4The Infection Control Plan Brief OverviewWhat is it?What does it do?Introduction to Your PlanLocationObtaining a Copy
5Applicable Laws and Standards 29 CFR29 CFR29 CFRNFPA 1500NFPA 1581Ryan White ActConnecticut DPH / OEMSCenter for Disease Control– Bloodborne pathogens.– Respiratory Protection.– Hazard Communication.NFPA 1500 – Fire Department Occupational Safety and Health ProgramNFPA 1581 – Comprehensive Occupational Medical Program for Fire DepartmentsRyan White Act – Federally Funded Program for people with HIV / AidsConnecticut Department of Public Health / Office of Emergency Medical ServicesCenter for Disease Control
12Six Types of Pathogens Viruses* Bacteria* Fungi Protozoa Rickettsia Parasitic Worms*Most Common
13For the Emergency Responder Diseases of ConcernFor the Emergency Responder
14Some Diseases of Concern EbolaEnterovirus (EV-D68)HepatitisHerpesHerpes Zoster (Shingles)HIV / AidsInfluenzaMeningitisTuberculosis
15EbolaEbola 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 itemMay be able to transmit the disease via semen for nearly two months.
16Ebola Symptoms Fever (greater than 38.6°C or 101.4°F) Severe headache Muscle painWeaknessDiarrheaVomitingAbdominal (stomach) painUnexplained hemorrhage (bleeding or bruising)
17Enterovirus (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.
18Enterovirus (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.
19Enterovirus (EV-D68) Symptoms Mild symptoms may include:FeverRunny noseSneezingCoughBody and Muscle achesSevere symptoms may include:WheezingDifficulty breathing
20Hepatitis FamilyViral hepatitis is the most common cause of hepatitis worldwide.Most common causes of viral hepatitis are the five unrelated hepatotropic viruses:hepatitis Ahepatitis Bhepatitis Chepatitis D (which requires hepatitis B to cause disease),hepatitis E
21Hepatitis Family Transmission: Symptoms: Fecal / Oral, Body fluids, bloodSymptoms:FeverLoss of appetite/NauseaJaundiceFatigueHeadacheVaccine Available for Hep A Virus, Hep B Virus
22Herpes Simplex VirusHerpes simplex virus 1 and 2 (HSV-1 and HSV-2), also known as human herpes virus 1 and 2Both 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.
23HSV-1 (Cold Sores) & HSV-2 (Genital) Transmission:Transmitted by direct contact with a lesion or the body fluid of an infected individualFingers are at particular risk.Symptoms:Lesions around mouth, Malaise, Sore ThroatNo vaccine available
24Herpes 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.
25Herpes 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.
26Herpes Zoster (Shingles) Earliest symptoms of herpes zoster:HeadacheFeverMalaiseFollowed by sensations of:burning painitchinghyperesthesia (oversensitivity) orparesthesia (“pins and needles”)tingling, pricking, or numbness
27HIV / AIDSThe 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 milklentivirus (a subgroup of retrovirus)
28HIV / AIDS Transmission: Symptoms: No vaccine available Blood Body fluids with bloodSymptoms:FeverCoughNight sweatsWeight lossNo vaccine available
29InfluenzaInfluenza, 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 surfacesprodrome is an early symptom (or set of symptoms) that might indicate the start of a disease before specific symptoms occur.
30Influenza Most common symptoms are: chills fever runny nose sore throatmuscle painsheadache (often severe)coughingweakness / fatiguegeneral discomfortprodrome is an early symptom (or set of symptoms) that might indicate the start of a disease before specific symptoms occur.
31MeningitisAn 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
32Meningitis Bacterial (Rare) Vaccine available Transmission: Symptoms: Direct Contact with Oral / Nasal SecretionsIntimate or Direct Exposure (i.e. Kissing)Symptoms:Fever >101 F, Sudden Severe HeadacheNeck / Back StiffnessMental ChangesRashesVaccine available
33Meningitis Viral (Common) No vaccine available Transmission: Symptoms: Fecal / OralSymptoms:Same as Bacterial; Also possible:Abdominal discomfortChest painRashNo vaccine available
34TuberculosisTuberculosis 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 airThe Mantoux tuberculin skin test is often used to screen people at high risk for TB
35Tuberculosis Transmission: Symptoms: Vaccine available Airborne Fever Night SweatsWeight lossFatigueVaccine available
36Other Diseases of Concern AnthraxChickenpoxSmallpoxLymeMRSAPneumonia (Bacterial & Viral)West Nile
37AnthraxAnthrax is an acute disease caused by the bacterium Bacillus anthracis.Most forms of the disease are lethalAnthrax 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
38ChickenpoxChickenpox 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
39SmallpoxSmallpox 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 personSmallpox is highly contagious, but generally spreads more slowly and less widely than some other viral diseasesprodrome is an early symptom (or set of symptoms) that might indicate the start of a disease before specific symptoms occur.
40Smallpox 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 trunkprodrome is an early symptom (or set of symptoms) that might indicate the start of a disease before specific symptoms occur.
41Smallpox Eczema Vaccinatum Eczema vaccinatum is a rare severe adverse reaction to smallpox vaccination .
42And… More Diseases… German Measles (Rubella) Lice Measles MononucleosisMumpsScabiesSyphilis
43Why is this important to know? Incubation Period(s)AnthraxEbolaHep. FamilyHIV/AIDSMeningitisTBChickenpoxPneumonia1 to 7 days21 Days25 days or more>3 Months2 to 10 days2 to 12 weeks14 to 16 daysSeveral daysWhy is this important to know?
44Infection Control Plan Health Maintenance System:Concept & Components
45Health Maintenance (HM) Concept “A system to optimize the healthof employees, and to minimizethe risk of occupationallyacquired illness or injury”A.K.A. “Risk Management!”
46HM System Components Physical Exam Immunizations PPE Post-exposure protocolMember assistance programs
54Universal 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
55Body Substance Isolation (BSI) “An infection control strategy that considers all body substances as potentially infectious.”Similar to Universal Precautions .. But goes further inisolating 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. GlovesEye / Face splash protectionSplash Protection – GownsN95 or N-100 maskDisposable resuscitation equipment
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.
64“Isolation” P.P.E. Gloves – Double Glove Eye / Face splash protection – NO GOGGLESGowns / Coveralls – Complete Body CoverageHood – if not part of Splash Protection or PAPR EnsembleRespiratory Protection: PAPR or N95(Powered Air Purifying Respirator)Boot Covers – if not using a one piece suitDisposable Resuscitation Equipment
65“Isolation” P.P.E. – Gloves Double Glove is highly recommended;First Pair put on first under sleeve cuffSecond 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 nearthe eyes to move goggles, thus potentially exposing to disease
73Post Exposure Protocol Critical Information for the Responder
74What 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!
75Post Exposure SystemA post exposure system establishes uniform procedures to protect the health of responders after a possible exposure to communicable diseases
76Post Exposure System The “Players” Responders Supervisors Infection Control Administrator (ICA)Infection Control Practitioner (ICP)Agency Physician (Fire / EMS / Law Enforcement)Health Department
77Treatment / Follow-up care Post Exposure SystemComponents:NotificationVerificationTreatment / Follow-up careDocumentationCounseling
78Post Exposure System Notification Phase Responder: Exposure is perceivedReports verbally to ICCompletes exposure reportSignificant vs. non-significant exposureContacts workers’ comp. HotlineNotifies Infection Control Administrator
79Post Exposure System Notification Phase Supervisor (IC) Visually verifies exposure when feasibleEnsures decon and treatment when neededEndorses exposure reportContacts Infection Control AdministratorVerifies workers’ comp. has been called
80Post Exposure System Verification Phase Starts on scene IC attempts to verify exposureICA schedules medical examPrimarily for significant exposuresRecommended within 48 hoursICA contacts receiving facilityRyan White Care Act
81Ryan White Care Act This act delineates specific notification requirements that allow responders to findout if they have been exposed to an“infectious disease.”
82Ryan White Care Act Routine Notification The hospital notifies transporting respondersof a potential exposureWithin 48 hoursDoes not apply to non-transporting respondersICP contacts ICAConfidential!
83Ryan White Care Act Notification by Request Initiated by local ICA ICA contacts receiving facility ICPReply within 48 hoursAn exposure took placeAn exposure did not take placeInsufficient information / undeterminedConfidential!
84Confidentiality Issues You’ve been exposed…Privacy act limits information that can be given to ICA or CEO by ICP / MDAll information is confidentialYou may give your consentReality checkHow hard is it to keep a secret in your agency?
85Post Exposure System Treatment Phase May start on scene Medical Evaluation w/in 48 hoursTestingInitial and follow-upIncubation periodTreatmentMay be long termProphylactics
86Post Exposure System Documentation Phase Exposure record Injury / illness reportWorkers’ compensationOSHA
87Post Exposure System Documentation Phase ICA conducts follow up review Within a reasonable period of timeConsiderations?Does responder need retraining?Does Agency need to alter current procedures?How can this be prevented from happening again?
88Post Exposure System Counseling Phase Peer support / CISD Stress managementSpousal or family counselingFamily protection(e.g. Safe sex practices)Retraining in infection control, if needed
89Incident Operations & Recovery The Infection Control Process
90Incident Operations & Recovery Four phases of responsePreparation for responseResponseScene managementPost-response recovery
91Preparation Phase IC Training SOP/SOG Enforcement Storage of PPE (vehicles & station)Regular inventory, maintenancePersonal HygieneIn and out of the station
92Response Phase Evaluation of dispatch information A.K.A. “Size-up”Don PPE en route when possiblePrepare mentallyConfidentiality and the radio
93Scene Management Phase Operations at sceneUse BSI / PPELimit patient contactUse mechanical resuscitation devicesDo not recap needlesHandle sharps only when necessary
94In health care workers, 80% of exposures are due to sharps injuries. The greatest percentage of needle-stick accidents occur during recapping!
95Scene Management Phase Operations at sceneUse mechanical clean up methods(e.g. Dust pan & brush)Properly dispose of wasteAppropriate containersProperly package contaminated gearTransport to fire station safely
96Scene Management Phase Public relations at the sceneExplain universal precautionsIf patient is uncomfortable with gloves, etc.Reasonable BSI(e.g. Coveralls for chest pains is overkill)
97Scene Management Phase Public information at the scenePatient’s medical status confidentialDo not broadcastUse care when discussing patient’s information at sceneMedical information is “need to know”
98Post Response Phase Proper disposal of PPE Appropriate containers Red “Bio” bagsSharps containersDesignated decon areaImmediate decon (In house)Storage for out-of-house decon
99Post Response Phase Disinfection, Decon, & Cleaning Four level’s of disinfection:Low level – Routine ambulance cleaningIntermediate – Typical post responseHigh level – (ie. Intubation equipment)Sterilization – Destroys all micro-organisms
100Disinfection Low level: Routine housekeeping Routine Cleaning Removal of soil in absence of visible body fluids
102Disinfection Intermediate level: Three types: EPA registered DisinfectantCommercially available hard surface germicidesWater-Chlorine Bleach (1:100)2 cups bleach to 1 gal. water
103Disinfection High level: Destroys all forms of micro-organisms Except large numbers of bacterial sporesRequired for reusable instrumentsContact with mucous membranes(i.e. Laryngoscope blades)
104Disinfection Sterilization: Destroys all micro-organisms Usually not practical for EMS
105Post Response Phase Equipment Decontamination Conducted in designated areaUse appropriate PPEGross DeconMild soap & waterUse appropriate level disinfectantAir dry in clean storage area
106Post Response Phase Cleaning of PPE - Uniforms Decon ASAP upon returningStore appropriately until launderingLaunder in designated front loading washer or commerciallyFollow manufacturers instructionsNo chlorine bleach on turnout gearDo not bring home!
107Post Response Phase Wash Hands and Exposed Skin Often Wash Thoroughly Wash with Anti-Bacterial Soap
108Station / Home Issues Equipment Storage Ensure proper storage equipment / suppliesMonitor usage levels for inventory ControlMonitor shelf lifeMaintain SDS’s
109Station / Home Issues Laundry Issues: Commercial front loading washer Automatic pre-metered detergentComputerized cyclesHigh temperatureWater completely drains outAgain… Do not bring home!
110Station / Home Issues Designated decontamination area Separate room, properly marked, secureProper ventilationAdequate drainage, including floorNon-porous sink with hot & cold waterAutomatic water for hand washingRack/shelves for dryingAppropriate supplies
111Program 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)PPEVaccinations