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Introduction to Infectious Disease Control & Prevention.

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2 Introduction to Infectious Disease Control & Prevention

3 Infectious Disease Control & Prevention 2 Todays 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.

4 Infectious Disease Control & Prevention 3 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

5 Infectious Disease Control & Prevention 4 Bloodborne Pathogens Standard 29 CFR , Occupational Exposure to Bloodborne Pathogens Published December 1991 Effective March 1992 Scope –ALL occupational exposure to blood and other potentially infectious material (OPIM)

6 Infectious Disease Control & Prevention 5 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.

7 Infectious Disease Control & Prevention 6 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.

8 Infectious Disease Control & Prevention 7 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 MVAs, or EMS assistance (lifting, etc.) So, YES volunteers are required under this standard.

9 Infectious Disease Control & Prevention 8 Infection Control Plan Training & Education. Health Maintenance. Immunizations. Exposure Management. Cleaning and Disposal.

10 Infectious Disease Control & Prevention 9 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.

11 Infectious Disease Control & Prevention 10 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.

12 Infectious Disease Control & Prevention 11 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.

13 Infectious Disease Control & Prevention 12 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.

14 Infectious Disease Control & Prevention 13 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.

15 Infectious Disease Control & Prevention 14 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.

16 Infectious Disease Control & Prevention 15 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 deaths annually. Vaccine will not help.

17 Infectious Disease Control & Prevention 16 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.

18 Infectious Disease Control & Prevention 17 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.

19 Infectious Disease Control & Prevention 18 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.

20 Infectious Disease Control & Prevention 19 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.

21 Infectious Disease Control & Prevention 20 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.

22 Infectious Disease Control & Prevention 21 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.

23 Infectious Disease Control & Prevention 22 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.

24 Infectious Disease Control & Prevention 23 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.

25 Infectious Disease Control & Prevention 24 Bloodborne Transmission 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.

26 Infectious Disease Control & Prevention 25 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 Bloodborne Transmission

27 Infectious Disease Control & Prevention 26 Aerosolized droplets spread into the air when patient… –Coughs –Speaks –Gags or vomits –Is suctioned –Sneezes Airborne Transmission

28 Infectious Disease Control & Prevention 27 Results from improper hand washing/hygiene –After a bowel movement, bacteria is transmitted to food or objects via the hands. Fecal-Oral Transmission

29 Infectious Disease Control & Prevention 28 Does contact with BIOHAZARD material always lead to 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… CONTAMINATION EXPOSURE INFECTION

30 Infectious Disease Control & Prevention 29 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. Disease Transmission Facts

31 Infectious Disease Control & Prevention 30 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. Disease Transmission Facts

32 Infectious Disease Control & Prevention 31 Suspect T.B. when… –Undiagnosed pulmonary or respiratory infection –Viral syndrome, night sweats, weight loss Disease Transmission Facts

33 Infectious Disease Control & Prevention 32 Productive cough (green or yellow sputum) –Coughing up blood –Difficulty breathing –Respiratory failure

34 Infectious Disease Control & Prevention 33 Prevention Employee education Hazard Communication PPE Labeling all infectious waste Frequent hand washing Cleaning equipment between patients. Biohazard Label

35 Infectious Disease Control & Prevention 34 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.

36 Infectious Disease Control & Prevention 35 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.

37 Infectious Disease Control & Prevention 36 Latex or non-latex gloves gloves… The minimum PPE for every patient contact. PPE

38 Infectious Disease Control & Prevention 37 For splash hazards and large amounts of fluids… –Eye protection –Face mask –Gown, apron, or turnout gear –Shoe covers PPE

39 Infectious Disease Control & Prevention 38 Highly infectious respiratory diseases… –Tuberculosis –Meningitis HEPA (high-efficiency particulate) respirator PPE

40 Infectious Disease Control & Prevention 39 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.

41 Infectious Disease Control & Prevention 40 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

42 Infectious Disease Control & Prevention 41 PPE Guidelines 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.

43 Infectious Disease Control & Prevention 42 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.

44 Infectious Disease Control & Prevention 43 Disinfect equipment between patients… Decontamination / Sterilization

45 Infectious Disease Control & Prevention 44 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.

46 Infectious Disease Control & Prevention 45 Sharps Far too frequently, EMTs 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.

47 Infectious Disease Control & Prevention 46 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.

48 Infectious Disease Control & Prevention 47 Sharps 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.

49 Infectious Disease Control & Prevention 48 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

50 Infectious Disease Control & Prevention 49 Regulated Medical Waste Contaminated sharps Pathological and microbiological wastes containing blood or other potentially infectious materials

51 Infectious Disease Control & Prevention 50 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.

52 Infectious Disease Control & Prevention 51 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.

53 Infectious Disease Control & Prevention 52 In Other Words Do Not Bring Back to Quarters Any Waste From an EMS Call Get Rid of It At The Hospital!!!

54 Infectious Disease Control & Prevention 53 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.

55 Infectious Disease Control & Prevention 54 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.

56 Infectious Disease Control & Prevention 55 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.

57 Infectious Disease Control & Prevention 56 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.

58 Infectious Disease Control & Prevention 57 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.

59 Infectious Disease Control & Prevention 58 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.

60 Infectious Disease Control & Prevention 59 Exposure Control Plan A hard copy of the plan must be provided within 15 working days of an employees request for a copy.

61 Infectious Disease Control & Prevention 60 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)

62 Infectious Disease Control & Prevention 61 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.

63 Infectious Disease Control & Prevention 62 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.

64 Infectious Disease Control & Prevention 63 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.

65 Infectious Disease Control & Prevention 64 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.

66 Infectious Disease Control & Prevention 65 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 in advance Preventionin advance

67 Infectious Disease Control & Prevention 66 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

68 Infectious Disease Control & Prevention 67 Revisions to Standard Additional definitions. New requirements in the Exposure Control Plan. Solicitation of input from non-managerial employees. Sharps injury log.

69 Infectious Disease Control & Prevention 68 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.

70 Infectious Disease Control & Prevention 69 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

71 Infectious Disease Control & Prevention 70 Safety Needle Systems

72 Infectious Disease Control & Prevention 71 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

73 Infectious Disease Control & Prevention 72 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

74 Infectious Disease Control & Prevention 73 Engineering and Work Practice Controls: Employers must select and implement appropriate engineering controls to reduce or eliminate employee exposure.

75 Infectious Disease Control & Prevention 74 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

76 Infectious Disease Control & Prevention 75 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

77 Infectious Disease Control & Prevention 76 Recordkeeping: (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

78 Infectious Disease Control & Prevention 77 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?

79 Infectious Disease Control & Prevention 78 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.

80 Infectious Disease Control & Prevention 79 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 HFDs HSO???????

81 Infectious Disease Control & Prevention 80 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.

82 Infectious Disease Control & Prevention 81 Know Your Rights & Responsibilities Your Agency Must: Provide PPE necessary to do your job. Inform you of safety standards. Train you in proper procedures.

83 Infectious Disease Control & Prevention 82 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!!!

84 Infectious Disease Control & Prevention 83 Lets Be Careful Out There Go Home Safe At The End of Your Shift

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