Infection Control

2013

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WHEN YOU START TO THINK THIS LECTURE IS BORING, REMEMBER…

YOU CAN GET SICK AND DIE,SO PAY ATTENTION!

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Training Objectives

• Educate NuCare emloyees in bloodborne pathogens seen by EMS workers in the field

• Discuss methods of protecting NuCare employees from bloodborne pathogens

• Provide information to allow the NuCare employee to make an educated decision about the HBV vaccination

• Discuss the OSHA standard on bloodborne pathogens

• Discuss NuCare’s methods of compliance with the OSHA Standard

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Definitions (From OSHA)

• Bloodborne Pathogen- microorganisms that are present in human blood and can cause disease in humans

• Exposure Incident- specific eye, mouth, mucous membrane, non-intact skin or parenteral contact with blood or OPIM that results from the performance of a member’s duties

• Parenteral- piercing mucous membranes or the skin barrier through such events as needle sticks, human bites, cuts, and abrasions

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Definitions (Continued)

• Personal Protective Equipment (PPE)- specialized clothing or equipment worn by a member for protection against a hazard. General work clothes (uniforms, jumpsuits, etc.) not intended to function as protection against a hazard are not PPE.

• Universal Precautions- an approach to infection control where all human blood and certain human body fluids are treated as if known to be infectious

• Body Substance Isolation (BSI)- a form of infection control based on the presumption that all body fluids are infectious. BSI calls for always using appropriate barriers to infection at an emergency scene, such as gloves, goggles, face shields, gowns, and protective eyewear.

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Definitions (Con’t)

• Exposure Control Plan (ECP)- agency’s plan to eliminate or minimize exposure

• Other Potentially Infectious Material (OPIM)-

• the following human body fluids: semen, vaginal secretions, CSF, synovial fluid, pleural, pericardial, peritoneal, amniotic, saliva (dental procedures), any bodily fluids contaminated with blood, any fluid that cannot be differentiated between fluid types.

• Any unfixed tissue or organ from a human (living or dead)

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Definitions (Final)

• Contaminated Laundry- laundry which has been soiled with blood or OPIM or may contain sharps

• Contaminated Sharps- any contaminated object that can penetrate the skin including needles, scalpels, broken glass, broken capillary tubes, and exposed ends of dental wire

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OSHA Standard

• Exposure Control Plan– Identifies job/procedures with identified risks

– Schedule for implementing provisions• All provisions have been implemented

– Procedure for investigation and follow-up

– Plan is accessible to all employees• Supervisor Office

• emsCharts Document Warehouse

– Annual review by committee

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OSHA Standard (Con’t)

• Initial training upon employment

• Annual re-training required

• Training in:– OSHA Standard

– Bloodborne Diseases and Transmission

– Exposure Control Plan

– Work Practices and PPE use

– HBV Vaccine

– Exposure recording and follow-up

– Trainer guidelines

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OSHA Standard (Con’t)

• Methods of compliance– Universal Precautions– Engineering and work practice controls– Hand washing– PPE/BSI– Written cleaning schedule– Sharps and regulated waste disposal

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OSHA Standard (Con’t)

• Record keeping– OSHA mandates

• Types of records to be kept

• Duration of storage

• Disposal of records

• Hazard Communication– Warning labels required (BioHazard) or– Red Bio hazard bags instead of labels– NuCare uses both methods

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Bloodborne Pathogen Standard

• Effective March 6th, 1992

• Purpose– Limit the occupational exposure to blood and other

potentially infectious material (OPIM)

• Scope– Covers all members who could be “reasonably

anticipated” as a result of performing their duties to face contact with blood and OPIM

– Everyone who works for NuCare or rides as an observer or student are “reasonably anticipated” to contact blood and OPIM.

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BBP Standard (Con’t)

• Mandates of the standard– Exposure Control Plan (ECP) prevention

program

– Work place engineering to prevent exposure

– HBV vaccine provided by RPI Ambulance

– Medical evaluation/follow up

– Training of employees

– Record keeping

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PPE and BSI

• Use as little or as much as you feel the situation dictates

• During all patient care EXAMINATION GLOVES WILL BE WORN!

• NuCare provides all PPE. You do not pay for any of it. NuCare replaces it when it becomes worn or soiled

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PPE/BSI (Con’t)

• NuCare provides the following– Non-sterile, non-latex exam gloves in

three sizes– Pre-packaged PPE kits containing

• Golves

• Mask

• Shoe covers

– Hand sanitizer on all ambulances– Anti-bacterial soap at the bases

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A word on hand-sanitizer

before we continue...

- For immediate, short term use

- Not suitable as a substitute for hand washing

-You still need to wash your hands thoroughly as soon as possible

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Sharps Disposal

• DO NOT RECAP SHARPS

• NuCare uses several types of sharps for BLS and ALS purposes– IV Angiocaths

– Glucose testing lancets

– Epi-Pens

• NuCare provides sharps containers on all ambulances… Use them!– $70,000.00 per improperly disposed sharp

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Two Major Definitions

• Infectious– An illness that is caused by the body's

rejection of a virus, fungi, or parasite

• Communicable– Able to spread from one person to another

A disease can be infectious and not communicable at the same time

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Infectious Material

• Primary Risks– Blood

– Semen

– Vaginal Secretions

• Secondary Risks– Synovial (joint)

fluid

– Cardiac fluid (other than blood))

– Abdominal and stomach fluid

– Pulmonary fluids

– Spinal fluid

– Amniotic fluid

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Other Potentially Infectious Material (OPIM)

• Tears

• Sweat

• Saliva

• Urine

• Stool

• Vomit

• Nasal secretions

• Sputum

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Modes of Transmission

• Direct contact – straight from person to person, exchange of blood or body fluids

ex: blood splash into the eyes

• Indirect contact – person to object; infection can spread by touching surfaces that have been contaminated with the bacteria or virus

ex: Loading stretcher into ambulance and not removing contaminated gloves before touching steering wheel of ambulancetouching a contaminated needle

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Direct Contact

• Bloodborne

• Airborne

• Occult– Occult means “hidden”– “Occult blood” is blood hidden inside

some other material

• Idiopathic – Fancy medical word meaning “We

don’t have a clue!”

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Indirect Transmission

• Vehicle-borne– The transfer of an infectious agent to a

host via contaminated items such as water, food, milk, or biological products, such as blood, tissues, and organs.

• Vector-borne– The transfer of infectious

microorganisms from an infected host via an insect or arthropod.

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Methods to Reduce Exposure

• Engineering Controls– Devices that may be used to eliminate,

minimize, or reduce occupational exposure to bloodborne pathogens.

• Work Practice Controls– Practices and procedures that reduce or

eliminate the chance of occupational exposure to bloodborne pathogens.

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Examples

• Engineering Controls– Sharps containers– Self capping needles– PPE

• Work Practice Controls– Decontaminating work area– Frequent hand washing– Consistent use of PPE

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PracticesProtect Yourself

• Wash your hands

• Wear PPE

• Avoid contact with broken skin or mucous membranes

• Wash your hands

• Did I mention… wash your hands

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Practices

• All infectious materials go into a red biohazard bag. No one is to remove anything from a biohazard bag.

• All infectious sharps go into a red sharps container. No one is to remove anything from a sharps container. Sharps containers are located on the ambulance and in the PCF.

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Bio-Hazard Disposal

• All bio-hazard bags can be disposed of at the hospital in designated bins

• All sharps containers are to be sealed using 3” tape and labeled “NuCare”

• Sharps are also disposed of at the hospital

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Bio-Hazard Bag Portable Sharps Wall Mounted Container Sharps Container

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Practices (Con’t)

• Hand washing is required after the completion of all patient care.

• Hand washing is the best way to avoid infection.

• No food, drink, smoking, application of cosmetics, or handling of contact lenses is permitted in any Patient Care Area.

• Mouth Pipeting/Suctioning is prohibited.

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Practices (Con’t)

• Disinfecting materials are provided on the Ambulance and in the PCF. The materials are:• LpH One Step Germicidal Disinfectant in a

1:256 solution with water (always wear gloves when handling this cleaner)

• Disposable paper towels (into a red bag, when done)

• 5:1 Water and bleach can be substituted

• Annual Training

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DISEASESKnow your enemy

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Hepatitis-B

• Virus that attacks the liver

• Those with HBV infection are divided into two categories. Both are equally able to infect you• Carrier- non-acute patient with virus in blood

• Acute- virus in blood and is symptomatic

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Hepatitis-B

• HBV can survive outside of the body for quite some time• Up to 14 days in a dried drop of blood

• Compared to HIV that dies instantly outside its environment

• HBV is not airborne

• You cannot “catch” HBV from casual contact

• There is a vaccine to protect you from HBV

• HBV is a larger risk than HIV to the healthcare provider!

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Hepatitis-B

• Each year over 12,500 Health Care workers acquire this disease as a result of their job

• Each year more than 500 Health Care workers die as a result of this disease

• 50 to 60% of infected individuals do not know they have the disease

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Hepatitis-B

• Begins with flu like symptoms• Smokers loose the desire to smoke• Yellow skin, eyes itching, dark urine and

white colored stool• Some individuals may only have flu like

symptoms or be completely asymptomatic

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HBV Vaccine

• Vaccinations available to all members at risk• Vaccine provided within three days of hire• NuCare provides the vaccine, free to you• You may decline the offer• A declination form is required if declining• Can be received at any time if initially

declined (notify manager in writing)• Booster now recommended between 5-10

years

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HBV Vaccine Facts

• Vaccine is created through genetic engineering.• No live or dead vaccine is injected into you.

• You cannot “catch” HBV from the vaccine

• Three IM Injections • Day 1, Day 30, and Day 180

• Some side effects are• 1% will have a sore arm (like a tetanus shot), fatigue,

and headache

• Itchiness or bump at the injection site

• Allergic Reaction- Vaccine is contraindicated if you are allergic to yeast

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HIV/AIDS

• Human Immunodeficiency Virus• HIV is the virus that causes Acquired

Immunodeficiency Syndrome (AIDS)• Those with HIV Infection may have no

symptoms, some symptoms, or may have full blown AIDS

• HIV destroys the body’s immune system, causing death by other diseases that the body would naturally fight off

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HIV/AIDS

• HIV cannot survive outside the body for a long period of time. When the virus contacts a dry environment, it loses the ability to infect you

• HIV is not airborne and cannot infect you through everyday contact

• HIV cannot survive outside the body for a long period of time. When the virus contacts a dry environment, it loses the ability to infect you

• HIV is not airborne and cannot infect you through everyday contact

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HIV/AIDS

• Antibodies are formed six to twelve (6-12) weeks after infection. The AIDS test looks for these antibodies, not the virus itself

• No anti-virus, no vaccine and no cure• There are a SMALL NUMBER of

healthcare providers who have contracted HIV infection through their duties as compared to HBV

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HIV 0.4%

HBV 30.00%

0% 5% 10% 15% 20% 25% 30% 35%

Percent

Risk of Infection Post Needle Stick

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Contracting HBV and HIV

• Neither of these viruses are airborne. You cannot catch them through routine contact

• You can contract the virus if • You suffer a needle stick from an infected sharp

(0.4% for HIV, 6-30% for HBV)

• Infected material comes in contact with your broken or non-intact skin (chapped, abrased, etc.)

• Infected material comes in contact with your mucous membranes of the eyes, nose, and mouth

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Hepatitis-C

• Unrelated to Hepatitis B• Viral disease• Transmitted by blood, needle stick, and sex• WILL BEGIN WITH SAME

SYMPTOMS AS HEPATITIS B• Only 25 % of infected individuals will

show signs or symptoms

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Hepatitis-C

• Incubation period is up to 200 days• NO VACCINE FOR PROTECTION• 4 to 8 % of infected individuals are health

care workers• NO CURE AT THIS TIME

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Tuberculosis

• Airborne virus attacking respiratory system

• Historically called “Consumption”– Tudors: Princess Margaret (Henry

VIII’s sister)– Moulin Rouge: Kidman’s character dies

of tuberculosis toward the end of the movie

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Tuberculosis

• Groups with high risk– HIV patients– Nursing home residents– Immigrants– Refugees– Homeless– Inmates

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TB Exposure Risk

• Dependant on – Time spent with the infected individual– Adequate ventilation– preventive measures used

• Filter Mask

• Double mask, caregiver and patient

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TB Signs and Symptoms

• Weight loss

• Night sweats

• Swollen lymph glands

• Cough ( may be productive )

• Positive skin test

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TB (Con’t)

• INH is the drug used to prevent disease development

• Multi-drug resistant TB can develop– has been identified in up to 20 states– Occurs when a patient fails to take all of

their recommended drug regimen– LIFE EXPECTANCY IS ONLY 16

WEEKS AFTER CONTRACTING DISEASE

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Meningitis

• 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.

• Can be life-threatening because of the inflammation's proximity to the brain and spinal cord; therefore the condition is classified as a medical emergency.[1][3]

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Meningitis

• Signs and Symptoms– Headache and neck stiffness associated with fever

– Confusion or altered level of consciousness

– Vomiting

– Inability to tolerate light (photophobia) or loud noises (phonophobia)

– Sometimes, especially in small children, only nonspecific symptoms may be present, such as irritability and drowsiness.

– If a rash is present, it may indicate a particular cause of meningitis; for instance, meningitis caused by meningococcal bacteria may be accompanied by a characteristic rash.[

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Meningitis

• Modes of transmission– Direct contact with respiratory

secretions– Physical skin contact

• Treatment only available for bacterial, but not viral

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Determining a True Exposure

• Two questions will determine whether or not an exposure has occurred:

– Is the fluid I came in contact with blood, semen, vaginal secretions, or any other body fluid containing blood?

– Did the fluid enter my body by a needle-stick, non-intact skin, laceration from a contaminated object, through my eyes, nose, or mouth?

• Both answers must be yes in order for an exposure to have occurred

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If You Are Exposed

• Notify dispatcher immediately

• Finish you call, and disinfect your ambulance if needed

• Return to base and complete an exposure/incident report– You are effectively out-of-service

• You will be send to the local primary care before completing your shift

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Post Exposure Evaluation

• Available to all exposed members• Confidential medical evaluation• Incident Report filed with Division

Manager or Team Leader as soon as possible after exposure

• May include– Several office visits– Re-vaccination– Prophylactic medications

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Final Thoughts

• Protect yourself well

• Don’t fall victim to bad (and dangerous) habits

• Don’t go home with anything you didn’t come to work with

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QUESTIONS

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