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Emergency Medical Services Emergency First Responders

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Presentation on theme: "Emergency Medical Services Emergency First Responders"— Presentation transcript:

1 Emergency Medical Services Emergency First Responders
“Infection Control” for Emergency First Responders October 01, 2014

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

3 Introduction Welcome! Class Schedule Breaks Motivation Outline

4 The Infection Control Plan
Brief Overview What is it? What does it do? Introduction to Your Plan Location Obtaining a Copy

5 Applicable Laws and Standards
29 CFR 29 CFR 29 CFR NFPA 1500 NFPA 1581 Ryan White Act Connecticut DPH / OEMS Center for Disease Control – Bloodborne pathogens. – Respiratory Protection. – Hazard Communication. NFPA 1500 – Fire Department Occupational Safety and Health Program NFPA 1581 – Comprehensive Occupational Medical Program for Fire Departments Ryan White Act – Federally Funded Program for people with HIV / Aids Connecticut Department of Public Health / Office of Emergency Medical Services Center for Disease Control

6 Communicable Diseases, Epidemiology
& Symptoms

7 Principles & Modes of Transmission

8 Four Modes of Disease Transmission
Direct Contact Indirect Contact Airborne Transmission Vector Transmission

9 Four Elements of Transmission
Pathogen Communicability and Virulence Quantity Dosage, Duration, & Frequency Susceptibility Host Resistance

10 Four Elements of Transmission
Entry Site Exposure type Significant Non-Significant Other Factor(s): Organism Hardiness Environmental Survivability

11 Exposure Severity Significant: Non-Significant: Mucosal Percutaneous
Eyes & Mouth Membranes Percutaneous Puncture, Non-Intact Skin, Human Bite Non-Significant: Clothing, Intact Skin

12 Six Types of Pathogens Viruses* Bacteria* Fungi Protozoa Rickettsia
Parasitic Worms *Most Common

13 For the Emergency Responder
Diseases of Concern For the Emergency Responder

14 Some Diseases of Concern
Ebola Enterovirus (EV-D68) Hepatitis Herpes Herpes Zoster (Shingles) HIV / Aids Influenza Meningitis Tuberculosis

15 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 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 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 Enterovirus (EV-D68) Enterovirus: EV-D68 was first identified in California in 1962. 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 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 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 Hepatitis Family Transmission: Symptoms:
Fecal / Oral, Body fluids, blood Symptoms: Fever Loss of appetite/Nausea Jaundice Fatigue Headache Vaccine Available for Hep A Virus, Hep B Virus

22 Herpes Simplex Virus 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.

23 HSV-1 (Cold Sores) & HSV-2 (Genital)
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

24 Herpes Zoster (Shingles)
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.

25 Herpes Zoster (Shingles)
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.

26 Herpes Zoster (Shingles)
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

27 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 lentivirus (a subgroup of retrovirus)

28 HIV / AIDS Transmission: Symptoms: No vaccine available Blood
Body fluids with blood Symptoms: Fever Cough Night sweats Weight loss No vaccine available

29 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 prodrome is an early symptom (or set of symptoms) that might indicate the start of a disease before specific symptoms occur.

30 Influenza Most common symptoms are: chills fever runny nose
sore throat muscle pains headache (often severe) coughing weakness / fatigue general discomfort prodrome is an early symptom (or set of symptoms) that might indicate the start of a disease before specific symptoms occur.

31 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 Meningitis Bacterial (Rare) Vaccine available Transmission: Symptoms:
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 Meningitis Viral (Common) No vaccine available Transmission: Symptoms:
Fecal / Oral Symptoms: Same as Bacterial; Also possible: Abdominal discomfort Chest pain Rash No vaccine available

34 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 Tuberculosis Transmission: Symptoms: Vaccine available Airborne Fever
Night Sweats Weight loss Fatigue Vaccine available

36 Other Diseases of Concern
Anthrax Chickenpox Smallpox Lyme MRSA Pneumonia (Bacterial & Viral) West Nile

37 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 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 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 prodrome is an early symptom (or set of symptoms) that might indicate the start of a disease before specific symptoms occur.

40 Smallpox Incubation period is 12-14 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 prodrome is an early symptom (or set of symptoms) that might indicate the start of a disease before specific symptoms occur.

41 Smallpox Eczema Vaccinatum
Eczema vaccinatum is a rare severe adverse reaction to smallpox vaccination .

42 And… More Diseases… German Measles (Rubella) Lice Measles
Mononucleosis Mumps Scabies Syphilis

43 Why is this important to know?
Incubation Period(s) 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?

44 Infection Control Plan
Health Maintenance System: Concept & Components

45 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 HM System Components Physical Exam Immunizations PPE
Post-exposure protocol Member assistance programs

47 Physical Examination

48 Physical Examination Pre-entry health assessment On Going Assessment
Initial exam Determination of baseline Fitness for service On Going Assessment Repeat exams as determined by MD

49 Proactive Infection Control
Immunizations Proactive Infection Control

50 Immunizations Proactive program offers protection to: Frequency:
Employee Spouse / family members of employee Emergency response organization Patients Frequency: Initial Annual

51 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 Hepatitis B Virus

52 Common Vaccinations Diphtheria-Pertussis-Tetanus (DPT)
Measles-Mumps-Rubella (MMR) Polio Influenza Pneumonia Chickenpox Smallpox

53 Personal Protective Equipment
Usage Concepts

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

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

58 “Standard” P.P.E. – Gloves

59 “Standard P.P.E. – Eye Protection

60 “Standard” P.P.E. – Gowns Gowns Aprons

61 “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 “Standard” P.P.E. – Kits

63 Disposable Respiratory Devices

64 “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 “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 “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 “Isolation” P.P.E. – Gown / Coveralls

68 Hoods offer more body protection, usually require PAPR air supply
“Isolation” P.P.E. – Hood Hoods offer more body protection, usually require PAPR air supply

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

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

71 “Isolation” P.P.E. – Ventilation Equipment

72 Personal Protective Equipment
Proper usage Storage location(s) Proper removal On scene self decontamination Hand Washing Disposal

73 Post Exposure Protocol
Critical Information for the Responder

74 What Do You Do? 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? Help!

75 Post Exposure System A post exposure system establishes uniform procedures to protect the health of responders after a possible exposure to communicable diseases

76 Post Exposure System The “Players” Responders Supervisors
Infection Control Administrator (ICA) Infection Control Practitioner (ICP) Agency Physician (Fire / EMS / Law Enforcement) Health Department

77 Treatment / Follow-up care
Post Exposure System Components: Notification Verification Treatment / Follow-up care Documentation Counseling

78 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 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 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 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 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 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 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 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 Post Exposure System Documentation Phase Exposure record
Injury / illness report Workers’ compensation OSHA

87 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 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 Incident Operations & Recovery
The Infection Control Process

90 Incident Operations & Recovery
Four phases of response Preparation for response Response Scene management Post-response recovery

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

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

93 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 In health care workers, 80% of exposures are due to sharps injuries.
The greatest percentage of needle-stick accidents occur during recapping!

95 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 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 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 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 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 Disinfection Low level: Routine housekeeping Routine Cleaning
Removal of soil in absence of visible body fluids

101 Disinfection Intermediate level: Destroys mycobacterium TB
Vegetative Bacteria Most viruses & Fungi NOT Bacterial spores Typical method for ambulances

102 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 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 Disinfection Sterilization: Destroys all micro-organisms
Usually not practical for EMS

105 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 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 Post Response Phase Wash Hands and Exposed Skin Often Wash Thoroughly
Wash with Anti-Bacterial Soap

108 Station / Home Issues Equipment Storage
Ensure proper storage equipment / supplies Monitor usage levels for inventory Control Monitor shelf life Maintain SDS’s

109 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 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 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 Program Evaluation Annual record review Safety committee Sharps log
Injury log Exposure reports Safety Committee

113 Summary Questions & Answers

114 Fire Service Instructor Connecticut Fire Academy Staff
Marc A. Scrivener Fire Service Instructor & Connecticut Fire Academy Staff

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