Blood Borne/Airborne Pathogens

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Blood Borne/Airborne Pathogens

• Provided by Dane County EMS
• Thank You to Ellen Smith Mel Reppen,
• Infection Control
• St. Marys Hospital

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By the very nature of what we do....
We are at risk for exposure to blood and airborne
diseases.
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Goal of this Presentation

• To Keep You Safe byIncreasing your awareness
  of
• Common blood and airborne pathogens
• Situations that put you at risk
• Engineering controls that help keep you safe
• Personal protective equipment available at your
  service
• Resources for information and support
• What to do if you are exposed to bloodborne or
  airborne pathogens

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The Chain of Infectioncontains 3 elements

• Organism GERMS (bacteria, virus, mold)
• Pathogen BAD Germs that can cause illness
• RouteTransit System, how the organism gets from
  one place to another
• Host GERM Condominium, where the germ lives and
  grows. This could be a patient, bystander, or
  this could be you!!

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Chain of Infection
HIV
YOU
Your Family
Host
The Patient
Hep-B
Organism
TB
sneeze
Route
dirty hands
blood splatter
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Organism

• Virus, Bacteria, Molds, Fungus
• There are thousands, but most are not problematic
• The common trouble makers
• Bacteria
• Viruses
• Any germ can be problematic in a person with
  compromised immune system!

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Routes of Disease Transmission

• There are several ways organisms are spread.
• Direct Contact
• Indirect contact
• Airborne/Droplet

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Direct Contact examples

• touching blood or blood tinged body fluids
• person touching another person with germs on
  their hand.

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(No Transcript)
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Indirect Contact example

• person handles an object that is contaminated or
  with contaminated hands and then gives the object
  to another person.

Bathroom Glass
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Airborne/Droplet example

• Person inhales organisms in the air or droplets
  contaminated with sputum or other secretions from
  a patient with the disease.

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Breaking the Chain of Transmission by

• Destroying the Organism
• By cleaning and disinfecting.
• Dirty equipment and surfaces need to be
  thoroughly cleaned with appropriate germicidal
  agents and allowed to air dry between patients.

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Breaking the Chain of Transmission

• DISCUSSION POINTS
• What should we be doing (SOGs) to clean
  equipment, uniforms and vehicles?
• What disinfectant(s) should we be using?
• Where are they located?

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FOOD for Thought!

• How often do the straps on the cot get wiped
  down?
• What about the door handles?
• The steering wheel?
• Radio handset? Cellphone?
• Consistent and thorough cleaning routines
  minimize the organisms on surfaces that you
  routinely touch without gloves!

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Breaking the Chain of Transmission by

• Barricading the Route
• Hand washing
• Wearing personal protective equipment
• Using engineering controls like Sharps
  containers

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Hand Hygiene is the single most important means
for preventing the spread of infection!
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What is hand hygiene?

• Its a handwash with soap
• and water
• Its hand cleaning with an
• antimicrobial soap
• and water or
• alcohol-based waterless solution

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Why is hand hygiene important in the healthcare
setting?

• It reduces spread of infection from you to
  patients
• It reduces risk of you becoming infected with
  organisms from patients
• It can reduce illness, death and expense of
  infections

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When is hand hygiene indicated?

• After using the restroom
• After coughing or sneezing
• After blowing your nose
• Before eating
• Frequently through-out the day
• After removing gloves

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How to wash your hands

• Wet hands with running water
• Lather well with soap
• Scrub all hand surfaces for 10-15 seconds
• Rinse hands without touching the sink
• Dry hands with a paper towel
• Use paper towel to turn off faucet
• Did you think about the handle on the
• Paper towel dispenser?

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How to use alcohol hand rubs

• Dispense a golf ball sized amount of foam into
  palm
• Spread over both hands up to ½ inch above your
  wrist
• Rub vigorously until dry
• ALCOHOL PRODUCTS SHOULD ONLY BE USED IF HANDS ARE
  NOT VISIBLY SOILED
• Or if nothing else is immediately available

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Stopping Transmission by using Personal
Protective Equipment (PPE)

• Prevent contact with body fluids and other
  contaminants by using the following PPE
• Hands Gloves
• Face N-95 mask / eye protection
• Clothing Cover gown / turn out gear
• PPE needs to be appropriate for the method of
  contact and should be donned as soon as the
  possibility of contact arises! Better yet..
  ANTICIPATE!

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Breaking the Chain of Transmission

• DISCUSSION POINTS
• What kinds of PPE do we have?
• Where are they located?
• What size fits you?

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FOOD for Thought Scenario 1

• You are called to a woman in labor, what PPE
  should you have on?
• Gloves.
• Having gloves on when you approach the patient
  allows you to provide care immediately without
  having to stop to don PPE.
• During your assessment, you realize the baby is
  coming now. What additional PPE do you need to
  put on?
• Cover gown, face/eye protection.
• There are lots of bloody body fluids involved in
  child birth. Anticipate and be prepared!

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FOOD for Thought Scenario 2

• You are called to aid an ill woman. What PPE
  should you have on?
• Gloves
• You find her lying on the floor in a pool of
  vomit and blood. What additional PPE should you
  put on?
• Face/Eye protection, cover gown
• You never know when the patient will vomit. You
  dont want to be a target.

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Stopping Transmission usingEngineering Controls

• Engineering Controls means equipment and
  techniques specific to preventing exposure!
• Examples of Engineering Controls
• Sharps Containers
• Safety Needles
• Ambulance Ventilation

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Breaking the Chain of Transmission

• DISCUSSION POINTS
• What kinds of engineering controls does your
  service have?
• Where are they located?

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Breaking the Chain of Transmission by

• Increasing Host Resistance
• Stay healthyGood health promotes a strong
• immune system which helps resist
• disease.
• Get Plenty of Sleep
• Exercise
• Eat right
• See your physician
• Regular Check-ups
• Immunizations
• Hep B
• Tetanus, Diptheria
• Influenza

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Significant Exposure What Happens Now?

• Exposure to Blood

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• HIV Statistics In Wisconsin
• 374 new cases of HIV infection were reported in
  2005.
• 9,116 cases have been reported since 1983.
• 3,488 person are known to have died.
• 5,628 persons with HIV infection were presumed to
  be alive at the end of 2005.

Retrieved January 15, 2007 from
http//dhfs.wisconsin.gov/aids-hiv/index.htm
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Significant Exposure toBloodborne Pathogens
Definition

• According to the CDC
• Contact with blood or other body fluids through
  percutaneous innoculation (needle stick) or
  contact with an open wound, non intact skin or
  mucous membrane during the performance of normal
  job duties.

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Levels of Risk

• Intact skin to intact skin
• Slight possibility
• Blood on intact skin
• Minimal
• Blood or body tinged body fluids on mucous
  membranes
• Moderate
• Needle stick, laceration, chapped skin, abrasion
  or dermatitis
• Significant

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When Significant Exposure Happens

• Turn over patient care, as soon as possible
• Provide yourself with immediate care
• Seek Emergency Care
• Report Exposure

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Immediate Care

• Goal remove Blood ASAP!
• Splash to the Eye
• BLINK! Several times
• RINSE with saline or water
• Contact with other Mucous Membranes Mouth
• SPIT!
• RINSE with water
• Nose
• BLOW!
• RINSE with water
• Needle stick or break in the skin
• SQUEEZE. Make it bleed a little
• WASH with soap and water

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Report the Exposure ASAP

• Report the exposure as soon as possible to the
  OIC, Crew Chief, and/or Infection Control Officer
• Seek evaluation at the Emergency Department right
  away

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FOOD for Thought!

• If you have been exposed to a patient with HIV,
  you may need to be started on a drug regimen
  ASAP!
• If you dont report a potential significant
  exposure right away, you have lost precious time!

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Reasons to Report an ExposureASAP

• Appropriate Treatment
• Access to the Source
• Source Patient Testing
• Prophylactic Drug Therapy
• May prevent development of the disease
• Documentation of the Incident
• Critical for Workers Compensation report

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What Happens in the ED?

• SOURCE PATIENT
• Registered
• Physician evaluation
• Appropriate treatment
• Request to draw blood
• Consent signed for blood tests
• Blood drawn
• Followup by the hospital

• YOU (EMT / DRIVER)
• Notify Service Infection Control Officer or
  Service Director
• Register as patient
• Physician evaluation
• Appropriate treatment
• Complete State Form
• Consent signed for baseline bloods
• Blood drawn
• Followup by the hospital

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State Significant Exposure Form

Must be filled out by the exposed person and
signed by the physician to ensure source patient
testing.
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DISCUSSION POINT Where are these forms kept?
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Confidentiality

• Wisconsin clearly defines to whom HIV status can
  be given without the patients consent!
• Information can be shared without consent only if
  the knowledge enhances care
• Watch what you say on the radio and in the store!

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Documenting HIV Status

• HIV status should only be included if it is
  pertinent to the call and treatment
• Needs to be done in a careful way
• use quotes
• document exactly what was said and who said it!
• Treat patients as you would want to be treated

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FOOD for Thought Scenario 1

• You are called to a residence for a 33 y/o male
  with respiratory distress.
• When you arrive, an older woman meets you at the
  door and tells you she is the patients mother.
  She also shares that the patient is HIV positive.
• Your crew provides care for this patient and
  begins transport. Do you include the patients
  HIV status in the radio report? On the run report?

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FOOD for Thought, contd.

• ANSWER Not during the radio report. Multiple
  scanners may allow this information to be
  overheard.
• If the information is pertinent to the patients
  health then it should be included on the run
  report. Use quotes if possible patients
  mother states he is HIV positive.

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FOOD for Thought Scenario 2

• Three weeks later, you are called to the same
  home for a 33 y/o male with ankle injury.
• None of the crew members were with you last time.
  Before you get to the scene, should you inform
  them that the patient is HIV positive?

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FOOD for Thought, contd.

• ANSWER According to statute, NO. there is no
  need to share this privileged information at this
  time.
• If there is blood, then PPE should be donned, no
  matter what the patients status.

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Discrimination Think About It!

• EMTs have a duty to act
• Can not deny care to certain patients
• Wisconsin Statute deals with discrimination
  against a person with AIDS. Establishes fines.
• Ways to be prepared
• Think about how you would care for a patient with
  AIDS that is bleeding
• Think PPE on every call
• Treat patients like you would like to be treated
  no matter what!

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Exposure to AIRBORNEDiseases

• Tuberculosis
• Common Cold
• Influenza
• Whooping Cough
• Measles

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Airborne Transmission
One Sneeze 4500 droplets flying 2-12 feet at
100 miles/hour
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What is TB?

• Tuberculosis is a bacterial infection
  predominately of the lung which destroys tissue.

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• TB Statistics In Wisconsin
• An estimated 250,000 people in Wisconsin are
  infected with the TB bacteria. (TB Infection).
• In 2004, there were 95 reported cases of TB.
  This is an increase from previous years.(TB
  Disease).
• During the year 2004, over half the TB cases were
  in persons born outside the United States.
• These individuals come to Wisconsin as students,
  workers, tourists, immigrants and refugees from
  areas of the world where TB rates are very high
  (Mexico, India, Laos, Thailand, Vietnam,
  Philippines).
• TB is on the rise and poses a threat to EMS and
  Healthcare personnel!

Retrieved January 15, 2007 from
http//dhfs.wisconsin.gov/TB
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How TB is spread?

• TB is spread by Airborne Transmission
• by breathing in droplets coughed into the air by
  a person with untreated TB

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What is TB Infection?

• It means the person has been exposed to the germ
  that causes TB. The exposed person
• The germ is inside the body
• But person is NOT sick--germ is inactive
• CAN NOT spread to others
• may develop disease in the future
• may need treatment
• 5-10 life long risk of activation to TB disease

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Persons most at risk for reactivation of TB

• Elderly
• Persons with compromised immune systems
• Substance abusers
• Recent infection with M. tuberculosis
• Persons with Diabetes mellitus
• Persons with low body weight

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What is TB Disease?

• Germs are active in your body
• Person is sick from germs
• Persons has symptoms of disease
• Can spread illness to others by being near them
• Must take medications for cure

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Signs and symptoms of TB disease include

• Cough lasting gt 2 weeks
• Night sweats
• Weight loss
• Loss of appetite
• Fever, chills, shortness of breath
• Chest pain

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How can you protect yourself?

• EMTs caring for suspect/known TB patients must
  wear NIOSH approved respirators (either N95 or
  HEPA)
• Employees must be fit tested prior to using the
  N95 or HEPA respirators
• Respirator Medical Evaluations must be completed
  prior to fit testing
• When you have a patient with respiratory
  symptoms, protect yourself. Wear appropriate PPE
  (N95 or HEPA)!

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Medical Screening

• Medical Screening
• Personnel must have a PPD skin test annually
• PPD skin tests must be read _at_ 48-72 hours
• Staff with known positive PPD skin test will
  complete an annual TB health assessment

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Exposure to AIRBORNE Diseases

• Harder to identify because you cant see them!
• Maintain an Index of Suspicion
• Watch for signs and symptoms
• Wear PPE when appropriate
• If your have an exposure, report it to your
  Infection Control Officer
• Ryan White Laws can help

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Index of Suspicion

• Productive cough
• Fever
• Rash
• Weight loss
• Runny nose
• Night sweats
• Just a feeling

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Report It

• Report it to
• the hospital
• your Infection Control Officer
• Dane County EMS
• The Hospital will
• provide information
• provide treatment for certain diseases if
  suspected

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Ryan- White Act Says

• If you think you have been exposed...
• Report to service Infection Control Officer
• He/she will request hospital to test for airborne
  disease
• If the hospital finds a communicable disease
  during the care of a patient...
• They will contact provider within 48 hrs.
• (Except for HIV)

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FOOD for Thought Scenario 1

• You are caring for a patient who is complaining
  of shortness of breath. Assessment finds the
  patient also has experienced weight loss, night
  sweats, and is coughing up blood-tinged sputum.
• What PPE should you have on?

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FOOD for Thought Scenario 1

• Answer This patient is exhibiting signs and
  symptoms of a respiratory illness, most likely
  TB. You should have on a HEPA or N95 mask.
• If the patient can tolerate it, consider putting
  a regular mask on them.

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Words of Wisdom

• If its wet and not yours dont touch it!
• If you think youve touched it... Report it!
• Dont go around exposing yourself... Your job is
  tough enough!

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RESOURCES

• http//cdc.gov
• http//dhfs.wisconsin.gov/aids-hiv/index.htm
• http//dhfs.wisconsin.gov/communicable
  /diseasereporting/index.htm
• http//dhfs.wisconsin.gov/TB