ARLINGTON FIRE DEPARTMENT
STANDARD OPERATING PROCEDURES
ISSUED: MARCH 2002
MEDICAL OPERATIONS
INFECTION CONTROL
205.03
PURPOSE
The purpose of this procedure is to provide an organizational outline for the prevention and control of
infectious diseases and the reporting of potential exposures.
PREVENTIVE AND CONTROL MEASURES
Body Substance Isolation
Because emergency services personnel are often unable to determine if body substances have the potential
to be infectious, all persons should be assumed to have a communicable disease and all of their body
substances should be considered infectious. AFD personnel shall use barrier techniques such as personal
protective equipment (gloves, masks, gowns, etc.) to prevent contact with blood or other potentially infectious
substances.
Personal Protective Equipment and Supplies
Gloves* - Wear disposable, nonporous gloves any time potential exists for contact with blood, body fluids,
non-intact skin, or other potentially infectious material. Clean hands with soap and water as soon as possible
after removing gloves, even if gloves appear intact. When wearing soiled gloves, avoid handling items such
as ink pens, steering wheels, portable radios, or clipboards that will later be touched with ungloved hands.
Eye Protection* - Use these any time splash contact with the face is possible. You may apply the facemask
to anyone who is transported and who is/has coughing, sneezing, fever or otherwise engaging in behavior so
that airborne pathogens are likely to be expelled.
Gown* - Wear when a need exists to protect your clothing from contact with body fluids.
Masks* - Should be worn by the caregivers or the patient for those infectious agents known to be transmitted
by the airborne route (i.e., tuberculosis, chicken pox, measles, etc.). Sufficient information should be
obtained to determine if a patient may have active tuberculosis (TB), recent history of TB, HIV infection, fever,
recent weight loss or cough. If there is a history suggestive of active TB, caregivers should wear masks
compatible with OSHA guidelines. Pocket masks with one-way valves or positive pressure ventilators should
be used for artificial respiration whenever possible.
*
The use of gowns, masks, eye protection and gloves should be determined based on the level of
exposure likely to be encountered.
Disposal of Contaminated Sharps
Fire Department members are responsible for protecting themselves, one another, and the public from
exposure to pathogens through accidental injury by contaminated needles and other sharp objects. To
accomplish this, contaminated sharps should never be left on a scene regardless of which agency may have
originally been responsible for the item. Needles and other sharp objects should be considered as potentially
infected and should be handled with extraordinary care. Needles should not be recapped. If it is absolutely
necessary to recap a needle, use the one hand method. Needles, syringes and broken glass vials should be
immediately placed in puncture-proof containers after use. The goal of this policy is to eliminate members’
carrying contaminated sharps containers in fanny packs or EMS bags, thus decreasing the risk of a
container’s contents spilling. Only sharp items should be placed in sharps containers. Other contaminated
items should be placed in a red, biohazard bag.
Page 1 of 4
ARLINGTON FIRE DEPARTMENT
STANDARD OPERATING PROCEDURES
ISSUED: MARCH 2002
MEDICAL OPERATIONS
INFECTION CONTROL
205.03
Single-use sharps containers
Each member shall carry a single-use sharps container in the fanny pack. Single-use sharps containers may
never be emptied and reused. After placing a sharp in a single use container, it shall be discarded in a multiuse container or station biohazard container as soon as possible/practical. The intent is to avoid packing
several sharps in the single-use container, regardless if it is in a fanny pack or EMS equipment case, in the
course of multiple incidents/responses.
Multi-use sharps containers
Every apparatus that responds to EMS calls will carry a multi-use sharps container. This container shall
serve as a receptacle for used single-use sharps containers and contaminated sharps that will not fit in the
single-use container. It shall be carried in the EMS cabinet or compartment. It shall be closed and secured in
such way that the contents will not be ejected during daily activities or a vehicle accident, including an incident
during which the apparatus rolls over.
When a multi-use container is first placed on the apparatus, the date shall be written in plain view on the
container. The container shall be discarded in the station biohazard trash and replaced when half full, 60
days after being placed in service, or 60 days after the date on the container; whichever comes first.
Containers still empty after 60 days may have the date changed to reflect another 60-day period.
Disposal of contaminated EMS supplies
Biohazard Waste Bags
Each Fire apparatus should carry a red plastic “BIOHAZARD” bag in their designated EMS compartment.
Personnel shall use these plastic bags to dispose of items such as used gloves, 4” x 4”s, and other trash
items from the scene of EMS runs that are contaminated with blood or other body fluids. Plastic bags that
are either red in color or contain the red biohazard label. Dispose of biohazard bags and their contents by
placing them in the biohazard waste containers at Fire stations or hospitals. The state law prohibits the
disposal of items contained in biohazard bags along with non-medical trash.
These plastic bags shall be used in the following manner:
1.
The bags may be used to hold accumulated disposable items from multiple EMS runs, as long as the
items placed in the bags are not contaminated with blood or other body fluids. Once the bag is full,
remove it, tie it, and place it in the biohazard container at the station.
2.
If items contaminated with blood or other body fluids are placed in the bag, remove and seal the bag
immediately and place it in the biohazard container at the station.
Under no circumstances are items contaminated with blood or other body fluids to be disposed of through
routine trash containers. Contact Resource Management for removal of the biohazard waste container when
it is half full. This will provide Resource Management with sufficient time to empty the container before it
becomes full.
Other Protective Measures
Uniform Care
Employees whose uniforms become soiled with blood or other body fluids should change clothes as soon as
possible to prevent cross contamination. Place the dirty uniform in a biohazard bag and launder separately
from other clothing using normal laundry cycles and detergent. The use of unusually hot water or bleach is
not necessary. Bleach will destroy Nomex uniforms and PBI bunker gear.
Page 2 of 4
ARLINGTON FIRE DEPARTMENT
STANDARD OPERATING PROCEDURES
ISSUED: MARCH 2002
MEDICAL OPERATIONS
INFECTION CONTROL
205.03
Skin Care
Covering any laceration or other area of non-intact skin with a bandage, even if later covered with gloves, will
significantly decrease the risk of occupational exposure to communicable diseases. Hands should always be
washed with soap and water after every patient contact even if gloved.
EQUIPMENT CARE AND CLEANING
A patient should never be exposed to another patient’s bodily fluids when under the care of the Arlington Fire
Department. Every attempt should be made to remove blood and other contaminants from reusable EMS
equipment (i.e. backboards, blood pressure cuffs, etc.) after each EMS incident in order to prevent cross
contamination. Those items should be cleaned thoroughly with a 10% bleach solution or by using an
equipment disinfectant supplied by Resource Management. Equipment that is unable to be cleaned of all
visible blood and or body fluids should be taken out of service and replaced as soon as possible.
EXPOSURES
Exposures to blood and other body fluids pose a significant risk to the health and safety of EMS providers.
These exposures can be a direct result of patient contact, contact with a device containing blood or body
fluids used in patient care or indirect contact with a patient’s blood or body fluids. Either way, exposures of
any kind must be identified and treated as quickly as possible.
Post-Exposure Incident Procedures
In the event a member is exposed while on duty, it is imperative that the exposed member along with his/her
supervisor follows the appropriate steps in order to receive the appropriate care.
Member’s Responsibilities:
1.
Immediately cleanse the exposed area.
a.
b.
For exposures to non-intact skin or a percutaneous exposure to blood or body fluids,
immediately wash the exposed area thoroughly with soap and water. If soap and water is not
available, immediately remove as much of the substance as possible and use an antiseptic
hand cleaner. Follow with soap and water as soon as possible.
For exposures to the eyes, nose, or mouth to blood or other body fluids, flush the eyes/nose
with water, rinse out the mouth with water.
2.
Immediately notify the Supervisor.
3.
Immediately notify your on-duty Battalion Chief for referral to the appropriate facility.
4.
Complete a Report of Potential Exposure Form and arrange for Notary’s signature. Return to Fire
Administration. Must be completed by next business day.
5.
Complete The City of Arlington Workers Compensation Injury Form (Only if associated with a
needle stick or injury.) Return the original to Human Resources, a copy to Fire Administration. Must
be completed by next business day.
6.
Complete The City of Arlington Report of Possible Exposure of Transporter Form. Leave it with
the attending physician or nurse at the hospital.
7.
If contaminated sharps are involved, complete a Texas Department of Health Contaminated
Sharps Reporting Form. Return to Fire Administration. Must be completed by next business day.
Page 3 of 4
ARLINGTON FIRE DEPARTMENT
STANDARD OPERATING PROCEDURES
ISSUED: MARCH 2002
MEDICAL OPERATIONS
INFECTION CONTROL
205.03
8.
Complete an Exposure Pre-Alert Notification Form.
completed by next business day.
Return to Fire Administration.
9.
Notify CIGNA Integrated Care 1-800-937-8535
10.
Contact the Medical Operations Battalion Chief for follow-up care referral.
Must be
Battalion Chief’s Responsibilities:
1.
Either transport our member to the hospital or meet our member at the hospital.*
2.
Ask for the Charge Nurse. Inform them of the situation. Our member should be fast-tracked through
Triage and Registration. Be discreet; we are receiving priority attention over many people in the
waiting area.
3.
A physician or Infection Control Nurse should see our member. The course of treatment will depend
on the source patient, degree of exposure, and condition of our member.
4.
Assure completion of a Report of Potential Exposure Form and arrange for Notary’s signature.
Return to Fire Administration. Must be completed by next business day.
5.
Assure completion of a The City of Arlington Workers’ Compensation Injury Form. (Only if
associated with a needle stick or injury.) Return the original to Human Resources, a copy to Fire
Administration. Must be completed by next business day.
6.
Assure completion of The City of Arlington Report of Possible Exposure of Transporter Form.
Leave with the attending physician or nurse at the hospital.
7.
If contaminated sharps are involved, assure completion of the Texas Department of Health
Contaminated Sharps Reporting Form. Return to Fire Administration. Must be completed by next
business day.
8.
Assure completion of an Exposure Pre-Alert Notification Form. Return to Fire Administration.
Must be completed by next business day.
9.
Assure notification of CIGNA Integrated Care 1-800-937-8535
10.
Notify the Medical Director by pager 817-227-5888.
Medical Operations Responsibilities:
1.
Provide support and assistance to employee.
2.
Insure all paperwork has been completed and turned in to the appropriate facility.
3.
Document event in the exposure database.
4.
Coordinate with hospitals and the Tarrant County Health Department.
5.
Coordinate follow-up testing and treatment with the employee and appropriate facility.
Note:
*Our member should when possible, go to the same hospital as the source patient. If not
possible, go to one of the Arlington hospitals for testing.
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