Transcript Well-Being of the EMT-Basic Part 2 Introduction to

Introduction to
Infectious Disease Control &
Prevention
Today’s Emergency Personnel face many hazards on the
job. One of these hazards is exposure to communicable
diseases that are spread by blood and other bodily fluids.
A generation ago, we did not concern ourselves with
bloodborne diseases.
Today we must.
It takes a special breed to be a firefighter or EMS
provider, the kind that is willing to risk their own well
being to help others.
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OSHA BBP Training
• What is a Blood Borne Pathogen, Infectious
Disease or Communicable Disease.
• Review of Routes of Transmission.
• Personal Protective Equipment.
• Disinfection of Equipment
• Exposure Control Plan.
• Exposure Reporting.
• Vaccinations
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Bloodborne Pathogens Standard
• 29 CFR 1910.1030, Occupational Exposure
to Bloodborne Pathogens
• Published December 1991
• Effective March 1992
• Scope
– ALL occupational exposure to blood and other
potentially infectious material (OPIM)
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RISK MANAGEMENT
• Adopt official written risk management
plan, that addresses policies and procedures.
• Develop a plan that addresses training &
PPE.
• Identify potential hazards to all job
functions.
•
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Who is Covered?
• Both fire and ambulance based EMS
providers, and others who are at risk for
exposure to blood or other potentially
infectious materials (OPIM) in the course of
duty
• All members who have been identified as
having occupational exposure must receive
initial training before starting work.
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Are Volunteer Covered?
• The standard states that all fire and EMS
providers are covered under this standard.
• Even if you are not EMS certified, there is
still chances of being exposed at MVA’s, or
EMS assistance (lifting, etc.)
• So, YES volunteers are required under this
standard.
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Infection Control Plan
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Training & Education.
Health Maintenance.
Immunizations.
Exposure Management.
Cleaning and Disposal.
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Training Requirements
• Must have initial training before starting your occupation,
includes volunteers.
• Must have annual in-service training.
• Exposure Control Plan (ECP)
• Engineering and Work Practice Controls
• Personal Protective Equipment (PPE)
• Vaccination, Post-Exposure Follow-up, Record keeping
• Training records must show your attendance, so if you do
not sign the attendance sheet, your fault.
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Blood Borne Pathogen
• Microorganisms such as viruses or bacteria
that are carried in blood and can cause
disease in people.
• There are many different types of pathogens
including malaria, syphilis, and brucellosis,
• Hepatitis B (HBV) and the Human
Immunodeficiency Virus (HIV) are the two
diseases specifically addressed by the
OSHA Bloodborne Pathogen Standard.
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Infectious vs. Communicable
• Infectious – is one that is caused by an
organism entering the body.
• Communicable – is one that can be passed
from one person to another.
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Incubation Period
• The time frame from an exposure to the
time a provider can develop and transmit a
disease to others.
• Time frames vary disease to disease.
• In some cases medications can be
administrated before the incubation period
to prevent disease spread.
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Hepatitis A
• Person to person contact.
• Working in areas of poor
hygiene.
• Occurs after floods or
other major disasters.
• Ingestion of contaminated
food or water.
• 10% to 15% of patients
symptomatic have the
disease up to 6 months.
• 20% to 25% require
hospitalization.
• Severe liver infection.
• Vaccine can help.
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Hepatitis B
• Exposure to infected
blood via open cuts
and scrapes.
• Accidental sticks by
contaminated needles.
• Unsafe sexual
practices.
• Severe liver damage,
cirrhosis.
• Chronic Hep B
infection causes up to
80% of liver cancer.
• Second to tobacco use
in causing cancer.
• Vaccine can help.
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Hepatitis C
• Contact with infected
blood.
• Illicit injectable drug
usage.
• Sexual contact with
infected partners, or
multiple partners.
• Severe liver damage,
liver cancer.
• Estimated 4 million
people in USA with
Hep C.
• Causes 8000-10000
deaths annually.
• Vaccine will not help.
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Hepatitis B (HBV)
• In the US, approximately 300,000 people are
infected annually. Of these cases, a small
percentage are fatal.
• “Inflammation of the liver," and, as its name
implies, HBV is a virus that infects the liver.
• HBV is transmitted primarily through "blood
to blood" contact.
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HBV
• HBV can lead to more serious conditions
such as cirrhosis and liver cancer.
• There is no "cure" or specific treatment for
HBV
• Many who contract the disease will develop
antibodies which help them get over the
infection and protect them from getting it
again.
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HBV Symptoms
• 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
a darkened urine will often occur.
• However, people who are infected with HBV
will often show no symptoms for some time.
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HBV
• After exposure it can take 1-9 months
before symptoms become noticeable.
• Loss 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.
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Human Immunodeficiency Virus
(HIV)
• HIV, is a virus that can lead to acquired
immune deficiency syndrome, AIDS.
• Once a person has been infected with
HIV, it may be many years before AIDS
actually develops.
• HIV attacks the body's immune system,
weakening it so that it cannot fight other
deadly diseases.
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HIV
• AIDS is a fatal disease, and while treatment
for it is improving, there is no known cure.
• Estimates on the number of people infected
with HIV vary, but estimates suggest that an
average of 35,000 are infected every year.
• Many people who are infected with HIV may
be completely unaware of it.
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HIV
• First stage happens when a person is
actually infected with HIV. After the initial
infection, a person may show few or no
signs of illness for many years.
• Second stage, an individual may begin to
suffer swollen lymph glands or other lesser
diseases which begin to take advantage of
the body's weakened immune system.
• Third stage, the body becomes completely
unable to fight off life-threatening diseases
and infections.
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HIV & HBV
If you believe you have been exposed
to HBV or HIV, especially if you have
experienced any of the signs or
symptoms of these diseases, you
should consult your physician or doctor
as soon as possible.
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Bloodborne Transmission
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•
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•
•
Bloodborne pathogens can be transmitted through
contact with infected human blood and other
potentially infectious body fluids such as:
Semen or Vaginal secretions
Cerebrospinal fluid
Amniotic fluid
Saliva (in dental procedures).
Any body fluid that is visibly contaminated with
blood.
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Bloodborne Transmission
INJECTION
– Needle sticks, broken glass, sharp objects
OTHER DIRECT CONTACT
– Splashing of fluids into open cut or sore;
mucous membranes of eyes, nose, mouth
INDIRECT CONTACT
– Touching a contaminated object/surface, then
touching mouth, eyes, nose, open wound
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Airborne Transmission
• Aerosolized droplets spread into the air
when patient…
–
–
–
–
–
Coughs
Speaks
Gags or vomits
Is suctioned
Sneezes
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Fecal-Oral Transmission
• Results from improper
hand washing/hygiene
– After a bowel movement,
bacteria is transmitted to
food or objects via the
hands.
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Does contact with BIOHAZARD material always
lead to infection?
CONTAMINATION
EXPOSURE
INFECTION
How old is pathogen?
How extensive is
contamination?
Length & route of exposure…
How quick was
decontamination?
Severity of exposure…
Virulence of pathogen…
Health of EMT…
Prophylactic drugs…
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Disease Transmission Facts
TUBERCULOSIS
– Airborn, spread by droplets
– Pulmonary infection with symptoms
developing within 2-10 weeks.
– Causes areas of “scar tissue” to develop in
lungs, leading to loss of pulmonary function.
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Disease Transmission Facts
Suspect T.B. when…
– Crowded living conditions (jails, military)
– Has close relative with active T.B.
– Person who:
•
•
•
•
Has HIV
On immunosuppressive drugs
Prolonged steroid therapy
IV drug users
– Recently had positive TB skin test.
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Disease Transmission Facts
Suspect T.B. when…
– Undiagnosed pulmonary or respiratory
infection
– Viral syndrome, night sweats, weight loss
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Productive cough (green or
yellow sputum)
– Coughing up blood
– Difficulty breathing
– Respiratory failure
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Prevention
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Employee education
Hazard Communication
PPE
Labeling all infectious
waste
• Frequent hand washing
• Cleaning equipment
between patients.
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PPE
• Much of the responsibility for PPE rests
with the employee.
• They are responsible for its use to protect
themselves.
• The employer is required to repair, replace,
and dispose of contaminated PPE at no cost
to the employee.
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PPE
• PPE should be selected based on the type of
exposure and the quantity of blood or OPIM
which can be reasonably anticipated to be
encountered during the course of the job
duties.
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PPE
Latex or non-latex gloves
gloves…
The minimum PPE
for every patient
contact.
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PPE
For splash hazards and
large amounts of
fluids…
– Eye protection
– Face mask
– Gown, apron, or
turnout gear
– Shoe covers
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PPE
Highly infectious
respiratory diseases…
– Tuberculosis
– Meningitis
HEPA (high-efficiency
particulate)
respirator
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Personal Protective Equipment - PPE
• Always wear personal protective
equipment in exposure situations.
• Remove/replace PPE that is torn or
punctured, or has lost its ability to
function as a barrier to bloodborne
pathogens.
• Remove PPE before leaving the work
area.
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PPE
If you are working in an area
where there is likelihood of
exposure,
You should never:
• Eat
• Drink
• Smoke
• Apply cosmetics or lip
balm
• Handle contact lenses
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Mask
Eyewear
Bleeding Control with Spurting Blood
Bleeding Control with Minimal Bleeding
Chidlbirth
IV Line Insertion
Endotrachial Intubation
Oral/Nasal Suctioning
Handling/Cleaning Contaminated Items
Measuring Blood Pressure
Measuring Temperature
Gown
Task
Gloves
PPE Guidelines
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
Yes
No
Yes
No
No
No
No
No
No
Yes
No
Yes
No
Yes
Yes
No
No
No
Yes
No
Yes
No
Yes
Yes
No
No
No
This chart is intended as a guideline ONLY.
Appropriate use of PPE is recommended any time skin or mucosa
may be exposed to body fluids.
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Decontamination
• Equipment and tools must be cleaned and
decontaminated before servicing or being put
back to use.
• A solution of 5.25% household bleach / Clorox
diluted between 1:10 and 1:100 with water. The
standard recommendation is to use at least a quarter
cup of bleach per one gallon of water.
• Lysol or some other EPA-registered tuberculocidal
disinfectant. Check the label of all disinfectants to
make sure they meet this requirement.
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Decontamination / Sterilization
Disinfect equipment between patients…
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Decontamination
If you are cleaning up a spill of blood, carefully cover the
spill with paper towels or rags (to prevent splashing).
Then gently pour your 10% solution of bleach over the
towels or rags, and leave it for at least 10 minutes.
This will help ensure that any bloodborne pathogens are
killed before you actually begin cleaning or wiping the
material up.
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Sharps
• Far too frequently, EMT’s and Paramedics
and others are punctured or cut by
improperly disposed needles.
• This, of course, exposes them to whatever
infectious material may have been on the
needle.
• For this reason, it is especially important to
handle and dispose of all sharps carefully in
order to protect yourself as well as others.
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Needles
• Needles should never be recapped.
• Needles should be moved only by using a
mechanical device or tool such as forceps,
pliers, or broom and dust pan.
• Never break or shear needles.
• Needles shall be disposed of in labeled
sharps containers only.
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Sharp’s Container
• Sharps containers shall be
closable, puncture-resistant,
leak-proof on sides and
bottom, and must be labeled
or color-coded.
• When moving sharps
containers, the containers
should be closed immediately
before removal or
replacement to prevent
spillage or protrusion of
contents during handling or
transport.
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Regulated Medical Waste
• Any liquid or semi-liquid blood or other
potentially infectious materials
• Contaminated items that would release blood
or other potentially infectious materials in a
liquid or semi-liquid state if compressed
• Items that are caked with dried blood or other
potentially infectious materials and are
capable of releasing these materials during
handling
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Regulated Medical Waste
• Contaminated sharps
• Pathological and microbiological wastes
containing blood or other potentially
infectious materials
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Disposing of Bio-Hazard Waste
• All regulated waste must be disposed in
properly labeled containers or red
biohazard bags.
• These must be disposed at an approved
facility. Most departments or facilities that
generate regulated waste will have some sort
of contract with an outside disposal company
that will come pick up their waste and take it
to an approved incineration/disposal facility.
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Non-Regulated Medical Waste
• Non-regulated waste that is not
generated by a medical facility such as
EMS operations may be disposed in
regular plastic trash bags if it has no
body fluids, blood or other sources of
bio-hazards.
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In Other Words
Do Not
Bring Back to Quarters
Any Waste From an EMS Call
Get Rid of It At The Hospital!!!
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Hepatitis B Vaccination
• Must be offered to employees/members that have
routine exposure to BBP.
• Three shot series at no cost.
• Although must be offered, employee /member
can decline vaccination. But should sign a
declination release.
• But can still request shots at anytime.
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Hepatitis B Vaccination
• Vaccination made from yeast cultures.
• No risk of getting disease from shots.
• Help build up the body immune system to
the virus.
• Once vaccination, no reason to get shots
again.
• There are booster shots, but may only need
in case of outbreak at a location.
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Hepatitis B Vaccination
Declination Form
For: [Print Name]
I understand that due to my occupational exposure to blood or
other potentially infectious materials I may be at risk of acquiring
hepatitis B virus (HBV) infection. I have been given the
opportunity to be vaccinated with hepatitis B vaccine, at no charge
to myself. However, I decline hepatitis B vaccination at this time. I
understand that by declining this vaccine, I continue to be at risk
of acquiring hepatitis B, a serious disease. If in the future I
continue to have occupational exposure to blood or other
potentially infectious materials and I want to be vaccinated with
hepatitis B vaccine, I can receive the vaccination series at no
charge to me.
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Exposure Control Plan
• An Exposure Control Plan is a written
program that outlines the protective
measures an employer will take to eliminate
or minimize the employees’ exposure to
blood or OPIM.
• At minimum the exposure control plan must
include; exposure determination which
identifies job classifications and tasks where
there is occupational exposure to blood or
OPIM.
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Exposure Control Plan
The exposure control plan must also contain
information and procedures for evaluating
the circumstances surrounding an exposure
incident and documentation of how and
when the plan will be implemented.
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Exposure Control Plan
• Annual review of the plan is required at
minimum.
• The exposure control plan should also be
reviewed whenever changes in tasks, procedures,
or employee positions affect or create new
occupational exposure.
• The plan must be accessible to all employees
while on duty.
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Exposure Control Plan
• A hard copy of the plan must be provided
within 15 working days of an employees
request for a copy.
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What Are Reportable Exposures
• Contact with infectious agents, such as body
fluids.
• Percutaneous events – These are when
blood or other body fluids enter through the
skin. (Needle sticks, bloody sharp object)
• Mucocutaneous events – These are when
blood or other body fluids enter through
mucous membranes. (Fluids splashing into
eye, nose or mouth)
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Exposure Reporting
•
•
•
If you are exposed, however, you should:
Wash the exposed area thoroughly with soap
and running water. Use non-abrasive,
antibacterial soap if possible.
If blood is splashed in the eye or mucous
membrane, flush the affected area with
running water for at least 15 minutes.
Report the exposure to your supervisor/safety
officer as soon as possible.
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Exposure Reporting
•
•
Fill out an exposure report form. This form
will be kept in your personnel file for 40 years
so that you can document workplace
exposure to hazardous substances.
You may also go to your MD or Occupational
Health to request blood testing or the
Hepatitis B vaccination if you have not
already received it.
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Exposure Reporting
• Document the route(s) of exposure and the
circumstances under which the exposure
incident occurred.
• Identify and document the source individual
unless such documentation is impossible or
prohibited by law.
• Test the source individual's blood for HBV
and HIV as soon as possible after consent is
obtained. If the source individual is known to
be seropositive for HBV or HIV, testing for
that virus need not be done.
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Exposure Testing
• Collect your blood as soon feasible, and
test it after your consent is obtained
• You have to wait for 72 hours before blood
can be tested.
• You have to meet with MD one on one to
get test results, not allowed to give over the
telephone.
• Then you need to be retested annually for at
least 3-5 years.
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Prevention—in advance
• Verify immune status
• Hepatitis B Vaccination (series of 3 shots, and
titer)
• Use PPE
• Tuberculin Purified Protein Derivative (PPD)
skin testing (at least annually).
• Proper Decontamination of equipment and
clothing
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Needlestick Safety & Prevention
Act
• Signed into law; November 6, 2000
• Revised Standard published in Federal
Register; Jan. 18, 2001
• Effective date; April 18, 2001
• Enforcement of new provisions; July 17,
2001
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Revisions to Standard
• Additional definitions.
• New requirements in the Exposure Control
Plan.
• Solicitation of input from non-managerial
employees.
• Sharps injury log.
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Engineering Controls
New Definition
“… means controls (e.g., sharps disposal
containers, self-sheathing needles, safer
medical devices, such as sharps with
engineered sharps injury protections and
needleless systems) that isolate or remove
the bloodborne pathogens hazard from the
workplace.”
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Needleless Systems
• Device that does not use a needle for:
– Collection of bodily fluids
– Administration of medication/fluids
– Any other procedure with potential exposure to
a contaminated sharp
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Safety Needle Systems
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ECP – New Provisions
The ECP must be updated to include:
• changes in technology that reduce/eliminate
exposure
• annual documentation of consideration and
implementation of safer medical devices
• solicitation of input from non-managerial
employees
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Solicitation of
Non-Managerial Employees
New Provision
• Identification, evaluation, and selection of
engineering controls
• Must select employees that are:
– Responsible for direct patient care
– Representative sample of those with potential
exposure
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Engineering and Work Practice
Controls: 1910.1030
Employers must select and
implement appropriate engineering
controls to reduce or eliminate
employee exposure.
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Other Things to be Done
• The employer must:
– Identify worker exposures to blood or OPIM
– Review all processes and procedures with exposure
potential
– Re-evaluate when new processes or procedures are used
– Evaluate available engineering controls (safer medical
devices)
– Train employees on safe use and disposal
– Implement appropriate engineering controls/devices
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Engineering and Work Practice
Controls
• The employer must:
– Document evaluation and implementation in
ECP
– Review, update ECP at least annually
– Review new devices and technologies annually
– Implement new device use, as appropriate and
available
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Recordkeeping: 1910.1030(h)
• Sharps Injury Log
– Only mandatory for those keeping records
under 29 CFR 1904
– Confidentiality
– Maintained independently from OSHA 200
At a minimum, the log must contain, for each
incident:
• Type and brand of device involved
• Department or area of incident
• Description of incident
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Things to Review
• Is your training up-to-date.
• Who is your Health/Safety Officer?
• Does your agency have a Exposure Control
Plan?
• Has the plan been reviewed annually?
• Does your agency have a occupational
medicine provider?
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Fire Chief
• Ultimate responsibility for health & safety
of members.
• Ensures that FD has a Infection Control
Plan.
• Although has little direct involvement in
daily operations, must ensure that this is
accomplished.
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Health / Safety Officer
• Has responsibility to ensure that FD has a
effective occupational health and safety
program.
• Might also be the Infection Control Officer.
• Appointed by Fire Chief.
• Who is HFD’s HSO???????
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Infection Control Officer
• Ryan White Care Act of 1990 requires each
FD to name a designated infection control
officer.
• Primary responsibility to act as liaison
between FD and treating facility.
• Ensures availability of PPE, maintain
required records.
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Know Your Rights & Responsibilities
Your Agency Must:
• Provide PPE necessary to do your job.
• Inform you of safety standards.
• Train you in proper procedures.
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Know Your Rights & Responsibilities
You Must:
• Wear PPE when on scene of incident.
• Follow all safety standards and proper
procedures.
• Please protect yourself so you can help
others!!!
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“Let’s Be Careful Out There”
Go Home Safe At The End of
Your Shift
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