Infection Control
2013
WHEN YOU START TO THINK THIS LECTURE IS
BORING, REMEMBER…
YOU CAN GET SICK AND DIE,
SO PAY ATTENTION!
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Training Objectives
• Educate NuCare emloyees in bloodborne
pathogens seen by EMS workers in the field
• Discuss methods of protecting NuCare employees
from bloodborne pathogens
• Provide information to allow the NuCare
employee to make an educated decision about the
HBV vaccination
• Discuss the OSHA standard on bloodborne
pathogens
• Discuss NuCare’s methods of compliance with the
OSHA Standard
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Definitions (From OSHA)
• Bloodborne Pathogen- microorganisms that are
present in human blood and can cause disease in
humans
• Exposure Incident- specific eye, mouth, mucous
membrane, non-intact skin or parenteral contact
with blood or OPIM that results from the
performance of a member’s duties
• Parenteral- piercing mucous membranes or the
skin barrier through such events as needle sticks,
human bites, cuts, and abrasions
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Definitions (Continued)
• Personal Protective Equipment (PPE)- specialized
clothing or equipment worn by a member for protection
against a hazard. General work clothes (uniforms,
jumpsuits, etc.) not intended to function as protection
against a hazard are not PPE.
• Universal Precautions- an approach to infection control
where all human blood and certain human body fluids are
treated as if known to be infectious
• Body Substance Isolation (BSI)- a form of infection
control based on the presumption that all body fluids are
infectious. BSI calls for always using appropriate barriers to
infection at an emergency scene, such as gloves, goggles,
face shields, gowns, and protective eyewear.
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Definitions (Con’t)
• Exposure Control Plan (ECP)- agency’s plan to
eliminate or minimize exposure
• Other Potentially Infectious Material (OPIM)• the following human body fluids: semen, vaginal
secretions, CSF, synovial fluid, pleural, pericardial,
peritoneal, amniotic, saliva (dental procedures), any
bodily fluids contaminated with blood, any fluid that
cannot be differentiated between fluid types.
• Any unfixed tissue or organ from a human (living or
dead)
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Definitions (Final)
• Contaminated Laundry- laundry which has been
soiled with blood or OPIM or may contain sharps
• Contaminated Sharps- any contaminated object
that can penetrate the skin including needles,
scalpels, broken glass, broken capillary tubes, and
exposed ends of dental wire
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OSHA Standard
• Exposure Control Plan
– Identifies job/procedures with identified risks
– Schedule for implementing provisions
• All provisions have been implemented
– Procedure for investigation and follow-up
– Plan is accessible to all employees
• Supervisor Office
• emsCharts Document Warehouse
– Annual review by committee
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OSHA Standard (Con’t)
• Initial training upon employment
• Annual re-training required
• Training in:
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OSHA Standard
Bloodborne Diseases and Transmission
Exposure Control Plan
Work Practices and PPE use
HBV Vaccine
Exposure recording and follow-up
Trainer guidelines
OSHA Standard (Con’t)
• Methods of compliance
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Universal Precautions
Engineering and work practice controls
Hand washing
PPE/BSI
Written cleaning schedule
Sharps and regulated waste disposal
OSHA Standard (Con’t)
• Record keeping
– OSHA mandates
• Types of records to be kept
• Duration of storage
• Disposal of records
• Hazard Communication
– Warning labels required (BioHazard) or
– Red Bio hazard bags instead of labels
– NuCare uses both methods
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Bloodborne Pathogen Standard
• Effective March 6th, 1992
• Purpose
– Limit the occupational exposure to blood and other
potentially infectious material (OPIM)
• Scope
– Covers all members who could be “reasonably
anticipated” as a result of performing their duties to face
contact with blood and OPIM
– Everyone who works for NuCare or rides as an observer
or student are “reasonably anticipated” to contact blood
and OPIM.
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BBP Standard (Con’t)
• Mandates of the standard
– Exposure Control Plan (ECP) prevention
program
– Work place engineering to prevent exposure
– HBV vaccine provided by RPI Ambulance
– Medical evaluation/follow up
– Training of employees
– Record keeping
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PPE and BSI
• Use as little or as much as you feel the
situation dictates
• During all patient care EXAMINATION
GLOVES WILL BE WORN!
• NuCare provides all PPE. You do not pay
for any of it. NuCare replaces it when it
becomes worn or soiled
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PPE/BSI (Con’t)
• NuCare provides the following
– Non-sterile, non-latex exam gloves in
three sizes
– Pre-packaged PPE kits containing
• Golves
• Mask
• Shoe covers
– Hand sanitizer on all ambulances
– Anti-bacterial soap at the bases
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A word on hand-sanitizer
before we continue...
- For immediate, short term use
- Not suitable as a substitute for hand washing
-You still need to wash your hands thoroughly as
soon as possible
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Sharps Disposal
• DO NOT RECAP SHARPS
• NuCare uses several types of sharps
for BLS and ALS purposes
– IV Angiocaths
– Glucose testing lancets
– Epi-Pens
• NuCare provides sharps containers
on all ambulances… Use them!
– $70,000.00 per improperly disposed sharp
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Two Major Definitions
• Infectious
– An illness that is caused by the body's
rejection of a virus, fungi, or parasite
• Communicable
– Able to spread from one person to another
A disease can be infectious and
not communicable at the same time
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Infectious Material
• Primary Risks
– Blood
– Semen
– Vaginal Secretions
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• Secondary Risks
– Synovial (joint)
fluid
– Cardiac fluid
(other than blood))
– Abdominal and
stomach fluid
– Pulmonary fluids
– Spinal fluid
– Amniotic fluid
Other Potentially Infectious
Material (OPIM)
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•
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•
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Tears
Sweat
Saliva
Urine
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Stool
Vomit
Nasal secretions
Sputum
Modes of Transmission
• Direct contact – straight from person to
person, exchange of blood or body fluids
ex: blood splash into the eyes
• Indirect contact – person to object;
infection can spread by touching surfaces
that have been contaminated with the
bacteria or virus
ex: Loading stretcher into ambulance and
not removing contaminated gloves before
touching steering wheel of ambulance
touching a contaminated needle
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Direct Contact
• Bloodborne
• Airborne
• Occult
– Occult means “hidden”
– “Occult blood” is blood hidden inside
some other material
• Idiopathic
– Fancy medical word meaning “We
don’t have a clue!”
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Indirect Transmission
• Vehicle-borne
– The transfer of an infectious agent to a
host via contaminated items such as
water, food, milk, or biological
products, such as blood, tissues, and
organs.
• Vector-borne
– The transfer of infectious
microorganisms from an infected host
via an insect or arthropod.
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Methods to Reduce Exposure
• Engineering Controls
– Devices that may be used to eliminate,
minimize, or reduce occupational
exposure to bloodborne pathogens.
• Work Practice Controls
– Practices and procedures that reduce or
eliminate the chance of occupational
exposure to bloodborne pathogens.
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Examples
• Engineering Controls
– Sharps containers
– Self capping needles
– PPE
• Work Practice Controls
– Decontaminating work area
– Frequent hand washing
– Consistent use of PPE
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Practices
Protect Yourself
• Wash your hands
• Wear PPE
• Avoid contact with broken skin or
mucous membranes
• Wash your hands
• Did I mention… wash your hands
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Practices
• All infectious materials go into a red
biohazard bag. No one is to remove
anything from a biohazard bag.
• All infectious sharps go into a red sharps
container. No one is to remove anything
from a sharps container. Sharps containers
are located on the ambulance and in the
PCF.
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Bio-Hazard Disposal
• All bio-hazard bags can be disposed
of at the hospital in designated bins
• All sharps containers are to be sealed
using 3” tape and labeled “NuCare”
• Sharps are also disposed of at the
hospital
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Bio-Hazard Bag
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Portable Sharps
Container
Wall Mounted
Sharps Container
Practices (Con’t)
• Hand washing is required after the
completion of all patient care.
• Hand washing is the best way to avoid
infection.
• No food, drink, smoking, application of
cosmetics, or handling of contact lenses is
permitted in any Patient Care Area.
• Mouth Pipeting/Suctioning is prohibited.
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Practices (Con’t)
• Disinfecting materials are provided on the
Ambulance and in the PCF. The materials
are:
• LpH One Step Germicidal Disinfectant in a
1:256 solution with water (always wear gloves
when handling this cleaner)
• Disposable paper towels (into a red bag, when
done)
• 5:1 Water and bleach can be substituted
• Annual Training
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Know your enemy
DISEASES
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Hepatitis-B
• Virus that attacks the liver
• Those with HBV infection are
divided into two categories. Both are
equally able to infect you
• Carrier- non-acute patient with virus in blood
• Acute- virus in blood and is symptomatic
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Hepatitis-B
• HBV can survive outside of the body for quite
some time
• Up to 14 days in a dried drop of blood
• Compared to HIV that dies instantly outside its
environment
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•
•
•
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HBV is not airborne
You cannot “catch” HBV from casual contact
There is a vaccine to protect you from HBV
HBV is a larger risk than HIV to the healthcare
provider!
Hepatitis-B
• Each year over 12,500 Health Care
workers acquire this disease as a result of
their job
• Each year more than 500 Health Care
workers die as a result of this disease
• 50 to 60% of infected individuals do not
know they have the disease
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Hepatitis-B
• Begins with flu like symptoms
• Smokers loose the desire to smoke
• Yellow skin, eyes itching, dark urine and
white colored stool
• Some individuals may only have flu like
symptoms or be completely asymptomatic
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HBV Vaccine
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•
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Vaccinations available to all members at risk
Vaccine provided within three days of hire
NuCare provides the vaccine, free to you
You may decline the offer
A declination form is required if declining
Can be received at any time if initially
declined (notify manager in writing)
• Booster now recommended between 5-10
years
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HBV Vaccine Facts
• Vaccine is created through genetic
engineering.
• No live or dead vaccine is injected into you.
• You cannot “catch” HBV from the vaccine
• Three IM Injections
• Day 1, Day 30, and Day 180
• Some side effects are
• 1% will have a sore arm (like a tetanus shot), fatigue,
and headache
• Itchiness or bump at the injection site
• Allergic Reaction- Vaccine is contraindicated if you are
allergic to yeast
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HIV/AIDS
• Human Immunodeficiency Virus
• HIV is the virus that causes Acquired
Immunodeficiency Syndrome (AIDS)
• Those with HIV Infection may have no
symptoms, some symptoms, or may have
full blown AIDS
• HIV destroys the body’s immune system,
causing death by other diseases that the
body would naturally fight off
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HIV/AIDS
• HIV cannot survive outside the body for a long
period of time. When the virus contacts a dry
environment, it loses the ability to infect you
• HIV is not airborne and cannot infect you through
everyday contact
• HIV cannot survive outside the body for a long
period of time. When the virus contacts a dry
environment, it loses the ability to infect you
• HIV is not airborne and cannot infect you through
everyday contact
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HIV/AIDS
• Antibodies are formed six to twelve (6-12)
weeks after infection. The AIDS test looks
for these antibodies, not the virus itself
• No anti-virus, no vaccine and no cure
• There are a SMALL NUMBER of
healthcare providers who have contracted
HIV infection through their duties as
compared to HBV
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Risk of Infection Post Needle Stick
HBV 30.00%
HIV 0.4%
0%
5%
10%
15%
20%
Percent
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25%
30%
35%
Contracting HBV and HIV
• Neither of these viruses are airborne. You
cannot catch them through routine contact
• You can contract the virus if
• You suffer a needle stick from an infected sharp
(0.4% for HIV, 6-30% for HBV)
• Infected material comes in contact with your broken
or non-intact skin (chapped, abrased, etc.)
• Infected material comes in contact with your
mucous membranes of the eyes, nose, and mouth
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Hepatitis-C
•
•
•
•
Unrelated to Hepatitis B
Viral disease
Transmitted by blood, needle stick, and sex
WILL BEGIN WITH SAME
SYMPTOMS AS HEPATITIS B
• Only 25 % of infected individuals will
show signs or symptoms
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Hepatitis-C
• Incubation period is up to 200 days
• NO VACCINE FOR PROTECTION
• 4 to 8 % of infected individuals are health
care workers
• NO CURE AT THIS TIME
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Tuberculosis
• Airborne virus attacking respiratory
system
• Historically called “Consumption”
– Tudors: Princess Margaret (Henry
VIII’s sister)
– Moulin Rouge: Kidman’s character dies
of tuberculosis toward the end of the
movie
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Tuberculosis
• Groups with high risk
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HIV patients
Nursing home residents
Immigrants
Refugees
Homeless
Inmates
TB Exposure Risk
• Dependant on
– Time spent with the infected individual
– Adequate ventilation
– preventive measures used
• Filter Mask
• Double mask, caregiver and patient
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TB Signs and Symptoms
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•
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•
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Weight loss
Night sweats
Swollen lymph glands
Cough ( may be productive )
Positive skin test
TB (Con’t)
• INH is the drug used to prevent
disease development
• Multi-drug resistant TB can develop
– has been identified in up to 20 states
– Occurs when a patient fails to take all of
their recommended drug regimen
– LIFE EXPECTANCY IS ONLY 16
WEEKS AFTER CONTRACTING
DISEASE
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Meningitis
• Inflammation of the protective membranes
covering the brain and spinal cord, known
collectively as the meninges.
• May be caused by infection with viruses,
bacteria, or other microorganisms.
• Can be life-threatening because of the
inflammation's proximity to the brain and
spinal cord; therefore the condition is
classified as a medical emergency.[1][3]
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Meningitis
• Signs and Symptoms
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Headache and neck stiffness associated with fever
Confusion or altered level of consciousness
Vomiting
Inability to tolerate light (photophobia) or loud noises
(phonophobia)
– Sometimes, especially in small children, only
nonspecific symptoms may be present, such as
irritability and drowsiness.
– If a rash is present, it may indicate a particular cause of
meningitis; for instance, meningitis caused by
meningococcal bacteria may be accompanied by a
characteristic rash.[
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Meningitis
• Modes of transmission
– Direct contact with respiratory
secretions
– Physical skin contact
• Treatment only available for
bacterial, but not viral
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Determining a True Exposure
•
Two questions will determine whether or
not an exposure has occurred:
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•
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Is the fluid I came in contact with blood, semen,
vaginal secretions, or any other body fluid containing
blood?
Did the fluid enter my body by a needle-stick, nonintact skin, laceration from a contaminated object,
through my eyes, nose, or mouth?
Both answers must be yes in order for an
exposure to have occurred
If You Are Exposed
• Notify dispatcher immediately
• Finish you call, and disinfect your
ambulance if needed
• Return to base and complete an
exposure/incident report
– You are effectively out-of-service
• You will be send to the local primary
care before completing your shift
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Post Exposure Evaluation
• Available to all exposed members
• Confidential medical evaluation
• Incident Report filed with Division
Manager or Team Leader as soon as
possible after exposure
• May include
– Several office visits
– Re-vaccination
– Prophylactic medications
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Final Thoughts
• Protect yourself well
• Don’t fall victim to bad (and dangerous) habits
• Don’t go home with anything you didn’t come
to work with
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QUESTIONS
?
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