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ENHANCING PERSONAL PROTECTION AGAINST AIRBORNE PATHOGENS N.H. DEPT. OF SAFETY - BUREAU OF EMS AIRBORNE PATHOGENS WORKGROUP UPDATED VERSION - 2009.

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Presentation on theme: "ENHANCING PERSONAL PROTECTION AGAINST AIRBORNE PATHOGENS N.H. DEPT. OF SAFETY - BUREAU OF EMS AIRBORNE PATHOGENS WORKGROUP UPDATED VERSION - 2009."— Presentation transcript:

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2 ENHANCING PERSONAL PROTECTION AGAINST AIRBORNE PATHOGENS N.H. DEPT. OF SAFETY - BUREAU OF EMS AIRBORNE PATHOGENS WORKGROUP UPDATED VERSION

3 5/09NH Bureau of EMS - Airborne Pathogens 2 NOTE TO INSTRUCTORS FOR YOUR CONVENIENCE WE HAVE INCLUDED SPEAKER’S NOTES TO SOME SLIDES THAT FURTHER DISCUSS SOME TOPICS. TO ALERT YOU THAT A SLIDE HAS SPEAKER’S NOTES THE TITLE AT THE TOP OF THE SLIDE WILL BE IN ORANGE INSTEAD OF YELLOW. PLEASE FEEL FREE TO CONTACT US REGARDING QUESTIONS OR SUGGESTIONS ABOUT SPEAKERS NOTES FOR THIS PRESENTATION DELETE THIS SLIDE BEFORE PRESENTING TO AN AUDIENCE

4 5/09NH Bureau of EMS - Airborne Pathogens 3 INTRODUCTION THIS EDUCATIONAL PROGRAM IS INTENDED TO... ENHANCE THE EMS PROVIDERS’ KNOWLEDGE OF RESPIRATORY COMMUNICABLE DISEASES AND, IMPROVE THEIR ABILITY TO PROTECT THEMSELVES AGAINST AIRBORNE PATHOGENS

5 5/09NH Bureau of EMS - Airborne Pathogens 4 INTRODUCTION THIS PROGRAM IS INTENDED TO BE ADDED TO EXISTING EXPOSURE CONTROL PLANS

6 5/09NH Bureau of EMS - Airborne Pathogens 5 COMMUNICABLE DISEASES DISEASES MAY BE TRANSMITTED FROM PERSON TO PERSON BY SEVERAL ROUTES: DIRECT CONTACT INDIRECT CONTACT/FOMITES BLOOD AND BLOODY BODY FLUIDS VECTORS DROPLET INFECTIONS AIRBORNE INFECTIONS

7 5/09NH Bureau of EMS - Airborne Pathogens 6 HANDWASHING THE SINGLE MOST IMPORTANT CONSIDERATION IN AVOIDING THE SPREAD OF ANY DISEASE IS FREQUENT AND THOROUGH HANDWASHING

8 5/09NH Bureau of EMS - Airborne Pathogens 7 SARS SEVERE ACUTE RESPIRATORY SYNDROME (SARS) WAS THE DRIVING FORCE BEHIND THIS EFFORT SARS IS A DEADLY DISEASE FOR WHICH THERE IS CURRENTLY NO VACCINE AND NO CURE AS OF EARLY 2006 SARS WAS NOT A CURRENT THREAT ANYWHERE IN THE WORLD BUT SARS ISN’T THE ONLY DISEASE WE SHOULD BE WORRIED ABOUT….

9 5/09NH Bureau of EMS - Airborne Pathogens 8 HEADLINES April Swine Flu Outbreak Could Result in Worldwide Pandemic Ten children in Colorado dead from flu - AP Boy, 7, dies of the flu: Outbreak grows; run on vaccine - San Francisco Chronicle Flu Vaccine Shortage College student dies as flu rises - Boston Globe Bacterial meningitis cluster hits NH, 4 children in critical condition, 18 year old dead

10 5/09NH Bureau of EMS - Airborne Pathogens 9 THE FOLLOWING OTHER DISEASES ARE AMONG THOSE TRANSMITTED BY THE RESPIRATORY ROUTE INFLUENZA (INCLUDING SWINE FLU & AVIAN FLU) COMMUNITY ACQUIRED PNEUMONIA COMMON VIRAL UPPER RESPIRATORY INFECTION RHINOVIRUS MEASLES MENINGITIS TUBERCULOSIS INHALATIONAL ANTHRAX THE DISEASE WE DON’T KNOW ABOUT YET...

11 5/09NH Bureau of EMS - Airborne Pathogens 10 DO YOU WANT YOURSELF OR YOUR FAMILY EXPOSED TO ANY OF THOSE? NO? YOU CAN PROTECT YOURSELF... MOST OF THE DISEASES ON THE LAST SLIDE REQUIRE A RELATIVELY SIMPLE LEVEL OF PROTECTION, BUT….. BECAUSE OF THE NATURE OF THE SARS VIRUS AND CONSIDERATIONS FOR PROTECTING AGAINST A NOVEL INFLUENZA EPIDEMIC A HIGHER LEVEL OF PROTECTION NEEDS TO BE IN THE PLAN

12 5/09NH Bureau of EMS - Airborne Pathogens 11 MASKS TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (APPE) ARE AVAILABLE & PRACTICAL FOR EMS: SURGICAL MASKN-95 MASK

13 5/09NH Bureau of EMS - Airborne Pathogens 12 MASKS A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER SURGICAL MASK REQUIRES NO FIT TESTING

14 5/09NH Bureau of EMS - Airborne Pathogens 13 MASKS AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS, AND AVIAN FLU PATIENTS FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS, A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL FIT TESTING DETERMINES: – WHICH SIZE MASK TO WEAR, –WHETHER A PROPER SEAL IS POSSIBLE –WHETHER THE EMS PROVIDER HAS ANY MEDICAL CONTRAINDICATIONS TO USING AN N-95 MASK

15 5/09NH Bureau of EMS - Airborne Pathogens 14 MASKS A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A BEARD) OTHER OPTIONS, SUCH AS AVOIDING PATIENT CONTACT OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED

16 5/09NH Bureau of EMS - Airborne Pathogens 15 HOW WILL YOU KNOW WHICH TO USE? THE NH BUREAU OF EMS RECOMMENDS THAT THE USE OF AIRBORNE PPE (APPE) BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS

17 5/09NH Bureau of EMS - Airborne Pathogens 16 HOW WILL YOU KNOW WHICH TO USE? IN EARLY FALL OF 2003 A MULTI-DISCIPLINARY TEAM, SPONSORED BY THE NHBEMS CAREFULLY CONSIDERED THE ENVIRONMENT IN WHICH EMS PROVIDERS PRACTICE, AND RESEARCHED THE APPROPRIATE DEVICES FOR PROVIDERS’ USE. THIS TEAM DEVELOPED GUIDELINES FOR NH EMS PROVIDERS THESE GUIDELINES ARE CONSISTENT WITH OR EXCEED CURRENT CDC RECOMMENDATIONS

18 5/09NH Bureau of EMS - Airborne Pathogens 17 RATIONALE AT THIS TIME THERE’S NO WAY FOR EMS PROVIDERS TO ACCURATELY DETERMINE THE NATURE OF A PATIENT’S RESPIRATORY ILLNESS IN THE FIELD AN N-95 MASK IS AS EFFECTIVE AS (OR BETTER THAN) A SURGICAL MASK AT PROTECTING A HEALTHCARE PROVIDER FROM AIRBORNE PATHOGENS THE BEST WAY TO DEVELOP A GOOD HABIT IS TO PRACTICE IT OFTEN ADHERING TO THE “KEEP IT SIMPLE” (KISS) PRINCIPLE IS A GOOD IDEA

19 5/09NH Bureau of EMS - Airborne Pathogens 18 HOW WILL YOU KNOW WHICH TO USE? THEREFORE…. THE NHBEMS GUIDELINES ADVOCATE THE USE OF N-95 MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE

20 5/09NH Bureau of EMS - Airborne Pathogens 19 SO REMEMBER… N-95 MASK FOR YOURSELF & SURGICAL MASK OR O2 MASK FOR YOUR PATIENT

21 5/09NH Bureau of EMS - Airborne Pathogens 20 YOU REALLY WANT ME TO PUT A SURGICAL MASK ON A PATIENT? YES, BASED ON THE CRITERIA WE’RE ABOUT TO DISCUSS IF THE PATIENT DOESN’T NEED O2 PUT A SURGICAL MASK ON THEM IF THEY DO REQUIRE OXYGEN APPLY A FACE MASK AT THE PROPER LITER FLOW OXYGEN FACE MASKS MAY BLOCK DROPLETS BUT PROBABLY NOT AIRBORNE PATHOGENS YOU MIGHT CONSIDER PUTTING A SURGICAL MASK OVER THE OXYGEN MASK DRAWBACK - CAN’T OBSERVE FOR CYANOSIS OF LIPS

22 5/09NH Bureau of EMS - Airborne Pathogens 21 WHEN SHOULD YOU BE THINKING ABOUT APPLYING APPE? DISPATCH INFORMATION SCENE SAFETY ASSESSMENT PATIENT ASSESSMENT

23 5/09NH Bureau of EMS - Airborne Pathogens 22 WHEN SHOULD YOU CONSIDER APPLYING APPE? DISPATCH INFORMATION –RESPIRATORY DISTRESS, SOB, DIFFICULTY BREATHING –FEVER –RASH –“SICK PERSON” or “ILL CALL” SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE

24 5/09NH Bureau of EMS - Airborne Pathogens 23 WHEN SHOULD YOU CONSIDER APPLYING APPE? SCENE SAFETY ASSESSMENT AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE? IS THE PATIENT COUGHING? –IF YES, YOU SHOULD APPLY YOUR MASK BEFORE PROCEEDING

25 5/09NH Bureau of EMS - Airborne Pathogens 24 WHEN SHOULD YOU CONSIDER APPLYING APPE? PATIENT ASSESSMENT IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE: DOES THE PATIENT HAVE A FEVER? PT/CAREGIVER HAS TAKEN A TEMP PT THINKS HE/SHE HAS A FEVER EMS PROVIDERS TAKE A TEMP IS THE PATIENT COUGHING? DOES THE PATIENT HAVE A RASH?

26 5/09NH Bureau of EMS - Airborne Pathogens 25 IF YES TO ANY OF THE PREVIOUS QUESTIONS…. AND YOU HAVEN’T PUT APPE ON YET - YOU SHOULD BE DOING IT NOW ALSO, ASK IF THE PATIENT HAS BEEN OUTSIDE THE USA WITHIN THE PAST 10 DAYS. IF SO, DOCUMENT WHERE THEY TRAVELED

27 5/09 26 APPE ALGORITHM CHIEF COMPLAINT TYPICAL PQRST QUESTIONS IS PATIENT COUGHING? YESNO MAY FEVER APPLY PRESENT? APPE NO YES DOES PT APPLY HAVE RASH? APPE YES NO APPLYAPPE MAY NOT APPEBE NECESSARY

28 5/09NH Bureau of EMS - Airborne Pathogens 27 YOU MADE THE DECISION TO APPLY APPE NOW EVALUATE THE EFFECTIVENESS IS THE PATIENT’S MOUTH & NOSE COVERED? ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS? HAVE YOU EVALUATED THE SARS OR PANDEMIC FLU (PF) RISK? – ALERT LEVEL –CLINICAL CRITERIA –TRAVEL TO AT RISK AREA –CONTACT WITH ILL PATIENT

29 5/09NH Bureau of EMS - Airborne Pathogens 28 IF HIGH LIKELIHOOD OF PF*/SARS ENSURE N-95 MASKS ARE USED –BY FIT TESTED PERSONNEL –USING THE RIGHT SIZE MASK ALSO USING EYE PROTECTION, GLOVES, GOWN, CAP & BOOTIES AND OTHER PF/SARS PROTECTION * PF – pandemic flu

30 5/09NH Bureau of EMS - Airborne Pathogens 29 OTHER PF/SARS PROTECTION LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (i.e. Nebulizer ) HEPA FILTRATION - BVM, SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES - MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE

31 5/09NH Bureau of EMS - Airborne Pathogens 30 OTHER CONSIDERATIONS ADVISE THE EMERGENCY DEPT. THAT RESPIRATORY PRECAUTIONS ARE IN PLACE, EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE

32 5/09NH Bureau of EMS - Airborne Pathogens 31 CLEANING / DISINFECTION AIR OUT PATIENT COMPARTMENT OF AMBULANCE WEAR PPE DURING CLEANING & DISINFECTION PROCESS WIPE UP FLUIDS USING PAPER TOWELS. DISCARD PAPER TOWELS IN RED BAG. SATURATE AREA WITH CLEANSING AGENT. WIPE AREA REMOVING ALL POSSIBLE ORGANIC MATERIAL. REPEAT UNTIL AREA LOOKS CLEAN. SATURATE AREA WITH DISINFECTANT. ALLOW MINIMUM 10 MINUTES CONTACT TIME. WIPE UP DISINFECTANT, RINSE, AIR DRY. DISPOSE OF CONTAMINATED MATERIALS AND PPE IN BIOHAZARDOUS WASTE CONTAINER. WASH YOUR HANDS !!! Adapted from Holdsworth & Associates © 1993 & CDC guidelines

33 5/09NH Bureau of EMS - Airborne Pathogens 32 CLEANING / DISINFECTION DISINFECTANTS MUST BE LIQUID OR PUMP SPRAY AND RATED AS TUBERCULOCIDAL A SOLUTION OF 1 PART BLEACH TO 10 PARTS WATER IS ACCEPTABLE IF MIXED AT THE TIME OF USE OR WITHIN THE PREVIOUS 24 HOURS. CONSULT CONTAINER LABEL, MSDS, OR MANUFACTURER’S SAFETY RECOMMENDATIONS BEFORE USING CHEMICALS. Adapted from Holdsworth & Associates © 1993 & CDC guidelines

34 5/09NH Bureau of EMS - Airborne Pathogens 33 SAFE REMOVAL / DISPOSAL OF PPE SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL & DISPOSAL OF PPE. PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK, DISPOSABLE GOWNS, BOOTIES, ETC.) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING. ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS. MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED, FOLLOWED BY GLOVES. THOROUGH HANDWASHING WITH EITHER SOAP & WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED.

35 5/09NH Bureau of EMS - Airborne Pathogens 34 SUMMARY BASIC INFECTION CONTROL PRACTICES - UNIVERSAL PRECAUTIONS, FREQUENT HANDWASHING, DISINFECTION, ETC. ARE AN IMPORTANT PART OF EMS PRACTICE THIS PROGRAM’S EMPHASIS ON AIRBORNE PRECAUTIONS FOR CERTAIN PATIENTS IS A MODULE TO FIT INTO YOUR OVERALL EXPOSURE CONTROL PLAN IF YOU FOLLOW THESE GUIDELINES THE LIKELIHOOD THAT YOU WILL CONTRACT PF/SARS ON THE JOB IS SIGNIFICANTLY DECREASED

36 5/09NH Bureau of EMS - Airborne Pathogens 35 SUMMARY THIS PROGRAM IS INTENDED AS A BASELINE FOR ALL EMS PROVIDERS. SOME AGENCIES MAY ELECT TO PROVIDE A MORE EXTENSIVE TRAINING PROGRAM TO ALLOW EMS PROVIDERS TO CHOOSE BETWEEN USING A SURGICAL MASK OR N-95 MASK. THE NH BEMS CONSIDERS THAT AN ACCEPTIBLE OPTION. IN THE ABSENCE OF SUCH TRAINING THE GUIDELINES SUGGESTED IN THIS TRAINING PROGRAM ARE STRONGLY RECOMMENDED.

37 5/09NH Bureau of EMS - Airborne Pathogens 36 THIS PROGRAM IS A WORK IN PROGRESS THE NH BEMS BELIEVES THIS INFORMATION TO BE ACCURATE AS OF MAY 2009 AS INFORMATION CHANGES WE WILL REVISE THE PROGRAM AS NEEDED REFER TO NH BEMS WEBSITE FOR UPDATES

38 5/09NH Bureau of EMS - Airborne Pathogens 37 FOR FURTHER INFORMATION PLEASE CONTACT BILL WOOD EMERGENCY PREPAREDNESS COORDINATOR NH BUREAU OF EMS 33 HAZEN DRIVE CONCORD, NH

39 5/09NH Bureau of EMS - Airborne Pathogens 38 WILL EMERGENCY PERSONNEL WEAR MASKS ? Seattle Police force during the 1918 Spanish Flu epidemic that killed 500,000 Americans. This strain of influenza seemed to target those aged

40 5/09NH Bureau of EMS - Airborne Pathogens 39 QUESTIONS AND COMMENTS

41 5/09 40 THANKS….


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