TRANSITION SERIES
Topics for the Advanced EMT
CHAPTER
20
Infectious Disease
Objectives
• Learn how infection spreads and how to
protect yourself from disease.
• Identify multi-resistant organisms.
• Discuss influenza.
• Recognize current infectious diseases
prevalent in the community.
• Discuss the role of EMS in public health.
Introduction
• From the common cold to multiresistant organisms, infectious disease
is a topic that should be on every
provider’s mind.
• Today’s Advanced EMTs are faced with
not only protecting themselves from
microorganisms but also preparing for
pandemic outbreaks and medicationresistant diseases.
Introduction (cont’d)
• This topic will focus on the evolving
threats that infectious disease poses to
the Advanced EMT and discuss the key
concepts in personal protection.
Spreading Infection
• Infectious disease is defined as
pathogenic microorganisms that can
spread directly or indirectly from one
person to another.
– Bacteria
– Viruses
– Parasites
– Fungi
Spreading Infection (cont’d)
• Communicable disease is one that is
transmitted easily from one person to
another.
• Standard precautions help to prevent
the transmission of disease.
Standard Precautions are required to protect you from disease.
Spreading Infection (cont’d)
• Bloodborne diseases pose a particular
threat to the Advanced EMT.
• Advanced skills such as intravenous
therapy and medication administration
require the use of needles and other
sharps that can pose a serious risk of
injury when not used safely.
Communicable Diseases
Epidemiology
• The Center for Disease Control and
Prevention (CDC) estimates that
roughly 82% of healthcare workers
being exposed to bloodborne diseases
occur as a result of needle or sharprelated incidents.
• Improved safety strategies have
demonstrated a 96% decline in the
number of incidents since 1983.
Hepatitis
• Translates into inflammation of the
liver.
• Generally caused by a viral infection.
• Classified as hepatitis A, B, C, D, or E.
– A and E – food and waterborne
– B, C, and D – bloodborne
• CDC estimates roughly 80,000 new
infections of hepatitis in the U.S. each
year.
Hepatitis (cont’d)
• Hepatitis virus seeks out healthy liver
cells and invades them.
• Reproduction destroys these cells and
causes an immune response in the
liver.
• Liver destruction occurs both
immediately and over a period of time
while the disease persists.
Hepatitis (cont’d)
• Chronic hepatitis
– Long term decline in the function of the
liver
• Acute hepatitis
– Short term, “flare ups”
• Roughly 4.4 million Americans live with
chronic hepatitis and are essentially
asymptomatic
Hepatitis (cont’d)
• Signs and symptoms
– Fatigue
– Abdominal pain
– Nausea
– Vomiting
– Jaundice
HIV/AIDS
• Human immunodeficiency virus (HIV) is
a bloodborne pathogen that potentially
leads to acquired immune deficiency
syndrome (AIDS).
• The CDC estimates that slightly fewer
than 700,000 Americans are infected
with HIV.
HIV/AIDS (cont’d)
• AIDS affects the immune system by
destroying essential T cells thus leaving
the body vulnerable to opportunistic
infections.
• Most AIDS deaths are caused by
secondary diseases such as respiratory
infections and malignancies.
HIV/AIDS (cont’d)
• Bloodborne disease transmitted
through needle stick and sharp-related
injuries.
• Only about 3 in 1000 needle stick
injuries will actually transmit disease.
HIV/AIDS (cont’d)
• Factors that contribute to the
probability of transmission
– Amount of blood on or in the sharp
– How deep the needle penetrated
– Whether or not it penetrated an artery
or vein
– How high the viral load in the patient
Tuberculosis
• Spread by a bacterium known as
Mycobacterium tuberculosis.
• Transmitted through respiratory
droplets.
• Roughly ⅓ of the world’s population is
currently infected with the TB bacillus.
Tuberculosis (cont’d)
• Vast majority have latent tuberculosis.
• Those at higher risk are drug users,
HIV patients, and those in congregate
settings.
Tuberculosis (cont’d)
• Active TB develops in 5-10% of those
exposed.
• Characterized by a massive immune
response in the lining of the airway and
parenchymal tissue.
• Inflammation and lung cell changes
cause poor diffusion and destruction of
lung tissue.
Tuberculosis (cont’d)
• Signs and symptoms
– Blood tinges sputum
– Fever
– Weight loss
– Night sweats
• N-95 type respirator protects from
droplet transfer of tuberculosis.
Multidrug-Resistant Organisms
• Enhanced by partial and unfinished
courses of antibiotic treatment.
• Bacteria is exposed to the medication
but is not completely eradicated when
the full course of treatment is not
received.
• Remaining bacteria reproduce and
develop resistance.
MRSA
• Methicillin-Resistant Staphylococcus
aureus
• About 25% of the population carries
staphylococcus bacteria on their
skin/nose.
MRSA (cont’d)
• Transmitted by skin or respiratory
contact
• Divided into two groups
– Hospital-acquired
– Community-acquired
MRSA (cont’d)
• Remember as an EMS provider, you are
exposed to Staphylococcus aureus and
MRSA every day.
• MRSA can be transmitted by skin
contact and/or by respiratory contact.
• Utilize the appropriate level of personal
protective equipment to prevent the
spread of bacteria.
Hand washing is vital for preventing the spread of disease.
Handwashing
• When washing, remember the key
elements to proper handwashing
– Warm flowing water and soap
– At least 15 seconds of scrubbing over all
the surfaces
– Thorough rinsing
Alcohol-based hand cleaner is effective and can be used when soap and water
are not available.
Influenza
• Influenza (flu) is a viral infection that
has multiple different classifications and
subclassifications.
– Influenza A, B, C
– H1N1, H5, N1
• Various strains of influenza strike
regionally each year.
Influenza (cont’d)
• The Center for Disease Control and
Prevention estimates that influenza kills
somewhere between 3,000 and 50,000
people each year in the United States.
• In 2009, Influenza A (H1N1) killed
more than 18,000 people and was
found in 214 countries.
• The WHO designated H1N1 a pandemic.
Influenza (cont’d)
• Influenza is quite virulent.
• Spread via airborne droplets and
through contact with respiratory fluids.
• Immune response causes inflammation
and changes in the lining of the
respiratory tract.
• Cytokines and other chemicals released
from infected cells cause S/S.
Influenza (cont’d)
• Signs and symptoms
– Fever
– Fatigue
– Chills
– Muscle pains
– Cough
Influenza (cont’d)
• EMS is at high risk to be exposed.
• Consider getting vaccinated each year.
• Protect yourself from respiratory
droplet contact in patients with a high
suspicion of influenza.
• Handwashing and decontamination are
essential.
EMS and Public Health
• EMS has developed a significant
responsibility within public health.
• Especially in the context of infectious
disease.
• EMS frequently partners with other
health care entities to develop and
enact strategies to prevent and stop
the spread of infectious disease.
EMS in the public health setting.
EMS in the public health setting.
EMS as an Agent of Public Health
Summary
• It is imperative that all EMS providers
protect themselves from, and prevent
the spread of, infectious disease.
• As diseases become challenging to
fight, partnerships continue to develop
in health care to provide an optimal
response.
Summary (cont’d)
• EMS plays a vital role in developing and
carrying out action plans against
disease.