22011-2012 Infectious Disease Training Review Applicable StandardsReview Infection Control Policy & ProceduresReview Engineering Controls and Work PracticesIdentify PPEDiscuss Body Substance IsolationReview Bloodborne PathogensReview Airborne Pathogens
4Infection Control Policy & Procedure Toggenburg Ski PatrolInfection Control PolicyFor Protection of the Members of TSPUniversal PrecautionsSome Body Fluids of Some Patients Potentially InfectiousRedefined as Body Substance Isolation (BSI)ALL Body Fluids of ALL Patients Potentially InfectiousAirborne PathogensRespiratory Protection Controls
5What can you be exposed to ? BloodborneHepatitis B & CHIVSyphilisAirborneTuberculosisMeningitisInfluenzaMeaslesMumpsChicken PoxSmall PoxSARS
6How can you be exposed? Bloodborne Needle stick Blood or other body fluids contactingnon intact skin,eyes, ormucus membranes.AirborneInhalation of droplets from a person coughing, sneezing, or breathing in close proximity or in an enclosed area. (Patrol Room)Inhalation of droplets from an aerosolized source.
8Hepatitis Hepatitis Viral Infection A - Food or contaminated water / Poor hygieneB - BloodborneC - BloodborneD - Bloodborne - must have HBVE - Food or contaminated water / Poor hygieneG - Not a lot known currently under research
9Hepatitis B (HBV) Viral Infection Virulent Lives outside of body for weeksDried bloodNo known cureDestroys the liverUsually Fatal
10HIV Cause : HIV Virus Very Fragile – Not Many Virus / Unit of blood Cannot live outside the body for very longTransmission: Blood and many body fluidsIncubation: 8 to 11 yearsOnset: Mild flu-like, fever, headache, rash, swollen glands, then remission and dormant illness
11HIV (con’t.)Course: AIDS is end-stage of HIV; complications from damaged immunity, infections, pneumonias, cancers; fatalTreatment: Drug treatment to delay onset of AIDS; Post-exposure prophylaxis may be an option within 36 hours of exposure.No curePrevention: Body Substance Isolation; safe sexWill not live outside the body.
13Tuberculosis (TB) Cause : Mycobacterium Tuberculosis Transmission: Airborne dropletsIncubation: 1 to 8 weeks - maybe longerSymptoms: Persistent productive cough, weight loss, fever, night sweats, coughing up blood, shortness of breath, fatigue
14Tuberculosis (con’t.) Treatment: INH, Rifampin , Pyrazinamide Prevention: Respiratory BSI precautions; post-exposure medications can be offered to prevent infection.T.B. testA surveillance form shall be completed annually for those employees who have previously tested positive.
15Tuberculosis High risk Groups Homeless people in sheltersAlcoholicsPrisonersIV drug usersHIV infected individualsResidents of long-term care facilitiesPeople with previous positive skin tests
16Tuberculosis High Risk Groups Contacts of known TB patientsElderly; chronically illImmunosuppressedForeign born, especially Asian, African, or Latin AmericaHealthcare ProvidersSki Patrollers
17Signs & Symptoms of TB Frequent Cough Coughing up blood Night Sweats FeverFatigueWeight loss
18SARS Severe Acute Respiratory Syndrome These diseases are grouped in a category know as Febrile (fever causing) Respiratory IllnessInfectious
19Febrile Respiratory Illness Signs and symptoms of febrile respiratory illness are:Fever of at least degrees F oOne or more clinical findings of respiratory illness, such as cough, shortness of breath, difficulty breathing, hypoxia;
20Respiratory Etiquette Strategy Implement the use of N95 Respirator masks by healthcare personnel, during the evaluation of patients with respiratory symptomsProvide N95 respirator masks to all patients with symptoms of a respiratory illness.Provide instructions on the proper use and disposal of N95 masks.
21Respiratory Etiquette Strategy (Cont) For patients who cannot wear a respirator mask: (in addition to medical treatment being provided)Provide tissues and instructions on proper use when coughing, sneezing, or controlling nasal secretionsHow and where to dispose of themAnd the importance of hand hygiene
22Respiratory Etiquette Strategy (Cont) Continue to use respiratory precautions to manage patients with respiratory symptomsUntil it is determined that the cause of symptoms is not an infectious agent
23What is an Exposure?: Direct or indirect contact of blood or other body fluids with non-intact skin or mucous membranes
25Body Fluids that may contain blood: Breast milkTearsNasal SecretionsUrineStoolEmesisSweatCSF
26Engineering ControlsReduce the risk by removing the hazard or isolating the worker from the hazard
27Engineering Controls PPE (G3) Gloves – Goggles – GownsDisposable suction components and cathetersDisposable BVM ResuscitatorsPocket masksSelf sheathing needles (Patients may have own)Needle less syringes and medication systems
28Work Practice Controls Reduce the hazard the by changing the manner in which the task is performed
29Accepted Work Practice Controls Washing handsUse of PPENot breaking off or recapping needles – (SHARPS)No eating, drinking, smoking, applying cosmetics or touching contact lens in work areas.Limit the number of people contacting patientUse of Pocket Mask or BVM to ventilate patients
30Body Substance Isolation Wash hands before and after patient contactWash hands immediately when soiled with blood or body fluids.Use Waterless Gel hand cleaner if soap and running water are not available.Wash hands immediately after removing glovesWear protective eyewear and mask whenever splashing is possible
31Body Substance Isolation Wear protective clothing when soiling is likelyUse pocket masks and/or Bag-valve-masks (BVM’s) to resuscitateAvoid direct patient care when your skin is not intactFollow procedures for handling sharps
32Body Substance Isolation Use red bag procedures for contaminated articlesUse approved decontamination and cleaning proceduresWear gloves for all contact with blood and body fluids – including during cleaning and decon
33Personal Protective Equipment GlovesGownsProtective eyewearMasks: approved N-95PPE should be wornduring treatment ofpatients when there is anyrisk of exposure to bloodBody fluids or airborne pathogens.
34Hepatitis B VaccineHepatitis B vaccination (3-shot) series is highly recommended. However, since we are not “employees” by NSP rules & regulations, the Hep-B series would be at your own expense, through your own physician.
35What is a Reportable Exposure? Needle sticksBlood or body fluid splash to:Non-intact skinMucous membranesEyesNoseMouth
36What to do if you’ve been exposed…. Thoroughly cleanse the area of exposure.Report the Exposure to the Infection Control Officer.Patrol Leader or Designated RepresentativeComplete the Exposure Report FormThe IC Officer will immediately determine exposure classification & contact Patrol LeaderReferrals for any necessary post-exposure treatment or follow-up
38TestingInfection Control Officer or Patrol Leader will seek existing information on the source individual.Have the source individual’s blood tested for HIV and Hepatitis B & C, as allowed by law.Exposed employee should be tested for base line HIV and Hepatitis status and antibody level.Subsequent HIV testing should be performed at 6 weeks, 12 weeks, 6 months and 1 year
39Work Related Illnesses Failure to comply with baseline testing, recommendations and or treatments of the physician or infectious disease professional may jeopardize your right to further medical care.
40Counseling Test results reviewed with the exposed employee Post exposure counselingHealth statusTreatment options.Information on prophylactic medications.
41Treatment OptionsHIV Post-Exposure Prophylaxis can be offered to those assessed to have suffered a high risk exposure.Prophylaxis medications should be administeredOptimally within 2-3 hours of exposureCan be provided up to 36 hrs after exposureThe risk of transmission of Hepatitis B or Hepatitis C is much greater than the risk of transmission of HIV
42Treatment Options (con’t) Hepatitis B infection can be preventedPre-exposureProphylactic Hepatitis B vaccine seriesNo known effective prophylaxis for Hepatitis CPost-exposureAdministration of Hepatitis B immune globulinMay not be as effective as prophylactic vaccine
43Labeling Methods for Contaminated Articles Bright fluorescent orange or orange-red colored stickers which contain the biohazard symbol and the word “BIOHAZARD” in a contrasting colorRed biohazard waste bags with the biohazard symbol and the word “BIOHAZARD” in a contrasting color
44The following items shall be labeled: Containers of regulated wasteSharps disposal containersLaundry bags and containersContaminated equipment for repair or cleaningContainers used to store, transport, or ship blood or other potentially infectious materials