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 informationWhen first assigned a task with potential

exposureRepeated annuallyDuring work hoursWhen 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 pathogencan 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 2-2.44D):

"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 glovesBefore and after every patient contactAfter toiletingBefore and after preparing foodBefore and after eating or smokingAfter 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 intactYou have had no occupational exposure to blood or

other potentially infectious materialsMaterial 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 SpraySpatter 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 toAny 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 post-exposure 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/mmwrhtml/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 TransmissionDirect 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:

Infectiousagent

Means oftransmission

Routes ofexposure

Host

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 coughingPneumothoraxRib 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, boilsPneumoniaBloodstream infectionsPotentially death

Transmission of MRSA

• Spread of MRSA skin infections is direct and indirect Close skin-to-skin contactCuts or abrasionsPoor hygiene

• Methods of ContractionCrowded living conditionsContaminated 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

FecesContaminated equipmentHealthcare 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 workplace2. 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 clinics4. 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 HBV2. Cerebrospinal fluid3. Urine4. 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 completed2. At the end of each work shift, if the surface may have become contaminated since the last cleaning3. Immediately or as soon as feasible following a spill of blood or other potentially infectious material4. 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