virus in their profession. This comprehensive guide will allow the reader to format an action plan to create a safe work environment for the entire funeral home administration and the families it serves.


Chapter 4: Diversity and Inclusion in Funeral Service


[2 CE hours] The course will further focus on the importance of respecting the cultural practices and traditions of co-workers, as well as client families served. Several strategies and suggestions are presented to assist in the serving of families with conflict resulting from diversity within the family. The most important lesson presented is the importance of respecting one another, regardless of others’ beliefs or practices.

Chapter 5: Infant Embalming


[1 CE hour] This course has been researched and designed as a guide to understand and work through the techniques, skills, and knowledge required in identifying, and performing the most appropriate modern-day embalming procedures on infant cases. Chapter 6: Infectious Disease Control for Funeral Directors and Embalmers [4 CE hours] Funeral professionals need to have knowledge of different types of infectious disease, modes of transmission, and also for maintaining a safe environment for personnel, the public and the environment.


Chapter 7: Understanding Mental Health and Funerals


[1 CE hour] In this course, the student will learn the steps intended to support funeral directors who care for the mental health needs of the bereaving family and friends as they plan the loved one’s memorial.

Final Examination Answer Sheet


©2023: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge in the areas covered. It is not meant to provide medical, legal or professional services advice. Colibri Healthcare, LLC recommends that you consult a medical, legal or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation or circumstances and assumes no liability from reliance on these materials.



Book code: FFL1223


What are the requirements for license renewal? Licenses Expire

Contact Hours

Mandatory Subjects

Funeral Directors and Embalmers Biennial renewals are due on August 31 odd years.

12 (All hours are allowed through home-study)

1 hour HIV/AIDS

How much will it cost? If you are only completing individual courses in this book, enter the code that corresponds to the course below online.



Chapter 1: HIV/AIDS - Communicable Disease Education (Mandatory)




Chapter 2: Aftercare - Extending a Helping Hand All Year Round


$14.95 FFL01ACE18

Chapter 3: Covid-19: The Complete Guide for Funeral Directors and Embalmers

2 2 1

$17.95 $17.95 $14.95


Chapter 4: Diversity and Inclusion in Funeral Service

Chapter 5: Infant Embalming


Chapter 6: Infectious Disease Control for Funeral Directors and Embalmers



Chapter7: Understanding Mental Health and Funerals




Best Value - Save $54.70 - All 12 Hours

12 $64.95


How do I complete this course and receive my certificate of completion? See the inside front cover for step by step instructions to complete and receive your certificate. Are you a Florida board-approved provider?

Yes, Colibri Healthcare, LLC is an approved provider by the Florida Department of Financial Services; Division of Funeral, Cemetery and Consumer Services, Provider No. 113. In addition, all courses are also approved by the state board. Are my hours reported to the Florida board? Yes. Colibri Healthcare, LLC will report your hours electronically within one business day. What information do I need to provide for course completion and certificate issuance? Please provide your license number on the test sheet to receive course credit. Your state may require additional information such as date of birth and/or last 4 of Social Security number; please provide these, if applicable. Is my information secure? Yes! We use SSL encryption, and we never share your information with third-parties. We are also rated A+ by the National Better Business Bureau. What if I still have questions? What are your business hours? No problem, we have several options for you to choose from! Online at EliteLearning.com/Funeral you will see our robust FAQ section that answers many of your questions, simply click FAQs at the top of the page, e-mail us at office@elitelearning.com, or call us toll free at 1-888-857-6920, Monday - Friday 9:00 am - 6:00 pm, EST. Important information for licensees: Always check your state’s board website to determine the number of hours required for renewal, mandatory topics (as these are subject to change), and the amount that may be completed through home-study. Also, make sure that you notify the board of any changes of address. It is important that your most current address is on file.

Licensing board contact information: Florida Department of Financial Services Division of Funeral, Cemetery and Consumer Services 200 East Gaines St., Larson Building I Tallahassee, Florida 32399-0361 I Phone (850) 413-3039 or (877) 693-5236 Website: http://www.myfloridacfo.com/division/funeralcemetery


Book code: FFL1223


Chapter 1: HIV/AIDS – Communicable Disease Education 1 CE Hour

By: Staff writer Learning objectives Š Understand OSHA’s Bloodborne Pathogen Standard. Š Understand proper sterilization and sanitation techniques for your instruments and workplace. Š Know the difference between HIV infection and AIDS. Bloodborne pathogens Bloodborne pathogens are microorganisms such as viruses or bacteria that are carried in the blood and can cause disease in people. There are many different bloodborne pathogens including malaria, syphilis, and brucellosis, but Hepatitis B Virus (HBV) and the Human Immunodeficiency Virus (HIV) are the two diseases specifically addressed by the OSHA Bloodborne Pathogen Standard. Hepatitis C Virus (HCV) is another virus that has dramatically increased in the United States. Background In March 1992, OSHA’s Bloodborne Pathogen Standard, 29 CFR 1910.1030 took effect. This standard was designed to prevent more than 200 deaths and 9,000 infections every year. While the standard was primarily aimed at hospitals, funeral homes, clinics, law enforcement agencies, emergency responders, and HIV/HBV research laboratories, anyone who can “reasonably expect to come in contact with blood or potentially infectious materials” as part of their job is covered by the standard. Purpose The purpose of the standard is to limit occupational exposure to blood and other potentially infectious materials since any exposure could result in transmission of bloodborne pathogens which could lead to disease or death. Scope The Standard covers all employees who could be “reasonably anticipated,” as the result of performing their job duties, to face contact with blood and other potentially infectious materials. OSHA has not attempted to list all occupations where exposure could occur. “Good Samaritan” acts such as assisting a co- worker with a nosebleed would not be considered occupational exposure. Infectious materials include semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, ammonic fluid, saliva, any body fluid visibly contaminated with blood and all body fluids in situations where it is difficult or impossible to differentiate between body fluids. They also include unfixed tissue or organ other than intact skin from a human (living or dead), Human Immunodeficiency Virus (HIV) containing cell or tissue cultures, organ cultures and HIV or Hepatitis B Virus (HBV)-containing culture medium or other medium or other solutions as well as blood, organs or other tissues from experimental animals infected with HIV or HBV. Exposure control plan The Exposure Control Plan requires employers to identify, in writing, tasks and procedures as well as job classification where occupational exposure to blood occurs without regard to personal protective clothing and equipment. It must also set forth the schedule for implementing provisions of the standard and specify the procedure for evaluating circumstances surrounding exposure incidents. The plan must be accessible to employees and available to OSHA. Employers must review and update it at least annually and more often if necessary to accommodate workplace changes.

Š Describe how HIV/AIDS infected employees should be treated. Š Describe the precautions you should take to limit exposure to bloodborne pathogens. Methods of compliance The Standard mandates universal precautions, (treating body fluids/materials as infectious) emphasizing engineering and work practice controls. The Standard stresses hand washing and requires employers to provide facilities and ensure that employees use them following exposure to blood. It sets forth procedures to minimize needlesticks, minimize splashing and spraying of blood, ensure appropriate packaging of specimens and regulated wastes and decontaminate equipment or label as contaminated before shipping to servicing facilities. Employers must provide, at no cost, and require employees to use appropriate personal protective equipment such as gloves, gowns, masks and must clean, repair and replace these when necessary. The Standard requires a written schedule for cleaning, identifying the method of decontamination to be used, in addition to cleaning following contact with blood or other potentially infectious materials. It specifies methods for disposing of contaminated sharps and sets forth standards for containers for these items and other regulated waste. Further, the standard includes provisions for handling contaminated laundry to minimize exposure. Hepatitis B vaccination Vaccinations need to be made available to all employees who have occupational exposure to blood within 10 working days of assignment, at no cost, at a reasonable time and place, under the supervision of a licensed physician/licensed healthcare professional and according to the latest recommendations of the U.S. Public Health Service (USPHS). Pre-screening may not be required as a condition of receiving the vaccine. Employees must sign a declination form if they choose not to be vaccinated, but may later opt to receive the vaccine at no cost to the employee. Should booster doses later be recommended by the USPHS, employees must be offered them. Post-exposure evaluation and follow-up Specific procedures are to be made available to all employees who have had an exposure incident plus any laboratory tests must be conducted by an accredited laboratory at no cost to the employee. Follow-up must include a confidential medical evaluation documenting the circumstances of exposure, identifying and testing the source individual if feasible, testing the exposed employee’s blood if he/she consents, post-exposure prophylaxis, counseling and evaluation of reported illness. Healthcare professionals must be provided specified information to facilitate the evaluation and their written opinion on the need for hepatitis B vaccinations following the exposure. Information such as the employee’s ability to receive the hepatitis B vaccine must be supplied to the employer. All diagnoses must remain confidential. Hazard communication Warning labels including the orange or orange-red biohazard symbol should be affixed to containers of regulated waste, refrigerators and freezers and other containers which are used to


Book Code: FFL1223

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Recordkeeping Medical records are to be kept for each employee with occupational exposure for the duration of employment plus 30 years. They must be kept confidential and must include name and social security number; hepatitis B vaccination status (including dates), results of any examination, medical testing and follow-up procedures; a copy of the healthcare professional’s written opinion; and a copy of information provided to the healthcare professional. Training records must be maintained for 3 years and must include dates, contents of the training program or summary, trainers name and qualifications, names and job titles of all persons attending the sessions. Medical records must be made available to the employee, anyone with written consent of the employee, OSHA and NIOSH. Disposal of records must be in accord with OSHA’s standard covering access to records. begin to grow. From there, they move through the blood to other parts of the body, such as the kidney, spine, and brain. TB in the lungs or throat can be infectious. This means that the bacteria can be spread to other people. TB in other parts of the body, such as the kidney or spine, is usually not infectious. People with TB disease are most likely to spread it to people they spend time with everyday. This includes family members, friends, and coworkers. In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. The bacteria become inactive, but they remain alive in the body and can become active later. This is called TB infection. People with TB infection: ● Have no symptoms. ● Don’t feel sick. ● Can’t spread TB to others. ● Usually have a positive skin test reaction. ● Can develop TB disease later in life if they do not receive preventive therapy. Many people who have TB infection never develop TB disease. In these people, the TB bacteria remain inactive for a lifetime without causing disease. But in other people, especially people who have weak immune systems, the bacteria become active and cause TB disease. The symptoms of viral hepatitis Early symptoms of viral hepatitis include: ● Fatigue. ● Tenderness in the upper right abdomen. ● Sore muscles & joints. ● Loss of appetite. ● An altered sense of taste & smell. ● Nausea, vomiting & diarrhea. ● Low-grade fever. ● Malaise. Other symptoms can include: ● Jaundice - abnormally yellow skin & eyes caused by bile entering the blood. ● Darkened urine; light-colored or gray stool. Diagnosis of hepatitis Although health providers use information about a person’s symptoms, health history and behaviors to help make a diagnosis, only blood tests can confirm the diagnosis and pinpoint which type of hepatitis a person has. Treatments for viral hepatitis Since there’s no medication that can treat the initial illness that viral hepatitis causes, health professionals manage symptoms as they occur and try to help the body’s immune system fight the infection. If you have viral hepatitis, your health care provider may tell you to:

store or transport blood or other potentially infectious materials. Red bags or containers may be used instead of labeling. When a facility uses universal precautions in its handling of all specimens, labeling is not required within the facility. Likewise when all laundry is handled with universal precautions, the laundry need not be labeled. Blood which has been treated and found free of HIV or HBV and released for clinical use, and regulated waste which has been decontaminated, need not be labeled. Information and training Training of the OSHA Bloodborne Pathogen Standard should be completed within 90 days of effective date, and annually thereafter. Training must include making accessible a copy of the regulatory test of the standard and explanation of its contents. Tuberculosis Tuberculosis, also known as TB, is an infectious disease that may affect almost any tissue in the body especially the lungs. It is caused by the bacteria mycobacterium tuberculosis and characterized by tubercles, the characteristic lesion of tuberculosis. Nearly one-third of the world’s population is infected with tuberculosis (TB), which kills almost 3 million people a year. TB is the leading cause of death due to an infectious agent in the world. In the mid-1980s a resurgence of outbreaks in the United States brought new attention to TB. Increases in the incidence of TB are related to the high risk among immunosuppressed persons, particularly those infected with human immunodeficiency virus (HIV). Drug resistant strains of this deadly disease have contributed to the problem. Outbreaks have occurred in hospitals, correctional institutions, homeless shelters, nursing homes, and residential care facilities for AIDS patients. Nationwide, at least several hundred employees have become infected and have required medical treatment after workplace exposure to TB. TB is spread through the air from one person to another. The bacteria are put into the air when a person with TB disease of the lungs or throat coughs or sneezes. People nearby may breathe in these bacteria and become infected. When a person breathes in TB bacteria, the bacteria can settle in the lungs and Hepatitis is an inflammation of the liver caused by medications, alcohol, or a variety of other agents including the viruses that cause mumps, measles, herpes and infectious mononucleosis. However, when health professionals talk about viral hepatitis, they usually mean hepatitis caused by the hepatitis A, hepatitis B, or hepatitis C virus. The differences between hepatitis A, B and C Although hepatitis A, B and C have similar symptoms, the viruses themselves are quite different. The hepatitis A virus can enter a person’s body when he/she eats or drinks something contaminated with the stool or blood of someone who has the disease. Symptoms usually appear within 2-6 weeks, but are not followed by the chronic problems that hepatitis B and C viruses can cause. The hepatitis B and C viruses can infect a person if his/her mucous membranes or blood are exposed to an infected person’s blood, saliva, wound exudates, semen or vaginal secretions. Symptoms appear more gradually than in hepatitis A. Unlike the hepatitis A virus, the hepatitis B and C viruses can stay in the body - sometimes for a lifetime - and eventually cause The basic facts on hepatitis Viral hepatitits Because the different viruses that cause hepatitis enter the body in different ways, there are several steps you can take to protect yourself from infection. Practicing good hygiene and safer sexual behaviors is a good first step. For more specific information, see the individual sections for hepatitis A, B and C. chronic, serious liver diseases. Protections against infection

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Book Code: FFL1223


● Avoid alcohol and other drugs, large doses of vitamins, and prescription drugs metabolized by the liver (sometimes including birth control pills). ● Drink high-calorie fluids such as fruit juices and eat a balanced diet that includes dairy products; meat, poultry or seafood; breads and cereals; and fruits and vegetables (To control nausea, try eating several smaller meals). ● Limit activity if your hepatitis is symptomatic; this typically means bed rest at first, progressing to normal activity as symptoms disappear. Hepatitis A (HAV) Hepatitis A infects 125,000 - 200,000 people each year and can be easily transmitted. You can become infected by eating or drinking something that has been contaminated with the stool (feces) or blood of someone who has the disease. Facts about hepatitis A Symptoms occur 2-6 weeks after exposure and can last from several days to six months. The virus usually causes mild illness and is often mistaken for a stomach virus, although occasionally symptoms are more serious. It is rarely fatal and does not cause permanent liver damage. A person with hepatitis A is considered contagious, which means they can transmit the virus to others as early as two weeks before symptoms appear. The hepatitis A virus does not cause the long-term, chronic symptoms that other hepatitis viruses can cause. Behavior practices associated with hepatitis A infection ● Eating contaminated food, such as undercooked shellfish from contaminated water or food handled by someone who has hepatitis A. ● Using silverware, cups or glasses that an infected person touched with unwashed hands. ● Changing diapers or linens that contain stool from someone with hepatitis A and neglecting to wash your hands. ● Sharing food with an infected person or drinking water contaminated with sewage. ● Oral or anal sexual contact with an infected person. ● Traveling to developing countries where the disease is common. Hepatitis B (HBV) In the United States, approximately 300,000 people are infected with HBV annually. Of these cases, a small percentage are fatal. “Hepatitis” means “inflammation of the liver,” and its name implies, hepatitis B is a virus that infects the liver. Hepatitis B is transmitted through ‘blood-to-blood` contact. Hepatitis B initially causes inflammation of the liver, but it can lead to more serious conditions such as cirrhosis and liver cancer. There is no “cure” or specific treatment for HBV, but many people who contract the disease will develop antibodies, which help them get over the infection and protect them from getting it again. It is important to note, however, that there are different kinds of hepatitis, so infection with HBV will not stop someone from getting another type. The hepatitis B virus is very durable, and it can survive in dried blood for up to seven days. For that reason, this virus is the primary concern for employees such as housekeepers, funeral directors, custodians, laundry personnel and other employees who may come in contact with blood or potentially infectious materials in a non first aid or medical care situation. Symptoms The symptoms of HBV are very much like a mild “flu.” Initially there is a sense of fatigue, possible stomach pain, loss of appetite, and even nausea. As the disease continues to develop, jaundice (a distinct yellowing of the skin and eyes), and darkened urine often develop. However, people who are infected with HBV will often show no symptoms for some time. After exposure it can take 1-9 months before symptoms become noticeable. Loss

Your health professional may recommend hospitalization if you experience severe vomiting or do not feel better after several weeks. You should know that researchers are making gains in treating the chronic liver disease associated with both hepatitis B and C. There is not much available for treatment. Interferon has been approved in chronic hepatitis B and C cases for those aged 18 or older. Prevention is still the best option.

● Sharing needles can also put you at risk. The hepatitis A virus can be transmitted through blood if needles are shared. However, poor hygiene - either among people who use drugs or among drug producers - is probably a more important reason for the high prevalence among drug users. Prevention of hepatitis A Practice good personal hygiene. Always wash your hands after postmortem contact with blood or fecal matter, when cleaning or after using the toilet, and before preparing or eating food. Avoid foods that could be contaminated, such as under-cooked shellfish or food that’s been prepared by someone who has the virus. When traveling to developing countries, drink only bottled or boiled water, don’t use ice, and don’t eat raw fruits or vegetables unless they’ve been peeled. It is also a good idea to get the hepatitis A vaccine. Exposure to hepatitis A If you think you’ve been directly exposed to the hepatitis A virus, visit your health care provider immediately for treatment. Some treatments can help ward off the infection if administered in time (hepatitis A vaccine and IgG). All people who have close household or sexual contact with an infected person also need treatment. Preventing the spread of hepatitis A If you think you may be infected with hepatitis A: ● Always wash your hands well after using the toilet. ● Don’t prepare or handle food for others while you are infectious. ● Avoid sexual contact with other people until you are fully recovered. of appetite and stomach pain, for example, commonly appear within 1-3 months, but can occur as soon as 2 weeks or as long as 6-9 months after infection. Hepatitis B (HBV) and sexually transmitted disease prevented by HBV vaccine The hepatitis B virus infects people of all ages. It is one of the fastest-spreading sexually transmitted infections (STI), and also can be transmitted by sharing needles or by any behavior in which a person’s mucus membranes are exposed to an infected person’s blood, semen, vaginal secretions, or saliva. While the initial sickness is rarely fatal, 10 percent of people who get hepatitis B are infected for life and run a high risk of developing serious, long-term liver diseases such as cirrhosis of the liver or liver cancer which can cause serious complications or death. A safe, effective vaccine that prevents hepatitis B is available. If you or someone you know practices behaviors that can spread hepatitis B, ask a medical professional about the vaccine. Don’t become one of the 300,000 Americans who contracts hepatitis B every year. Facts about hepatitis B (HBV) ● Symptoms, if they occur, appear from one to six months after exposure to the virus. ● An infected person can begin infecting others four to six weeks before symptoms appear, and can continue infecting others long after symptoms subside. ● About one in ten people infected with hepatitis B become chronic carriers; they continue carrying the virus and spread it to others even though their symptoms have disappeared.


Book Code: FFL1223

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remains, and using bathrooms. Don’t share razors, toothbrushes or pierced earrings with anyone. Exposure to hepatitis B If you have not been vaccinated against hepatitis B but are exposed to the virus, your health professional can treat you with hepatitis B immune globulin (HBIG), combined with the hepatitis B vaccination. Don’t delay - get immunized and vaccinated as soon as possible after exposure. Preventing the spread of hepatitis B ● Don’t engage in sexual contact without a condom. ● Don’t donate blood. Bandage all cuts and open sores. ● Don’t share anything that could be contaminated with your blood, semen, vaginal secretions or saliva - such as needles, razors or toothbrushes. ● Wash your hands well after using the toilet or handling human remains. ● If you have hepatitis B and you’re pregnant, your baby must be immunized at birth. All pregnant women should be screened for hepatitis B. ● Hepatitis B vaccinations As previously discussed, employees who have routine exposure to bloodborne pathogens (such as doctors, nurses, embalmers, first aid responders, etc.) shall be offered the hepatitis B vaccine series at no cost to themselves unless: ● They have previously received the vaccine series. ● Antibody testing has revealed they are immune. ● The vaccine is contraindicated for medical reasons. Although your employer must offer the vaccine, you do not have to accept that offer. You may opt to decline the vaccinations series, in which case you will be asked to sign a declination form. Even if you decline the initial offer, you may choose to receive the series at anytime during your employment thereafter, for example, if you are exposed on the job at a later date. The hepatitis B virus vaccination is given in a series of three shots. The second shot is given one month after the first, and the third shot follows five months after the second. This series gradually builds up the body’s immunity to the hepatitis B virus. The vaccine itself is made from yeast cultures, there is no danger of contracting the disease from getting the shots, and, once vaccinated, a person does not need to receive the series again. Risk behaviors You are at risk if you share needles; receive contaminated blood during a blood transfusion; work with contaminated blood as a funeral director or embalmer; or have vaginal, oral or anal contact without barrier protection with infected partners. Prevention of hepatitis C Since hepatitis C is transmitted in much the same way as hepatitis B, you can help avoid infection by using some of the same precautions. Always use barrier protection during vaginal, anal or oral contact; practice good personal hygiene; and never share needles, razors, toothbrushes or pierced earrings with anyone. All donated blood is screened for the virus. Drugs are licensed for treatment of persons with chronic infection, though they are only about 15-30% effective. Currently, there is no vaccine available. Modes of transmission Bloodborne pathogens such as HAV, HBV, HCV and HIV can be transmitted through contact with infected human blood and other potentially infectious body fluids such as: ● Semen.

About one-quarter of these chronic carriers eventually die of severe, chronic liver diseases, including cirrhosis - a serious scarring of the liver - and liver cancer. ● About half of the people infected with hepatitis B virus never develop symptoms; but they can become chronic carriers. ● Since some areas of the world have high rates of infection, people from places such as Southeast Asia, South Pacific Islands, sub-Saharan Africa, Alaska, Amazon, Bahia, Haiti, and the Dominican Republic are at risk. Risk behaviors for contracting HBV Practicing unsafe sex. The more partners with whom you have vaginal, anal or oral contact, the higher your risk of becoming infected with hepatitis B. Abstinence is the most effective way to prevent sex-related transmission. If you have vaginal, anal or oral contact, always use barrier protection. People who have sex with multiple partners should ask their health provider about getting vaccinated for hepatitis B. Sharing needles. No matter what drug is injected, whether it’s crack, heroin or steroids, sharing needles is extremely risky. In fact, an estimated 60-80 percent of the people who share needles are or have been infected with hepatitis B. Similarly, beware of needles that could be contaminated when getting tattoos, having acupuncture or your ears pierced. Select a reputable professional for these services. Close, frequent contact with the blood, semen, vaginal secretions or saliva of infected patients. If you are a health care worker, consider getting vaccinated. Occasionally, people who share living quarters for a long time with others who have hepatitis B have gotten infected. Receiving a blood transfusion or other blood products no longer carries the threat of hepatitis B that it once did. Today, all blood is screened for hepatitis B before it is used. Prevention of hepatitis B If you are at risk of contracting hepatitis B, get vaccinated. The hepatitis B vaccine is an inactivated antigen (genetically engineered; not a live or killed virus). It is administered in a series of three injections over a six-month period. Approximately 95% of persons who receive the three injections obtain full immunity after receiving the vaccine. You are asked to report side effects (rash, nausea, joint pain, and/or fatigue) to your health care provider. Also, avoid high-risk behaviors and practice good personal hygiene when sharing food, handling human Hepatitis C (HCV) HCV is widely viewed as one of the most serious of the five hepatitis viruses. The hepatitis C virus is spread primarily through contact with infected blood and can cause cirrhosis (irreversible and potentially fatal liver scarring), liver cancer, or liver failure. Hepatitis C is the major reason for liver transplants in the United States, accounting for 1,000 of the procedures annually. The disease is responsible for between 8,000 and 10,000 deaths yearly. Some estimates say the number of HCV-infected people may be four times the number of those infected with the AIDS virus. Hepatitis C is less likely than the other hepatitis viruses to cause serious illness at first (only one-quarter of the people infected actually develop symptoms); about 70% of those infected develop chronic liver disease. Like hepatitis B, hepatitis C can be spread by contact with infected blood, and possibly semen, vaginal secretions and saliva. Hepatitis C infects about 150,000 Americans each year. Hepatitis D (HDV) The delta virus (also known as hepatitis D) is a defective virus that may cause infection only in the presence of active hepatitis B infection. The symptoms and routes of transmission are similar to those of hepatitis B infection, but are particularly significant with intravenous drug abusers and pregnant women.

● Vaginal secretions. ● Cerebrospinal fluid. ● Synovial fluid.

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Book Code: FFL1223


● Pleural fluid. ● Amniotic fluid.

● Saliva (in dental procedures); and ● Any body fluid that is visibly contaminated with blood.

Human immunodeficiency virus (HIV) What is HIV?

Worldwide: Based on estimates from the United Nations AIDS program (UNAIDS), During 2002 AIDS caused the deaths of an estimated 3.1 million people and an estimated 5 million people contracted HIV. An estimated 42 million people are living with HIV infection or AIDS and an estimated 26 million people have died since the beginning of the epidemic. Nearly one-third of those living with AIDS are between the ages of 15-24 and 95% of all cases reported are in developing countries. Symptoms Symptoms of HIV infection can vary, but often include weakness, fever, sore throat, nausea, headache, diarrhea, a white coating of the tongue, weight loss, and swollen lymph glands. HAV, HBV, HCV and HIV are most commonly transmitted through: ● Sexual contact (less likely for HCV). ● Sharing of hypodermic needles. ● From mothers to their babies at/before birth. ● Accidental puncture from contaminated needles, broken glass, or other sharps. ● Contact between broken or damaged skin and infected body fluids. ● Contact between mucous membranes and infected body fluids. In most work situations, transmission is most likely to occur because of accidental puncture from contaminated needles, broken glass, or other sharps; contact between broken or damaged skin and infected body fluids; or contact between mucous membranes and infected body fluids. For example, if someone infected with HBV cut his or her finger on a piece of glass, and then you cut yourself on the now infected piece of glass, it is possible that you could contract the disease. Anytime there is blood-to-blood contact with infected blood or body fluids, there is a slight potential for transmission. Unbroken skin forms an impervious barrier against bloodborne pathogens. However, infected blood can enter your system through: ● Open sores. ● Cuts. ● Abrasion. ● Acne. ● Any sort of damaged or broken skin such as sunburn or blisters. Bloodborne pathogens may also be transmitted through the mucous membranes of the: ● Eyes. ● Nose. ● Mouth. For example, a splash of contaminated blood to your eye, nose or mouth could result in transmission. How does HIV research help with the cure of other diseases? Many ask how does HIV/AIDS affect me and why is research so important. The fact is, HIV/AIDS research is helping solve many other medical mysteries. Treatments for several types of cancer have grown directly out of AIDS research. One promising experimental therapy for advanced cancer is high dose chemotherapy followed by a bone marrow transplant. But the profound immune suppression necessary for a successful transplant often leads to devastating, even fatal, infections. New drugs to treat and prevent these infections have come directly from AIDS targeted research. Treatments for other cancers are also emerging from AIDS research. Several natural body hormones called growth factors promote the activity of HIV. Many of these hormones also accelerate the growth and spread of cancer cells. Blocking the

The human immunodeficiency virus or HIV for short, is the virus that causes AIDS. HIV is transmitted from one person to another through blood-to-blood and sexual contact. Additionally, infected pregnant women can pass HIV to their unborn child during pregnancy, delivery and breast-feeding. Most people that have the HIV infection will develop AIDS. What is AIDS? AIDS stands for acquired immunodeficiency syndrome. An HIV- infected person receives a diagnosis of AIDS after developing one of the defined AIDS indicator illnesses. A positive HIV test result does not mean that a person has AIDS. A diagnosis of AIDS is made by a physician using certain clinical criteria (e.g., AIDS indicator illnesses). Infection with HIV can weaken the immunes sytem to the point that it has difficulty fighting off certain infections. These types of infections are known as “opportunistic” infections because they take the opportunity a weakened immune system gives to cause illness. Many of the infections that cause problems or may be life-threatening for people with AIDS are usually controlled by a healthy immune system. The immune system of a person with AIDS is weakened to the point that medical intervention may be necessary to prevent or treat serious illness. Today there are medical treatments that can slow down the rate at which HIV weakens the immune system. There are other treatments that can prevent or cure some of the illnesses associated with AIDS. As with other diseases, early detection offers more options for treatment and preventative care. The origins of HIV and AIDS Scientists have different theories about the origin of HIV, but none have been proven. The earliest known case of HIV was from a blood sample collected in 1959 from a man in Kinshasha, Democratic Republic of Congo. (How he became infected is not known.) Genetic analysis of this blood sample suggests that HIV-1 may have stemmed from a single virus in the late 1940s or early 1950s. We do know that the virus has existed in the United States since at least the mid- to late 1970s. From 1979-1981 rare types of pneumonia, cancer, and other illnesses were being reported by doctors in Los Angeles and New York among a number of gay male patients. These were conditions not usually found in people with healthy immune systems. HIV and AIDS statistics United States: The Center for Disease Control (CDC) estimates that between 800,000 and 900,000 people are living with HIV with approximately 40,000 new infections every year. Through December 2001, a total of 816,149 cases of AIDS had been reported to the CDC. 666,026 reported among men, 141,048 reported among women, and 9,074 reported among children under 13. New infections By gender - 70% of new infections each year occur among men. Males account for 83% of all AIDS cases. By risk group – Homosexual men represent the largest proportion of new infections, followed by heterosexuals and intravenous drug users. By race – More than half of new HIV infections occur among blacks though they represent only 13% of the population. Hispanics, who represent 12% of the general population, are also disproportionately affected. 42% of all AIDS cases are white, 38% black and 18% Hispanic. Since the beginning of this epidemic, 467,910 AIDS-related deaths have been reported in the United States. Of those deaths, 462,653 have been adults and adolescents, 5,257 have been children under age 15 and 388 whose age at death was unknown.


Book Code: FFL1223

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way to block this process may benefit not only those with AIDS, but a much broader population as well. How does the study of HIV/AIDS help in the treatment of other diseases? HIV/AIDS therapies may be critical in the treatment of other diseases. For example, lamivudine and adefovir can help patients with hepatitis B who have no other options. In addition, protease inhibitors are being developed to combat infections, such as hepatitis C, influenza, and most recently, SARS is based on a concept similar to that of an anti-HIV entry inhibitor called enfuvirtide, or fuzeon, which was approved for use in 2003. A modified version of another AIDS drug called cidofovir, used to treat CMV eye infections in AIDS, is now being developed to treat and possibly prevent smallpox infection. AIDS drugs have been used to eliminate diseases in plants. Two of them, adefoir and tenofovir, can eradicate the banana streak virus, which infects a substantial proportion of the world’s banana harvest. Since HIV is a virus that attacks the immune system, what does AIDS research teach us about autoimmune disorders or immune-based therapies for other diseases? HIV-positive people often develop autoimmune problems, such as psoriasis or blood abnormalities associated with lupus. For these autoimmune diseases, treatments developed for AIDS should also apply when the same conditions occur spontaneously. Certain hormones that modify the function of immune cells are now being tested as treatments for AIDS. Some of the most recent include IL-12 and TNF ( tumor necrosis factor)-alpha inhibitors, which may also boost the immune systems of cancer patients. Specific legal boundaries of reasonable accommodation Employers and employees trying to determine appropriate accommodations should be aware of the specific legal boundaries of “reasonable accommodation.” Many of the employers profiled in these case studies provided assistance and accommodations that went above and beyond what the law would require. As a general rule of thumb, given that the ADA governs many of the actions in this area, employers should consider the ADA implications of any decisions involving an employee with HIV infection or AIDS. This includes any decisions about disclosing an employee’s HIV status. The ADA has strict rules about maintaining confidentiality of such information, and employers should ensure that they do not violate these rules. As awareness of the ADA and its employment provisions increases, more and more employees are stepping forward to disclose their HIV status to their employers, managers, coworkers, and friends. Disclosure often takes courage and is unlikely to happen without an environment in which the disclosure will be met with cooperation and support. Because of the stigma still associated with HIV, this disclosure — especially in the workplace setting — too often does not occur until a crisis forces the issue out into the open. By this time an otherwise manageable situation can become a crisis, and everyone loses — the HIV-positive employee, the employer, the manager, coworkers, and the worksite. Many employers believe that encouraging disclosure may not be desirable because it creates certain obligations that might not have otherwise existed. An environment that discourages or is hostile to disclosure, however, may present altogether different problems, legal and otherwise, just as a company experiences similar problems when it does not encourage employees with harassment complaints to come forward. Most human resource professionals agree that providing an environment where complaints or situations (such as the existence of a disability and the need for an accommodation) can be discussed and remedied without the fear of retaliation is a sound policy for both overall productivity and legal reasons.

activity of these hormones is a strategy first used experimentally to treat kaposi’s sarcoma, a cancer found in patients with HIV/ AIDS. Now it is also being tested in bladder, vulvar, and breast cancers and has shown some exciting recent success in treating colon cancer. In addition, small proteins and drugs that can block the growth of new blood vessels ( which is critical to the survival of tumor cells) were originally developed to treat Kaposi’s sarcoma, but are now being tested in many other cancers as well. Are other treatments for major diseases likely to emerge from AIDS research any time soon? Absolutely, AIDS research is helping to improve treatments for Alzheimer’s disease and heart disease. Alzheimer’s disease is a progressive, global dementia whose cause is unknown. Profound dementia is commonly seen in the late stages of AIDS as well, so drugs that are successful in lessening nerve damage and dementia in AIDS, for example, may benefit patients with Alzheimer’s. The characteristic plaques that fill the brain cells of an Alzheimer’s patient are formed partly by enzymes called proteases, so scientists are now investigating the use if protease inhibitors to treat this debilitating dementia. Many HIV positive children and adults also suffer heart attacks and strokes because HIV appears to affect small blood vessels in the heart and the brain, which makes them vulnerable to spasm, blood clots, and early atherosclerosis. The small arteries of a two-year-old child with AIDS often resemble those of a 50 -year-old man. In HIV infection, a process of programmed cell death injures the cells that line the small blood vessels of the heart. Similar damage occurs in HIV-negative people with atherosclerosis. Discovering a Workplace accommodations for employees with HIV/AIDS People living with HIV infection and AIDS can be productive workers for many years. Even in the best of circumstances, the challenges associated with HIV can be significant. In addition to complex medical and legal concerns, AIDS raises difficult emotional issues such as fear, stigma, death, and dying. HIV/AIDS is an increasingly important issue in workplaces throughout the country. Two-thirds of large businesses and one in 10 small businesses have already encountered an employee with HIV infection or AIDS. More than 75 percent of all AIDS cases occur among people between the ages of 25 and 44 — the same group comprising the bulk of the U.S. workforce. Employment provisions under the Americans with Disabilities Act of 1990 The Americans with Disabilities Act (ADA) prohibits discrimination against all people with disabilities or perceived disabilities, including people with HIV infection and AIDS. A detailed explanation of the ADA is beyond the scope of this publication but can be found at www.ada.gov Similar legal requirements have been in place for employers covered by the Rehabilitation Act and by certain State and municipal ordinances covering disability discrimination in employment. The employment provisions of the ADA also require employers to provide “reasonable accommodations” for employees with disabilities. Reasonable accommodations are changes or adjustments in the job or work environment that permit individuals with disabilities to perform the essential functions of a job. The term “reasonable accommodation” is a legal term that refers to certain changes and adjustments in the workplace. An employer may choose to go beyond the ADA and provide an accommodation that would not be required under the law. For example, removing an essential function from an employee’s job description and providing HIV education for all employees are not examples of reasonable accommodations. Similarly, while allowing an employee to work part-time is a type of reasonable accommodation, continuing to pay that employee a full-time salary is not required by the law. The ADA establishes a baseline — a floor, not a ceiling.

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Book Code: FFL1223


There is no simple formula for accommodation of employees with HIV infection or AIDS The dual goals of accommodation are to ensure that work assignments are accomplished and that the individual with HIV infection or AIDS continues working as long as possible. Accommodation is a process of ongoing problem solving between an employee with HIV infection or AIDS and his or her supervisor. Because the manifestations of HIV infection and AIDS are different in different people, accommodation is not a one-time alteration of a job or physical structure. Just as each person with HIV infection and AIDS experiences the disease differently, each person will also require different accommodations. An accommodation that is effective for an earlier phase of HIV infection may not be effective for a later phase; an accommodation is an ongoing process requiring ongoing evaluation, in part because the manifestations of HIV infection and AIDS change over time, and in part because some attempted accommodations may not work for either the employer or the employee. Effective accommodation does not require lowering the expectations of the employee. Rather, it requires ongoing negotiation and creative problem solving to determine alternative means of accomplishing work assignments. This negotiation process may result in different outcomes in similar circumstances. For example, one employee might convert from a full-time job to part time. Providing accommodation to employees with HIV infection or AIDS is a team effort with impact on a company’s workforce, managers, and policies Because of the fear and stigma still associated with HIV/AIDS, accommodating people with HIV infection and AIDS affects virtually everyone in the workplace. A fearful work environment is not a productive work environment. In the process of providing accommodation of employees with HIV infection or AIDS, an employer might consider addressing coworker attitudes. In order to dispel unwarranted fears and to ensure cooperation in the accommodation process, managers need accurate information about HIV infection and AIDS. Confronting AIDS also involves confronting grief. Coworkers and managers in these profiles responded constructively in a supportive environment where emotional responses to HIV could be addressed. Leadership is an important part of effective accommodation. A message from the manager about how an employee with HIV infection or AIDS will be treated is critical because it sets a clear standard. The benefits of accommodating employees with HIV infection and AIDS balance the costs Companies that effectively manage HIV/AIDS grow stronger. How a company treats one employee with a chronic illness is a clear indicator and a signal of the standard it will use in managing other employees. Witnessing support, accommodation, and respect for a coworker with a terminal illness strengthens worker morale, loyalty, and productivity. Coworkers and supervisors share a deeply human connection. Employers have the satisfaction of knowing they are making a contribution to the dignity and well-being of one of their own employees. Sometimes companies directly benefit financially from accommodations as well. One employee, working on commission-based pay, wanted to reduce the pressure caused by his income depending directly on his daily sales. His accommodation included converting from commission-based pay to a fixed salary. When his sales were high, this arrangement benefited the company since it kept the commissions he would have received. Confidentiality of a funeral service Confidentiality should be observed throughout all aspects of funeral service and particularly when any infectious case is encountered. In cases where it is felt necessary to preserve confidentiality funeral directors may be told a cadaver is low, medium or high risk without giving a specific diagnosis. In this circumstance it is the responsibility of the certifying clinician (who

Companies benefit when employees who become ill can help train other employees to share and eventually assume some of their responsibilities. The expertise of a knowledgeable and experienced employee is thus passed on to a new employee. This may also give ill employees some peace of mind knowing their responsibilities are being taken care of in their absence. Employees who fully disclosed their HIV status in the workplace felt relieved and strengthened Being an employee with HIV/AIDS, as one interviewee described it, is “not for cowards.” The employee must manage the overwhelming emotions of facing a terminal and often stigmatizing illness while still continuing to be a productive worker. People with HIV infection and AIDS are challenged to manage and plan for an everchanging set of ailments, health care needs, and financial demands — all while maintaining motivation and self-esteem. HIV-positive employees must decide whom to inform about their health status, how much information to reveal, and when to reveal it. The stigma still associated with HIV/AIDS makes such decisions all the more difficult. Fear of rejection, regrettably, is a fear based in reality. The decision to disclose HIV status is the prerogative of the HIV- positive individual. It is illegal for an employer to ask a current or prospective employee about HIV status. Nonetheless, the HIV- positive employee may have to disclose some health information to managers or supervisors in order to seek an accommodation. Accommodations can be made without the supervisor’s knowing that the individual is HIV-positive or has AIDS; the supervisor may know only that the individual is ill. Disclosure of one’s HIV status can take place in many settings. Some employees have chosen to disclose it in letters to colleagues or work groups; others do so in face-to face meetings with individuals or groups. Intensive workplace AIDS education may precede or follow a disclosure. Employees may inform managers of their health condition but request that the information be kept confidential; and by law, the employer must comply with that request. Over time, however, if coworkers unaware of these circumstances become suspicious of perceived preferential treatment, they may become resentful and spend considerable time, energy, and effort trying to figure out “what’s wrong.” Rumors may circulate. When the performance of their work groups is called into question by superiors, managers may find themselves unable to adequately explain the situation. In such circumstances, the employee may be uncomfortable as well, knowing that rumors are circulating and feeling the unwanted attention from others. At that point, it may be helpful for the manager to discuss with the employee what, if anything, he or she wants to do to address the situation. The decision to disclose rests with the employee, but the employee may be willing to risk disclosure if the manager is not forcing the individual to disclose but, instead, offers support for whatever decision is made. Finally, many employees with HIV/AIDS believe that continuing to work is critical to their mental and physical health and survival. Work can provide a sense of purpose, financial support, productiveness, continuity, involvement, peer support, and the opportunity to focus on something other than one’s illness. In our culture and society, a person’s work and profession often hold deep ethical, economic, and personal significance. The importance of work and the workplace context for people with HIV infection and AIDS should not be underestimated. should seek infection control advice if necessary) to ensure that the cadaver is correctly classified. Those refusing to disclose a diagnosis have a responsibility for ensuring that funeral directors are given sufficient information to protect themselves and their staff. Inaccurate or insufficient information may result in families being denied the right to view a body. Denying relatives the


Book Code: FFL1223

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