Transcript CBT621-EMT11: Infectious Disease

BLS 2014: Infectious Disease
Introduction
 Infectious disease has many potentially
sources
 Bloodborne pathogens
 Airborne pathogens
 Bio-terrorism
Given the worldwide concern about
infectious diseases—as an EMS provider and
a citizen—you are responsible to help
recognize infectious disease, treat your
patients properly, and keep yourself safe.
Objectives
1. Identify the types of PPE and how and when
they should be applied.
2. Identify the characteristic infectious diseases
that are a threat to EMS providers (HIV, HepC,
HBV).
3. Identify appropriate measures for protecting
yourself against infectious diseases.
4. Identify the appropriate actions to take for
exposure to an infectious disease.
Terms

Antibodies — Proteins made by the immune system that
have a memory for an invading virus and help recognize
and destroy future invasions by that virus.

Antibiotic — Medicine or drug that is effective in killing
bacteria or inhibiting their growth.

Bacteria — A single-celled, microscopic organism that
can cause damage to the body's cells. They multiply very
quickly by dividing.
Terms, continued
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Epidemic — An outbreak of a contagious disease that
spreads among many individuals in an area or a
population at the same time.
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Pandemic — An outbreak of a contagious disease that
affects an entire population over a wide geographical
area. A pandemic affects a far higher number of people
and a much larger region than an epidemic.

Parasite — An organism that grows, feeds, and is
sheltered on or in a different organism while
contributing nothing to the survival of its host.
Terms, continued
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Pathogen — An agent that causes disease such as a
bacterium, virus or fungus.
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Vaccine — A preparation of a weakened or disabled virus
that stimulates antibody production and provides
immunity when injected into the body.

Virus — A very small agent made of genetic information
(RNA or DNA) surrounded by a protein coat. It cannot
reproduce on its own but must take over a living cell to
multiply.
Terms, continued

Body Substance Isolation (BSI) — An infection control practice
that assumes all body substances including blood, urine,
saliva, feces, tears, etc., are potentially infectious.

MRSA — Methicillin-resistant Staphylococcus Aureus (MRSA)
are a type of staphylococcus or "staph" bacteria that are
resistant to many antibiotics.

Personal Protective Equipment (PPE) - Specialized clothing or
equipment worn for protection against health and safety
hazards.

Universal Precautions - Universal precautions should be
should be observed on every incident. Universal precautions
include personal protective equipment (PPE) and body
substance isolation (BSI).
Infectious Diseases
MRSA
Methicillin-resistant Staphylococcus Aureus
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Type of staph bacteria
resistant to common
antibiotics
Traditionally associated
with hospitals but now is
epidemic of communityacquired MRSA
Multiplies rapidly causing
many types of infection
ranging from skin
infections to septicemia
and toxic shock syndrome
Cutaneous abscess caused by MRSA
MRSA, continued
 Transmission
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Found commonly on human skin, in nose & throat
and, less commonly, in colon & in urine
Can infect other tissues when skin or mucosal lining
have been breached
Occupational Exposure

Can be spread through contact with pus from
infected wound, skin-to-skin contact with infected
person, & contact with objects such as towels,
sheets, or clothing used by infected person.
MRSA, continued
Pre-hospital Presentation
 Staph infections, including MRSA, generally
start as small red bumps that resemble
pimples, boils, or spider bites
 Can quickly turn into deep, painful abscesses
 Rarely, may also burrow deep into body,
causing potentially life-threatening infections
in bones, joints, surgical wounds, the
bloodstream, heart valves, & lungs.
MRSA, continued
Prevention
 Best defense against MRSA – wash hands
often, especially after contact with other people

Thorough washing with soap & water or alcohol hand
disinfecting gels is effective against MRSA
 Wear a gown when caring for patients with a
known or suspected MRSA infection of the skin
 In some cases MRSA is a respiratory infection
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Patient has known or suspected MRSA skin infection & has a
cough, or has MRSA respiratory infection, wear fitted mask
Put surgical or procedure mask on the patient if they can
tolerate it.
HIV
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AIDS caused by Human Immunodeficiency Virus (HIV)
HIV attacks cells of immune system
Immune system fails & patient becomes susceptible to
"opportunistic" diseases & infections
Chest x-ray of HIV-infected man with
pulmonary Kaposi sarcoma
Kaposi's sarcoma on the skin of an AIDS
patient
HIV, continued
 Transmission:
Unprotected sex with an infected partner
Sharing of needles by IV drug users
Infected mother to her baby
Infected blood given during a transfusion
(extremely rare)
 Occupational transmission usually by a
needle stick of infected blood (also extremely
rare)
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HIV, continued
 Pre-hospital Presentation:
 Depends on which opportunistic disease or
infection the person develops:
 Dehydration & hypotension secondary to
diarrheal diseases
 Seizures or altered mental status secondary to
nervous system infection
 Dyspnea secondary to respiratory infection
 Medication reactions
 End of life issues
HIV, continued
 Occupational Risk:
 The occupational risk of acquiring AIDS is
VERY LOW (less than 2% after a needlestick with
infected blood; much lower after exposure to
mucus membranes)
 Prevention:
 Prevention should focus on preventing
significant blood exposures (needlesticks).
 Post-exposure prophylaxis (PEP) if available if
there is a significant exposure.
Hepatitis C
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Four million persons infected with
Hepatitis C in United States
Caused by hepatitis C virus (HCV)
found in blood of persons who have
disease
Spread by contact with blood of
infected person
Most common chronic bloodborne
viral infection in United States
Can cause cirrhosis of liver & liver
cancer.
Cirrhosis of the liver and liver cancer
Hepatitis C
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Transmission
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Blood & other bodily fluids
Sharing needles with infected person
Sex with infected person
From a woman to her baby during birth
Pre-hospital Presentation
 Hepatitis C infection generally produces no signs or
symptoms during its early stages; may produce none for
years
 If encountered, symptoms may include:
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Fatigue
Nausea
Vomiting
 Poor appetite
 Muscle & joint pain
 Low-grade fever
Hepatitis C
 Occupational Risk
 After needle stick or sharps exposure to HCV
positive blood, about 2 healthcare workers
out of 100 become infected with HCV
 Approximately 20% of patients with Hepatitis
C recover completely following treatment with
interferon and ribavirin
 Prevention
 No effective vaccine for hepatitis C
 Only way to protect yourself – avoid exposure
to infected blood
Hepatitis B
 Caused by hepatitis B virus (HBV), which damages
liver
 Vaccination against HBV has been available since
1982
 Spread by contact with blood of person infected
with the disease or by sexual transmission
Hepatitis B Virus
Hepatitis B, continued
 Transmission:
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Sex with infected person
Blood & other bodily fluids
Sharing needles with infected person
From a woman to her baby during birth
Hepatitis B, continued
 Pre-hospital Presentation:
 Most signs & symptoms of Hep B mild
 Unlikely you will be called to respond to acute
illness caused by this virus
 However you may on occasion see a patient
with end stage liver cancer or other
complications from the disease
Hepatitis B, continued
 Occupational Risk:
 Occupational risk for acquiring HBV from
unvaccinated person is significant. The risk
for a vaccinated person is VERY LOW.
 Prevention:
 Best way to prevent occupational exposure to
HBV, in addition to taking care to protect
yourself from blood exposure, is to be
vaccinated against the disease
Tuberculosis (TB)
 Caused by small bacteria that travels from
small airways to cells of lungs
 Less than 10% of people infected with TB
develop active disease
 In the others, bacteria hides, causing no
disease until host (patient) becomes
immuno-compromised or otherwise
debilitated
Tuberculosis, continued
 Transmission:
 Via small airborne particles expelled by
cough, sneezing, or speaking
 Particles are inhaled into small airways
 Prolonged exposure in confined space
confers highest risk
Tuberculosis, continued
 Pre-hospital Presentation:
 Cough, often productive of blood-tinged
sputum
 Fatigue & weakness
 Night sweats
 Low-grade fever
 Loss of appetite & weight loss
Tuberculosis, continued
 Occupational Risk:
 Occupational risk low but difficult to quantify
 Prevention:
 Maintain high index of suspicion among
patients who are at risk of having TB
 Take precautions if patients present with
suspicious signs & symptoms
Influenza (flu)
 Caused by the influenza virus which
attacks the respiratory system.
 Occurs seasonally from November to April
in the northern hemisphere.
 The structure of the virus changes slightly
but frequently over time; this accounts for
the appearance of different strains each
year.
Influenza (flu), continued
 Transmission:
 Coughed droplets
 Touching contaminated surfaces (less
common)
Influenza (flu), continued
 Pre-hospital Presentation
 Sudden onset of:
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High fever
Malaise
Headache
Dry cough
Body aches
Influenza (flu), continued
Occupational Risk: Varies depending on the strain.
Prevention:
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Hand washing, clean surfaces
Place mask on patient or ask
patient to cover mouth when
coughing
Best prevention is the flu
vaccine, which must be
taken yearly
Best flu prevention is
the flu vaccine
Pandemic Flu
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Outbreak of contagious disease that affects entire
population over a wide geographical area
Caused by influenza virus to which humans have little or
no natural resistance
Such an outbreak has potential to cause many deaths &
illnesses
Past pandemic flu viruses known for virulence causing
rapid death, especially in young people
It is difficult to accurately predict which strain of
influenza may give rise to next pandemic
Pandemic vs. Seasonal
 Pandemic outbreaks different from seasonal
outbreaks of influenza
 Seasonal outbreaks caused by subtypes of
influenza viruses that already circulate among
humans
 Pandemic outbreaks caused by new subtypes

Subtypes never circulated
among people or subtypes
not circulated among people
for a long time
Microbiologist examining reconstructed 1918
Pandemic Influenza Virus
Norovirus
 Highly contagious virus responsible for
outbreaks of gastrointestinal disease on
cruise ships, nursing homes, etc.
 Norovirus is the general name given to
viruses of this type.
 Responsible for many cases of severe but
short-lived illnesses causing vomiting,
diarrhea, and stomach cramps.
 "Stomach flu" and "food poisoning" are
typical infections of a Norovirus.
Norovirus, continued
 Transmission
 Occurs via fecal-oral route
 For example, food handler does not wash his
hands after using bathroom; a person then
ingests food that has been contaminated
with small amounts of fecal matter
Norovirus, continued
 Pre-hospital Presentation
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Nausea, vomiting & diarrhea
Stomach cramps
Low-grade, transient fever
General feeling of malaise, headache, body
aches
Symptoms begin suddenly, may last one to three days,
and usually resolve on their own. Because the disease
is caused by a virus, antibiotics are useless.
Norovirus, continued
 Occupational Risk:
 Community-acquired, usually situations
where large numbers share same food or
living space (cruise ships, college dorms)
 Several outbreaks of noroviruses among staff
at hospitals & nursing homes
Norovirus, continued
 Prevention:
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Wear gloves
Wash your hands thoroughly
Consider use of protective eyewear & mask
Surfaces contacted by the patient must be
thoroughly disinfected
If you become sick, wait two days after the last of your
symptoms before returning to work.
Personal Safety and PPE
Personal Protective Equipment
 Consider possible infectious disease for
every patient that you see.
 Avoid infection from fluids and airborne
particles by using PPE
 Wash your hands frequently
 Decontaminate equipment and surfaces
after use.
Types of PPE
 Fit-tested masks (such as N95 and N100
masks)
 Eye protection (such as glasses, face
shields and goggles)
 Gowns (or suits)
 Gloves
Donning PPE
 Put on PPE before entering the patient
area. Base the PPE you use on your
assessment of risk.
 The sequence for donning PPE is MEGG:
Mask
Eye protection
Gown
Gloves
Doffing PPE
 Remove PPE once call is complete or crew has
left patient area
 Be careful not to contaminate yourself taking it
off
 To remove PPE, reverse the order that you put it
on:
Gloves
Gown—hand washing min 20 sec.
Eye protection
Mask—hand washing min 20 sec.
Hand Washing is Vital
 Single most effective way to prevent
spread of disease
 Soap & water for at least 20 seconds or
with waterless alcohol
 After all patient contact, even if you wore
gloves
Equipment Decontamination
After completing a response to an infectious patient,
must decontaminate everything touched including:
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All equipment that was exposed or crosscontaminated
Outside of kits
Stethoscopes
Radios
AEDs, etc.
Wear new gloves while decontaminating equipment.
Wear clean eye protection and mask if there is splash
risk or vapors.
Masks
 Don a fit-tested mask before entering the
scene.
 Place a mask on the patient, if tolerated.
 Fitted masks provide the highest level of
protection.
 Remove and dispose of the mask without
self contamination.
Eye Protection
 Wear eye protection on all calls. You must
prepare for unanticipated splashes such as:
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Vomiting
Blood flicked from bloody hand
Violent spit
Glucometer strips
Splashing fluids
Respiratory infection
Violent cough or sneeze
Gloves
 Wear medical gloves on all calls
 Most bodily fluids, such as vomit or urine, do not
typically carry blood borne viruses
 While working in rescue or extrication
environment where risk of both cut & body
substance exposure present, wear latex or
nitrile inner gloves & other protective outer
gloves
Glove Up!
Limits of Gloves
 Gloves are for use during patient contact.
 Wash your hands after all patient contact,
even if you wore gloves.
 Gloves will not protect you from sharp
objects such as needles.
Sharps
 Needlesticks represent greatest risk of
occupational blood borne transmission
 Many "exposures" involve cases where
EMS providers inadvertently stuck
themselves with used needles!
 Keep eye on paramedics & needles
 Watch where you put your hands
Needlestick
 For needlestick exposures:
 Wash area well with soap & water
 Do NOT use bleach or other harsh chemicals
 These may damage the skin, making it more likely
for the virus to enter the body
 Report exposure immediately to your officer
for testing and possible post-exposure
prophylaxis
Skin/Mucus
 For exposures to non-intact skin:
 Wash with soap and water.
 Report the exposure immediately to your
officer for testing and possible post-exposure
prophylaxis.
Blood on intact skin is not considered a
significant exposure. Non-intact skin includes
abrasions and cuts.
Skin/Mucus, continued
 For exposures to mucus membranes
(eyes, mouth):
 Flush liberally with water
 Report exposure immediately to your officer
for testing & possible post-exposure
prophylaxis
Airborne
 Report possible exposure to your company
officer
 The hospital may notify exposed responders
if patient is diagnosed with airborne disease
(e.g., TB or bacterial meningitis)
 Some diseases may require automatic &
immediate post-exposure prophylaxis
 Others may require post-exposure testing &
then treatment only if you become positive
PEP for HIV
 Any possible exposure to a blood borne
disease must be reported immediately to
your company officer
 Post-exposure prophylaxis reduces the
already very low risk of acquiring the
disease
 Medications taken for PEP are TOXIC
 If patient is determined to be HIVnegative, PEP medications can be
stopped
Summary
Summary
 Hand washing is the most effective
method of preventing infectious disease
 Clean visible contamination first, then
disinfect surface
 Wear gloves when disinfecting equipment
 Occupational risk of acquiring AIDS is
VERY LOW
Summary, continued
 Best way to prevent occupational
exposure to HBV, in addition to taking
care to protect yourself from blood
exposure, is to be vaccinated
 Remove gloves when you are done with
patient contact, before getting into your
rig, talking on the radio, or driving
Summary, continued
 If you suspect TB, put a mask on patient
(if tolerated), & wear a mask yourself
 Needlesticks represent the greatest risk of
occupational blood borne transmission
 If PEP is to be started, it should be started
IMMEDIATELY after exposure, if at all
possible within two hours
Resources
The recertification exam for this module is
based on a variety of resources. We
recommend that you review the following:
Chapter 2 – Wellbeing of the EMT in Emergency Care
and Transportation of the Sick and Injured, 9th edition
(AAOS).
Questions
EMS Online
Guidelines and Standing Orders
http://www.emsonline.net/downloads.asp
Susan Kolwitz
Program Manager
Email support: [email protected]
Dr. Mickey Eisenberg
Medical Director
Ask the Doc: http://www.emsonline.net/doc.asp