1. International Trauma Life Support for Prehospital Care Providers Sixth Edition for Prehospital Care Providers Sixth Edition Patricia M. Hicks, MS, NREMTP Roy Alson, PhD, MD, FACEP Donna Hastings, EMT-P John Emory Campbell, MD, FACEP and Alabama Chapter, American College of Emergency Physicians Patricia M. Hicks, MS, NREMTP Roy Alson, PhD, MD, FACEP Donna Hastings, EMT-P John Emory Campbell, MD, FACEP and Alabama Chapter, American College of Emergency Physicians Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Chapter 22 Standard Precautions in the Prehospital Setting Chapter 22 Standard Precautions in the Prehospital Setting

2. Standard Precautions in Prehospital Setting Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Standard Precautions in the Prehospital Setting

3. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Overview Bloodborne viral illnesses Most common for EMS exposure Signs and symptoms of tuberculosis Protective measures Potentially infectious materials precautions Appropriate personal protective equipment use Accidental exposure procedures 2Standard Precautions -

4. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Standard Precautions 3 Exposure does not mean infection. Exposure can be treated. Standard Precautions -

5. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Standard Precautions Common bloodborne viral infections Hepatitis B (HBV) Hepatitis C (HBC) HIV infection Primary modes of exposure Contaminated blood Other potentially infectious materials (OPIM) 4Standard Precautions -

6. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Potentially Infectious 5 CSF Synovial fluid Amniotic fluid Pericardial fluid Other potentially infectious materials: Plural fluid Body fluid with gross visible blood Standard Precautions -

7. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Potentially Infectious 6 Tears Sweat Saliva Urine Only with gross visible blood Standard Precautions - Stool Vomitus Nasal secretions Sputum

8. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Viral infections involving liver: Fecal transmission: Types A, E Bloodborne transmission: Types B, C, D Type D only with Type B Prevention is best treatment! Viral Hepatitis 7Standard Precautions -

9. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Hepatitis B (HBV) Modes of exposure Contaminated blood Other potentially infectious materials (OPIM) Sexual transmission Direct contact with nonintact skin Health care risk of infection: 6–30% Needlestick exposure to HBV blood and no vaccination or immune response 8Standard Precautions -

10. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Hepatitis B (HBV) 9 Immigrants from HBV prevalent Incarcerated Institutionalized IV drug users High-risk groups Standard Precautions - Male homosexuals Hemophiliacs Household contacts Hemodialysis

11. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Hepatitis B (HBV) Clinical manifestation Acute hepatitis Chronic hepatitis Cirrhosis Liver cancer Chronic carrier risk: 5–10% 10Standard Precautions -

12. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Hepatitis B (HBV) Health care protection Hepatitis B vaccines Does not contain antibodies Life-long protection Effective immunity in 90% Hepatitis B immunoglobulin Contains antibodies Passive protection for 6 months Effective immunity in 70% 11Standard Precautions -

13. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Hepatitis C (HBC) Modes of exposure Contaminated blood Other potentially infectious materials (OPIM) Sexual transmission Direct contact with nonintact skin Health care risk of infection Needlestick exposure to HCV blood: 1.8% 12Standard Precautions -

14. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Hepatitis C (HBC) Clinical manifestation Less severe than HBV Chronic carrier risk > HBV risk Liver failure, cirrhosis 10–20% of carriers Health care protection Vaccine not available Immunoglobulin (IG) not shown effective 13Standard Precautions -

15. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ HIV Infection Modes of exposure: Contaminated blood Other potentially infectious materials (OPIM) Sexual transmission Direct contact with nonintact skin HIV does not survive outside body. No special cleaning agents are required Transmitted less efficiently than HBV 14Standard Precautions -

16. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ HIV Infection Health care risk of infection Needlestick exposure to HIV blood: 0.3% Mucosal or nonintact skin exposure: 0.09% Large amounts HIV blood 15Standard Precautions - Male homosexuals Bisexuals IV drug users Transfused Blood, pooled-plasma HIV sexual contact High-risk groups:

17. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ HIV Infection Clinical manifestation Immune system defective Higher risk of unusual infections Many are asymptomatic Chronic carrier risk: 100% All HIV infected can transmit HIV Current HIV treatment reduces risk 16Standard Precautions -

18. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ HIV Infection Health care protection Vaccine not available Antiretroviral drug regimen Prolongs life, does not cure May reduce risk of infection by significant exposure if administered “within hours, not days” –Recommended for Highest Risk exposures –Possible benefit for Increased Risk exposures –Unlikely benefit for Low Risk exposures 17Standard Precautions -

19. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Tuberculosis Mycobacterium tuberculosis Deadliest infectious disease globally Not highly communicable Mode of exposure Direct contact through air, cough, sneeze Preventive measure Place surgical mask on any suspected patient 18Standard Precautions -

20. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Tuberculosis Health care risk of infection Up to 5% skin test positive in high-prevalence environment High-risk groups: HIV infected Immigrants from TB prevalent Homeless Live in congregate settings 19Standard Precautions -

21. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Tuberculosis Clinical manifestation Severe cough >3 weeks with two or more: Chest pain Bloody sputum Weakness or fatigue Unexplained weight loss Loss of appetite Fever, chill, night sweats Hoarseness 20Standard Precautions -

22. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Tuberculosis Health care protection TB infection (no active disease) Isoniazid (INH) or rifampin for 6–9 months TB disease Antibiotic agents 21Standard Precautions -

23. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Precautions for Prevention Be knowledgeable Bandage lesions Routine handwashing Immunizations Report exposures 22Standard Precautions -

24. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ 23 If exposed, wash exposed area Standard Precautions - immediately.

25. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Reporting Exposures Contact designated official. Determines if exposure occurred Interacts with medical facility Coordinates needed tests Write incident report soon as possible. EMS report may supplement, but not replace Know local laws. Confidential exposure report form in U.S. 24Standard Precautions -

26. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Summary Health-care workers are at risk of exposure to many contagious diseases. Prevention: Health-care workers should be HBV immunized. Knowledge of modes of exposure, adherence to barrier precautions, and postexposure medical follow-up reduces risk of infection. 25Standard Precautions -

27. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Discussion 26Standard Precautions -