Chapter 6 Infection Control. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation....

Chapter 6Infection Control

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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

Overview

Infection Control Legal Obligations Causes of Disease Disease Transmission Portal of Entry Susceptibility to Disease Defense against Disease Preparing for Infection Control

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Infection Control

An infection is a disease caused by some type of microorganism (microscopic life form)

Each microorganism has a particular mode of transmission

Infection control measures can help prevent the spread of infectious diseases

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Infection Control

Personal safety– Measures must be taken to prevent EMTs from

acquiring an infectious disease on the job– Risk management

• Assessment for potential dangers– Risk profile

• Potential for disease process within the community

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Infection Control

Patient safety– EMTs should “do no harm” to the patient;

precautions should be taken to bring no infectious disease to the patient

– Stress can cause the patient’s body to be more susceptible to infection

– Immunocompromised patients are highly susceptible to infections that would not make a healthy person sick

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Infection Control

Family safety– EMTs who are exposed to infectious diseases at

work may inadvertently bring them home– Children have immature immune systems– Elderly patients may have declining immune

systems– EMTs need to take precautions to avoid becoming

disease carriers

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Legal Obligations

U.S. Centers for Disease Control and Prevention (CDC) – Monitors outbreaks of infections – Advises affected groups how to handle the

situation and control the spread of disease

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Legal Obligations

Occupational Health and Safety Administration produces standards for infection control practice in EMS– Bloodborne Pathogens Rule (29 CFR 1910.1030)

The National Fire Protection Association addresses the issue of infection control– (NFPA 1581)

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Legal Obligations

The safety officer or infections control officer– Responsible for reviewing publications for new

rules and standards that could affect EMS operations• Publications from agencies such as the CDC, OSHA,

and the NFPA

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Legal Obligations

Reporting exposure– The EMT who believes that she has been exposed

to a potentially infectious material must seek medical treatment and follow-up

– Notify safety or infection control officer– Follow departmental procedures– All incidents must be reported immediately in case

prophylaxis is needed

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Legal Obligations

Notifications by hospitals– Hospital is obligated under the Ryan White Law to

notify the EMS agency’s designated officer if:• A patient transported by EMS to the hospital is found to

have an infectious disease that may have posed a danger to EMS providers

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Stop and Review

Who are some of the people impacted by infection control?

Which federal agency is responsible for producing standards for infection control practice in EMS?

List elements in the 29 CFR 1910.1030 standard.

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Causes of Disease

Microorganisms that can cause infection and disease are classified into three major groups:– Fungi– Bacteria– Viruses

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Disease Transmission

Disease transmission occurs between people by:– Direct contact (person to person)– Indirect contact (via a contaminated object)

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Contact transmission– Occurs through direct contact with a substance

harboring an infectious agent, such as blood or another body substance

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Airborne transmission– The most common means of disease

transmission is via droplets in the air

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Vehicle transmission– An indirect method of

disease transmission in which food or water is a carrier of the disease-causing organism, e.g., Salmonella

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Vector-borne transmission– Transmission through a living creature such as an

animal or insect called a vector• Example: ticks and mosquitoes transmit Lyme disease

and malaria

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Portal of Entry

Means of entry for the organism is called the portal of entry

Mucous membranes are a common portal of entry– Mouth– Nose – Eyes

Nonintact skin is another common but often protectable portal of entry

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Susceptibility to Disease

Actual illness caused by exposure to an infectious agent is dependent on:– Strength of the organism (virulence)– Strength of the person’s immune system

To cause an illness, the organism must be virulent enough to overcome the resistance of the host

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The immune system is very effective against small numbers of microorganisms

If the dose is large, then these defenses can become overwhelmed and illness may result

The contagious EMT can transmit the disease and poses a potential danger to family, friends, coworkers, and patients

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One method of protection is isolation An EMT should not work whenever suffering

from a contagious illness

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Stop and Review

What are some of the more common infectious diseases an EMT may encounter?

In what two ways are diseases transmitted? What is meant by the term portal of entry?

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Defense against Disease

Skin represents the first barrier to disease– Unless there is a break in the skin, it serves as a

relatively impenetrable barrier to most infectious microogranisms

A healthy body is the best defense against disease– Less expensive to prevent disease than to treat it

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Immunizations– Some are given once in a lifetime– Others require periodic boosters to maintain

immunity– OSHA requires that every EMT have the

opportunity to receive the hepatitis B vaccine– There is no vaccine to protect against:

• TB• HIV

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Hand hygiene– Hand hygiene/washing can significantly aid in

preventing the spread of disease– Type of soap (antiseptic or antibacterial) is not as

important as hand washing technique– Scrubbing is the most important action in hand

washing

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Hand hygiene/washing– After every patient contact and before the next

patient contact, the EMT must wash her hands– Open wounds should be covered, as they are a

portal of entry for an infection

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Personal protective equipment (PPE)– EMS has a “dress up” philosophy: when

you need it, you put it on– Treat all body fluids as if they are

potentially infectious

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Personal protective equipment– Body substance isolation has been replaced with

more accurate terminology (standard precautions)– Standard precautions describes the need to

assume that all patients potentially have some form of infectious disease, and protective measures should be considered standard for every patient encounter

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Barrier devices– Any article that creates a physical partition

between the EMT and the environment

Barrier devices: Gloves– One-time use only– Different sizes should be made available

to the EMT– Hands must be washed after wearing gloves

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Barrier devices: Goggles– Eyes represent one of the EMT’s largest exposed

mucous membranes– Eyes remain vulnerable to splashes of body fluids

if they are unprotected– Use goggles or protective safety glasses– Eyeglasses require side splash protection to

prevent accidental exposure

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Barrier devices: Masks– Provide protection from blood and other body

fluids splashing into the open mouth of the EMT– Masks also provide protection from inhaling

airborne infectious particles– Due to the increased incidence of resistant

tuberculosis, patients presenting with a cough necessitate the EMT wearing a mask

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Barrier devices: Pocket mask– An EMT must always consider her own protection

by using a pocket mask to ventilate a patient– If a pocket mask is not available, the EMT should

have a transparent shield device– Either device allows effective ventilation while

preventing direct contact of the rescuer’s mouth with a patient’s oral secretions

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Barrier devices: Gowns– Childbirth– Severe arterial bleeding

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Donning and removing protective apparel– Don mask and eye protection first, followed by

gown, if necessary, and gloves last– Doffing should be done in reverse order– In cases of gross contamination, assistance

should be obtained in disrobing

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Stop and Review

What is one of the most effective personal defenses against disease transmission?

What is meant by the term personal protective equipment?

Define the term standard precautions. When would a pocket mask be used?

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Preparing for Infection Control

Review infection control manual At the start of every shift or tour of duty,

ensure:– An adequate supply of gloves, gowns, and

masks is available– Floors are routinely mopped with a cleaning

solution that includes a disinfectant such as bleach

– Interiors are also regularly cleaned

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House rules– Follow good health practices while at quarters,

such as the EMS station or firehouse

Responding to a call– Prearrival information from dispatch can alert

the EMT to what kind of additional PPE might be needed


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On the scene– The patient’s chief complaint should prompt the

EMT to consider additional PPE• A patient with a rash or cough may have a contagious

disease

– PPE should be readily available– It is not good practice to leave PPE in the

ambulance if it is needed on scene


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Needle disposal– Single largest risk of occupational exposure to

bloodborne diseases is by accidental needle stick– EMTs must be familiar with how to handle sharps

such as needles, syringes, and scalpel blades


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The sharps container– All used sharps go in the sharps container!– The sharps container should be easily accessible– Do not force sharps into container– The scene must be clear of all sharps; don’t leave

needles, etc., lying around– Don’t stick sharps into the squad bench; they go

directly into the sharps container!


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Disposal of waste– A biohazard is any material that is potentially

contaminated with biological waste– Bloody bandages and other contaminated waste

must be disposed of properly before leaving the scene

– Biohazards need to be placed in a red plastic bag that is clearly marked with a biohazard sign


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After the call– Remove contaminated clothing– The importance of thorough hand washing after a

call cannot be overemphasized; do this before smoking, applying makeup, eating, etc.

– If a sink with running water is not immediately available, use either a waterless, alcohol-based cleaning gel or an antiseptic cloth made for that purpose


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Documentation– Documentation of infectious disease can be

divided into patient reporting and exposure reporting

– When documenting a patient’s condition, all pertinent signs and symptoms must be listed, even if they do not appear to be related to the chief complaint


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Cleaning up: Decontamination– Low level—if there is no visible blood or body

fluids, then the equipment is simply wiped down with hospital disinfectant designed for low-level disinfection

– High level—requires sterilization• Designed to kill all microorganisms on the surface• Typically most equipment that EMTs use is not sterilized• Most equipment is disposable


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Cleaning up: Emergency equipment cleanup– Intermediate decontamination

• For equipment that touches a patient’s skin• Use germicide or bleach and water solution (1:100

mixture) to kill pathogens

– High-level decontamination • For equipment that comes in contact with a patient’s

mucous membranes


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Cleaning up: Cleaning areas– Emergency departments have a “dirty” utility room

• For disposing liquid waste • For cleaning certain prehospital equipment, e.g.,

bedpans, backboards

– Cleaning areas are well lighted and well ventilated – All drains from sinks, hoppers, toilets, and floor

empty into a separate sewer system


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Cleaning up: Cleaning the ambulance– Rules for cleaning the ambulance are the same as

for cleaning equipment– Scrub the surfaces with soap and water to remove

grossly visible contamination– Disinfect with either a bleach solution or a

germicide– Air out the ambulance afterwards for 10–15

minutes to dry


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Stop and Review

When would high-level disinfection be required?

If a patient is found to have an infectious disease that may have posed a danger to EMS providers, what is the hospital obligated to do?

Under what law are hospitals obligated to do this?

Chapter 6 Infection Control. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation....

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Transcript of Chapter 6 Infection Control. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation....