Infection Control and Communicable Diseases

By: Darryl Jamison

Macon County EMS Training Coordinator

ALWAYS WEAR GLOVES WITH EVERY PATIENT

Background

Nurses—5,378 Health Aides—5,638 Technicians—3,182 Physicians—1,792 Therapists—1,082 Dental Workers—492 Paramedics—476 Surgeons—122 Other—5,050

Total—23,212

Healthcare Personnel with Documented and Possible Occupationally Acquired AIDS/HIV as of December 2001

Nurses—24/35 Laboratory Worker/Clinical—16/17 Physician (non-surgical)—6/12 Lab. Tech./Non-clinical—3/0 Housekeeper—2/13 Surgical Technician—2/2 Embalmer—1/2 Respiratory therapist—1/2 Dialysis Tech.—1/3 EMT/Paramedic—0/12 Surgeon—0/6

Post Exposure Evaluation and Follow-Up

Protocol for Obtaining Medical Treatment, Counseling, Baseline Blood Testing, and Prophylaxis

Contact the supervisor immediately. Employees will be seen initially at

AMC Emergency Dept. and will receive follow-up care and counseling from Macon County Health Department, with the exception of HIV exposure which should be followed up with primary care physician. This will include but not limited too, prophylactics.

Initial evaluation will be according to the protocol of the receiving medical facility, and CDC guidelines for Occupational Exposure of Healthcare Professional.

Each exposure shall be documented on a MCEMS Exposure Report Form and appropriate Workers’ Comp form. An appt. should be made ASAP , no longer than 24 hours p exposure.

Serological Testing of Exposed Employees

The exposed employees’ consent is required for collection and testing of blood for exposure. If baseline consent is denied, the exposed employee should be requested to have blood drawn and stored, usually for a period of 3 months, leaving the option open for the person to provide consent for serological testing at a later date.

Source Patient Consent for Blood Draw

By NC general statute the source patient has no right to refuse blood testing.

Should be made from the time of initial care within the hospital setting, if for some reason the exposure occurs at the scene, contact supervisor or training officer, and he/she will make contact with the source patient for testing arrangements.

Should also contact shift supervisor of the receiving facility for proper testing.

Medical Followup The facility that provides initial baseline testing,

and prophylactic treatment of exposed employees shall forward the information to the Macon County Health Department, within 24 hours if possible (ie. Weekends).

Macon County Health Department will provide additional treatment, exception for HIV exposure, and counseling, which should be done in person if possible.

Accident/Incident Review

T.O. will review the circumstances of the exposure to determine if procedures, protocols and/or training need to be repeated or revised to prevent a reoccurence of the incident.

The completed “Exposure Incident Report Form” should be completed and returned to the T.O. to initiate this process.

Post Exposure Highlights Documentation of exposure routes and how exposure

incident occurred. Identification of documentation of source individuals

infectivity, if possible Collection and testing of employees or students blood for

HBV and HIV serological status, consent required Post-exposure prophylaxis when medically indicated Counseling Evaluation of reported illness

Housekeeping Clean up kit. A 1:10 dilution of 5.25% clorox and

water. Red bag Use only tongs, forceps or brush and

dust pan for cleaning up broken glass Inspect and decontaminate on a

regular basis reusable receptacles (ie, trash cans)

If visibly contaminated clean as soon

as feasible.

Shall disinfect each shift, preferably after each call, anything that touches the patient and/or you touch will providing care after transfer.

Regulated medical waste shall be placed in a closable and labeled or color-coded container.

When discarding contaminated sharps, place them in a closable, puncture-resistant, appropriately labeled leak-proof container for that purpose.

Cont. Sharps containers shall be placed where they are easily accessible,

to the immediate area where sharps will be used. Containers shall be kept upright throughout use, replaced routinely,

closed when moved, and not allowed to overfill When replaced, take to the hospital for disposal.

NEVER recap any needles clean or contaminated ALWAYS make sure that the safety mechanism is

working NEVER hand someone else YOUR needle Immediately discard used needle after use ALWAYS draw up your own medicine

Retracting lancets with safety featuresRetracting lancets with safety features

Before During After

Before During After

In use After use

Disposable scalpels with safety Disposable scalpels with safety featuresfeatures

Retracted position

Protracted positionProtracted position

Exposure Control Plan:Exposure Control Plan:1910.1030(c)1910.1030(c)New ProvisionsNew Provisions

The ECP must be updated to include:

changes in technology that reduce/eliminate exposure

annual documentation of consideration and implementation of safer medical devices

solicitation of input from non-managerial employees

Exposure DeterminationExposure Determination

The employer must:– Identify worker exposures to blood or OPIM

– Review all processes and procedures with exposure potential

– Re-evaluate when new processes or procedures are used

Engineering and Work Engineering and Work Practice Controls (Practice Controls (con’tcon’t))

The employer must:– Evaluate available engineering controls (safer

medical devices)

– Train employees on safe use and disposal

– Implement appropriate engineering controls/devices

Engineering and Work Engineering and Work Practice Controls (Practice Controls (con’tcon’t))

The employer must:– Document evaluation and implementation in

ECP

– Review, update ECP at least annually

– Review new devices and technologies annually

– Implement new device use, as appropriate and available

Engineering and Work Engineering and Work Practice Controls (Practice Controls (con’tcon’t))

The employer must:– Train employees to use new devices and/or

procedures

– Document in ECP

Types of Safety Needles