1. Communicable Disease Education

2. Overview Introduction Infectious Communicable Diseases Definition
Manifestation
Transmission
Exposure Protection
Decontamination
Exposure Procedure

3. Infectious Disease
A disease caused by the growth of disease causing microorganisms in the body.
May or may not be contagious

4. Four Types of Infectious Agents
Bacteria
Virus
Fungus
Parasites

5. Communicable Disease
Transmitted readily from one person to another either directly or indirectly.
Or from animal to human (zoonotic)

6. Exposure/Routes of Infection
Percutaneously
Mucocutaneously
Airborne
Breast Feeding

7. Diseases
HIV
Hepatitis
Tuberculosis
Influenza
Meningitis
MRSA

8. Diseases
Shingles
C. diff
Whooping Cough
Rubella
V.R.E.

9. HIV
HIV is the virus which causes AIDS by damaging a person’s body by destroying specific blood cells, called CD4+ T cells, which are crucial to helping the body fight diseases.

10. HIV Manifestation
Within a few weeks of being infected with HIV, some people develop flu-like symptoms that last for a week or two, but others have no symptoms at all.
AIDS is the late stage of HIV infection, when a person’s immune system is severely damaged and has difficulty fighting diseases and certain cancers.

11. HIV Transmission
Contact with infectious blood, semen, and other body fluids from having sex with an infected person, sharing contaminated needles to inject drugs, or from an infected mother to her newborn.

12. Hepatitis
Inflammation of the liver and also refers to a group of viral infections that affect the liver . The most common types are Hepatitis A, Hepatitis B, and Hepatitis C.

13. Hepatitis Manifestation
Hepatitis A Is a contagious liver disease that results from infection with the Hepatitis A virus. It can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months.

14. Hepatitis Manifestation
Hepatitis B
Ranges in severity from a mild illness, lasting a few weeks (acute), to a serious long-term (chronic) illness that can lead to liver disease or liver cancer.

15. Hepatitis Manifestation
Hepatitis C
Sometimes results in an acute illness, but most often becomes a chronic condition that can lead to cirrhosis of the liver and liver cancer.

16. Hepatitis Transmission
Hepatitis A
Ingestion of fecal matter, even in microscopic amounts, from close person-to-person contact or ingestion of contaminated food or drinks.

17. Hepatitis Transmission
Hepatitis B
Contact with infectious blood, semen, and other body fluids from having sex with an infected person, sharing contaminated needles to inject drugs, or from an infected mother to her newborn.

18. Hepatitis Transmission
Hepatitis C Contact with the blood of an infected person, primarily through sharing contaminated needles to inject drugs.

19. Tuberculosis
Is a disease caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain.

20. Tuberculosis Manifestation
- a bad cough that lasts 3 weeks or longer - pain in the chest - coughing up blood or sputum - weakness or fatigue - weight loss - no appetite - chills - fever - sweating at night

21. Tuberculosis Transmission
TB is spread through the air from one person to another. The TB bacteria are put into the air when a person with active TB disease of the lungs or throat coughs, sneezes, speaks, or sings. People nearby may breathe in these bacteria and become infected.

22. Influenza
A contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death.

23. Influenza Manifestation
Fever* or feeling feverish/chills
Cough
Sore throat
Runny or stuffy nose
Muscle or body aches
Headaches
Fatigue (tiredness)
Some people may have vomiting and diarrhea, though this is more common in children than adults.
* It's important to note that not everyone with flu will have a fever.

24. Influenza Transmission
People with flu can spread it to others up to about 6 feet away. Most experts think that flu viruses are spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Less often, a person might also get flu by touching a surface or object that has flu virus on it and then touching their own mouth or nose.

25. Meningitis
A disease caused by the inflammation of the protective membranes covering the brain and spinal cord known as the meninges. The inflammation is usually caused by an infection of the fluid surrounding the brain and spinal cord. Meningitis is also referred to as spinal meningitis.

26. Meningitis Manifesation
Meningitis infection is characterized by a sudden onset of fever, headache, and stiff neck. It is often accompanied by other symptoms, such as
Nausea
Vomiting
Photophobia (sensitivity to light)
Altered mental status

27. Meningitis Transmission
Bacterial meningitis is contagious. The bacteria are spread through the exchange of respiratory and throat secretions (for example, through coughing or kissing).
Viral meningitis is contagious. The viruses that most often cause viral meningitis are spread person to person through fecal contamination (such as by someone who uses the toilet or changes a baby’s diaper and does not wash her/his hands well afterward).

28. MRSA
Methicillin-resistant Staphylococcus Aureus (MRSA) is a type of staph bacteria that is resistant to certain antibiotics called beta-lactams.

29. MRSA Manifestation
In the community, most MRSA infections are skin infections that may appear as pustules or boils which often are red, swollen, painful, or have pus or other drainage. They often first look like spider bites or bumps that are red, swollen, and painful.

30. MRSA Manifestation
MRSA in healthcare settings usually causes more severe and potentially life-threatening infections, such as bloodstream infections, surgical site infections, or pneumonia. The signs and symptoms will vary by the type and stage of the infection.

31. MRSA

32. MRSA Transmission
Skin infections enters the body through an opening in the skin.
Respiratory MRSA is spread through droplets from coughing, sneezing or speaking.

33. Shingles
Is a painful skin rash caused by the varicella zoster virus (VZV). VZV is the same virus that causes chickenpox. After a person recovers from chickenpox, the virus stays in the body. Usually the virus does not cause any problems; however, the virus can reappear years later, causing shingles.

34. Shingles Manifestation
Shingles usually starts as a rash on one side of the face or body. The rash starts as blisters that scab after 3 to 5 days. The rash usually clears within 2 to 4 weeks.
Before the rash develops, there is often pain, itching, or tingling in the area where the rash will develop. Other symptoms of shingles can include fever, headache, chills, and upset stomach.

35. Shingles

36. Shingles Transmission
Shingles cannot be passed from one person to another. However, the virus that causes shingles, VZV, can be spread from a person with active shingles to a person who has never had chickenpox through direct contact with the rash. The person exposed would develop chickenpox, not shingles. The virus is not spread through sneezing, coughing or casual contact. A person with shingles can spread the disease when the rash is in the blister-phase.

37. C. diff
Clostridium difficile is a bacterium that may develop due to the prolonged use of antibiotics during healthcare treatment.

38. C. Diff Manifestation watery diarrhea fever loss of appetite nausea
abdominal pain/tenderness

39. C. Diff Transmission
Clostridium difficile is shed in feces. Any surface, device, or material (e.g., commodes, bathing tubs, and electronic rectal thermometers) that becomes contaminated with feces may serve as a reservoir for the Clostridium difficile  spores. Clostridium difficile spores are transferred to patients mainly via the hands of healthcare personnel who have touched a contaminated surface or item.

40. Whooping Cough
Pertussis, also known as whooping cough, is a highly contagious respiratory disease. It is caused by the bacterium Bordetella pertussis.

41. Whooping Cough Manifestation
Pertussis is known for uncontrollable, violent coughing which often makes it hard to breathe. After fits of many coughs, someone with pertussis often needs to take deep breathes which result in a "whooping" sound. Pertussis most commonly affects infants and young children and can be fatal, especially in babies less than 1 year of age.

42. Whooping Cough Transmission
People with pertussis usually spread the disease by coughing or sneezing while in close contact with others, who then breathe in the pertussis bacteria.

43. Rubella
An acute viral disease that causes fever and rash.

44. Rubella Manifestation
Rash and fever for two to three days (mild disease in children and young adults)

45. Rubella Transmission
Spread by contact with an infected person, through coughing and sneezing

46. VRE
Enteroccocci are bacteria that are normally present in the human intestines and in the female genital tract and are often found in the environment. These bacteria can sometimes cause infections. Vancomycin is an antibiotic that is used to treat some drug-resistant infections caused by enterococci. In some instances, enterococci have become resistant to this drug and thus are called vancomycin-resistant enterococci (VRE). Most VRE infections occur in hospitals.

47. V.R.E. Manifestation
VRE can live in the human intestines and female genital tract without causing disease (often called colonization). However, sometimes it can cause infections of the urinary tract, the bloodstream, or of wounds associated with catheters or surgical procedures.

48. V.R.E. Transmission
VRE is often passed from person to person by the contaminated hands of caregivers. VRE can get onto a caregiver's hands after they have contact with other people with VRE or after contact with contaminated surfaces. VRE can also be spread directly to people after they touch surfaces that are contaminated with VRE. VRE is not spread through the air by coughing or sneezing.

49. Exposure Protection
Consider ANY patient’s blood or body fluid to be infectious !

50. Exposure Protection anytime you could possibly contact body fluids
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

51. Exposure Protection 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, meningitis, influenza, respiratory MRSA, whooping cough, rubella or V.R.E. patient, put a surgical mask on the patient.

52. Exposure Protection 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)

53. Exposure Protection
Gowns
Indicated for situations such as childbirth or uncontrolled bleeding

54. Exposure Protection Cover Broken Skin
Cuts, abrasions, insect bites, etc. should be protected with a Band-Aid or a dressing

55. Exposure Protection
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
If you had gloves on, or should have had gloves on, wash your hands when you take the gloves off

56. Exposure Protection
Quit licking things! Cross contamination occurs on every call! Change gloves if contaminated before handling other items, wash you hands before eating and disinfect anything that came in contact with the patient.

57. Decontamination
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

58. 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

59. 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

60. Decontamination
All sharps must be transported and disposed of in a heavy, impervious container

61. Decontamination
Items such as blood soaked sheets should be placed in a red 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

62. Exposure Care Percutaineous
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 alcohol until proper disinfecting measures can be taken.

63. Exposure Care Percutaineous Continued
Have emergency department physician assess and provide treatment for wound as needed.
Notify your Supervisor immediately
Document the circumstances concerning the exposure.

64. Exposure Care Mucocutaneously
Flush eye(s) thoroughly for 15 minutes and/or rinse mouth with saline or water
Have emergency department physician assess and provide treatment needed.
Notify your Supervisor immediately
Document the circumstances concerning the exposure.

65. Exposure Procedure Obtain source patient information:
a) Date and time of incident.
b) Name of patient.
c) Name of hospital transported to.
d) Known or suspected diagnosis.

66. Exposure Procedure Ensure First Report filed
Supervisor should ensure that a First Report of Injury is completed. The incident should be called in to the following numbers:
Montgomery County First Report of Injury line:

67. Exposure Procedure
Call the FROMS Injury and Exposure Hotline: Please provide as many details as possible, include patient information and where the employee was treated if the exposure occurred when FROMS was closed. Please also include information regarding whether or not a request was made for source patient testing and results from tests if available

68. Exposure Procedure Obtain testing and treatment for exposed employee.
If FROMS is open:
Employee should come to FROMS if exposure occurs during or close to FROMS hours of operation. Please contact FROMS at the main number to advise them the employee is coming, :
Hours of Operation:
Monday, Tuesday, Wednesday, Friday: 7:30 am 7:00 pm
Thursday: 7:30 am 9:00 pm
Alternate Saturdays: 7:00 am 12:00 pm (check Quick links for dates)

69. Exposure Procedure
FROMS will follow up with hospitals to ensure that appropriate testing of source patient is completed.
If it is determined by the physician that treatment with prophylactic anti-HIV medications ( Post Exposure Prophylaxis , or PEP) is warranted for the employee, FROMS will provide the employee with the first dose and a prescription for the rest.

70. Exposure Procedure
If FROMS is closed-Treatment at Provider, ER, or Urgent Care Center:
The employee may go to any provider, ER, or urgent care center of his/her choice. This includes the hospital to which the source patient was transported. All hospitals in Montgomery County will test and treat the Fire Fighter as long as he/she registers as a patient, with the exception of Suburban Hospital. A good choice is Shady Grove Adventist Hospital, as they have an ongoing relationship with MCFRS.

71. Exposure Procedure
If FROMS is closed-Treatment via Montgomery County Designated Treatment Provider:
All Montgomery County employees may receive treatment for blood borne pathogen exposures and/or other injuries or exposures from Medical Access, a facility which has contracted with the County to provide such care. They are available 24 hours per day, 7 days per week. Information follows:

72. Exposure Procedure Medical Access 19504 Amaranth Drive
Germantown, MD 20874
Hours of Operation:
Monday Friday: 8:30 am 7:30 pm
Saturday, Sunday: 10:00 am 5:00 pm
Telephone numbers
Office
After hours, please call answering service at
**If you do not receive a return call within 30 minutes, please contact Dr. Manbir Takhar directly at **

73. Exposure Procedure
If it is determined that treatment is warranted, the hospital or Medical Access will provide the first dose. They will then either give the employee enough medication to tide them over through the weekend, or give them a prescription.

74. Exposure Procedure
Regardless of the immediate follow up if FROMS is closed, the employee must contact or report to FROMS the next business day.

75. Exposure Procedure Ensure Testing of the Source Patient.
Employee and/or supervisor should contact the Emergency department supervising nurse or physician where the source patient was taken, explain the situation, and request that the following lab tests be performed on the patient:
a) HIV antibody
b) Hepatitis B surface antigen
c) Hepatitis C antibody

76. Exposure Procedure
Maryland law provides that for exposures involving EMS and public safety personnel, HIV testing can be performed on the source patient without consent if the patient is unable or unwilling to give consent. All EMS Duty Officers have been provided with a copy of the law.

77. Summary Introduction Infectious Communicable Diseases Definition
Manifestation
Transmission
Exposure Protection
Decontamination
Exposure Procedure