Infection Control Policy & Procedure Toggenburg Ski Patrol –Infection Control Policy For Protection of the Members of TSP –Universal Precautions Some Body Fluids of Some Patients Potentially Infectious –Redefined as Body Substance Isolation (BSI) ALL Body Fluids of ALL Patients Potentially Infectious –Airborne Pathogens Respiratory Protection Controls
What can you be exposed to ? Bloodborne Hepatitis B & C HIV SyphilisAirborne Tuberculosis Meningitis Influenza Measles Mumps Chicken Pox Small Pox SARS
How can you be exposed? Bloodborne Needle stick Blood or other body fluids contacting non intact non intact skin, eyes, or mucus membranes. Airborne Inhalation 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.
Bloodborne Pathogens HIV Hepatitis B, C, D, G? Syphilis
Hepatitis Hepatitis Viral Infection A - Food or contaminated water / Poor hygiene B - Bloodborne C - Bloodborne D - Bloodborne - must have HBV E - Food or contaminated water / Poor hygiene G - Not a lot known currently under research
Hepatitis B (HBV) Viral Infection Virulent Lives outside of body for weeks –Dried blood No known cure Destroys the liver Usually Fatal
HIV Cause : HIV Virus Very Fragile – Not Many Virus / Unit of blood Cannot live outside the body for very long Transmission: Blood and many body fluids Incubation: 8 to 11 years Onset: Mild flu-like, fever, headache, rash, swollen glands, then remission and dormant illness
HIV (cont.) Course: AIDS is end-stage of HIV; complications from damaged immunity, infections, pneumonias, cancers; fatal Treatment: Drug treatment to delay onset of AIDS; Post-exposure prophylaxis may be an option within 36 hours of exposure. No cure Prevention: Body Substance Isolation; safe sex Will not live outside the body.
Tuberculosis (TB) Cause : Mycobacterium Tuberculosis Transmission: Airborne droplets Incubation: 1 to 8 weeks - maybe longer Symptoms: Persistent productive cough, weight loss, fever, night sweats, coughing up blood, shortness of breath, fatigue
Tuberculosis (cont.) Treatment: INH, Rifampin, Pyrazinamide Prevention: Respiratory BSI precautions; post- exposure medications can be offered to prevent infection. T.B. test A surveillance form shall be completed annually for those employees who have previously tested positive.
Tuberculosis High risk Groups Homeless people in shelters Alcoholics Prisoners IV drug users HIV infected individuals Residents of long-term care facilities People with previous positive skin tests
Tuberculosis High Risk Groups Contacts of known TB patients Elderly; chronically ill Immunosuppressed Foreign born, especially Asian, African, or Latin America Healthcare ProvidersHealthcare Providers –Ski Patrollers
Signs & Symptoms of TB Frequent Cough Coughing up blood Night Sweats Fever Fatigue Weight loss
SARS Severe Acute Respiratory Syndrome These diseases are grouped in a category know as Febrile (fever causing) Respiratory Illness Infectious
Febrile Respiratory Illness Signs and symptoms of febrile respiratory illness are: –Fever of at least degrees F o –One or more clinical findings of respiratory illness, such as cough, shortness of breath, difficulty breathing, hypoxia;
Respiratory Etiquette Strategy Implement the use of N95 Respirator masks by healthcare personnel, during the evaluation of patients with respiratory symptoms Provide N95 respirator masks to all patients with symptoms of a respiratory illness. Provide instructions on the proper use and disposal of N95 masks.
Respiratory 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 secretions How and where to dispose of them And the importance of hand hygiene
Respiratory Etiquette Strategy (Cont) Continue to use respiratory precautions to manage patients with respiratory symptoms Until it is determined that the cause of symptoms is not an infectious agent
What is an Exposure?: Direct or indirect contact of blood or other body fluids with non-intact skin or mucous membranes
Body Fluids that may contain blood: Breast milk Tears Nasal Secretions Urine Stool Emesis Sweat CSF
Engineering Controls Reduce the risk by removing the hazard or isolating the worker from the hazard
Engineering Controls PPE (G3) –Gloves – Goggles – Gowns Disposable suction components and catheters Disposable BVM Resuscitators Pocket masks Self sheathing needles (Patients may have own) Needle less syringes and medication systems
Work Practice Controls Reduce the hazard the by changing the manner in which the task is performed
Accepted Work Practice Controls Washing hands Use of PPE Not 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 patient Use of Pocket Mask or BVM to ventilate patients
Body Substance Isolation Body Substance Isolation Wash hands before and after patient contact Wash 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 gloves Wear protective eyewear and mask whenever splashing is possible
Body Substance Isolation Wear protective clothing when soiling is likely Use pocket masks and/or Bag-valve-masks (BVMs) to resuscitate Avoid direct patient care when your skin is not intact Follow procedures for handling sharps
Body Substance Isolation Use red bag procedures for contaminated articles Use approved decontamination and cleaning procedures Wear gloves for all contact with blood and body fluids – including during cleaning and decon
Personal Protective Equipment Gloves Gowns Protective eyewear Masks: approved N-95 PPE should be worn during treatment of patients when there is any risk of exposure to blood Body fluids or airborne pathogens.
Hepatitis B Vaccine Hepatitis 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.
What is a Reportable Exposure? Needle sticks Blood or body fluid splash to: –Non-intact skin –Mucous membranes Eyes Nose Mouth
What to do if youve been exposed…. Thoroughly cleanse the area of exposure. Report the Exposure to the Infection Control Officer. –Patrol Leader or Designated Representative Complete the Exposure Report Form The IC Officer will immediately determine exposure classification & contact Patrol Leader Referrals for any necessary post-exposure treatment or follow-up
Post Exposure Evaluation and Follow up
Testing Infection Control Officer or Patrol Leader will seek existing information on the source individual. Have the source individuals 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
Work 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.
Counseling Test results reviewed with the exposed employee Post exposure counseling –Health status –Treatment options. –Information on prophylactic medications.
Treatment Options HIV Post-Exposure Prophylaxis can be offered to those assessed to have suffered a high risk exposure. Prophylaxis medications should be administered –Optimally within 2-3 hours of exposure –Can be provided up to 36 hrs after exposure The risk of transmission of Hepatitis B or Hepatitis C is much greater than the risk of transmission of HIV
Treatment Options (cont) Hepatitis B infection can be prevented Pre-exposure –Prophylactic Hepatitis B vaccine series –No known effective prophylaxis for Hepatitis C Post-exposure –Administration of Hepatitis B immune globulin – May not be as effective as prophylactic vaccine
Labeling Methods for Contaminated Articles Bright fluorescent orange or orange-red colored stickers which contain the biohazard symbol and the word BIOHAZARD in a contrasting color Red biohazard waste bags with the biohazard symbol and the word BIOHAZARD in a contrasting color
The following items shall be labeled: Containers of regulated waste Sharps disposal containers Laundry bags and containers Contaminated equipment for repair or cleaning Containers used to store, transport, or ship blood or other potentially infectious materials
Q & A Beau Blair
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