Emergency Medical Services
“Infection Control”
for
Emergency First Responders
Body Substance Isolation
March 04, 2020
Department of Emergency Services and Public Protection
Body Substance Isolation (BSI)
“An infection control strategy that
considers all body substances as
potentially infectious.”
Similar to Universal Precautions .. But goes further in
isolating workers from Pathogens
Department of Emergency Services and Public Protection
“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
Department of Emergency Services and Public Protection
“Standard” Recommended P.P.E.
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Gloves
Eye / Face splash protection
Splash Protection – Gowns
N95 or N-100 mask
Disposable resuscitation equipment
Department of Emergency Services and Public Protection
“Standard” P.P.E. – Gloves
Department of Emergency Services and Public Protection
“Standard P.P.E. – Eye Protection
Department of Emergency Services and Public Protection
“Standard” P.P.E. – Gowns
Aprons
Gowns
Department of Emergency Services and Public Protection
“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.
Department of Emergency Services and Public Protection
“Standard” P.P.E. – Kits
Department of Emergency Services and Public Protection
Disposable Respiratory Devices
Department of Emergency Services and Public Protection
“Isolation” P.P.E.
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Gloves – Double Glove
Eye / Face splash protection – NO GOGGLES
Gowns / Coveralls – Complete Body Coverage
Hood – if not part of Splash Protection or PAPR
Ensemble
• Respiratory Protection: PAPR or N95
(Powered Air Purifying Respirator)
• Boot Covers – if not using a one piece suit
• Disposable Resuscitation Equipment
Department of Emergency Services and Public Protection
“Isolation” P.P.E. – Gloves
Double Glove is highly recommended;
First Pair put on first under sleeve cuff
Second Glove over top on top of Sleeve Cuff
Department of Emergency Services and Public Protection
“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 near
the eyes to move goggles, thus potentially exposing to disease
Department of Emergency Services and Public Protection
“Isolation” P.P.E. – Gown / Coveralls
Department of Emergency Services and Public Protection
“Isolation” P.P.E. – Hood
Hoods offer more body protection,
usually require PAPR air supply
Department of Emergency Services and Public Protection
“Isolation” P.P.E. – Respiratory
Powered Air Purifying Respirators (PAPR)
are recommended for long duration work
capacity and reliability
Department of Emergency Services and Public Protection
“Isolation” P.P.E. – Boot Covers
Knee high boot covers are recommended
depending on the type of protective suit /
coveralls being used
Department of Emergency Services and Public Protection
“Isolation” P.P.E. – Ventilation Equipment
Department of Emergency Services and Public Protection
Personal Protective Equipment
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Proper usage
Storage location(s)
Proper removal
On scene self decontamination
Hand Washing
Disposal
Department of Emergency Services and Public Protection
Incident Operations &
Recovery
The Infection Control Process
Department of Emergency Services and Public Protection
Incident Operations & Recovery
• Four phases of response
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Preparation for response
Response
Scene management
Post-response recovery
Department of Emergency Services and Public Protection
Preparation Phase
• IC Training
• SOP/SOG Enforcement
• Storage of PPE (vehicles & station)
– Regular inventory, maintenance
• Personal Hygiene
– In and out of the station
Department of Emergency Services and Public Protection
Response Phase
• Evaluation of dispatch information
– A.K.A. “Size-up”
• Don PPE en route when possible
• Prepare mentally
• Confidentiality and the radio
Department of Emergency Services and Public Protection
Scene Management Phase
• Operations at scene
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Use BSI / PPE
Limit patient contact
Use mechanical resuscitation devices
Do not recap needles
Handle sharps only when necessary
Department of Emergency Services and Public Protection
In health care workers, 80% of
exposures are due to sharps
injuries.
The greatest percentage of needle-stick
accidents occur during recapping!
Department of Emergency Services and Public Protection
Scene Management Phase
• Operations at scene
– Use mechanical clean up methods
(e.g. Dust pan & brush)
– Properly dispose of waste
• Appropriate containers
– Properly package contaminated gear
• Transport to fire station safely
Department of Emergency Services and Public Protection
Scene Management Phase
• Public relations at the scene
– Explain universal precautions
• If patient is uncomfortable with gloves, etc.
– Reasonable BSI
(e.g. Coveralls for chest pains is overkill)
Department of Emergency Services and Public Protection
Scene Management Phase
• Public information at the scene
– Patient’s medical status confidential
• Do not broadcast
– Use care when discussing patient’s information at
scene
• Medical information is “need to know”
Department of Emergency Services and Public Protection
Post Response Phase
• Proper disposal of PPE
– Appropriate containers
• Red “Bio” bags
• Sharps containers
– Designated decon area
• Immediate decon (In house)
• Storage for out-of-house decon
Department of Emergency Services and Public Protection
Post Response Phase
• Disinfection, Decon, & Cleaning
– Four level’s of disinfection:
• Low level – Routine ambulance cleaning
• Intermediate – Typical post response
• High level – (ie. Intubation equipment)
• Sterilization – Destroys all micro-organisms
Department of Emergency Services and Public Protection
Disinfection
• Low level:
– Routine housekeeping
– Routine Cleaning
– Removal of soil in absence of visible
body fluids
Department of Emergency Services and Public Protection
Disinfection
• Intermediate level:
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Destroys mycobacterium TB
Vegetative Bacteria
Most viruses & Fungi
NOT Bacterial spores
Typical method for ambulances
Department of Emergency Services and Public Protection
Disinfection
• Intermediate level:
– Three types:
• EPA registered Disinfectant
• Commercially available hard surface germicides
• Water-Chlorine Bleach (1:100)
– 2 cups bleach to 1 gal. water
Department of Emergency Services and Public Protection
Disinfection
• High level:
– Destroys all forms of micro-organisms
• Except large numbers of bacterial spores
– Required for reusable instruments
• Contact with mucous membranes
(i.e. Laryngoscope blades)
Department of Emergency Services and Public Protection
Disinfection
• Sterilization:
– Destroys all micro-organisms
– Usually not practical for EMS
Department of Emergency Services and Public Protection
Post Response Phase
• Equipment Decontamination
– Conducted in designated area
– Use appropriate PPE
– Gross Decon
• Mild soap & water
– Use appropriate level disinfectant
– Air dry in clean storage area
Department of Emergency Services and Public Protection
Post Response Phase
• Cleaning of PPE - Uniforms
– Decon ASAP upon returning
– Store appropriately until laundering
– Launder in designated front loading washer or
commercially
– Follow manufacturers instructions
– No chlorine bleach on turnout gear
– Do not bring home!
Department of Emergency Services and Public Protection
Post Response Phase
• Wash Hands and Exposed Skin Often
• Wash Thoroughly
• Wash with Anti-Bacterial Soap
Department of Emergency Services and Public Protection
Station / Home Issues
• Equipment Storage
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Ensure proper storage equipment / supplies
Monitor usage levels for inventory Control
Monitor shelf life
Maintain SDS’s
Department of Emergency Services and Public Protection
Station / Home Issues
• Laundry Issues:
– Commercial front loading washer
• Automatic pre-metered detergent
• Computerized cycles
• High temperature
• Water completely drains out
• Again… Do not bring home!
Department of Emergency Services and Public Protection
Station / Home Issues
• Designated decontamination area
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Separate room, properly marked, secure
Proper ventilation
Adequate drainage, including floor
Non-porous sink with hot & cold water
Automatic water for hand washing
Rack/shelves for drying
Appropriate supplies
Department of Emergency Services and Public Protection
Program 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)
• PPE
• Vaccinations
Department of Emergency Services and Public Protection
Program Evaluation
• Annual record review
– Safety committee
• Sharps log
• Injury log
• Exposure reports
Safety Committee
Department of Emergency Services and Public Protection
Summary
Questions & Answers
Department of Emergency Services and Public Protection
NEVER FORGET
Department of Emergency Services and Public Protection