OverviewIntroduction

• Infectious • Communicable

Diseases• Definition• Manifestation• Transmission

Exposure ProtectionDecontaminationExposure Procedure

Infectious Disease

A disease caused by the growth of disease causing microorganisms in the body.

May or may not be contagious

Four Types of Infectious Four Types of Infectious AgentsAgents

BacteriaVirusFungusParasites

Communicable DiseaseTransmitted readily from one

person to another either directly or indirectly.

Or from animal to human (zoonotic)

Exposure/Routes of Infection•Percutaneously•Mucocutaneously•Airborne•Breast Feeding

DiseasesHIVHepatitisTuberculosisInfluenzaMeningitisMRSA

DiseasesShinglesC. diffWhooping CoughRubellaV.R.E.

HIV

HIV is the virus which causes AIDS by damaging a person’s body by destroying specific blood cells, called CD4+ T cells, which are crucial to helping the body fight diseases.

HIVManifestationWithin a few weeks of being infected with HIV, some

people develop flu-like symptoms that last for a week or two, but others have no symptoms at all.

AIDS is the late stage of HIV infection, when a person’s immune system is severely damaged and has difficulty fighting diseases and certain cancers.

HIVTransmission

Contact with infectious blood, semen, and other body fluids from having sex with an infected person, sharing contaminated needles to inject drugs, or from an infected mother to her newborn.

Hepatitis

Inflammation of the liver and also refers to a group of viral infections that affect the liver . The most common types are Hepatitis A, Hepatitis B, and Hepatitis C.

HepatitisManifestation

Hepatitis A Is a contagious liver disease that results from infection with the Hepatitis A virus. It can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months.

HepatitisManifestation

Hepatitis BRanges in severity from a mild illness, lasting a few weeks (acute), to a serious long-term (chronic) illness that can lead to liver disease or liver cancer.

HepatitisManifestation

Hepatitis CSometimes results in an acute illness, but most often becomes a chronic condition that can lead to cirrhosis of the liver and liver cancer.

HepatitisTransmission

Hepatitis AIngestion of fecal matter, even in microscopic amounts, from close person-to-person contact or ingestion of contaminated food or drinks.

HepatitisTransmission

Hepatitis BContact with infectious blood, semen, and other body fluids from having sex with an infected person, sharing contaminated needles to inject drugs, or from an infected mother to her newborn.

HepatitisTransmission

Hepatitis CContact with the blood of an infected person, primarily through sharing contaminated needles to inject drugs.

TuberculosisIs a disease caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain.

TuberculosisManifestation

- a bad cough that lasts 3 weeks or longer - pain in the chest - coughing up blood or sputum- weakness or fatigue - weight loss - no appetite - chills - fever - sweating at night

TuberculosisTransmission

TB is spread through the air from one person to another. The TB bacteria are put into the air when a person with active TB disease of the lungs or throat coughs, sneezes, speaks, or sings. People nearby may breathe in these bacteria and become infected.

Influenza

A contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death.

InfluenzaManifestationFever* or feeling feverish/chillsCoughSore throatRunny or stuffy noseMuscle or body achesHeadachesFatigue (tiredness)Some people may have vomiting and diarrhea, though this is

more common in children than adults.* It's important to note that not everyone with flu will have a

fever.

InfluenzaTransmission

People with flu can spread it to others up to about 6 feet away. Most experts think that flu viruses are spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Less often, a person might also get flu by touching a surface or object that has flu virus on it and then touching their own mouth or nose.

MeningitisA disease caused by the inflammation of the protective membranes covering the brain and spinal cord known as the meninges. The inflammation is usually caused by an infection of the fluid surrounding the brain and spinal cord. Meningitis is also referred to as spinal meningitis.

MeningitisManifesationMeningitis infection is characterized by a

sudden onset of fever, headache, and stiff neck. It is often accompanied by other symptoms, such as

NauseaVomitingPhotophobia (sensitivity to light)Altered mental status

MeningitisTransmission

Bacterial meningitis is contagious. The bacteria are spread through the exchange of respiratory and throat secretions (for example, through coughing or kissing).Viral meningitis is contagious. The viruses that most often cause viral meningitis are spread person to person through fecal contamination (such as by someone who uses the toilet or changes a baby’s diaper and does not wash her/his hands well afterward).

MRSA

Methicillin-resistant Staphylococcus Aureus (MRSA) is a type of staph bacteria that is resistant to certain antibiotics called beta-lactams.

MRSAManifestation

In the community, most MRSA infections are skin infections that may appear as pustules or boils which often are red, swollen, painful, or have pus or other drainage. They often first look like spider bites or bumps that are red, swollen, and painful.

MRSAManifestation

MRSA in healthcare settings usually causes more severe and potentially life-threatening infections, such as bloodstream infections, surgical site infections, or pneumonia. The signs and symptoms will vary by the type and stage of the infection.

MRSA

MRSATransmissionSkin infections enters the body through an

opening in the skin.Respiratory MRSA is spread through droplets

from coughing, sneezing or speaking.

ShinglesIs a painful skin rash caused by the varicella zoster virus (VZV). VZV is the same virus that causes chickenpox. After a person recovers from chickenpox, the virus stays in the body. Usually the virus does not cause any problems; however, the virus can reappear years later, causing shingles.

ShinglesManifestationShingles usually starts as a rash on one side of the

face or body. The rash starts as blisters that scab after 3 to 5 days. The rash usually clears within 2 to 4 weeks.

Before the rash develops, there is often pain, itching, or tingling in the area where the rash will develop. Other symptoms of shingles can include fever, headache, chills, and upset stomach.

Shingles

ShinglesTransmission

Shingles cannot be passed from one person to another. However, the virus that causes shingles, VZV, can be spread from a person with active shingles to a person who has never had chickenpox through direct contact with the rash. The person exposed would develop chickenpox, not shingles. The virus is not spread through sneezing, coughing or casual contact. A person with shingles can spread the disease when the rash is in the blister-phase.

C. diff

Clostridium difficile is a bacterium that may develop due to the prolonged use of antibiotics during healthcare treatment.

C. DiffManifestationwatery diarrhea fever loss of appetite nausea abdominal pain/tenderness

C. DiffTransmission

Clostridium difficile is shed in feces. Any surface, device, or material (e.g., commodes, bathing tubs, and electronic rectal thermometers) that becomes contaminated with feces may serve as a reservoir for the Clostridium difficile spores. Clostridium difficile spores are transferred to patients mainly via the hands of healthcare personnel who have touched a contaminated surface or item.

Whooping Cough

Pertussis, also known as whooping cough, is a highly contagious respiratory disease. It is caused by the bacterium Bordetella pertussis.

Whooping CoughManifestation

Pertussis is known for uncontrollable, violent coughing which often makes it hard to breathe. After fits of many coughs, someone with pertussis often needs to take deep breathes which result in a "whooping" sound. Pertussis most commonly affects infants and young children and can be fatal, especially in babies less than 1 year of age.

Whooping CoughTransmission

People with pertussis usually spread the disease by coughing or sneezing while in close contact with others, who then breathe in the pertussis bacteria.

Rubella

An acute viral disease that causes fever and rash.

RubellaManifestation

Rash and fever for two to three days (mild disease in children and young adults)

RubellaTransmission

Spread by contact with an infected person, through coughing and sneezing

VREEnteroccocci are bacteria that are normally present in the human intestines and in the female genital tract and are often found in the environment. These bacteria can sometimes cause infections. Vancomycin is an antibiotic that is used to treat some drug-resistant infections caused by enterococci. In some instances, enterococci have become resistant to this drug and thus are called vancomycin-resistant enterococci (VRE). Most VRE infections occur in hospitals.

V.R.E.Manifestation

VRE can live in the human intestines and female genital tract without causing disease (often called colonization). However, sometimes it can cause infections of the urinary tract, the bloodstream, or of wounds associated with catheters or surgical procedures.

V.R.E.Transmission

VRE is often passed from person to person by the contaminated hands of caregivers. VRE can get onto a caregiver's hands after they have contact with other people with VRE or after contact with contaminated surfaces. VRE can also be spread directly to people after they touch surfaces that are contaminated with VRE. VRE is not spread through the air by coughing or sneezing.

Exposure Protection

Consider ANY patient’s blood or body fluid to be infectious !

Exposure ProtectionGloves : All Fire/Rescue personnel MUST don appropriate protective gloves PRIOR to arrival at the scene of any EMS incidentanytime you could possibly contact body

fluidsduring extrications, wear under heavy

gloveswhile decontaminating &/or disinfecting

Exposure ProtectionMasksWear in any situation in which blood or

body fluids could be splashed in your face, or droplet infection is suspected.

With a potential or known TB, meningitis, influenza, respiratory MRSA, whooping cough, rubella or V.R.E. patient, put a surgical mask on the patient.

Exposure Protection

Eye ProtectionWear any time blood or body fluids could be

splashed in your eyes, such as active bleeding, vomiting or mentally disturbed patients (spit)

Exposure Protection

GownsIndicated for situations such as childbirth or

uncontrolled bleeding

Exposure Protection

Cover Broken SkinCover Broken SkinCuts, abrasions, insect bites, etc. should be Cuts, abrasions, insect bites, etc. should be

protected with a Band-Aid or a dressingprotected with a Band-Aid or a dressing

Exposure ProtectionWash Your HandsWash Your HandsWith disinfectant or anti-bacterial soap as soon With disinfectant or anti-bacterial soap as soon

as possible after every call.as possible after every call.At the hospitalAt the hospitalAfter handling items soiled with blood or body After handling items soiled with blood or body

fluidsfluidsIf you had gloves on, or sIf you had gloves on, or shouldhould have had gloves have had gloves

on, wash your hands when you take the gloves on, wash your hands when you take the gloves offoff

Exposure ProtectionQuit licking things!

Cross contamination occurs on every call! Change gloves if contaminated before handling other items, wash you hands before eating and disinfect anything that came in contact with the patient.

DecontaminationAll non-disposable equipment used in patient care

should be cleaned after each useAny equipment in contact with body fluids needs to

be cleaned and disinfectedwear gloves and other protective devices as

neededclean with detergent, etc. to remove dirt, blood,

etc. You cannot disinfect a surface that is dirty

Decontamination

After cleaning, After cleaning, DISINFECTDISINFECT the equipment by using the equipment by using one or more of the following agents:one or more of the following agents: A freshly mixed solution of 1 part bleach to 9 parts of A freshly mixed solution of 1 part bleach to 9 parts of

waterwater for non-metallic surfacesfor non-metallic surfaces especially effective on fresh (non-dry) blood spillsespecially effective on fresh (non-dry) blood spills Contact time: 20-30 minutes for high level disinfection, Contact time: 20-30 minutes for high level disinfection,

followed by clear water rinse & air dryfollowed by clear water rinse & air dry

DecontaminationDisinfectant Soaps:Disinfectant Soaps:

May be used on most equipment where a high level disinfection is not necessary

70 % Isopropyl alcohol:70 % Isopropyl alcohol:contact time : 5-30 minutesis NOT EFFECTIVE in presence of blood or dirtgood for use on skin, metals, and electrical equipment

3 % Hydrogen Peroxide3 % Hydrogen PeroxideNot recommended for high-level disinfectiongood for removing blood on fabrics

Decontamination

All sharps must be transported and disposed of in a heavy, impervious container

DecontaminationItems such as blood soaked sheets should be

placed in a red impervious plastic bag & transported to the hospital with the patient.DO NOT throw the sheets in the hamper

Each station must have an approved bio-hazard waste container. They are disposed of by an approved bio-hazard contractor

Exposure CarePercutaineousWipe off excess blood from skin and scrub area

with soap & water or antiseptic hand cleaner for 5-10 minutes.

If the wound is bleeding, allow it to bleed to remove any contaminants.

If soap & water are not immediately available apply alcohol until proper disinfecting measures can be taken.

Exposure CarePercutaineous Continued

Have emergency department physician assess and provide treatment for wound as needed.

Notify your Supervisor immediatelyDocument the circumstances concerning the

exposure.

Exposure CareMucocutaneouslyFlush eye(s) thoroughly for 15 minutes and/or

rinse mouth with saline or waterHave emergency department physician assess and

provide treatment needed.Notify your Supervisor immediatelyDocument the circumstances concerning the

exposure.

Exposure Procedure Obtain source patient information:a) Date and time of incident.b) Name of patient.c) Name of hospital transported to.d) Known or suspected diagnosis.

Exposure ProcedureEnsure First Report filedSupervisor should ensure that a First Report

of Injury is completed. The incident should be called in to the following numbers:Montgomery County First Report of Injury line: 888-606-2562

Exposure ProcedureCall the FROMS Injury and Exposure Hotline: 240-777-5085. Please provide as many details as possible, include patient information and where the employee was treated if the exposure occurred when FROMS was closed. Please also include information regarding whether or not a request was made for source patient testing and results from tests if available

Exposure ProcedureObtain testing and treatment for exposed

employee. If FROMS is open:

Employee should come to FROMS if exposure occurs during or close to FROMS hours of operation. Please contact FROMS at the main number to advise them the employee is coming, 240-777-5185:

Hours of Operation:Monday, Tuesday, Wednesday, Friday: 7:30 am 7:00 pmThursday: 7:30 am 9:00 pmAlternate Saturdays: 7:00 am 12:00 pm (check Quick links for dates)

Exposure ProcedureFROMS will follow up with hospitals to ensure that

appropriate testing of source patient is completed.

If it is determined by the physician that treatment with prophylactic anti-HIV medications ( Post Exposure Prophylaxis , or PEP) is warranted for the employee, FROMS will provide the employee with the first dose and a prescription for the rest.

Exposure ProcedureIf FROMS is closed-Treatment at Provider, ER,

or Urgent Care Center:The employee may go to any provider, ER, or urgent care

center of his/her choice. This includes the hospital to which the source patient was transported. All hospitals in Montgomery County will test and treat the Fire Fighter as long as he/she registers as a patient, with the exception of Suburban Hospital. A good choice is Shady Grove Adventist Hospital, as they have an ongoing relationship with MCFRS.

Exposure ProcedureIf FROMS is closed-Treatment via Montgomery County

Designated Treatment Provider:All Montgomery County employees may receive

treatment for blood borne pathogen exposures and/or other injuries or exposures from Medical Access, a facility which has contracted with the County to provide such care. They are available 24 hours per day, 7 days per week. Information follows:

Exposure ProcedureMedical Access19504 Amaranth Drive

Germantown, MD 20874Hours of Operation:

Monday Friday: 8:30 am 7:30 pmSaturday, Sunday: 10:00 am 5:00 pm

Telephone numbersOffice 301-428-1070

After hours, please call answering service at 301-552-0955.**If you do not receive a return call within 30 minutes, please contact Dr. Manbir Takhar directly at 301-483-1905**

Exposure Procedure

If it is determined that treatment is warranted, the hospital or Medical Access will provide the first dose. They will then either give the employee enough medication to tide them over through the weekend, or give them a prescription.

Exposure ProcedureRegardless of the immediate follow up if FROMS

is closed, the employee must contact or report to FROMS the next business day.

Exposure ProcedureEnsure Testing of the Source Patient.Employee and/or supervisor should contact the

Emergency department supervising nurse or physician where the source patient was taken, explain the situation, and request that the following lab tests be performed on the patient:a) HIV antibodyb) Hepatitis B surface antigenc) Hepatitis C antibody

Exposure ProcedureMaryland law provides that for exposures involving EMS and public safety personnel, HIV testing can be performed on the source patient without consent if the patient is unable or unwilling to give consent. All EMS Duty Officers have been provided with a copy of the law.

SummaryIntroduction

• Infectious • Communicable

Diseases• Definition• Manifestation• Transmission

Exposure ProtectionDecontaminationExposure Procedure