Everyone Sign Roster
•Sign-In Rosters
•Required for all CCVESA Providers.
•Please Print Name, MIEMSS I.D. #, and Company
Affiliation
•All completed rosters must be sent back to the EMS
Training Coordinator.
Carroll County Volunteer Emergency Services Association
Bloodborne Pathogen
2014 Update
Training Objectives
• The purpose of this training is to
– Review OSHA Bloodborne Pathogen Standard.
– Using Case Studies to Review BBP diseases that you could come in
contact with
– Review PPE needed to minimize exposure
– Review what constitutes an exposure incident
– Review Needle Stick exposures
– Review the appropriate actions to take and persons to contact in an
emergency involving an Exposure
– Review procedures to follow if an exposure incident occurs
– Review of required documentation that MUST be completed
following an exposure
– Review the post-exposure evaluation and follow up procedures
OSHA Standard
• Occupational Safety and Health
Administration
• OSHA Standard 19 CFR 1910.1030
• “Occupational Exposure to Bloodborne
Pathogens”
• Applies to all occupational exposure to blood
or other potentially infectious materials.
OSHA Standard
19 CFR 1910.1030
• Each employer having employee(s) with the potential of
exposure shall establish a written Exposure Control Plan
• Establish Exposure Determination
• Provide Personal Protective Equipment
• Establish good housekeeping procedures
• Provide Hepatitis B Vaccinations
• Establish Post-exposure Evaluation & Follow-up procedures
• Communication of hazards to employees with appropriate
Labels and Signs
• Provide Information and Training
• Recordkeeping
Annual BBP Training Records
• OSHA requires annual BBP training for all
volunteer and employees
• Training records are to completed for each
volunteer or employee upon completion of
training
• These documents must be kept for at least
three (3) years at the office of the EMS
Training Coordinator
Annual BBP Training Records
• Training Records should include
– The dates of the training sessions
– The contents or a summary of the training
sessions
– The names and qualifications of the persons
conducting the training
– The names and job titles of all persons attending
the training sessions
Bloodborne Pathogens of
Special Concern To Health Care
Providers
– HBV: Hepatitis B virus
– HCV: Hepatitis C virus
– HIV: Human Immunodeficiency virus
– Influenza…H1N1
– Meningitis
– MRSA Staphylococcus Aureus (Staph)
– Tuberculosis
BloodBorne Pathogens
• Every patient is a threat to our safety
• Most common BBP are Hepatitis B/C and HIV
• Most common type of BBP exposure in EMS
are a result of needlesticks.
• There are approximately 600-800k reported
needlesticks of healthcare workers every year.
Types of BBP Exposures
• Percutaneous Exposures Occur Through Broken Skin and
include
– needle stick with contaminated needle
– cut with a contaminated sharp object
– direct contact of contaminated blood or other
infectious material with non-intact skin (skin that is
chapped, abraded, afflicted with dermatitis, etc.)
• Mucotaneous Exposures Occur when infectious material
contacts mucous membranes of the mouth or nose
What constitutes a BBP
exposure?
• The transfer of a patient’s blood, other bodily
fluids containing blood, or other potentially
infectious material, to the provider’s
bloodstream by direct transfer, via mucous
membrane inoculations, or through openings in
the skin.
• Simple handling of a patient does NOT
constitute an exposure
• Small amounts of blood or other infectious
material on intact skin do not constitute an
exposure.
Important things to keep in mind…
• Patient contact does not equal exposure
• It is NOT in your best interest to “upgrade” a
near miss (for example, blood on intact skin or
blood near but not on mucus membranes) to an
actual exposure
• Exposure to blood does not necessarily (or even
usually) result in exposure to disease
• Most exposures to disease do NOT result in
infection
• You can greatly decrease your risk of
occupationally acquired disease by following
the guidance in this presentation.
CASE STUDY 1
• November 21….1930 Hrs
• Your unit is dispatched to a 1624 Main Street
for a “sick female patient”
ARRIVAL ON SCENE
• Upon arrival you find a 42 year old female
patient lying supine in bed. She thinks she
may have the “flu”
• Patient c/o fever, some upper abdominal pain,
and nauseated.
• Patient states she has felt extremely tired and
has no desire to eat.
INITIAL ASSESSMENT
• Airway: Patent
• Breathing: Regular, RR 18
• Circulation: HR 100 , skin warm & diaphortic
and her skin has a yellowish discoloring
PHYSICAL EXAM
• Head/Neck
– Pupils - PERRL
– Eyes – slight jaundice in her eyes
• Chest
– Equal lung sounds and expansion
• Abdomen
– Soft, non-tender
– Dull pain across both upper quadrants
PHYSICAL EXAM
• Pelvis
– Stable
• Extremities
– PMS present all extremities
• Posterior
– No evidence of trauma
VITAL SIGNS
• BP: 114/88
• HR: 100 regular
• RR: 18
• SpO2: 96% Room Air
PATIENT HISTORY
•
•
•
•
•
A: NKDA
M: Tylenol for the fever
P: IV Drug Abuser 10 years ago
L: Not eating due to loss of appetite
E: Not feeling well for past couple of days
What would you consider to
be this patient’s chief
medical problem?
PATIENT DIAGNOSIS
Hepatitis B
What should you have done
prior to & while in contact
with this patient?
Hepatitis B
-- Attempt to Avoid exposure
–Assume every patient is infected
–Prevention with use of universal
precautions against Hepatitis B
–Use appropriate PPE/Gloves
–Follow all policies and procedure
–Get Hepatitis B Vaccination
Personal Protective Equipment
(PPE)
• Gloves
– MINIMUM required PPE for all patients
– shall be worn at all times when participating directly or indirectly in patient
care
– Shall also be worn during clean up activities, when handling any potentially
contaminated items, and at any other time exposure to blood or other
bodily fluids is possible.
– Remove contaminated gloves before touching equipment (e.g. portable
radios), vehicle door handles, or anything else that may lead to further
contamination. If this practically cannot be done, be certain to
decontaminate as soon as possible.
– NEVER wear contaminated gloves in the front (driver/passenger)
compartment of the medic unit.
Hepatitis B
• Infection of liver caused by Hepatitis B virus
(HBV)
• Transmitted by contact with bodily fluids
such as blood, saliva, and semen
• NOT transmitted by food or water,
breastfeeding, sharing eating utensils, hugs
or kisses
Hepatitis B
• Hepatitis B…
– can be fatal
– is very easy to catch compared to other diseases
spread by BBP
• Hepatitis B can survive outside the body
up to one week!
• Is preventable through vaccination
Hepatitis B Symptoms
• Initial symptoms may be mild or absent!
–
–
–
–
–
–
–
Tiredness
Loss of appetite
Fever
Vomiting
Yellow skin & eyes (jaundice)
Dark-colored urine.
Light colored stool
Hepatitis B
• There are 1.4 million chronically infected
• Approximately 73K new cases each year
• 15-25% mortality
Highest risk of contracting Hepatitis B
• Those with multiple sexual partners
(unprotected)
• IV drug abusers
• Infants born to infected mothers
• Regular household contact with chronically
infected persons
• Hemodialysis patients
Hepatitis B – Prevention
• Vaccine is the best prevention
– vaccine is 95% effective and in most cases, provides lifelong
immunity to the person receiving it
– vaccine comes as a series of three shots.
– after the 1st IM shot is administered, a 2nd shot will be given 30
days later, and the 3rd dose is administered 6 months after the
2nd dose.
– Lab titers may be necessary to ensure that the vaccine is still
working, and occasionally a person may need a booster shot to
bring the number of antibodies in the body up to necessary
levels.
• Safe handling of sharps and other potentially infected
products
Hepatitis B Prevention
• Make sure you are vaccinated against
Hepatitis B
– Vaccination (or formal declination) is mandatory
– The vaccine is safe. It is NOT a live virus vaccine, and cannot give
you hepatitis B
– The protection is permanent and highly effective
– Vaccination requires 3 doses of vaccine over 4-6 months and then
a blood titer
– The titer is essential to verify you have responded to the vaccine
& are protected!
• Avoid exposure - prevention with universal precautions
remains your best protection against Hepatitis B and all
other BBP
– Assume every patient is infected
– Use appropriate PPE
– Follow all policies and procedures
Hepatitis B Vaccination
• Volunteer Members or Employees
– Hepatitis B vaccines are available at no cost
to you within 10 days of initial assignment
– Vaccination will be provided by the CCVESA
Physician
Hepatitis B Vaccination is encouraged
unless…
• Documentation exists that the volunteer or
employee has previously received the series
• Antibody testing reveals that the volunteer or
employee is immune
• Medical evaluation shows that vaccination is
contraindicated
Hepatitis B Vaccination is declined by a
volunteer or employee…
• They must sign a declination form
• Documentation of refusal of the vaccination is
kept at the CCVESA Physician’s facility
• Volunteers or employees who decline may
request and obtain the vaccination at a later
date at no cost.
HEPATITIS B VACCINE DECLINATION
FORM
•
HEPATITIS B VACCINE DECLINATION (MANDATORY)
• I understand that due to my occupational exposure to blood or other
potentially infectious materials I may be at risk of acquiring Hepatitis B
virus (HBV) infection. I have been given the opportunity to be vaccinated
with Hepatitis B vaccine, at no charge to myself. However, I decline
Hepatitis B vaccination at this time. I understand that by declining this
vaccine, I continue to be at risk of acquiring Hepatitis B, a serious disease.
If in the future I continue to have occupational exposure to blood or other
potentially infectious materials and I want to be vaccinated with Hepatitis
B vaccine, I can receive the vaccination series at no charge to me.
• Signed: __________________ Date: _________________
CASE STUDY 2
• October 15….2200 Hrs
• Your unit is dispatched to a Nursing Home @
1122 Pepper Lane for a “sick male patient”
ARRIVAL ON SCENE
• Upon arrival you are met by a staff member of
the nursing, who directs you to the patient’s
room and provides you with an appropriate
MOLST form. She advises that he had fell and
injured his right wrist and his attending
physician wants him evaluated at the ER.
ARRIVAL ON SCENE
• Patient is a 88 year old male sitting up in a
chair c/o injury to his right wrist
• You note that there is some deformity of the
right wrist.
• Patient states he fell on to his right hand as he
went down
• Patient has no other obvious injuries
INITIAL ASSESSMENT
• Airway: Patent
• Breathing: Regular, RR 22
• Circulation: HR 110, skin is hot and dry, You
notice a rash on his skin, with multiple
boils/pimples and several pus-filled abscesses
PHYSICAL EXAM
• Head/Neck
– Pupils - PERRL
• Chest
– Equal lung sounds and expansion
– No bruising or deformities
• Abdomen
– Soft, non-tender
– No discoloration
PHYSICAL EXAM
• Pelvis
– Stable
• Extremities
– Deformity to right wrist
– Good PMS in all extremities
• Posterior
– No evidence of trauma
VITAL SIGNS
• BP: 150/90
• HR: 110
• RR: 22
• SpO2: 93%
PATIENT HISTORY
•
•
•
•
•
A: Penicillin
M: Synthroid
P: Hypothyroid
L: Supper
E: Walking back to his room and lost his
balance and fell to the floor
What would you consider to
be this patient’s chief
medical problem?
FINAL DIAGNOSIS
MRSA
What should you have done
prior to & while in contact
with this patient?
MRSA
--Attempt to avoid exposure
–Assume every patient is infected
–Prevention with use of universal
precautions against MRSA
–Use appropriate PPE/Gloves
–Follow all policies and procedure
MRSA
• MRSA was first discovered in 1961 in the
United Kingdom.
• The first major outbreak in the US was in 1981
and was noted in a large population of IV drug
users.
• Since then, approximately 94k Americans are
infected every year.
• More than 18k people will die in the hospital
as a result of this organism.
MRSA
• Multiple drug-resistant strain of staph aureus
• Resistant to several common antibiotics and
even antibiotics that have been developed
within the past few years, making it extremely
dangerous and difficult to treat.
• Grows on every single surface
• Survives outside the host for several months
MRSA – Risks
Outbreaks
•
•
•
•
IV Drug users
Athletes
Nursing homes
Prisons
Race/Population
• Age 65+ years
• African Americans
• Males
MRSA- Complications
• Develops drug resistance within 72 hours of
host invasion
– most common portals of entry include wounds, IV
catheters, and the urinary tract.
• 75% all infections involve skin
– Boils/Pimples
– Fever
– Rashes
– Pus-filled abscesses
CASE STUDY 3
• January 5….1430 Hrs
• Your unit is dispatched to a 2750 North
Avenue for a “sick male patient”
ARRIVAL ON SCENE
• Upon arrival you find a 34 year old male
patient in bed who states “I think I have the
Flu”
• Patient c/o runny nose, coughing, headache,
chills and body aches all over.
• Patient also states “I have been having some
trouble breathing”
INITIAL ASSESSMENT
• Airway: Patent
• Breathing: Regular, RR 24
• Circulation: HR 90, skin is warm & dry
PHYSICAL EXAM
• Head/Neck
– Pupils - PERRL
• Chest
– Equal lung sounds and expansion
• Abdomen
– Soft, non-tender
PHYSICAL EXAM
• Pelvis
– Stable
• Extremities
– Good PMS in all four extremities
• Posterior
– No evidence of trauma
VITAL SIGNS
• BP: 114/88
• HR: 90
• RR: 24
• SpO2: 98%
PATIENT HISTORY
•
•
•
•
A: NKDA
M: Tyelnol as needed
P: None
L: Lunch, attempt a bowl of soup, but that was
vomited back up
• E: Has felt sick with Flu like symptoms for past
24 hours
What would you consider to
be this patient’s chief
medical problem?
FINAL DIAGNOSIS
H1N1 VIRUS
What should you have done
prior to & while in contact
with this patient?
H1N1 Virus
--Attempt to avoid exposure
–Assume every patient is infected
–Prevention with use of universal
precautions against H1N1 Virus
–Use appropriate PPE/Gloves/mask
–Follow all policies and procedure
–Get Influenza/H1N1 Vaccination
Surgical Masks
• Surgical Masks
– Protect against large droplets produced by coughing or sneezing
• Most respiratory illness spread in this way
• Follow respiratory hygiene/cough etiquette
– Protect against splashes or sprays of blood or other body fluids
when worn in combination with eye protection (mask plus shield
or goggles)
• Wear during patient care activities or procedures where
splashes or sprays are possible
• This includes all persons in vicinity of patient during bag-mouth
ventilation, intubation or suctioning
• Effective use of face and eye protection dramatically reduces
mucus membrane exposures.
Cough hygiene/respiratory etiquette
•
•
Put a mask on all patients with cough, or other
signs/symptoms of respiratory illness
– Non-rebreather – if O2 by non-rebreather mask is
indicated
– Nasal cannula with surgical mask - If O2 via nasal cannula is
indicated
– Surgical mask alone – for stable, alert patients with cough
or S/S of respiratory illness when O2 is not indicated, AND
Put a mask on ALL providers (surgical or N95) within 3 feet of
the patient when a mask also is indicated for the patient with
cough or S/S of respiratory illness – THIS IS MANDATORY FOR
YOUR PROTECTION!
H1N1 Virus
• The H1N1 Virus is also referred to as “Swine
flu.” It is called this because it has similar
genes to the virus that infects pigs.
• Pandemic- thousands of patients affected
worldwide
• 1st US case: April 2009
• Similar to seasonal flu
• Human to Human transmission
H1N1 Risk Factors
•
•
•
•
•
Age (Over 65 or under 5)
Pregnant
Chronic Medical Conditions
Immunosuppressed
Asthma
H1N1 Flu Virus Signs/Symptoms
•
•
•
•
•
•
•
•
•
•
•
Stuffy or runny nose
Sore throat
Cough
Fever
Chills
Headache
Fatigue
Body aches
Vomiting
Diarrhea
Respiratory symptoms without a fever
Influenza/H1N1 Vaccination
• Why should health care providers - including “first
responders” be vaccinated?
– Protect Your Patients
• Influenza can be fatal for our frail, immunocompromised patients
• Per the CDC - “First responders” are a high priority group for
immunization
– Protect Yourself
– Protect Your family
• Vaccination makes sense at least through March (flu season lasts
into May)
Seasonal Flu
•
•
•
•
Affects 5-20% of the US population every year
Peak season: January and February
200K sick/hospitalized every year
36K Americans die annually
Seasonal Flu- Spread
• Airborne droplets
– usually the result of a cough or sneeze
– droplets land on the recipient’s face and then are
inhaled into the nostrils.
• Contagious one day prior to S/S appearing and
for 5-7 days after sickness
Seasonal Flu- Risk Factors
• Children
– Children are susceptible due to having immature
immune systems. Usually in those less than age 5.
• Elderly
– The elderly, usually considered over 65 years of age,
are also at a higher risk due to many times having
previous medical conditions.
• Pregnant
• Asthmatics
• Diabetics
Seasonal Flu- Signs/Symptoms
•
•
•
•
•
•
•
•
•
•
Fever
Headache
Dry cough
Sore throat
Muscle aches
Lethargy
Runny nose
Nausea*
Vomiting*
Diarrhea*
* Occasional
CASE STUDY 4
• September 15….O130 Hrs
• Your unit is dispatched to a 2900 South Bend
Road for Motor Vehicle Collision
ARRIVAL ON SCENE
• Upon arrival you have a 28 year male patient,
with multiple injuries from being ejected from
the vehicle
• You are assisting with stabilization of this
patient, and as an IV is being established the
patient becomes combative secondary to a
head injury and the IV needle comes out of
the patient and you accidently get stuck in
your left hand
What action needs to be taken?
POST-EXPOSURE EVALUATION AND
FOLLOW-UP
• Exposed provider should contact Member Company
Exposure/Infection Control Officer
• Contact should be made immediately if not involved in an
emergency response or immediately upon completion of the
call of an emergency incident
• The Member Company Exposure/Infection Control Officer will
contact the CCVESA Exposure Control Officer or designee
Contact
• The CCVESA Exposure Control Officer or designee will contact
– Carroll Hospital Center
– Carroll Occupational Health
- Carroll County Health Department
POST-EXPOSURE EVALUATION AND
FOLLOW-UP
• Carroll Hospital Center, Carroll Occupational Health
and/or County Health Department will report back
the follow up procedures to the CCVESA Exposure
Control Officer or designee
• The CCVESA Exposure Control Officer or designee will
report back to the Member Company
Exposure/Infection Control Officer
• The Member Company Exposure/Infection Control
Officer will report back to the Exposed provider
POST-EXPOSURE EVALUATION AND
FOLLOW-UP
• The exposed provider should receive an
immediate confidential medical evaluation
and follow-up conducted by Carroll
Occupational Health if open ….
• or at Carroll Hospital Center if Carroll
Occupational Health is closed
CCVESA Exposure Control Officer
• Will ensure that the Health care professional
evaluating the volunteer or employee after an
exposure incident receives
– Description of volunteer’s or employee’s job duties
relevant to the exposure incident
– Route(s) of exposure
– Circumstances of exposure
– If possible, results of source individual’s blood test
– Relevant volunteer/employee medical records, including
vaccination status
POST-EXPOSURE EVALUATION AND
FOLLOW-UP
• If actual exposure did occur
– Clean, irrigate and dress area as appropriate
– Allow puncture wounds to bleed
– Irrigate mucus membranes copiously with water –
Ringers also is appropriate
POST-EXPOSURE EVALUATION AND
FOLLOW-UP
• If provider and Source patient are transported
to Carroll Hospital Center
– Advise Charge Nurse upon arrival that there has
been an exposure and you would like the source
patient’s blood tested.
– Carroll Hospital Center will obtain the source
patient’s blood and have it tested
POST-EXPOSURE EVALUATION AND
FOLLOW-UP
• If provider and source patient are transported to
another hospital
– Advise Charge Nurse upon arrival that there has been an
exposure and you would like the source patient’s blood
tested.
– The Hospital will obtain the source patient’s blood and
have it tested
– Results of the source patient’s blood test should be sent to
Carroll Occupational Health
– If Carroll Occupational Health is Closed have the results
sent to Carroll Hospital Center
POST-EXPOSURE EVALUATION AND
FOLLOW-UP
• The member infection/exposure control officer
should transport the exposed provider to Carroll
Occupational Health for initial evaluation and
treatment
• The member infection/exposure control officer
should Advise the Charge Nurse upon arrival that you
have provider that an exposure has occurred and the
source patient’s blood is being tested at the receiving
hospital
POST-EXPOSURE EVALUATION AND
FOLLOW-UP
• In the event that Carroll Occupational Health is
closed and the Source patient was transported to
Carroll Hospital Center then…
• The exposed provider will receive the initial
evaluation and treatment at Carroll Hospital Center
• Results of the source patient and the provider will be
sent to Carroll Occupational Health
POST-EXPOSURE EVALUATION AND
FOLLOW-UP
• In the event that Carroll Occupational Health is closed and the
Source patient was transported to another Hospital then…
• The exposed provider should be transported to Carroll
Hospital Center
• The member infection/exposure control officer should Advise
the Charge Nurse upon arrival that you have provider that an
exposure has occurred and the source patient’s blood is being
tested at the receiving hospital
• The exposed provider will receive the initial evaluation and
treatment at Carroll Hospital Center
• Results of the source patient and the provider will be sent to
Carroll Occupational Health
Exposure Policy and Procedures
• Treatment for Providers’ possible BBP exposure
–
–
–
–
Prompt evaluation and treatment
Source patient blood testing
PEP antiviral medications if indicated
Baseline and serial blood tests for six months after the
exposure for our provider
– Any other appropriate support, counseling or treatment
• The exposed provider must complete the exposure survey
provided by the CCVESA Exposure Control Officer (required by
federal regulation)
Exposure Policy and Procedures
• Remember: If treatment with HIV antiviral
medications (postexposure prophylaxis) is
indicated following an exposure, they should be
started as soon as possible… “within hours”
according to the CDC.
• All Carroll County EMS providers with suspected
BBP exposure will receive initial treatment and
evaluation at Carroll Hospital Center
– This applies only to BBP exposures
– The member infection/exposure control Officer
will confer with the Exposure Control Officer
and provide guidance
POST-EXPOSURE DOCUMENTATION
Carroll County Volunteer Emergency Services Association
Exposure Survey
Must be Completed for Any Type of Exposure
and must be completed by the exposed provider
Carroll County Volunteer Emergency Services Association
Exposure Survey
Complete for Any Type of Exposure
Exposed Provider: Please complete carefully and include all requested information.
Member Company infection Control Officer : Please review for accuracy and completeness prior to
submitting. This form is to be completed by the provider at the time of the incident and
submit the required paperwork to CCVESA Exposure Control Officer.
1. ID#: ____________________Unit/Shift ____________
2. Date of this Report:__________
3. Date of exposure: __________ Time_____
4. If this exposure occurred outside: (Leave section 4 blank if the exposure was indoors)
Ambient Conditions: Cold_____ Warm _____ Hot _____
Wet _____ Dry _____
5. If Inside or Outside: (Fill in regardless if indoors or outdoors)
Lighting Conditions: Good_____ Fair _____ Poor _____
6. Type of Exposure: _____ Blood
_____ Other (Describe)______
7. Type of contact: _____Splash/Spill/Spray
_____Droplet/Inhalation
Area of body exposed_____________
If Skin exposed, any wounds, sores or abrasions? ____
_____ Dirty Needle Stick
_____ Dirty IV Needle
Self-Sheathing? ___Y ___N
_____ Dirty Vacutainer Needle
Self-Sheathing? ___Y ___N
_____ Dirty Lancette Needle
Self-Sheathing? ___Y ___N
_____ Dirty Needle Attached to Syringe
Self-Sheathing? ___Y ___N
_____ Dirty Needle as part of a Pre-loaded drug
Self-Sheathing? ___Y ___N
CCVESA Exposure Survey Page 1 of 4
04-01-10
_____ Glass
_____ Broken Drug
_____ Opening glass vial
_____ Other Glass on scene
_____ Other – Describe:
For all sharps exposures the following MUST be completed:
Type of Device (IV cath, etc):
__________________________
Brand or Model of Device (Protectiv, etc.):
__________________________
Manufacturer of Device (Johnson & Johnson, etc.):
__________________________
Did the design of the device or any other engineering control factor play a role in this exposure? If yes, in what way?
8. Information regarding the type of scene to which you responded:
_____ Private Residence (House, any type)
_____ Private Residence (Apartment, house divided into apartments)
_____ Store or Business (Type___________)
_____ Nursing Home or Assisted Living Facility
_____ Public area (Pedestrian) ie mall, sidewalk
_____ Road, Roadside etc.
9. Information regarding Location where exposure actually occurred:
_____ Private Residence (House, any type)
_____ Private Residence (Apartment, house divided into apartments)
_____ Store or Business (Type______)
_____ Nursing Home or Assisted Living Facility
_____ Public Area (Pedestrian I.E. outdoor mall or sidewalk)
_____ Road or Roadside
_____ Inside of the Medic Unit
If the actual exposure occurred inside the unit, how many people were in the patient compartment at the time of the exposure, NOT including
the patient? _____
CCVESA Exposure Survey Page 2 of 4
04-01-10
10. Patient Description at time of the exposure: (Check all that apply)
_____ Medical Patient
_____ Trauma Patient
_____ Alert/Cooperative
_____ Alert/Uncooperative or combative
_____ Disoriented or Confused, cooperative
_____ Disoriented or Confused, combative
_____ Unconscious
_____ Seizure Activity
_____ flaccid
_____ Other (Describe)__________
11. Your activity at the time of the exposure: (Check all that apply)
_____ Airway Management (Direct or invasive)
_____ Using a Sharp
_____ Preparing/Setting up the needle or device
_____ Restraining/Holding the patient, not controlling the needle
_____ Finger Stick
_____ Transferring blood for Glucometer Reading
_____ Transferring blood to vacutainer
_____ Controlling the needle, disposing of sharp
_____ Not controlling needle, assisting with disposal:
_____ Passing or Holding Sharps Disposal Box
_____ Other (Describe) __________
_____ Not engaged in Patient contact (injured during clean up, exchanging sharps box etc, describe_______________
12. PPE in use at time of exposure:
_____ Eye protection
_____ Mask
_____ Gloves:
_____Standard _____Hi Risk
Any comments of quality/feel/ease of use of glove?
13. Individual Training: Blood Borne Pathogen:
______Initial Blood Borne Pathogen Training? Year of Training ________
______Approx. Date of last Update?
CCVESA Exposure Survey Page 3 of 4
04-01-10
14. Provide a precise and complete explanation of the circumstances surrounding this exposure and describe exactly how and why this exposure
occurred:
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
___________________________________________
15. Do you have any suggestions for preventing future exposures of this type?
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
_______________________________________________________________
16. Are there any additional comments, recommendations or clarifications you would like to make? (Use back of page if additional room is needed.)
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
_________________________________________________________________
Thank you for taking the time to carefully complete this survey. This survey is used to evaluate how we do things and find ways we can make our
work safer. It also is used to maintain a legally required record of exposures. Please go back and make sure that all applicable information has been
provided before sending this to the CCVESA Exposure Control Officer.
CCVESA Exposure Survey Page 4 of 4
04-01-10
POST-EXPOSURE DOCUMENTATION
• Exposed volunteer or employee must complete a Carroll
County Volunteer Emergency Services Association Exposure
Survey Form
• Exposed volunteer or employee will also be required to
complete any Exposure forms that may required at any post
exposure follow-up facility.
• Exposed volunteer or employee must complete a station’s
“First Report of Injury”
• Workers Compensation First Report of Injury/Illness Form
must be completed and submitted by the appropriate
member company personnel
Evaluating the Circumstances
Surrounding an Exposure Incident
• CCVESA Exposure Control Officer and member
company Exposure/ Infection Control Officer will
review the circumstances of all exposure incidents to
determine
– Engineering controls in use at the time
– Work practices followed
– Description of the device being used (including type and
brand)
Evaluating the Circumstances
Surrounding an Exposure Incident
• Determine…..
– Protective equipment or clothing that was used at
the time of the exposure incident (gloves, eye
shields, etc.)
– Location of the incident (on the scene of an
incident, inside a transport unit, in the station,
etc.
– Procedure being performed when the incident
occurred
– Volunteer’s or employee’s training level
Needle Sticks –
Most Dangerous Type of Blood Exposures
• Some needle stick exposures are caused by needles
sticking thru medical bags!
– Make sure the needle goes in the sharps container, the
sharps container is snapped closed, and the bag
compartment is zipped shut.
– Other needle sticks can be caused by not having sharps
container at patient’s side and open ready to receive sharp.
• Protect yourself and your coworkers!
Most Needle Sticks
Are Avoidable
•Protect yourself and your coworkers
from preventable needle stick exposures
by:
•Locking the protective sheath over the
needle during withdrawal
•Making sure the IV catheter goes into
the sharps container
•Snapping closed the sharps container
after sharp is deposited, and zipping
closed the medical bag’s compartment
top
IV Catheters
•Use only self sheathing IV catheters.
•Use devices only if you have been instructed on their
proper use. If you don’t know, ASK!
•IV Caths: If you don’t “click” ‘em, they are not safe!
Needle Sticks –
Must be Reported & Documented
Effect immediately all percutaneous injuries
from contaminated sharps must be
documented in a “Sharps Injury Log” as per 29
CFR 1904
“Sharps Injury Log”
• CCVESA Exposure Control Officer will record all
percutaneous injuries from contaminated sharps in a
“Sharps Injury Log” as per 29 CFR 1904
• Incidences must include
– Date of the injury
– Type and brand of the device involved (syringe, IV needle,
etc.)
– Department or work area where incident occurred
– Explanation of how the incident occured
“Sharps Injury Log”
– This log is reviewed as part of the annual program
evaluation
– This log must be maintained for at least five (5)
years following the end of the calendar year
covered
– If a copy is requested by anyone, it must have any
personal identifiers removed from the report
CASE STUDY 5
• April 29….1730 Hrs
• Your unit is dispatched to a 3520 Maple Road
for a “sick female patient”
ARRIVAL ON SCENE
• Upon arrival you found a 85 year old female
sitting in a chair c/o not feeling well
• She states that she has been very tired ,has
not felt like eating, has had some abdominal
pains.
• When she did try to eat something, she got
nausated and vomited
INITIAL ASSESSMENT
• Airway: Patent
• Breathing: Regular, RR 14
• Circulation: HR 88, Exposed skin is warm/dry
and slightly jaundice
PHYSICAL EXAM
• Head/Neck
– Pupils - PERRL
• NOTE jaundice in her eyes
• Chest
– Equal lung sounds and expansion
• Abdomen
– Soft, non-tender
PHYSICAL EXAM
• Pelvis
– Stable
• Extremities
– Good PMS in all four extremities
• Posterior
– No evidence of trauma
VITAL SIGNS
• BP: 150/92
• HR: 88
• RR: 14
• SpO2: 94%
PATIENT HISTORY
• A: NKDA
• M: none
• P: Had hip replacement surgery in 1985, when
she had to have a blood transfusion
• L: attempted lunch 5 hours ago
• E: Has had these symptoms for several days
What would you consider to
be this patient’s chief
medical problem?
FINAL DIAGNOSIS
Hepatitis C
What should you have done
prior to & while in contact
with this patient?
Hepatitis C Virus
--Attempt to avoid exposure
–Assume every patient is infected
–Prevention with use of universal
precautions against Hepatitis C
–Use appropriate PPE/Gloves
–Follow all policies and procedure
Hepatitis C
• Most common BBP infection in U.S.
• High rate among IV drug users.
• Mainly spread by exposure to blood and other
bodily fluids containing blood
• Causes Infection of the liver, leads to high rate
of chronic disease (75%) and cancer
• Before early 1990’s spread through blood
transfusions
• Most infected people have no symptoms and do
not know they are infected
Hepatitis C (HCV) Signs/Symptoms
• Initial symptoms may be mild or absent!
–
–
–
–
–
–
–
Tiredness
Loss of appetite
Abdominal pain
Nausea
Vomiting
Yellow skin & eyes (jaundice)
Urine that is dark in color
Hepatitis C (HCV) Treatment
• No vaccine currently available
• Hepatitis B vaccine will not protect you
from Hepatitis C
• No postexposure prophylaxis currently
recommended
• Treatment with antiviral medications
recommended for some patients with
chronic disease
• Not all people respond to treatment
Hepatitis C
• Leading cause of liver transplant
• Accounts for 20% of all acute viral hepatitis
cases
• 85% result in chronic infections
• 5% mortality
• 19K new cases/year
• 4.1 million Americans
Hepatitis C- Risk Factors
• Blood transfusions prior to 1992
• Long-term kidney dialysis
• IV drug users
Hepatitis C can survive outside the body
for up to 16 days!
Hepatitis C- Signs/Symptoms
• Jaundice
• Dark Urine
• Fatigue
• Abdominal Pain
• Nausea
• Anorexia
While these are common signs & symptoms, 80% of
those infected may not exhibit any signs or
symptoms until very late stages.
CASE STUDY 6
• October 18….2230 Hrs
• Your unit is dispatched to a 13 East Landover
Street for a “sick male patient”
ARRIVAL ON SCENE
• Upon arrival you find a 48 year old male
patient sitting at the kitchen .
• The patient is c/o fever, chills and coughing for
past three weeks
• The patient also c/o night sweats, loss of
appetite and coughing up blood
INITIAL ASSESSMENT
• Airway: Patent
• Breathing: Regular, RR 30, coughing
• Circulation: HR 78, skin is warm & dry
PHYSICAL EXAM
• Head/Neck
– Pupils - PERRL
• Chest
– Equal lung sounds and expansion
• Abdomen
– Soft, non-tender
PHYSICAL EXAM
• Pelvis
– Stable
• Extremities
– Good PMS in all four extremities
• Posterior
– No evidence of trauma
VITAL SIGNS
• BP: 100/68
• HR: 78
• RR: 30
• SpO2: 90 %
PATIENT HISTORY
•
•
•
•
•
A: NKDA
M: none
P: none
L: 5 hours ago
E: Been feeling sick for past several weeks
What would you consider to
be this patient’s chief
medical problem?
FINAL DIAGNOSIS
Tuberculosis
What should you have done
prior to & while in contact
with this patient?
TUBERCULOSIS
--Attempt to avoid exposure
– Assume every patient is infected
– Prevention with use of universal
precautions against Tuberculosis
– Use N-95 mask
– Provide flow through ventilation in the
patient compartment during transport
– Use appropriate PPE/Gloves/N-95 Mask
– Follow all policies and procedure
N-95 MASKS
• N95 Masks
– Protect against very small particles
– Wear whenever TB (tuberculosis), rubeola
(measles), or varicella (chickenpox) is known or
suspected
– Fit testing required to ensure proper fit
– If transporting a patient with suspected TB, use
the exhaust fan AND by opening the windows to
allow flow through ventilation
TUBERCULOSIS
• Bacterial disease caused by the infectious
agent Mycobacterium tuberculosis
• Bacteria that cause TB are transmitted by
infected airborne particles
• Infectious particles are produced when the
infected person talks, coughs, or sneezes
TUBERCULOSIS
• Latent TB
– Person has a TB infection, but the bacteria
remains in the body in an inactive state and
causes no symptoms
– This is not contagious
• Active TB
– Person has TB with signs & symptoms
– This person is contagious and can spread TB to
others
ACTIVE TUBERCULOSIS
Signs & Symptoms
•
•
•
•
•
•
•
•
•
Unexplained weight loss
Fatigue
Fever
Night sweats
Chills
Loss of appetite
Coughing that lasts three or more weeks
Coughing up blood
Chest pain, or pain with breathing or coughing
TUBERCULOSIS
• Procedures performed that may increase
the risk of exposure to TB
– Endotracheal intubation
– Suctioning
– Use of bag valve masks
– Administering aerosolized medications such as
albuterol
– Enclosed in the patient compartment of the
ambulance
TUBERCULOSIS
PREVENTION
• Avoid exposure - prevention with universal
precautions remains your best protection against TB
– Use appropriate PPE
– Use N-95 mask
– Provide flow through ventilation in the patient
compartment during transport
– Follow all policies and procedures
CASE STUDY 7
• August 24….1930 Hrs
• Your unit is dispatched to a 2432 West
Lighthouse Lane for a “sick male patient”
ARRIVAL ON SCENE
• Upon arrival you find a 34 year old male
patient lying in bed.
• Patient c/o fever for several days, weight loss
and feeling weak
INITIAL ASSESSMENT
• Airway: Patent
• Breathing: Regular, RR 20
• Circulation: HR 84, skin is cool & dry, HR 84
PHYSICAL EXAM
• Head/Neck
– Pupils - PERRL
• Chest
– Equal lung sounds and expansion
• Abdomen
– Soft, non-tender
PHYSICAL EXAM
• Pelvis
– Stable
• Extremities
– Good PMS in all 4 extremities
• Posterior
– No evidence of trauma
VITAL SIGNS
• BP: 114/88
• HR: 84
• RR: 20
• SpO2: 92%
PATIENT HISTORY
• A: NKDA
• M: none
• P: Pneumonia, Lymphomia, swollen lymp
nodes
• L: Very light lunch at noon
• E: Sitting around the house and felt he should
be transported to the ER
Patient states that approximately 10 years ago
he was IV drug abuser
What would you consider to
be this patient’s chief
medical problem?
FINAL DIAGNOSIS
HIV – Human
Immunodeficiency Virus
HIV – Human Immunodeficiency Virus
--Attempt to avoid exposure
–Assume every patient is infected
–Prevention with use of universal
precautions against HIV – Human
Immunodeficiency Virus
–Use appropriate PPE/Gloves
–Follow all policies and procedure
HIV – Human Immunodeficiency Virus
• Spread by blood and certain other bodily fluids
• 0.3% risk of seroconversion following
percutaneous occupational exposure
• Risk may be higher for certain exposures
– Hollow bore needle contaminated with visible
blood
– Other objects visibly contaminated with blood,
especially deep punctures
AIDS – Acquired Immune Deficiency
Syndrome
• Develops months to years after HIV infection
• Signs and symptoms of AIDS
– Fever
– Weight loss
– Swollen lymph nodes
– White patches in mouth (thrush)
– Cancer - Kaposi’s sarcoma, certain lymphomas
– Infections - pneumocystis pneumonia, TB
• NO CURE – drugs may slow the progress of the disease
HIV – Postexposure Prophylaxis
• Reduces the risk of infection up to 81%
• Four week regimen with 2 - 3 antiviral drugs
• If the source patient blood tests negative for HIV,
PEP is not recommended by the CDC
• If the source patient HIV status is not yet known,
PEP may be offered or recommended.
• If the source patient is HIV positive PEP will in most
cases be recommended.
– If indicated, PEP should be started as soon as
possible after an exposure!
HIV/AIDS
• There are roughly 1.1 million Americans
infected
• At least 21% are unaware or undiagnosed
• Spread by blood and bodily fluids
• Does not survive outside body
• Greatest risk factors are IV drug use and
multiple unprotected sexual partners
HIV/AIDS
• Auto-immune disorder transmitted by blood
and bodily fluids such as semen and vaginal
secretions
• Almost always begins as HIV, but can progress
into AIDS
• 21% of those with the disease are unaware
and undiagnosed, therefore putting
themselves and those they are in contact with
at high risk
HIV/AIDS
• The virus does not survive outside the body
for longer than 10 seconds
• Risks to EMS workers who come into contact
with infection patient’s blood, most
commonly from needle sticks
• Risk from needle stick is very low, only .3% of
needle sticks result in HIV infections
Exposure Policy and Procedures
• Remember: If treatment with HIV antiviral
medications (postexposure prophylaxis) is
indicated following an exposure, they should be
started as soon as possible… “within hours”
according to the CDC.
CASE STUDY 8
• August 4….0930 Hrs
• Your unit is dispatched to a 1624 Main Street
for a “sick female patient”
ARRIVAL ON SCENE
• Upon arrival you find a 19 year old female
patient lying in bed c/o severe headache, a
high fever 105, nausated and vomiting.
• Patient also c/o has loss of appetite, cannot
sleep and bright lights bother her
INITIAL ASSESSMENT
• Airway: Patent
• Breathing: Regular, RR 24
• Circulation: HR 110, skin is hot & dry, and a
skin rash noted
PHYSICAL EXAM
• Head/Neck
– Pupils - PERRL
– Signs indicating a stiff neck
• Chest
– Equal lung sounds and expansion
• Abdomen
– Soft, non-tender
PHYSICAL EXAM
• Pelvis
– Stable
• Extremities
– Good PMS in all 4 extremities
• Posterior
– No evidence of trauma
VITAL SIGNS
• BP: 124/78
• HR: 110
• RR: 24
• SpO2: 99%
PATIENT HISTORY
•
•
•
•
•
A: NKDA
M: None
P: None
L: Supper last night
E: Has had a high fever for past two days
What would you consider to
be this patient’s chief
medical problem?
FINAL DIAGNOSIS
Meningococcal
Meningitis
What should you have done
prior to & while in contact
with this patient?
Meningococcal Meningitis
--Attempt to avoid exposure
– Assume every patient is infected
– Prevention with use of universal
precautions against Meningococcal
Meningitis
– Use N-95 mask
– Provide flow through ventilation in the
patient compartment during transport
– Use appropriate PPE/Gloves/N-95 Mask
– Follow all policies and procedure
Other Diseases - Meningitis
• An inflammation of the membranes covering the brain
and spinal cord.
• Caused by several different organisms
– Bacterial
• Neisseria meningitidis (Meningococcal)
• Streptococcus pneumoniae
• Haemophilus influenzae type B (Hib)
– Viral
• Several different viruses
• Most cases of meningitis are viral
• Meningococcal meningitis is the type that poses the
greatest risk of death or serious disease.
• Immediately report to the Infection Control Officer any
patient determined by you or reported by a hospital to
possibly have meningitis.
Meningococcal Meningitis
Signs & Symptoms
•
•
•
•
•
•
•
•
•
•
High fever
Severe headache
Stiff neck
Vomiting or nausea
Confusion or difficulty concentrating
Seizures
Sleepiness or difficulty waking up
Sensitivity to light
Lack of interest in drinking or eating
Skin rash
Meningococcal Meningitis
• Meningococcal Meningitis FACTS you should know to
help you keep things in perspective:
– "Health care personnel are rarely at risk when caring for infected
patients; only intimate exposure to nasopharyngeal secretions (e.g. as
in mouth to mouth resuscitation) warrants prophylaxis." (American
Public Health Association)
– “Fortunately, none of the bacteria that cause meningitis are as
contagious as things like the common cold or the flu, and they are not
spread by casual contact or by simply breathing the air where a person
with meningitis has been.” (CDC)
– "Despite the public fear, bordering on hysteria, that may follow a case
of meningococcal disease, more than 95 percent of cases in the United
States and other developed countries are sporadic. Thus, in the
majority of instances, a second case does not follow a first one.” (New
England Journal of Medicine)
Meningococcal Meningitis
– At least 2%, and perhaps as many as 10%, of the population are carriers
of this disease
– Notification from hospital staff regarding meningitis
• Must be reported immediately to the on-call Exposure Control
Officer
• Historically, in the vast majority of cases patients have not had
meningococcal disease or anything else that requires treatment or
follow-up for our personnel
• Will be promptly investigated in close cooperation with the Carroll
County Health Department
• Rarely warrants prophylaxis before appropriate testing and
evaluation is done
• In most cases, further testing shows prophylaxis is not indicated.
– Prophylaxis will be provided if needed.
– Use of proper PPE reduces the already low risk if you do come in
contact with an infected person
Four types of “cleaning”
in the EMS setting
1. Cleaning:
– This is the physical removal of obvious dirt, dust, and
debris.
– It is the necessary first step before any other
measures can be taken
2. Decontamination:
– This is the most common type of cleaning that
happens in EMS. This process removes most diseaseproducing organisms to make equipment safe for
handling. It has limited effectiveness against more
serious pathogens
Four types of “cleaning”
in the EMS setting
3 Disinfection:
-This process destroys nearly all diseaseproducing organisms, however it does not
work on bacterial spores.
– Spores are bacteria that have protection
against extreme types of environments and
can become activated in the right setting.
Four types of “cleaning”
in the EMS setting
4 Sterilization:
-This is the complete elimination of
microbial life.
-It can be an expensive process and takes
quite some time to complete.
-Since disinfection covers most of the
pathogens that are worrisome in EMS, this
process is generally considered
unnecessary
REMEMBER IN THE EVENT OF
EXPOSURE TO AN INFECTIOUS DISEASE
• Exposed provider needs to contact Member Company
Exposure/Infection Control Officer
• Contact should be made immediately if not involved in an
emergency response or immediately upon completion of the
call of an emergency incident
• The Member Company Exposure/Infection Control Officer will
contact the CCVESA Exposure Control Officer or designee
Contact
• The CCVESA Exposure Control Officer or designee will contact
– Carroll Hospital Center
– Carroll Occupational Health
- Carroll County Health Department
• Carroll Hospital Center, Carroll Occupational Health
and/or County Health Department will report back
the follow up procedures to the CCVESA Exposure
Control Officer or designee
• The CCVESA Exposure Control Officer or designee will
report back to the Member Company
Exposure/Infection Control Officer
• The Member Company Exposure/Infection Control
Officer will report back to the Exposed provider as to
appropriate follow-up action should be taken
• All exposures must be reported!
Your time and attention during
this training program has been
appreciated.
If you have any questions,
comments, or concerns
concerning bloodborne
pathogens please contact the
CCVESA Exposure Control
Officer.