1. Montgomery County Fire & Rescue Training Academy
Infection Control
This is a self running show, you can not advance the show prematurely
Montgomery County Fire & Rescue Training Academy

2. May or may not be contagious
INFECTIOUS DISEASE
A disease caused by the growth of disease causing microorganisms in the body.
May or may not be contagious

3. Four Types of Infectious Agents
Bacteria
Virus
Fungus
Parasites

4. Smaller than red blood cells
Bacteria
Smaller than red blood cells
Live on their own, outside body cells
Antibiotics usually effective

5. Herpes Simplex Hard to kill without harming healthy cells
VIRUS
Smaller than bacteria
Must penetrate and inhabit body cells to survive
Herpes Simplex
Hard to kill without harming healthy cells
Solution: Immunization
Measles

6. Basically, the ONLY way to prevent viral infection
VIRUS
Herpes Zoster (Shingles)
Immunization prevents a virus from entering the body cells
Basically, the ONLY way to prevent viral infection

7. FUNGUS
Mold
Yeast

8. Parasites
Intestinal Lice
Tapeworm

9. INFECTIOUS DISEASE Communicable
Transmitted readily from one person to another either directly or indirectly.
Or from animal to human (zoonotic)
Mosquitoes , Bats, Rabid Animals

10. Chain of Infection is required for a person to become infected
Infectious
Agent
Reservoir
Susceptible
Host
Means of
Entry
Means of
Exit
Mode of
Transmission

11. EXPOSURE/ROUTES OF INFECTION for F/R Personnel
Percutaneously
Mucocutaneously
Airborne

12. PERCUTANEOUSLY
Through the skin or any situation where the patient’s blood may enter an open wound.
i.e.... Needle Stick

13. MUCOCUTANEOUSLY
Across the mucus membranes, patient’s blood or body fluids come in contact with the care providers:
Eyes
Nose
Mouth

14. AIRBORNE INFECTION:
Droplet infection, transmitted by inhaling droplets from infected carrier by coughing, sneezing, or talking

15. Bloodborne
Diseases

16. HUMAN IMMUNODEFICIENCY
VIRUS
HIV attacks the body’s immune system, making the body vulnerable to opportunistic diseases.

17. While HIV is fatal, infected persons usually die from the opportunistic diseases that overwhelm the body.
Pneumonia
Tuberculosis (TB)
Toxoplasmosis (protozoan infection)
Some Cancers
Diarrheal Disease

18. HIGH- RISK HIV PATIENTS
Homosexual Males
Users of Injectable Drugs
Sexually Promiscuous
Babies born of HIV mother

19. Acquired Immune
Deficiency Syndrome

20. May take years to develop
AIDS
Late stage HIV disease, when opportunistic diseases develop
May take years to develop

21. ROUTE OF INFECTION HIV is a blood borne disease and:
Semen, Cervicovaginal Fluid, Breast Milk
Saliva has not been discounted or proven, but the HIV virus is found in it, although in small amounts.
HIV infected blood has approximately 1 thousand viral particles per milliliter (ml.).

22. INCUBATION PERIOD
Disease may develop in a matter of months or take several years.
Antibodies usually detected by a blood test 2 weeks to 3 months after infection.
May develop later in a small percentage of persons

23. Illness, disability, and except in rare instances, DEATH!
Prognosis:
HIV/AIDS has become more manageable.
It is a chronic disease for many people, but still has no definite cure or vaccine
Illness, disability, and except in rare instances, DEATH!

24. Now Hepatitis D, E, F & G Hepatitis Type A (HAV) Type B (HBV)
Type C (HCV)
Now Hepatitis D, E, F & G

25. Hepatitis type A Highly contagious
Usually transmitted via the fecal - oral route
Outbreaks of type A hepatitis often occur after people have eaten seafood that came from contaminated water.
Common exposures occur in care facilities such as convalescent / nursing homes, mental institutions, day care centers and schools

26. Incubation 15 to 50 days, depending on dose Average of 28 to 30 days
Hepatitis type A
Incubation
15 to 50 days, depending on dose
Average of 28 to 30 days

27. PROGNOSIS Hepatitis type A
In most patients with HAV, liver cells eventually regenerate with little or no residual damage.
Patients usually recover readily, with a life-long immunity to hepatitis type A, but not type B or type C
Old age & serious medical conditions (CHF, severe anemia, diabetes) make complications more likely.

28. Description: HEPATITIS B
A generalized inflammation of the liver caused by HBV that attacks and destroys liver cells.
Description:

29. HIGH-RISK PATIENTS Homosexual Males Users of Injectable Drugs
Sexually Promiscuous (Multiple Partners)
Prostitutes (sex for money or drugs)
(homosexual and/or heterosexual)
Babies born/breast feeding HBV mother
NOTE: Some blood bank statistics report as many as 80% of homosexual males have been exposed to HBV

30. Route of Infection:
Classified as a blood borne disease, considered to be spread by contact with body fluids such as:
Blood
Saliva
Semen
Vaginal Fluid
Note: HBV has approximately 1 billion viral particles per milliliter of blood, making HBV much more infectious than HIV and more difficult to kill on surfaces

31. RECOMBIVAX VACCINE
Available to all Montgomery County Fire & Rescue personnel, career and volunteer, through Fire Rescue Occupational Medical Services (FROMS) at no charge.

32. with the average being 60-90 days.
INCUBATION PERIOD:
days
[6-weeks to 6-months]
with the average being days.

33. PROGNOSIS:
If detected early, prognosis is good. Although not usually fatal, it causes many liver diseases, such as cirrhosis and causes up to 80% of all liver cancer.
Despite the fact that Hepatitis B is curable, it still causes about 200 deaths to HEALTHCARE WORKERS each year.

34. Hepatitis C (HCV)
Thought to be leading cause of hepatitis resulting from blood transfusions.
NOT transmitted efficiently by sexual contact
Primarily a BLOODBORNE disease:
Single needle stick can contaminate
Greater likelihood of becoming a chronic carrier of HCV after infection.
No current vaccine
Immune globulin (IG) following exposure to HCV provides temporary, passive immunity.

35. Transmitted By Mosquitoes
West Nile Virus a
Bloodborne Disease
Transmitted By Mosquitoes

36. Airborne
Diseases

37. TB
Tuberculosis

38. A bacterial infection that infects via the respiratory systemTB
Usually settles in the lower 2/3 of the lungs, where ventilation (exchange) is minimal.
May spread to lymph nodes and other areas: brain, meninges, kidneys, adrenal glands, stomach, intestines, peritoneum and bones.

39. High-Risk Persons Recent Immigrants
Persons living in overcrowded / poverty conditions (homeless).
Persons with low immunity
HIV, Cancer, Long term steroid use, Elderly
Alcohol/Drug abusers

40. Long-term care facility residents Close contact of TB patients
High-Risk Persons
HIV Infected persons
Correctional Inmates
Long-term care facility residents
Close contact of TB patients
Substance Abusers

41. High-Risk Persons
Foreign-born individuals from countries with high incidence of TB
Health-care workers providing care to high-risk groups
Persons with previous Hx of TB
People in Poverty: Crowded conditions, poor sanitation, poor nutrition

42. Multi-Drug Resistant TB
MDR-TB
Multi-Drug Resistant TB
Usually found only in high-density population areas
Common in DC, New York

43. PROGNOSIS:
After several weeks, otherwise healthy patients may develop a specific immunity, encapsulating the TB bacteria in granular tumors.
These granulomas usually remain dormant for life, but are capable of producing the disease again at any time.
If untreated, 8-20% of TB patients will develop serious diseases.

44. Route of Infection:
Droplet infection, transmitted by inhaling droplets from infected carrier by coughing, sneezing, or talking

45. EMERGENCY CARE: A-B-C, O2 as needed
NIOSH approved face masks for all EMS personnel
Disposable surgical masks on:
Patient, unless on O2
Family members riding in the ambulance
Notify hospital of potential TB patient so they may prepare respiratory isolation.
Ventilate back of ambulance by opening windows
TB Bacillus is very sensitive to light and air.

46. MENINGITIS

47. DESCRIPTION:
Inflammation of the membranes of the brain and spinal cord (meninges). Meningitis may be caused by
Bacteria
Virus
Other organism that reaches the meninges by:
Bloodstream
Lymphatic System
Trauma (open wounds)
From adjacent sinuses

48. Patients at High-Risk Persons in overcrowded / poor living conditions
Homeless
Schools & Colleges
Institutions
Military Barracks
Persons with low immunity
HIV, Cancer, Long term use of steroids

49. VERY SERIOUS IF:
Petechiae (small, purple, spider-like hemorrhage spots on skin)
Signs of Infection
Chills
Low Or Dropping B/P
Rapid, Shallow Respirations
Rapid Pulse
Purpura - purple spots that don’t turn
white when pressed

50. Route of Infection DROPLET
Transmitted by inhaling droplets from coughing, sneezing or talking by the infected carrier
Saliva Exchange

51. Prognosis: Favorable with PROMPT diagnosis & treatment
May leave long term neurological disorders if diagnosis and/or treatment are delayed.
Potentially fatal
Most serious in
Children (especially neonates)
Elderly

52. EMERGENCY CARE: A-B-C, O2 as needed
NIOSH approved face masks for all F/R personnel
Disposable surgical masks on:
Patient, unless on O2
Family members riding in the ambulance
Notify hospital of potential meningitis patient so they may prepare respiratory isolation.
Ventilate back of ambulance by opening windows

53. Best Defense Against Infection:
PREVENTION

54. BODY
SUBSTANCE
ISOLATION

55. Body Substance Isolation Eliminates the Means of Entry
Infectious
Agent
Susceptible
Host
Reservoir
Means of
Entry
Means of
Exit
Mode of
Transmission

56. Body Substance Isolation
Consider ANY patient’s blood or body fluid to be infectious
GLOVES : All fire/Rescue personnel MUST don appropriate protective gloves PRIOR to arrival at the scene of any EMS incident
Anytime you could possibly contact body fluids
During extrications, wear under heavy gloves
While decontaminating &/or disinfecting

57. MASKS
Wear in any situation in which blood or body fluids could be splashed in your face, or droplet infection is suspected.
With a potential or known TB or meningitis patient, put a surgical mask on the patient.
Mouth-to-mouth ventilations should not be performed, rescuer should use a pocket mask with a one-way valve

58. EYE PROTECTION
Wear any time blood or body fluids could be splashed in your eyes, such as active bleeding, vomiting or mentally disturbed patients (spit)

59. GOWNS
Indicated for situations such as childbirth or uncontrolled bleeding
Blood-soiled gowns and/or other contaminated clothing is considered infectious.

60. PROTECT BROKEN SKIN
Cuts, abrasions, insect bites, etc. should be protected with a Band-Aid or a dressing.

61. SHARPS
IV needles, etc. are to be placed in a sharpe-safe container as soon as possible
NEVER leave on seat, litter or squad bench
NEVER leave ANY contaminated materials or sharps at the scene or patient's residence
NEVER recap a used needle: put it in a sharps container.

62. WASH YOUR HANDS !!!
With disinfectant or anti-bacterial soap as soon as possible after every call.
At the hospital
After handling items soiled with blood or body fluids
Wash your hands when you take the gloves off

63. Cleaning/Decontamination Procedures
All non-disposable equipment used in patient care should be cleaned after each use
Any equipment in contact with body fluids needs to be cleaned and disinfected
Wear gloves and other protective devices as needed
Clean with detergent, etc. To remove dirt, blood, etc. You cannot disinfect a surface that is dirty

64. Cleaning & Decontamination
After cleaning, DISINFECT the equipment by using one or more of the following agents:
A freshly mixed solution of 1 part bleach to 9 parts of water
For non-metallic surfaces
Especially effective on fresh (non-dry) blood spills
Contact time: minutes for high level disinfection, followed by clear water rinse & air dry

65. Cleaning & Decontamination
Disinfectant Soaps:
May be used on most equipment where a high level disinfection is not necessary
70 % Isopropyl alcohol:
Contact time : 5-30 minutes
Is NOT EFFECTIVE in presence of blood or dirt
Good for use on skin, metals, and electrical equipment
3 % Hydrogen Peroxide
Not recommended for high-level disinfection
Good for removing blood on fabrics

66. DISPOSABLE ITEMS
All sharps MUST BE transported and disposed of in a approved Sharps container………ONLY!

67. DISPOSABLE ITEMS
Items such as blood soaked sheets should be placed in a red BIOHAZARD impervious plastic bag & transported to the hospital with the patient.
DO NOT throw the sheets in the hamper
Each station must have an approved bio-hazard waste container. They are disposed of by an approved bio-hazard contractor

68. EXPOSURE TO INFECTIOUS DISEASE

69. WHAT IS NOT A PERCUTANEOUS EXPOSURE ?
Blood or body fluids on equipment
Blood or body fluids on clothing with intact skin underneath
Blood or body fluids on intact skin unless it is a LARGE quantity of blood & a prolonged exposure (i.e. greater than 20 mins)
BLOODBORNE diseases CANNOT be transmitted by talking to or touching an infected person

70. EXPOSURE PROCEDURE Immediate Self-Care: Percutaneous
Wipe off excess blood from skin and scrub area with soap & water or antiseptic hand cleaner for 5-10 minutes.
If the wound is bleeding, allow it to bleed to remove any contaminants.
If soap & water are not immediately available apply your issued Antiseptic Handwash from your fanny pack until proper disinfecting measures can be taken.

71. EXPOSURE PROCEDURE Immediate Self-Care: Mucocutaneous
Flush eye(s) thoroughly for 15 minutes and/or rinse mouth with saline or water.
As soon as patient care allows, or upon arrival at the hospital, wash your hands and the wound thoroughly.
Wash face as necessary.
Have emergency department physician assess and provide treatment for wound as needed.

72. EXPOSURE PROCEDURE Immediate Self-Care
Access the DRFS-STP Infectious Disease web site and click on “Exposure” for the current, complete exposure procedure.

73. FOLLOW UP PROCEDURE Notify your Supervisor immediately
Document the circumstances concerning the exposure.
Career personnel must follow Policy & Procedure #807.
If you were not on the transporting unit, regardless of the type of exposure, report to the hospital ED for the appropriate treatment.

74. FOLLOW UP PROCEDURE
For both Career and Volunteer personnel: notify Fire & Rescue Occupational Medical Section (FROMS) at as soon as possible following an exposure.
If it is determined that a patient that was treated has a communicable disease, the EMS section of the DFRS will notify the individuals departments.

75. FOLLOW UP PROCEDURE
It is extremely important that the run sheets be left for all transported patients with the Emergency Department as well as properly listing all personnel that were involved with the incident on the MAIS report & FIREHOUSE!!!!

76. QUESTIONS Contact the On-Duty EMS captain.
Reference the Website on Quicklinks