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Department of Emergency Services and Public Protection Emergency Medical Services “Infection Control” for Emergency First Responders October 01, 2014.

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Presentation on theme: "Department of Emergency Services and Public Protection Emergency Medical Services “Infection Control” for Emergency First Responders October 01, 2014."— Presentation transcript:

1 Department of Emergency Services and Public Protection Emergency Medical Services “Infection Control” for Emergency First Responders October 01, 2014

2 Department of Emergency Services and Public Protection Objectives: Define Terminology & Concepts Identify Means of Transmission Identify Risk Factors Demonstrate P.P.E. Discuss Infection Control Policies and Procedures Answer Questions

3 Department of Emergency Services and Public Protection Introduction Welcome! Class Schedule Breaks Motivation Outline

4 Department of Emergency Services and Public Protection The Infection Control Plan Brief Overview What is it? What does it do? Introduction to Your Plan Location Obtaining a Copy

5 Department of Emergency Services and Public Protection Applicable Laws and Standards 29 CFR CFR CFR NFPA 1500 NFPA 1581 Ryan White Act Connecticut DPH / OEMS Center for Disease Control

6 Department of Emergency Services and Public Protection Communicable Diseases, Epidemiology & Symptoms

7 Department of Emergency Services and Public Protection Principles & Modes of Transmission

8 Department of Emergency Services and Public Protection Four Modes of Disease Transmission Direct ContactDirect Contact Indirect ContactIndirect Contact Airborne TransmissionAirborne Transmission Vector TransmissionVector Transmission

9 Department of Emergency Services and Public Protection Four Elements of Transmission 1.Pathogen ̶ Communicability and Virulence 2.Quantity ̶ Dosage, Duration, & Frequency 3.Susceptibility ̶ Host Resistance

10 Department of Emergency Services and Public Protection Four Elements of Transmission 4.Entry Site –Exposure type Significant Non-Significant Other Factor(s): –Organism Hardiness Environmental Survivability

11 Department of Emergency Services and Public Protection Exposure Severity Significant: –Mucosal Eyes & Mouth Membranes –Percutaneous Puncture, Non-Intact Skin, Human Bite Non-Significant: –Clothing, Intact Skin

12 Department of Emergency Services and Public Protection Six Types of Pathogens Viruses* Bacteria* Fungi Protozoa Rickettsia Parasitic Worms *Most Common

13 Department of Emergency Services and Public Protection Diseases of Concern For the Emergency Responder

14 Department of Emergency Services and Public Protection Some Diseases of Concern Ebola Enterovirus (EV-D68) Hepatitis Herpes Herpes Zoster (Shingles) HIV / Aids Influenza Meningitis Tuberculosis

15 Department of Emergency Services and Public Protection Ebola Ebola hemorrhagic fever (EHF) or simply Ebola is a disease of humans and other primates caused by Ebola viruses. The virus is acquired by contact with blood or other body fluids of an infected human or other animal. May also occur by direct contact with a recently contaminated item May be able to transmit the disease via semen for nearly two months.

16 Department of Emergency Services and Public Protection Ebola Symptoms Fever (greater than 38.6°C or 101.4°F) Severe headache Muscle pain Weakness Diarrhea Vomiting Abdominal (stomach) pain Unexplained hemorrhage (bleeding or bruising)

17 Department of Emergency Services and Public Protection Enterovirus (EV-D68) Enteroviruses are a genus of positive-sense single- stranded RNA viruses associated with several human and mammalian diseases. 71 human Enterovirus serotypes on the basis of antibody neutralization tests. Enteroviruses affect millions of people worldwide each year, and are often found in the respiratory secretions (e.g., saliva, sputum, or nasal mucus) and stool of an infected person.

18 Department of Emergency Services and Public Protection Enterovirus (EV-D68) Enterovirus: EV-D68 was first identified in California in Most people who get infected are infants, children and teens. Infections with Enteroviruses are usually common in the United States during summer and fall. There is no specific treatment for EV-D68. Talk to your child's doctor about the best way to control his or her symptoms.

19 Department of Emergency Services and Public Protection Enterovirus (EV-D68) Symptoms Mild symptoms may include: –Fever –Runny nose –Sneezing –Cough –Body and Muscle aches Severe symptoms may include: –Wheezing –Difficulty breathing

20 Department of Emergency Services and Public Protection Hepatitis Family Viral hepatitis is the most common cause of hepatitis worldwide. Most common causes of viral hepatitis are the five unrelated hepatotropic viruses: –hepatitis A –hepatitis B –hepatitis C –hepatitis D (which requires hepatitis B to cause disease), –hepatitis E

21 Department of Emergency Services and Public Protection Hepatitis Family Transmission: –Fecal / Oral, Body fluids, blood Symptoms: –Fever –Loss of appetite/Nausea –Jaundice –Fatigue –Headache Vaccine Available for Hep A Virus, Hep B Virus

22 Department of Emergency Services and Public Protection Herpes simplex virus 1 and 2 (HSV-1 and HSV-2), also known as human herpes virus 1 and 2 Both HSV-1 (which produces most cold sores) and HSV-2 (which produces most genital herpes) are ubiquitous and contagious. Herpes simplex can be spread through contact with saliva, such as sharing drinks. A cure for herpes has not yet been developed. Once infected, the virus remains in the body for life. Herpes Simplex Virus

23 Department of Emergency Services and Public Protection Transmission: –Transmitted by direct contact with a lesion or the body fluid of an infected individual –Fingers are at particular risk. Symptoms: –Lesions around mouth, Malaise, Sore Throat No vaccine available (Cold Sores) & (Genital) HSV-1 (Cold Sores) & HSV-2 (Genital)

24 Department of Emergency Services and Public Protection The initial infection with Varicella Zoster Virus (VZV) causes the acute, short-lived illness chickenpox which generally occurs in children and young adults. Once an episode of chickenpox has resolved, the virus is not eliminated. (Shingles) Herpes Zoster (Shingles)

25 Department of Emergency Services and Public Protection Transmission: –As with chickenpox and / or other forms of herpes, direct contact with an active rash can spread VZV to a person who has no immunity to the virus. This newly infected individual may then develop chickenpox, but will not immediately develop shingles. (Shingles) Herpes Zoster (Shingles)

26 Department of Emergency Services and Public Protection Earliest symptoms of herpes zoster: –Headache –Fever –Malaise Followed by sensations of: –burning pain –itching –hyperesthesia (oversensitivity) or –paresthesia (“pins and needles”) tingling, pricking, or numbness (Shingles) Herpes Zoster (Shingles)

27 Department of Emergency Services and Public Protection HIV / AIDS The Human Immunodeficiency Virus (HIV) is a lentivirus (a subgroup of retrovirus) that causes the Acquired Immunodeficiency Syndrome (AIDS). Infection with HIV occurs by the transfer of blood, semen, vaginal fluid, pre-ejaculate, or breast milk

28 Department of Emergency Services and Public Protection HIV / AIDS Transmission: –Blood –Body fluids with blood Symptoms: –Fever –Cough –Night sweats –Weight loss No vaccine available

29 Department of Emergency Services and Public Protection Influenza Influenza, commonly known as "the flu", is an infectious disease of birds and mammals caused by RNA viruses of the family Orthomyxoviridae, Typically, influenza is transmitted through the air by coughs or sneezes, creating an aerosol containing the virus. Influenza can also be transmitted by direct contact with bird droppings or nasal secretions, or through contact with contaminated surfaces

30 Department of Emergency Services and Public Protection Influenza Most common symptoms are: –chills –fever –runny nose –sore throat –muscle pains –headache (often severe) –coughing –weakness / fatigue –general discomfort

31 Department of Emergency Services and Public Protection Meningitis An acute inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. May be caused by infection with viruses, bacteria, or other microorganisms

32 Department of Emergency Services and Public Protection Meningitis Bacterial (Rare) –Transmission: Direct Contact with Oral / Nasal Secretions Intimate or Direct Exposure (i.e. Kissing) –Symptoms: Fever >101 F, Sudden Severe Headache Neck / Back Stiffness Mental Changes Rashes Vaccine available

33 Department of Emergency Services and Public Protection Meningitis Viral (Common) –Transmission: Fecal / Oral –Symptoms: Same as Bacterial; Also possible: –Abdominal discomfort –Chest pain –Rash No vaccine available

34 Department of Emergency Services and Public Protection Tuberculosis Tuberculosis typically attacks the lungs, but can also affect other parts of the body. Spread through the air when people who have an active TB infection cough, sneeze, or otherwise transmit respiratory fluids through the air The Mantoux tuberculin skin test is often used to screen people at high risk for TB

35 Department of Emergency Services and Public Protection Tuberculosis Transmission: –Airborne Symptoms: –Fever –Night Sweats –Weight loss –Fatigue Vaccine available

36 Department of Emergency Services and Public Protection Anthrax Chickenpox Smallpox Lyme MRSA Pneumonia (Bacterial & Viral) West Nile Other Diseases of Concern

37 Department of Emergency Services and Public Protection Anthrax Anthrax is an acute disease caused by the bacterium Bacillus anthracis. Most forms of the disease are lethal Anthrax can enter the human body through the intestines (ingestion), lungs (inhalation), or skin (cutaneous) Anthrax does not usually spread from an infected human to a non-infected human. Effective vaccines against anthrax are now available

38 Department of Emergency Services and Public Protection Chickenpox Chickenpox is a highly contagious disease caused by primary infection with Varicell Zoster Virus (VZV). Chickenpox is an airborne disease which spreads easily through coughing or sneezing

39 Department of Emergency Services and Public Protection Smallpox Smallpox was an infectious disease caused by either of two virus variants, Variola major and Variola minor. Transmission occurs through inhalation of airborne variola virus, usually droplets expressed from the oral, nasal, or pharyngeal mucosa of an infected person Smallpox is highly contagious, but generally spreads more slowly and less widely than some other viral diseases

40 Department of Emergency Services and Public Protection Smallpox Incubation period is days Characteristic rash appears 2-3 days after nonspecific, flu-like prodrome (fever and headache) Rash begins on face, hands, forearms and spreads to legs and centrally to trunk; Lesions are more predominant on the extremities than the trunk

41 Department of Emergency Services and Public Protection Smallpox Eczema Vaccinatum

42 Department of Emergency Services and Public Protection And… More Diseases… German Measles (Rubella) Lice Measles Mononucleosis Mumps Scabies Syphilis

43 Department of Emergency Services and Public Protection Anthrax Ebola Hep. Family HIV/AIDS Meningitis TB Chickenpox Pneumonia 1 to 7 days 21 Days 25 days or more >3 Months 2 to 10 days 2 to 12 weeks 14 to 16 days Several days Why is this important to know? Incubation Period(s)

44 Department of Emergency Services and Public Protection Infection Control Plan Health Maintenance System: Concept & Components

45 Department of Emergency Services and Public Protection Health Maintenance (HM) Concept “A system to optimize the health of employees, and to minimize the risk of occupationally acquired illness or injury” A.K.A. “Risk Management!”

46 Department of Emergency Services and Public Protection HM System Components Physical Exam Immunizations PPE Post-exposure protocol Member assistance programs

47 Department of Emergency Services and Public Protection Physical Examination

48 Department of Emergency Services and Public Protection Physical Examination Pre-entry health assessment –Initial exam –Determination of baseline –Fitness for service On Going Assessment –Repeat exams as determined by MD

49 Department of Emergency Services and Public Protection Immunizations Proactive Infection Control

50 Department of Emergency Services and Public Protection Immunizations Proactive program offers protection to: –Employee –Spouse / family members of employee –Emergency response organization –Patients Frequency: –Initial –Annual

51 Department of Emergency Services and Public Protection Common Vaccinations HBV or A/B combo –OSHA requirement to be offered (HBV) (f)(1)(i) Declination statement – App A –Three shot series –Titer recommended by CDC As of 02/09/1990

52 Department of Emergency Services and Public Protection Common Vaccinations Diphtheria-Pertussis-Tetanus (DPT) Measles-Mumps-Rubella (MMR) Polio Influenza Pneumonia Chickenpox Smallpox

53 Department of Emergency Services and Public Protection Personal Protective Equipment Usage Concepts

54 Department of Emergency Services and Public Protection Universal Precautions “Precautions taken to prevent occupational risk exposure to blood and other bodily fluids.” Universal Precautions now referred to as “Standard Precautions” Often “Body Substance Isolation” used in its’ place by First Responders

55 Department of Emergency Services and Public Protection Body Substance Isolation (BSI) “An infection control strategy that considers all body substances as potentially infectious.” Similar to Universal Precautions.. But goes further in isolating workers from Pathogens

56 Department of Emergency Services and Public Protection “Two” “Two” Levels of B.S.I. – P.P.E. “Standard”“Standard” Level of B.S.I. –Everyday calls, First Responder Protection “Isolation”“Isolation” Level of B.S.I.(special circumstances) –Full Body Protection – No Skin Exposed

57 Department of Emergency Services and Public Protection “Standard” Recommended P.P.E. Gloves Eye / Face splash protection Splash Protection – Gowns N95 or N-100 mask Disposable resuscitation equipment

58 Department of Emergency Services and Public Protection “Standard” “Standard” P.P.E. – Gloves

59 Department of Emergency Services and Public Protection “Standard “Standard P.P.E. – Eye Protection

60 Department of Emergency Services and Public Protection “Standard” “Standard” P.P.E. – Gowns Aprons Gowns

61 Department of Emergency Services and Public Protection “Standard” “Standard” P.P.E. – Respiratory Respirators that filter out at least 95% of airborne particles during “worse case” testing using a “most-penetrating” sized particle are given a "95" rating. Those that filter out at least 99% receive a “99” rating. And those that filter at least 99.97% (essentially 100%) receive a “100” rating.

62 Department of Emergency Services and Public Protection “Standard” “Standard” P.P.E. – Kits

63 Department of Emergency Services and Public Protection Disposable Respiratory Devices

64 Department of Emergency Services and Public Protection “Isolation” P.P.E. Gloves – Double Glove Eye / Face splash protection – NO GOGGLES Gowns / Coveralls – Complete Body Coverage Hood – if not part of Splash Protection or PAPR Ensemble Respiratory Protection: PAPR or N95 (Powered Air Purifying Respirator) Boot Covers – if not using a one piece suit Disposable Resuscitation Equipment

65 Department of Emergency Services and Public Protection “Isolation” “Isolation” P.P.E. – Gloves Double Glove is highly recommended; First Pair put on first under sleeve cuff Second Glove over top on top of Sleeve Cuff

66 Department of Emergency Services and Public Protection “Isolation” P.P.E. – Eye Protection CDC is recommending full face shields or full hoods for eye protection. Googles / Glasses tend to “Fog” – Responders then place hands near the eyes to move goggles, thus potentially exposing to disease

67 Department of Emergency Services and Public Protection “Isolation” P.P.E. – Gown / Coveralls

68 Department of Emergency Services and Public Protection “Isolation” P.P.E. – Hood Hoods offer more body protection, usually require PAPR air supply

69 Department of Emergency Services and Public Protection “Isolation” P.P.E. – Respiratory Powered Air Purifying Respirators (PAPR) are recommended for long duration work capacity and reliability

70 Department of Emergency Services and Public Protection “Isolation” P.P.E. – Boot Covers Knee high boot covers are recommended depending on the type of protective suit / coveralls being used

71 Department of Emergency Services and Public Protection “Isolation” P.P.E. – Ventilation Equipment

72 Department of Emergency Services and Public Protection Personal Protective Equipment Proper usage Storage location(s) Proper removal On scene self decontamination Hand Washing Disposal

73 Department of Emergency Services and Public Protection Post Exposure Protocol Critical Information for the Responder

74 Department of Emergency Services and Public Protection You’re operating at the scene of a stressful emergency; You think you’ve just been exposed to blood or body fluids… What do you do? Who do you notify? Should you go to the hospital? What Do You Do?

75 Department of Emergency Services and Public Protection Post Exposure System A post exposure system establishes uniform procedures to protect the health of responders after a possible exposure to communicable diseases

76 Department of Emergency Services and Public Protection Post Exposure System The “Players” –Responders –Supervisors –Infection Control Administrator (ICA) –Infection Control Practitioner (ICP) –Agency Physician (Fire / EMS / Law Enforcement) –Health Department

77 Department of Emergency Services and Public Protection Post Exposure System Components:Components: Notification Verification Treatment / Follow-up care Documentation Counseling

78 Department of Emergency Services and Public Protection Post Exposure System Notification Phase –Responder: Exposure is perceived Reports verbally to IC Completes exposure report –Significant vs. non-significant exposure Contacts workers’ comp. Hotline Notifies Infection Control Administrator

79 Department of Emergency Services and Public Protection Post Exposure System Notification Phase –Supervisor (IC) Visually verifies exposure when feasible Ensures decon and treatment when needed Endorses exposure report Contacts Infection Control Administrator Verifies workers’ comp. has been called

80 Department of Emergency Services and Public Protection Post Exposure System Verification Phase –Starts on scene IC attempts to verify exposure –ICA schedules medical exam Primarily for significant exposures Recommended within 48 hours –ICA contacts receiving facility Ryan White Care Act

81 Department of Emergency Services and Public Protection Ryan White Care Act This act delineates specific notification requirements that allow responders to find out if they have been exposed to an “infectious disease.”

82 Department of Emergency Services and Public Protection Ryan White Care Act Routine Notification –The hospital notifies transporting responders of a potential exposure Within 48 hours Does not apply to non-transporting responders ICP contacts ICA Confidential!

83 Department of Emergency Services and Public Protection Ryan White Care Act Notification by Request –Initiated by local ICA –ICA contacts receiving facility ICP –Reply within 48 hours An exposure took place An exposure did not take place Insufficient information / undetermined –Confidential!

84 Department of Emergency Services and Public Protection Confidentiality Issues You’ve been exposed… –Privacy act limits information that can be given to ICA or CEO by ICP / MD –All information is confidential –You may give your consent –Reality check How hard is it to keep a secret in your agency?

85 Department of Emergency Services and Public Protection Post Exposure System Treatment Phase –May start on scene –Medical Evaluation w/in 48 hours –Testing Initial and follow-up Incubation period –Treatment May be long term Prophylactics

86 Department of Emergency Services and Public Protection Post Exposure System Documentation Phase –Exposure record –Injury / illness report –Workers’ compensation –OSHA

87 Department of Emergency Services and Public Protection Post Exposure System Documentation Phase –ICA conducts follow up review Within a reasonable period of time –Considerations? Does responder need retraining? Does Agency need to alter current procedures? How can this be prevented from happening again?

88 Department of Emergency Services and Public Protection Post Exposure System Counseling Phase –Peer support / CISD –Stress management –Spousal or family counseling –Family protection (e.g. Safe sex practices) –Retraining in infection control, if needed

89 Department of Emergency Services and Public Protection Incident Operations & Recovery The Infection Control Process

90 Department of Emergency Services and Public Protection Incident Operations & Recovery Four phases of response –Preparation for response –Response –Scene management –Post-response recovery

91 Department of Emergency Services and Public Protection Preparation Phase IC Training SOP/SOG Enforcement Storage of PPE (vehicles & station) –Regular inventory, maintenance Personal Hygiene –In and out of the station

92 Department of Emergency Services and Public Protection Response Phase Evaluation of dispatch information –A.K.A. “Size-up” Don PPE en route when possible Prepare mentally Confidentiality and the radio

93 Department of Emergency Services and Public Protection Scene Management Phase Operations at scene –Use BSI / PPE –Limit patient contact –Use mechanical resuscitation devices –Do not recap needles –Handle sharps only when necessary

94 Department of Emergency Services and Public Protection In health care workers, 80% of exposures are due to sharps injuries. The greatest percentage of needle-stick accidents occur during recapping!

95 Department of Emergency Services and Public Protection Scene Management Phase Operations at scene –Use mechanical clean up methods (e.g. Dust pan & brush) –Properly dispose of waste Appropriate containers –Properly package contaminated gear Transport to fire station safely

96 Department of Emergency Services and Public Protection Scene Management Phase Public relations at the scene –Explain universal precautions If patient is uncomfortable with gloves, etc. –Reasonable BSI (e.g. Coveralls for chest pains is overkill)

97 Department of Emergency Services and Public Protection Scene Management Phase Public information at the scene –Patient’s medical status confidential Do not broadcast –Use care when discussing patient’s information at scene Medical information is “need to know”

98 Department of Emergency Services and Public Protection Post Response Phase Proper disposal of PPE –Appropriate containers Red “Bio” bags Sharps containers –Designated decon area Immediate decon (In house) Storage for out-of-house decon

99 Department of Emergency Services and Public Protection Post Response Phase Disinfection, Decon, & Cleaning –Four level’s of disinfection: Low level – Routine ambulance cleaning Intermediate – Typical post response High level – (ie. Intubation equipment) Sterilization – Destroys all micro-organisms

100 Department of Emergency Services and Public Protection Disinfection Low level: –Routine housekeeping –Routine Cleaning –Removal of soil in absence of visible body fluids

101 Department of Emergency Services and Public Protection Disinfection Intermediate level: –Destroys mycobacterium TB –Vegetative Bacteria –Most viruses & Fungi –NOT Bacterial spores –Typical method for ambulances

102 Department of Emergency Services and Public Protection Disinfection Intermediate level: –Three types: EPA registered Disinfectant Commercially available hard surface germicides Water-Chlorine Bleach (1:100) –2 cups bleach to 1 gal. water

103 Department of Emergency Services and Public Protection Disinfection High level: –Destroys all forms of micro-organisms Except large numbers of bacterial spores –Required for reusable instruments Contact with mucous membranes (i.e. Laryngoscope blades)

104 Department of Emergency Services and Public Protection Disinfection Sterilization: –Destroys all micro-organisms –Usually not practical for EMS

105 Department of Emergency Services and Public Protection Post Response Phase Equipment Decontamination –Conducted in designated area –Use appropriate PPE –Gross Decon Mild soap & water –Use appropriate level disinfectant –Air dry in clean storage area

106 Department of Emergency Services and Public Protection Post Response Phase Cleaning of PPE - Uniforms –Decon ASAP upon returning –Store appropriately until laundering –Launder in designated front loading washer or commercially –Follow manufacturers instructions –No chlorine bleach on turnout gear –Do not bring home!

107 Department of Emergency Services and Public Protection Post Response Phase Wash Hands and Exposed Skin OftenWash Hands and Exposed Skin Often Wash ThoroughlyWash Thoroughly Wash with Anti-Bacterial SoapWash with Anti-Bacterial Soap

108 Department of Emergency Services and Public Protection Station / Home Issues Equipment Storage –Ensure proper storage equipment / supplies –Monitor usage levels for inventory Control –Monitor shelf life –Maintain SDS’s

109 Department of Emergency Services and Public Protection Station / Home Issues Laundry Issues: –Commercial front loading washer Automatic pre-metered detergent Computerized cycles High temperature Water completely drains out Again… Do not bring home!

110 Department of Emergency Services and Public Protection Station / Home Issues Designated decontamination area –Separate room, properly marked, secure –Proper ventilation –Adequate drainage, including floor –Non-porous sink with hot & cold water –Automatic water for hand washing –Rack/shelves for drying –Appropriate supplies

111 Department of Emergency Services and Public Protection Program Evaluation On-going risk assessment –Annual Re-Evaluation of: Administrative controls (Management Policy) Engineering controls (Physical changes to the workplace) Work practice controls (Modified methods) PPE Vaccinations

112 Department of Emergency Services and Public Protection Program Evaluation Annual record review –Safety committee Sharps log Injury log Exposure reports Safety Committee

113 Department of Emergency Services and Public Protection Summary Questions & Answers

114 Department of Emergency Services and Public Protection Marc A. Scrivener Fire Service Instructor & Connecticut Fire Academy Staff


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