Bloodborne Pathogen
Training
2010
Advocate Condell EMS System
Prepared by: Sharon Hopkins, RN, BSN, EMT-P
Objectives
• Upon successful completion of this module the
EMS provider will be able to:
– Define the mission of OSHA
– Describe what the OSHA Standard was designed
for
– Describe the training program for bloodborne
pathogens
– Define bloodborne pathogen
– Provide an example of potential bloodborne
pathogens
– Define the term universal precaution
Objective cont’d
– Define the term body substance isolation
(BSI)
– List an example of engineering control
– List an example of a work place control
– List PPE products available to use
– Describe when PPE’s should be used
– Recognize signs or labels that indicate the
presence of a bloodborne pathogen hazard
– Describe components of housekeeping and
when they are performed
Objective cont’d
– Describe necessary recordkeeping related to
bloodborne pathogens
– Define an exposure incident
– Review the CMC EMS System Operating
Guideline (SOG) policy for infection control
and exposure
– Describe the “Notification of Significant
Exposure” form and how to complete
– List routes of exposure to potential BBP
Objective cont’d
– List transmission routes of bloodborne
pathogens in the workplace
– List factors affecting disease transmission
– Describe the phases of the infectious process
– Discuss definition, incubation period,
transmission route, signs and symptoms, and
PPE to use for a variety of infectious diseases
– Successfully complete the post quiz with a
score of 80% or better
What is OSHA?
• A federal agency of the US Department of
Labor
• Created by Congress in 1971 under the
Occupational Safety and Health Act
• Mission:
– To prevent work-related injuries, illnesses, and
death
What is NIOSH?
• National Institute for Occupational Safety
and Health (NIOSH) created by the OSH
Act
• Functions as a research agency focusing
on occupational health and safety
What is “The Standard”?
• In 1990, OSHA issued a standard
(Bloodborne Pathogen Standard)
designed to prevent healthcare workers
and others from being exposed to
bloodborne pathogens such as hepatitis B
and HIV
Who does the Standard cover?
All employees who could "reasonably
anticipate"
contact with blood
contact with other potentially infectious
materials
while performing their job duties
Compliance with the Standard
• The Bloodborne Pathogen Standard
specifies methods that are to be used to
minimize the transmission of bloodborne
pathogens in the work place.
• These methods include:
Universal Precautions
Engineering and Work Practice Controls
Personal Protective Equipment (PPE)
Appropriate Housekeeping Measures
Training
• Employees must be provided information
When first assigned a task with potential
exposure
Repeated annually
During work hours
When new tasks or procedures are
added
• New exposure risk created must be
addressed
Training Requirements
• Make copy of standard accessible to all
• Have a general discussion of bloodborne
pathogen diseases and their transmission
• Review your department’s exposure plan
• Review how to obtain/view a copy of your
department’s exposure plan 24/7
• Discuss how to recognize tasks and other
activities that may involve exposure
Training Requirements cont’d
• Discuss the use and limitations of methods
for protecting or reducing exposure risk
– Engineering practices
– Work practice controls
– PPE’s
• Provide information on the Hepatitis B
vaccine
• Review how to handle a response to an
emergency involving potential exposure
Training Requirements cont’d
• Review the process when an exposure
incident occurs
• Review your department’s post exposure
program and follow-up program
• Discuss signs, labels, and color-coding
used to indicate hazards
• Provide an opportunity to ask questions
and receive answers
Definition Bloodborne Pathogen
• Microorganisms that:
are present in human blood
can infect and cause disease in people who
are exposed to blood containing the pathogen
can be transmitted through contact with
contaminated blood and body fluids
Examples Bloodborne Pathogens
•
•
•
•
•
•
•
•
Human Immunodeficiency Virus (HIV)
Hepatitis B (HBV)
Hepatitis C (HCV)
Non A, Non B Hepatitis
Syphilis
Malaria
Babesiosis
Brucellosis
Examples cont’d
•
•
•
•
•
•
Leptospirosis
Arboviral infections
Relapsing fever
Creutzfeld-Jakob disease
Human T-lymphotrophic Virus Type 1
Viral hemorrhagic fever
Universal Precautions
• The concept that all blood and potentially
infectious materials must be treated as if
they are known to contain HIV, HBV, or
other bloodborne pathogens
You can’t tell if material is or is not infectious
so treat all materials as if they are
infectious!
Body Substance Isolation
• Body Substance Isolation is an alternative
infection control method in which all body
fluids and substances are defined as
infectious
• Coverage of the Bloodborne Pathogen
Standard extended to include all body
substances
Controls in Place
• The objective of engineering controls
and work practice controls is the
same:
–to reduce or minimize employee
exposure to bloodborne pathogens
Engineering & Work Practice
Controls
• Differences
– One control isolates or removes the
hazard from the workplace
• Engineering control
– One reduces the risk of exposure by
altering how tasks are performed
• Work practice control
OSHA Impact
• OSHA gives precedence to engineering controls,
where feasible, over work practice controls, as
stated in a November 1999 compliance directive
– Enforcement Procedures for the Occupational
Exposure to Bloodborne Pathogens (OSHA CPL 22.44D):
"Where engineering controls will reduce employee
exposure either by removing, eliminating, or
isolating the hazard, they must be used."
Implementing Controls
• To guide selection of proper engineering
and work practice controls to implement:
Determine tasks and procedures performed in
the workplace where occupational exposure
may occur
Determine which employees are at risk for
occupational exposure while carrying out their
normal duties
Engineering Controls
• Examples:
– labeled sharps disposal containers
– self-sheathing needles
– safer medical devices
• sharps with engineered sharps injury
protections and needleless systems
– handwashing facilities
– antiseptic hand cleanser
– cleaning supplies and equipment
Work Practice Control
• Examples:
– Handwashing
– Prohibiting recapping of needles by a
two-handed technique
– Handwashing
– No eating, drinking, smoking in the ambulance
– Handwashing
– Disinfecting equipment and vehicle
– Handwashing
– Removing a soiled uniform
– Handwashing
Handwashing
• One of the simplest and most effective
practices used to prevent the transmission
of bloodborne pathogens
• Prevents transfer of contamination from
your hands to other areas of your body, to
other persons, or to other surfaces you
may contact later
Handwashing
 As soon as possible following an occupational
exposure to blood or other potentially infectious
materials
 After removal of gloves
 Before and after every patient contact
 After toileting
 Before and after preparing food
 Before and after eating or smoking
 After coughing or sneezing into hands or
blowing nose
Handwashing How-to
•
•
•
•
•
•
•
•
Take off rings
Turn on faucet
Wet hands
Apply soap
Scrub your hands - minimum 15 seconds
Rinse
Dry hands
Turn off faucet – use paper towel
Scrubbing Your Hands
• Rub palms and backs of hands
• Rub your fingers
– Special attention to thumb and fingertips
• Interlace fingers
– Get into web spaces
• Clean under and around fingernails
• Rub your wrists
– Go 2 - 3 inches up forearm
Antiseptic Hand Cleaner
• Antiseptic hand cleaners may be used as an
appropriate hand washing practice IF:
 Your gloves remained intact
 You have had no occupational exposure to blood or
other potentially infectious materials
 Material can be left to air dry on your skin
• Choose product with at least 60% alcohol
• Washing with soap and running water every time
you remove your gloves is the recommended
practice.
Did You Know?
• Liquid soap is preferred
– Bar soap can transfer microorganisms
• Antimicrobial or plain soap?
– Plain soap good enough for ordinary washing
– Antimicrobial is preferred during patient care
Antiseptic Cleanser Precaution
• Gels contain 60-65% ethanol
– Same type of product found in beer and wine
• Beer usually contains 3-6% alcohol
• Wine generally contains 8-16% alcohol
• Spirits contain over 40% alcohol
• A teaspoon or 2 could make a toddler
intoxicated or give them alcohol poisoning
• Keep hand sanitizers out of children’s reach
Source: Illinois Poison Center
Personal Hygiene
Personal hygiene involves using
good judgment when working in
areas with the potential for
exposure
 Minimizing splashing, spraying, spattering and
generation of droplets when attending to an
injured person.
 Refraining from eating, drinking, smoking,
applying cosmetics or lip balms, or handling
contact lenses where there is a reasonable
likelihood of occupational exposure.
 Keeping food or drink away from refrigerators,
freezers, shelves cabinets or on countertops or
bench tops where blood or other potentially
infectious materials are present.
 Refraining from mouth pipetting/suctioning of
blood or other potentially infectious materials.
Personal Protective Equipment PPE
• The type of protective equipment
appropriate for your job or research varies
with the task and the degree of exposure
you anticipate
PPE - Gloves
• Should be made of latex, nitrile, rubber, or
other water impervious materials
• If particularly thin or flimsy, double gloving
can provide an additional layer of
protection
• If you have cuts or sores on your hands,
cover these with a bandage or similar
protection as an additional precaution
before donning your gloves
Gloves
• Always inspect your gloves thoroughly
before putting them on
• Never use gloves that are damaged, such
as torn or punctured
• Remove contaminated gloves carefully,
avoiding touching the outside of the gloves
with bare skin
• Dispose of contaminated gloves in a
proper container
Removing Gloves
• Grab one glove cuff and pull
off glove
• Capture removed glove in other palm
• Pull off remaining glove by grabbing inside
of cuff
• Pull glove off and over first
removed glove
• Dispose of gloves
PPE – Eye Protection
• Bloodborne pathogens can be transmitted
through the mucous membranes of the
eyes.
• Use eye protection whenever there is a
risk of splashing or vaporization of
contaminated fluid
– Airway control (ie: intubation, suctioning)
– Cleaning up spills
– Cleaning equipment
Mask and Face Shields
• Masks and face shields provide additional
protection for potential eye, nose, or mouth
contamination
• Used during tasks that may generate blood or
other potentially infectious materials via:
Splashes
Spray
Spatter
Droplets
Protective Clothing
• Appropriate protective clothing such as,
but not limited to, gowns, aprons, lab
coats, clinic jackets, or similar outer
garments shall be worn in occupational
exposure situations
• Type and characteristics will depend upon
the task and degree of exposure
anticipated.
General Guidelines for Personal
Protective Equipment Use
• Persons should be trained to use the equipment
properly.
• The equipment should be appropriate for the
task and should fit properly, especially gloves.
• Equipment should be free from physical flaws
that could compromise safety.
• Persons must use appropriate protective
equipment each time they perform a task
involving potentially infectious materials.
Employer Responsibilities
 Issue PPE or make it readily accessible in the
work area
 Maintain, replace or dispose of any PPE at no
cost to employees
• Employer can provide the engineering controls
• The employee needs to exercise the work
practice controls for the process to be effective
Signs, Labels & Color Coding
• Signs and labels in the workplace
communicate bloodborne pathogen
hazards to employees.
• Warning label must include the universal
biohazard symbol and the term
"biohazard" in a color that contrasts with
the fluorescent orange,
orange-red background
Using Warning Labels
• Warning labels must be affixed to
containers of regulated waste,
refrigerators and freezers containing blood
or other potentially infectious material, and
other containers used to store, transport,
or ship blood or other potentially infectious
materials.
• Red bags or red containers can be
substituted for labels.
Warning Labels
• Contaminated equipment which is to be
serviced or shipped must also have a
warning label and a statement regarding
which portions of the equipment remain
contaminated.
Research Laboratories
• HIV and HBV Research Laboratory and
Production Facilities must have biohazard
signs posted at the entrance.
• Signs must also include:
Name of the infectious agent
Special requirements for entering the area
Name, telephone number of the laboratory
director or other responsible person
Cleaning and Decontamination
Duties
• Review product labeling for any special
directions/precautions
• Wear appropriate PPE for task being performed
• Remove all blood and debris from surface to be
cleaned
– Products can’t clean the surface if they can’t be in
contact with the surface
• Allow disinfectant to air dry
– Leave surface wet 30 seconds for HIV disinfection
– Leave surface wet 10 minutes for HBV disinfection
Clean Up Involving Blood or Body
Fluids
• Wear appropriate Personal Protective
Equipment (PPE).
• Carefully cover the spill with absorbent material,
such as paper towels, to prevent splashing.
• Decontaminate the area of the spill using an
appropriate disinfectant, such as a solution of
one part bleach to ten parts water. When
pouring disinfectant over the area always pour
gently and work from the edge of the spill
towards the center to prevent the contamination
from spreading out.
Clean Up of Spills cont’d
• Wait 10 minutes to ensure adequate
decontamination, and then carefully wipe up the
spilled material.
• Be very alert for broken glass or sharps in or
around the spill.
• Disinfect all mops and cleaning tools after the
job is done.
• Dispose of all contaminated materials
appropriately.
• Wash your hands thoroughly with soap and
water immediately after the clean up is
complete.
Housekeeping and Waste Disposal
• Keeping the worksite clean and sanitary is
a necessary part of controlling worker
exposure to bloodborne pathogens.
• Cleaning schedules and decontamination
methods depend on:
– type of surface to be cleaned
– type of soil that is present
– particular tasks or procedures that are being
performed
General Housekeeping Guidelines
• Clean and decontaminate all equipment and
working surfaces after contact with blood or
other potentially infectious materials
• Disinfect contaminated work surfaces, such as
counters, cots, side rails, B/P cuffs:
 after completing procedures
 immediately or as soon as feasible if they are heavily
contaminated or if there has been a spill of blood or
other potentially infectious materials
 at the end of the work shift if the surface may have
become contaminated since the last cleaning.
Housekeeping cont’d
• Inspect and decontaminate bins, pails,
cans, and similar receptacles intended for
reuse which have a reasonable likelihood
for becoming contaminated with blood or
other potentially infectious substances on
a regularly scheduled basis.
• Clean and decontaminate receptacles
immediately or as soon as feasible upon
visible contamination.
Cleaning Glucometers
• Clean surface when visible blood or body fluids
are present
– Wipe with a cloth dampened with soap and water to
remove any visible organic material
• If no visible organic material is present, disinfect
exterior surfaces after each use following the
manufacturer’s directions
– Use a cloth/wipe with either an EPA-registered
detergent/germicide with a tuberculocidal HBV/HIV
label claim, or a dilute bleach solution of 1:10 (one
part bleach to 9 parts water) to 1:100 concentration
Cleaning Glucometers
• Alcohol should never be used because it can
damage the light emitting diodes (LED) readout
– Can cause “fogging" of the plastic screens
• All manufacturers caution that having the cloth
too saturated with appropriate cleaning product
could allow liquid to get inside the glucometer
and cause damage
– Screens and ports currently are not sealed on these
devices.
Handling and Disposing of Broken
Glassware
• Do not pick broken glassware up directly with your
hands.
• Use items such as a brush and dust pan, tongs, or
forceps to clean up glassware.
• Sterilize broken glassware that has been visibly
contaminated with blood with an approved disinfectant
solution before disturbing it or cleaning it up.
• Dispose of decontaminated glassware in an appropriate
sharps container. Sharps containers should be closable,
puncture-resistant, leak-proof on sides and bottom, and
appropriately labeled.
• Dispose of uncontaminated broken glassware in a
closable, puncture resistant container such as a coffee
can.
Waste Disposal
Regulated waste refers to
 Any liquid or semi-liquid blood or other
potentially infectious materials
 Contaminated items that would release blood or
other potentially infectious materials in a liquid or
semi-liquid state if compressed
 Items that are caked with dried blood or other
potentially infectious materials and are capable
of releasing these materials during handling
 Contaminated sharps
 Pathological and microbiological wastes
containing blood or other potentially infectious
materials
Recordkeeping
• Medical records must be kept for each employee
with occupational exposure for the duration of
employment plus 30 years, must be confidential
and must include name and social security
number; hepatitis B vaccination status (including
dates); results of any examinations, medical
testing and follow-up procedures; a copy of the
healthcare professional's written opinion; and a
copy of information provided to the healthcare
professional.
Recordkeeping cont’d
• Medical records must be made available
to the subject employee, and anyone with
written consent of the employee, but they
are not to be available to the employer.
Recordkeeping cont’d
• Training records must be maintained for
three years and must include dates,
contents of the training program or a
summary, trainer's name and
qualifications, names and job titles of all
persons attending the sessions.
Exposure Incidents
• An exposure incident is an event resulting from
the performance of an employee's duties in
which there has been:
 A percutaneous injury involving a potentially
contaminated needle or other sharp
 A splash of blood or other potentially infectious
materials to the eyes, mouth, or mucous
membranes
 Blood or other potentially infectious materials
contacting broken skin
Potential Exposure
• An occupational exposure should always be
considered an urgent medical concern to ensure
timely postexposure management and
administration of hepatitis B immune globulin
(HBIG), hepatitis B vaccine, and/or HIV postexposure prophylaxis (PEP).
• If you are injured or exposed, tell your
supervisor immediately. Your supervisor is
responsible for reporting your injury
correctly.
Advocate CMC EMS System
Policy
• Notification of significant exposure is to be
reported immediately to the receiving
hospital
• Complete “Notification of Significant
Exposure” form
– Leave in sealed envelope for EMS coordinator
• The ED MD on duty will advise the
appropriate medical follow-up or need for
consultation with private physician
EMS System Policy cont’d
• Follow-up fees responsibility of the
provider
• If ED care is rendered to the provider, they
must sign-in as a patient in the ED
– Guarantees proper documentation the
incident and of care rendered
Notification of Significant Exposure
Form
• Fill in information in the 1st four columns as
completely as possible
• Check all means of exposure that apply
• Provide information on the type and brand
of device, if involved
• Receiving hospitals in Illinois are required
to notify ambulance providers if a patient
has been diagnosed as actively
contagious
– Notification made within 72 hours of diagnosis
• Early treatment can significantly
reduce the chance of disease
transmission!
Postexposure Prophylaxis
• The U.S. Public Health Service (PHS) has
published Guidelines for the Management
of Occupational Exposures to HBV, HCV,
and HIV and Recommendations for
Postexposure Prophylaxis", which can be
accessed at:
http://www.cdc.gov/mmwr/preview/mmwrht
ml/rr5011a1.htm.
Microorganisms
• Disease causing organisms
• Microscopic in nature
• Can be part of the normal flora or
pathogenic (able to cause disease)
– Bacteria
– Viruses
– Fungi
– Protozoa
– Parasites
Routes of Exposure
• Bloodborne
– HIV, HBV, HCV, syphilis
• Airborne
– TB, influenza, common cold, RSV, chickenpox
• Droplet
– Influenza, meningitis, measles, mumps, rubella,
chickenpox (varicella)
• Fecal-oral
– HAV, food poisoning
• Note: Multiple diseases could be airborne and/or droplet
Disease Transmission
 Direct contact
– Person to person
– Physical transfer of microorganisms
• Coughing, sneezing, kissing, sexual contact,
contact with blood or body fluid
 Indirect contact
– Susceptible person infected from contact with
contaminated surface
– Person most likely brings contaminated hands to their
face
• Telephones, door knobs, steering wheels, B/P
cuffs, EKG cable, handrails, pens
• Via food products, water, soil
Bloodborne Exposure
• Direct or indirect contact with blood or
infected body fluids
– Needle stick
– Splash on broken skin
– Splash on mucous membranes
• Eyes, nose, mouth
Airborne Exposure
• Particles remain suspended in air a long
time and float a distance
• At risk when less than 6 feet from patient
• Transmitted via sneezing, coughing, talking,
shedding of skin
• Healthcare worker should wear a N95 mask
• Patient should wear a tight fitting surgical
mask
– TB, polio, pneumonia, influenza, chicken pox
Droplet Exposure
• Droplet of moisture expelled from the upper
respiratory tract and then inhaled into the
respiratory system or contacts the mucous
membranes
• Droplets too heavy to remain airborne for long
• Transmitted during sneezing, coughing, talking
• Most at risk when within 3 feet of patient
• Wear surgical masks when threat of droplet
exposure
– Common cold, influenza, H1N1, meningitis, rubeola
(measles), whooping cough
Fecal-oral Route
• Ingestion of contaminated food or water
• Contaminated hands (usually from
improper handwashing or lack of
handwashing) transfers microorganisms to
all surfaces and objects touched
• Recipient touches surface and then brings
contaminated hands to their face or
ingests contaminated product
– HAV, food poisoning
Terms Defined
• Communicable disease
– Capable of being transmitted to another host
• Contamination
– Infectious agent on surface of host but not
penetrating it
• Infection
– Penetration of agent has occurred to host
– Having the infection does not automatically
imply having the disease
Factors Affecting Disease
Transmission
• Mode of entry
– Intact skin an excellent barrier
– Mucous membranes often the point of entry
• Eyes, nose, mouth
• Virulence
– Organism strength (ability to infect)
• HBV infectious for weeks
• HIV die when exposed to air and light
• Dose
– Number of organisms
• Host resistance – general health
Phases of Infectious Process
• Latent period
– Host infected, does not transmit to others
• Communicable period
– May have signs and can transmit disease
• Incubation period
– Time between exposure and appearance of
symptoms
Phases cont’d
• Seroconversion
– Antibodies created after exposure; lab tests
are positive
• Window phase
– Time between exposure and seroconversion
– May test “negative” even though person is
infected
• Disease period
– Time from onset of signs and symptoms until
resolution or death
Preventing Infection
• Break the cycle:
Infectious
agent
Means of
transmission
Host
Routes of
exposure
Selected Infectious Diseases
Definition
Incubation Period
Transmission Mode
Signs & Symptoms
Recommended PPE’s
Special Considerations
HIV
• A fragile virus that attacks the immune
system
• Eventually leads to AIDS – a collection of
signs and symptoms
• Incubation is variable and can be in years
• Transmission
– Sexual contact
– Contact with contaminated blood
– Mother to newborn
HIV cont’d
• Signs & symptoms
– Fatigue, fever, sore throat, lymphadenopathy,
splenomegaly, rash, diarrhea, secondary
infections, weight loss, dementia, psychosis
• No vaccine
• PPE – gloves, goggles, mask, gown as
needed to avoid blood contamination
• HIV rarely presents life threatening
– Is more often a psychosocial challenge
Hepatitis B (HBV)
• Viral infection; can develop into chronic
state; affects the liver
• Incubation 4 - 25 weeks
• Transmitted by direct contact with blood or
body fluids
• Complaints start as flu-like symptoms
– Dark urine, light colored stools, fatigue, fever,
jaundice
• PPE’s – gloves, goggles, mask, avoidance
of needlesticks
Hepatitis B Virility
• The CDC states that Hepatitis B Virus can
survive for at least one week in dried blood
on environmental surfaces or on
contaminated instruments.
Hepatitis B Vaccine
• Must be offered within 10 days of assignment to
task with exposure risk involved
• If employee declines, must sign declination form
– Kept on file
• Employee may, at any time, request the hepatitis
B vaccine after initial declination
– 3 injection series
– Given IM in deltoid
– Once started, 2nd dose is in 1 month; 3rd dose 6
months from 1st dose
Hepatitis C (HCV)
• Viral infection causing inflammation of liver
• Can lead to cirrhosis and cancer
• Leading reason for liver transplants in the
USA
• Incubation 2-25 weeks
• Transmission – contact with contaminated
blood
• Contagious throughout course of infection
HCV cont’d
• Symptom onset slow (up to 20 years for
chronic infection)
– Loss of appetite
– Vague abdominal discomfort
– Nausea and/or vomiting
– Jaundice less common than with HBV
• No vaccine is available
• PPE’s – gloves, mask, goggles, avoidance
of needle sticks
Tuberculosis (TB)
• Bacterial infection most commonly
affecting the lungs
• TB infection
– Person has the bacteria but is not ill; cannot
spread disease
• TB disease
– Person ill, can spread TB
• Incubation 4 -12 weeks
• Transmission via airborne droplet
– Prolonged exposure increases risk
TB cont’d
• Signs and symptoms
– Fever
– Chills
– Weakness. fatigue
– Night sweats
– Weight loss
– Dyspnea
– Productive cough
– Chronic cough
TB cont’d
• PPE’s
– Respiratory isolation
– Tight fitting surgical mask on patient
– N95 mask for providers
• Obtain periodic skin testing
– If positive, need chest x-ray
• Provide adequate ventilation while caring
for and transporting the patient with
suspected or positive diagnosis
Chickenpox (Varicella)
• Viral infection
• Transmitted via direct and indirect contact
and airborne droplets
• Incubation 10 - 21 days
• Signs and symptoms
– Sudden onset low-grade fever
– Mild feeling of not being well (malaise)
– Rash
Chickenpox cont’d
• Contagious about 2 days prior to rash and
until all vesicles have scabbed over
• Skin eruptions continue over 3 – 4 days
• PPE’s – gloves; surgical mask on patient,
mask on healthcare provider
• Vaccination added to childhood
immunization schedule
Bacterial Meningitis
• Bacterial infection causing inflammation of
the covering the brain and spinal cord
• Transmitted via contact with respiratory
droplets
• Incubation – 2 – 10 days
• Sudden onset high fever, headache, stiff
neck, nausea with vomiting, irritability
– Infants – poor feeding, irritability
Bacterial Meningitis cont’d
• PPE’s – gloves, mask (patient and
provider)
• Vaccination provided in childhood
immunization schedule
• Postexposure antibiotic prophylaxis
provided after exposure
Influenza – The Flu
• Upper respiratory viral disease
• Transmitted via respiratory droplet or
airborne in crowded, enclosed spaces
• Incubation usually 1 – 5 days
• Adults contagious 3 – 5 days after
symptom onset
– Up to 7 days in children
• Rapid onset high fever, headache, muscle
aches, sore throat, dry cough
Flu cont’d
• PPE – Mask the patient and provider
• Frequent handwashing
• Daily cleaning of environment
– Phones, door handles, steering wheels,
counter tops, computers
• Best protection – annual flu vaccine
H1N1 Influenza – Swine Flu
• A new strain of influenza virus
• Transmitted person to person primarily via
droplets
– Coughing
– Sneezing
– Contact with contaminated objects
• Contaminated hands touch the nose and mouth
and introduce the virus
• Incubation could range 1 – 7 days
• Considered contagious up to 7 days from
symptom onset
H1N1 cont’d
• Symptoms similar to regular flu
–
–
–
–
–
–
Fever
Cough
Sore throat
Body aches
Chills
Fatigue
• Critical situation
– Respiratory difficulty
– Cyanosis
– Pain, pressure in chest or abdomen
H1N1 cont’d
• PPE
– Gloves
– HANDWASHING
• Disinfecting surfaces after each call
• Frequently disinfect surfaces likely to have
hand contact
General Advice
• Get vaccinated
• Cover mouth and nose when coughing or
sneezing
– Use elbow not hand
– Throw tissue away after one use
• Wash hands often
• Avoid touching eyes, nose, mouth with hands
• Practice good personal health
–
–
–
–
Get plenty of rest
Eat healthfully
Manage stress
Stay physically active
3 C’s To Stay Healthy
• CLEAN – COVER – CONTAIN
Wash your hands
Cover your cough and sneeze
Contain your germs
• Stay home if sick
Pertussis – Whooping Cough
• Highly contagious bacterial disease
• Incubation 7 – 10 days
– Range total 4 – 21 days
• Transmitted most commonly respiratory
droplet and airborne
• Most at risk
– Infants prior to vaccination
– Aging population with lost immunity
– Those never vaccinated
Whooping Cough cont’d
• Signs and symptoms in phases
– 1st phase – sneezing, watery eyes, loss of
appetite, listless, noticeable night cough
– 2nd phase – in 10 -14 days paroxysms of
coughing, thick mucous coughed up
– 3rd phase – in 4 weeks coughing decreases in
frequency; can last for months
– Vaccination – DTaP
• Immunity not life long; need repeat
vaccination
Whooping Cough cont’d
• PPE – gloves, surgical mask patient and
provider, goggles, possible gown
• Complications often from the spasmodic
forceful coughing
Pneumothorax
Rib fractures
Hypoxia during coughing spells
Staph Infections
• Staphylococcus aureus, often referred to simply
as "staph," are bacteria commonly carried on the
skin or in the nose of healthy people
• Approximately 25% to 30% of the population is
colonized (bacteria are present, but not causing
an infection) in the nose with staph bacteria
• One of the most common causes of skin
infections in the United States
• Most of these skin infections are minor (such as
pimples and boils) and can be treated without
antibiotics
• Staph bacteria can also cause serious infections
MRSA – Methicillin-Resistant
Staphylococcus Aureus
• Type of bacteria that is resistant to
common antibiotics such as methicillin,
oxacillin, penicillin and amoxicillin.
• Consequently, MRSA infections can be far
more difficult to treat quickly than
traditional staph infections.
• Occurs most frequently among persons in
hospitals and healthcare facilities who
have weakened immune systems.
Community Associated MRSA
• MRSA infections acquired by persons who have
not been recently hospitalized or had a medical
procedure (such as dialysis, surgery, catheters)
are known as CA-MRSA (Community Associated
MRSA) infections.
• CA-MRSA infections can be transmitted in
settings such as workout facilities or locker
rooms
• Are usually manifested as skin infections such
as pimples and boils
Results Of Contracting MRSA
Skin infections, pimples, boils
Pneumonia
Bloodstream infections
Potentially death
Transmission of MRSA
• Spread of MRSA skin infections is direct
and indirect
Close skin-to-skin contact
Cuts or abrasions
Poor hygiene
• Methods of Contraction
Crowded living conditions
Contaminated items or surfaces
Weakened immune system
MRSA
• PPE
– Gloves
– Transport patient with a clean sheet
• Do not use the sheet from the bed the
patient was lying in, if possible
– Avoid placing laundry in contact with
uniform; wear gown if contact made with
uniform
– Handwashing
Vancomycin-resistant Enterococcus
- VRE
• Bacteria normally found in intestines
• Produces disease when bacteria invade
other areas
– Urinary tract, wounds, blood
• Healthy individuals rarely at risk
– Healthy individuals can transmit VRE via
indirect methods
• Those at most risk – weakened immune
systems and other health issues
VRE
• Spread via contact
Feces
Contaminated equipment
Healthcare worker’s hands
• PPE
– Gloves
– Gown if clothing contact anticipated
– Handwashing – single most important process
to control spread of VRE
– Disinfect equipment after calls
• Prevents indirect spread of VRE
Content Review
• Review the following questions
• After determining an answer, click the
mouse to check your knowledge
• Complete the course with a 10 questions
quiz
Question # 1
• Who does the OSHA's Bloodborne
Pathogens standard cover?
1. All employees, regardless of occupation or
workplace
2. All employees in jobs where occupational
exposure to bloodborne pathogens can be
"reasonably anticipated“
3. Only employees who work in health care
settings, such as hospitals or clinics
4. Only employees who use needles on the job
Question # 2
• Which label indicates that a biohazard
is present?
Question # 3
• Which of the following is not an example of
an other potentially infectious material
(OPIM)?
1. Blood from experimental animals infected
with HIV or HBV
2. Cerebrospinal fluid
3. Urine
4. Unfixed body organs going to the lab for
analysis
Question # 4
• Which of the following is a true statement
concerning handwashing after occupational
exposure to blood or other potentially infectious
materials?
1. If your gloves are still intact when you remove them,
there is no need to wash your hands afterwards.
2. Strong abrasive soaps are most effective in removing
contamination from hands.
3. Using an antiseptic towelette is always an acceptable
alternative to washing your hands with soap and water.
4. The best practice is to thoroughly wash your hands
with soap and water after any potential exposure.
Question # 5
• How often should work surfaces, such as
counters or cabinet surfaces, be
decontaminated?
1. Whenever procedures involving blood or other
potentially infectious materials are completed
2. At the end of each work shift, if the surface
may have become contaminated since the last
cleaning
3. Immediately or as soon as feasible following a
spill of blood or other potentially infectious
material
4. All of the above
Question #6
• Are gloves required when giving an
injection?
YES
or
NO
Gloves are not required to be worn when giving an
injection as long as hand contact with blood or other
potentially infectious materials is not reasonably
anticipated.
Source: USDOL FAQ’s
Resources
•
•
•
•
www.lakecountyil.gov/Health/H1N1.htm
Ready.illinois.gov
www.flu.gov
LCHD Flu Hotline: 847-377-8350
Bibliography
• Condell Medical Center EMS System Operational
Guidelines & Infield Policy Manual. January 2001
• Environmental Health & Safety On-line Training Module.
BBP. 2010.
• Region X SOP’s March 2007. Amended May 1, 2008.
• www.cdc.gov
• www.cdc.gov/ncidod/hip/Blood/Exp to blood.pdf
• www.cdc.gov/sharpsafety/
• www.Illinoispoisoncenter.org
• www.osha.gov/OshDoc/data_BloodborneFacts/
• www.osha.gov/SLTC/bloodbornepathogens/index.html