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WELCOME TO THE FIRE/EMS TRAINING ACADEMY S INFECTIOUS

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WELCOME TO THE FIRE/EMS TRAINING ACADEMY S INFECTIOUS CONTROL ANNUAL REFRESHER TRAINING PROGRAM If you have any questions regarding the Infection Control Training ... – PowerPoint PPT presentation

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Title: WELCOME TO THE FIRE/EMS TRAINING ACADEMY S INFECTIOUS


1
  • WELCOME TO THE FIRE/EMS TRAINING ACADEMYS
  • INFECTIOUS CONTROL
  • ANNUAL REFRESHER TRAINING PROGRAM
  • If you have any questions regarding the Infection
    Control Training Class, please refer to the
    Infectious Control General Order 5-16 (new
    General Order 08-07).
  • If you are still unable to answer your question,
  • please contact the Emergency Operations Center
    at
  • 301-583-2200 to reach the On-Duty Infectious
    Control Training Instructor.

2
BLOODBORNE PATHOGENS PREVENTING DISEASE
TRANSMISSION INFECTION CONTROL
Revised 2008
3
  • Approximately 5.6 million workers in healthcare
    and other facilities are at risk of exposure to
    bloodborne pathogens such as Human
    Immunodeficiency Virus (HIV the virus that
    causes AIDS), the Hepatitis B virus (HBV), and
    the Hepatitis C virus (HCV)
  • OSHAs Bloodborne Pathogens standard prescribes
    safeguards to protect workers against the health
    hazards from exposure to blood and other
    potentially infectious materials, and to reduce
    their risk from this exposure

4
Objectives
  • At the end of this session, the student will be
    able to
  • Describe what laws and safety regulations cover
    Bloodborne Pathogens
  • List and describe the diseases that cause the
    greatest concerns for providers
  • Describe how to prevent disease transmission

5
Objectives
  • Describe the necessary steps the provider must
    complete when an exposure occurs
  • Locate and describe the Exposure Control Plans
    for the Prince Georges County Fire/EMS Department

6
Topics
  • Laws and Safety Regulations
  • How Exposures Occur
  • Diseases that Cause Concern
  • Preventing Disease Transmission
  • If an Exposure Occurs
  • Exposure Control Plans

7
Laws and Safety Regulations
  • OSHA Standard 29 CFR 1910.1030
  • MOSH 09.12.31, Occupational Safety and Health Act
  • Prince Georges County Fire/EMS Departments
    General Orders
  • General Order 5-16, Infection Control Program
  • General Order 5-17, Tuberculosis Exposure Control
    Program
  • General Order 5-19, Non-Infectious Occupational
    Exposure Program

8
Laws and Safety Regulations
  • OSHA, the Occupational Safety Health
    Administration, issued the Occupational Exposure
    to Bloodborne pathogens, OSHA 29 CFR 1910.1030,
    to protect employees by reducing or removing the
    hazards of bloodborne pathogens from the
    workplace.
  • The regulation applies to employers whose
    employees, as a result of job requirements, have
    the potential for exposure to bloodborne
    pathogens.

9
Laws and Safety Regulations
  • OSHA Web Site
  • http//www.osha.gov/SLTC/bloodbornepathogens/index
    .html

10
How Exposures Occur
  • Most common needlesticks
  • Cuts from other contaminated sharps (scalpels,
    broken glass, etc.)
  • Contact of mucous membranes (for example, the
    eye, nose, mouth) or broken (cut or abraded) skin
    with contaminated blood

11
How Exposures Occur
  • Disease transmission is a two-way street. It is
    just as easy for you to infect a person with whom
    you come in contact as it is for that person to
    infect you.
  • A pathogen is a disease-producing organism that
    enters the body basically, a germ.
  • The immune system relies heavily on the skin to
    keep the amount of pathogens that enter the body
    to a minimum.

12
How Infections Occur
  • Chain of Infection
  • Infectious Agent
  • Reservoir
  • Means of Exit
  • Mode of Transmission
  • Means of Entry
  • Susceptible Host

13
How Infections Occur
Infectious Agent
Susceptible Host
Reservoir
Means of Exit
Means of Entry
Mode of Transmission
Chain of Infection
14
How Infections Occur
  • Routes of Transmission
  • Direct contact
  • Indirect contact
  • Airborne transmission
  • Vector-borne transmission

15
How Infections Occur
  • Direct Contact
  • Touching the body fluids from an infected person
  • Indirect Contact
  • Touching objects that have been in contact with
    the body fluid of an infected person
  • Airborne
  • Breathing in droplets that became airborne when
    an infected person coughs or sneezes
  • Vector-borne
  • Through a bite from an infected animal or insect

16
How Infections Occur
  • Most infectious diseases are caused by one of
    five types of pathogens.The most common are
    viruses and bacteria.
  • Viruses
  • Bacteria
  • Fungi
  • Protozoa
  • Parasites

17
How Infections Occur
  • Viruses
  • Hepatitis, Chicken Pox, HIV, etc.
  • Bacteria
  • Meningitis, Tuberculosis, food poisoning
  • Fungi
  • Athletes foot, ringworm
  • Protozoa
  • Malaria, dysentery
  • Parasites
  • Abdominal pain, anemia, etc.

18
What are Bloodborne Pathogens?
  • Bloodborne Pathogens are causative agents of
    disease that are carried in blood, blood products
    and other potentially infectious materials. They
    can result in severe and deadly disease in
    healthcare or research personnel.

19
How Infections Occur
  • Just because pathogens have a means of getting
    into the body does not mean that disease will be
    transmitted.
  • For diseases to be transmitted, all four of the
    following conditions must be met
  • A pathogen is present.
  • There is sufficient quantity of the pathogen to
    cause disease.
  • A person is susceptible to the specific pathogen.
  • The pathogen enters the body through the correct
    entry site.

20
Diseases that Cause Concern
  • What Is infectious?
  • Capable of causing infection
  • Caused by a pathogen
  • Illness resulting from an invasion of a host by a
    disease producing organism

21
Diseases that Cause Concern
  • You should be familiar with diseases that can
    have serious consequences if transmitted.
  • These include -
  • Herpes - These viruses cause infections to the
    skin and mucus membranes.
  • Meningitis - A severe infection of the coverings
    of the brain and spinal cord.
  • TuberculosisA disease that predominantly affects
    the respiratory system.
  • Hepatitis - A viral infection of the liver.
    Different forms of hepatitis are transmitted in
    different ways.

22
Diseases that Cause Concern
  • HIV A disease that attacks white blood cells and
    destroys the bodys ability to fight infections.
  • Childhood Diseases Diseases such as measles,
    mumps and chicken pox pose a serious risk for
    persons who did not contract the diseases as
    children or were not immunized against them.

23
Diseases that Cause Concern
  • Bloodborne Pathogens of Special Concern To
    Health Care Providers
  • HBV Hepatitis B virus
  • HCV Hepatitis C virus
  • Other emerging viral hepatitis
  • HIV Human Immunodeficiency virus

24
Diseases that Cause Concern
  • Hepatitis B (HBV)
  • Infection of liver caused by HBV
  • Virus is in blood and other body fluids
  • Spread by exposure to blood and body fluids
  • Some people are at higher risk of HBV
  • In 1983 there were 17,000 new cases among
    healthcare workers, while in 1995 there were only
    400 occupationally acquired infections. With the
    introduction of the HBV vaccine to healthcare
    workers, the period from 1983 to 1995 had a 95
    decrease in new cases among healthcare workers.

25
Diseases that Cause Concern
Hepatitis B (HBV) Symptoms
  • Lethargy
  • Loss of appetite
  • Fever
  • Vomiting
  • Yellow skin eyes (jaundice)
  • Dark-colored urine.
  • Light colored stool

DID YOU KNOW??? It is estimated that 4.9 of all
Americans have been infected with HBV
26
Diseases that Cause Concern
  • HBV Treatment
  • NO CURE
  • Fluids
  • Rest
  • Right diet
  • Avoid alcohol some medicines

27
Diseases that Cause Concern
  • Hepatitis B Prevention
  • Avoid exposure
  • A VACCINE IS AVAILABLE!
  • (Get complete vaccination series)

28
Diseases that Cause Concern
  • Hepatitis C (HCV)
  • Infection of the liver
  • Virus is in blood and other body fluid
  • HCV mainly spread by exposure to blood and blood
    products
  • Certain people are at higher risk of getting HCV

29
Diseases that Cause Concern
Hepatitis C (HCV) Symptoms
  • Vomiting
  • Yellow skin eyes (jaundice)
  • Urine that is dark in color
  • Lethargy
  • Loss of appetite
  • Abdominal pain
  • Nausea

30
Diseases that Cause Concern
Hepatitis C (HCV) Treatment
  • NO CURE
  • Treatment limited
  • Rest fluids
  • Avoid alcohol some medicines

31
Diseases that Cause Concern
  • Hepatitis C (HCV) Prevention
  • NO effective VACCINE!
  • Taking the same precautions that protect you from
    Hepatitis B and HIV will help prevent
    transmission of HCV in the workplace.

32
Diseases that Cause Concern
Human Immunodeficiency Virus (HIV)
  • AIDS is caused by the HIV virus
  • Some people at higher risk than others
  • HIV is in blood and other body fluids
  • HIV is spread by exposure to HIV infected blood
    and HIV infected body fluids

33
Diseases that Cause Concern
  •  As of 2002, and according to the Centers for
    Disease Control and Prevention (CDC), there are
    over 816,000 reported cases of people with AIDS
    in the US, and an estimated 5 million people were
    infected with the Human Immunodeficiency Virus
    (HIV) worldwide.
  • In the US, HIV-related illness was the leading
    cause of death among young adults between the
    ages of 25 and 44 years old in 1995.

34
Diseases that Cause Concern
AIDS annual rates per 100,000 population -
United States, January - December 1996
4.0
14.5
MD. 44.4
3.9
6.1
26.6
D.C. 232.3
30.1
12..0
25.3
50.9
13.4
14.2
35
Diseases that Cause Concern
  • HIV
  • Certain symptoms conditions may be associated
    with HIV/AIDS
  • Fever
  • Weight loss
  • Swollen lymph nodes
  • White patches in mouth (thrush)
  • Certain cancers eg. Kaposis sarcoma, certain
    lymphomas
  • Infections eg. pneumocystis pneumonia, TB, etc.

36
Diseases that Cause Concern
  • HIV
  • A blood test may tell if you have HIV infection
    or AIDS
  • HIV treatment
  • No CURE
  • A treatment protocol (Zidovudine (AZT) plus
    lamivudine (3TC) for 28 days) has been developed
    by the U.S. Public Health Service and is to be
    administered following a high-risk exposure to a
    known HIV-infected source.
  • Combination therapy with a variety of medications
    help people with HIV by slowing the disease
    process

37
Diseases that Cause Concern
  • HIV and AIDS are Preventable
  • There is NO VACCINE!
  • Avoid exposure
  • Follow standard (universal precautions) such as
    the use of gloves, eye protection, gowns, etc.

DID YOU KNOW??? According to previous reports
from the CDC, HIV does not survive well outside
the body. The number of infectious HIV particles
is reduced by 90 to 99 percent within several
hours. However, this natural inactivation can
take up to 8 hours or longer!
38
Diseases that Cause Concern
  • A diagnosis of TB should be suspected in any
    patient with the following
  • Productive cough (gt2 to 3 wks duration)
  • Fever - Chills
  • Night sweats
  • Easily fatigable
  • Loss of appetite (anorexia) - weight loss
  • Hemoptysis (bloody sputum)

39
Diseases that Cause Concern
  • Managing patients who may have TB in
    ambulatory care setting and emergency
    departments
  • Attempt to identify any potentially TB infected
    patient e.g. history, signs symptoms, any
    previous positive TB treatment, or any current
    anti-tuberculosis medications

40
Diseases that Cause Concern
  • Utilize engineering controls where possible and
    use of approved PPE when treating and
    transporting a patient suspected of having TB
  • TB patients, if medically stable, should remain
    in the transport unit (with a provider) until
    receiving facility is notified and ready to
    accept the patient

41
Diseases that Cause Concern
  • Developing, implementing, maintaining, and
    evaluating a respiratory protection program
  • Personal Protective Equipment (PPE) Respiratory
    Protection (NIOSH approved mask e.g. N-99 or HEPA
    and other PPE as per local protocol)
  • Meets adequate filtration standards

42
Diseases that Cause Concern
  • Qualitatively or quantitatively fit tested
  • Respirators available in units
  • Ability to be checked for face piece fit (OSHA)
  • Must comply with CFR 1910.134 (OSHA Respiratory
    Standard)

43
Diseases that Cause Concern
  • Use precautions while performing
    cough-inducing and other high hazard procedures
  • Characterized by potential to generate airborne /
    droplet secretions
  • Aerosolized medication treatment
  • Endotracheal Intubation
  • Suctioning
  • Transporting a patient with active TB disease in
    a closed vehicle

44
Diseases that Cause Concern
  • What Is Tuberculosis?
  • Mycobacterial disease
  • Caused by the infectious agentMycobacterium
    tuberculosis
  • Transmitted by infected airborne particles called
    droplet nuclei

45
Diseases that Cause Concern
  • TB Infection can result from exposure to
    infectious droplet nuclei
  • Positive PPD but, no clinically apparent signs or
    symptoms of TB
  • Negative CXR negative smears and cultures which
    means usually not infectious
  • May develop into TB disease

46
Diseases that Cause Concern
  • TB disease develops in a person with tuberculosis
    infection
  • Usually is infectious if not treated
  • Signs and symptoms apparent with positive lab test

47
Diseases that Cause Concern
  • Develop and implement a program for routine
    periodic counseling and screening of HCWs for
    active and latent TB infection
  • PPD skin testing is used to detect TB infection

48
Diseases that Cause Concern
  • Skin test conversion from negative to positive
    indicates a new infection with TB
  • A person with a positive PPD should be clinically
    evaluated for active tuberculosis
  • A person with a positive PPD should be evaluated
    for preventive therapy if no active disease is
    present
  • If TB disease is detected, begin treatment per
    local policy

49
Diseases that Cause Concern
  • Interpretation of TB Skin TestIndurations of
  • 5 mm or larger considered positive after close
    personal contact, abnormal CXR or in known HIV
    infected persons
  • 10 mm or larger considered positive in persons
    with other known risk factors (HCW)
  • 15 mm or larger considered positive in all other
    populations

50
Diseases that Cause Concern
  • Promptly evaluate possible episodes of
    tuberculosis transmission in your healthcare
    setting
  • An exposure to TB is defined as
  • Potential exposure to the exhaled air of an
    individual with suspected or confirmed TB disease
  • Exposure to high hazard procedure performed on
    persons with suspected or confirmed TB disease

51
Diseases that Cause Concern
  • Risk Factors for TB Disease Development
  • Only about 1 in 10 people infected ever suffer
    active disease
  • Reactivation of TB is likely if the host has
    impaired immunity, including diabetes, chronic
    renal failure, malnourished, high-dose
    corticosteroid therapy, some hematologic
    disorders, or HIV infection

52
Diseases that Cause Concern
  • Treatment of Tuberculosis
  • Drug susceptibility testing should be performed
    on all initial isolates from patients with TB
  • Until results are known, two basic principles of
    therapy apply1) Start with the four primary
    drugs used in the treatment of TB until
    sensitively and resistance are known2)
    Continue treatment regimen with at least two
    drugs known to be effective on the isolate

53
Diseases that Cause Concern
  • Drug Resistant Tuberculosis
  • Where therapy is not continuous or incomplete,
    multi-drug resistant tuberculosis can develop
    (MDR-TB).
  • MDR-TB can be treated but, treatment is with
    second line drugs that are less effective.
  • MDR-TB requires longer treatment regimens 18
    to 24 months (due to lower efficacy)

54
Diseases that Cause Concern
  • TB Surveillance Reporting
  • Skin test conversions among personnel
  • PPD done at time of employment and (annually)
    periodic re-testing thereafter
  • Evaluation of exposure incidents
  • Evaluations management of positive PPD skin
    tests or symptoms of TB
  • Follow-up of personnel with positive PPD skin test

55
Diseases that Cause Concern
  • Follow-up After TB Exposure
  • Clinically evaluate for active TB
  • Negative PPD in preceding 3 months - repeat 12
    weeks after exposure
  • Negative PPD longer than 3 months ago, repeat
    baseline and if this one is negative, repeat in
    12 weeks
  • A positive PPD requires clinical evaluation and
    management

56
Diseases that Cause Concern
  • Tuberculosis Prevention Control
  • Unit ventilation keep adequate ventilation in
    the treatment area of the transport vehicle e.g.,
    windows, exhaust fans, air out vehicle after run
  • Work practices to prevent the spread of airborne
    droplets
  • When treating and transporting HIV infected
    patients, IVDAs, foreign born, and other high
    risk groups for TB, PPE should routinely
    include airborne protection

57
Diseases that Cause Concern
  • TB Prevention Control - Continued
  • Face eye protection during exposure prone
    activities, e.g. endotracheal intubation,
    suctioning, positive pressure demand valve
    ventilation
  • Decontamination with E.P.A. approvedhospital
    grade detergent disinfectant
  • Tuberculosis screening program
  • Preventive therapy or treatment
  • Documentation

58
Diseases that Cause Concern
  • Review procedures in the Prince Georges County
    Fire/EMS Departments General Order 5-17,
    Tuberculosis Exposure Control Program

59
Preventing Disease Transmission
  • Identify tasks and other activities that may
    involve exposure to blood or other potentially
    infectious body materials

60
Preventing Disease Transmission
  • Patient assessment
  • Airway management
  • Assisting respirations
  • Bleeding control
  • Contact with body fluids
  • Clean-up of scene equipment
  • Establishing an IV
  • Emergency childbirth
  • Other patient care activities where contact with
    blood or body fluids occur

61
Preventing Disease Transmission
  • To reduce the risk of infection
  • Wear gloves
  • Minimize contact with body fluids
  • Wash hands or any exposed area immediately and
    thoroughly after you provide care or clean a spill

62
Preventing Disease Transmission
  • Precautions taken to prevent exposure to blood or
    other body fluids containing visible blood are
    known as Universal Precautions.
  • Precautions taken to prevent exposure to any
    other type of body fluids or substances are known
    as Body Substance Isolation (BSI).

Since August 1987, the Centers for Disease
Control and Prevention have defined Universal
Precautions as"Since medical history and
examination cannot reliably identify all patients
infected with HIV or other blood-borne pathogens,
blood and body- fluid precautions should be
consistently used for ALL patients."
63
Preventing Disease Transmission
  • Preventing disease transmission involves
    following basic precautions
  • Personal hygiene Personal habits or practices
    such as hand washing and proper grooming
  • Protective equipment Protects a person from
    direct contact with infected material (i.e.,
    gloves, masks, etc.)

64
Preventing Disease Transmission
  • Engineering and work practice controls. Help
    eliminate or reduce the risk of exposure in the
    workplace.
  • Engineering controls isolate or remove the hazard
    (i.e., containers for sharp items such as
    needles)
  • Work practice controls reduce the likelihood of
    exposure by changing the way a task is carried
    out (i.e., washing hands before and after giving
    first aid)

65
Preventing Disease Transmission
  • Equipment cleaning and disinfecting
  • Careful handling of all soiled equipment,
    supplies, or other materials until properly taken
    care of (i.e., placing soiled clothing in
    properly marked plastic bags for disposal or
    washing)

66
Preventing Disease Transmission
  • The following steps shall be followed when
    cleaning-up a contaminated area/scene
  • Isolation of Containments
  • Isolate the area where the material is located to
    prevent accidental contamination.
  • Personal Protective Equipment
  • Before attempting to clean the contaminated area,
    apply appropriate Personal Protective Equipment
    (may include Gloves, protective eye wear,
    footwear, and clothing).

67
Preventing Disease Transmission
  • Clean-Up Contaminated Area
  • If the area has been contaminated with blood or
    other bodily fluids, clean the area immediately.
  • Retrieve Bio-Hazard Clean-Up Kit.
  • Wipe up any excess fluids with disposable towels,
    you may also use the absorbent powder to solidify
    any excess fluids and then scoop-up the material
    and place it into the Red Bio-Hazard Bag.
  • Place contaminated towels in a Red Bio-Hazard
    Bag.

68
Preventing Disease Transmission
  • Clean-Up Contaminated Area
  • A 110 dilution of 5.256.15 sodium
    hypochlorite (i.e., household bleach) or an
    EPA-registered tuberculocidal disinfectant has
    been recommended for decontaminating blood
    spills.
  • Let the mixture stand for at least 15 minutes.
  • Wipe area with disposable towels and let area
    air dry.
  • Place all exposed/contaminated materials in the
    Red Bio-Hazard Bag.
  • Contact your vendor for proper disposal of your
    Red Bio-Hazard Bag, it is considered Medical
    Waste and it must be disposed of properly.

69
Preventing Disease Transmission
  • Disinfect / Wash Hands
  • As soon as possible, wash hands to reduce the
    risk of infection / contamination. If you are
    not able to disinfect / wash hands within a
    reasonable amount of time, you may use a
    commercial waterless hand cleanser.

70
Exposure Control Plans
  • Preventing disease transmission begins with
    preparation and planning.
  • The Exposure Control Pan creates a system to
    protect people from infection.
  • The Plan requires the employer to identify who
    will receive training, protective equipment and
    vaccination.

71
Exposure Control Plans
  • An Exposure Control Plan should contain the
    following elements
  • Exposure determination
  • Schedule and method of implementing other parts
    of the OSHA Standard
  • Procedures for evaluating details of an exposure
    incident

72
If an Exposure Occurs
  • An exposure may include contact with potentially
    infectious blood or other body fluids through a
    needle stick, broken skin,or membranes of the
    eyes, nose, or mouth.
  • If it is believed that an exposure has occurred,
    clean the area of contact thoroughly, write down
    what happened, and notify your supervisor
    immediately.
  • Necessary follow-up care should be secured.
  • Follow your worksites post-exposure policies and
    procedures.

73
If an Exposure Occurs
  • Review procedures in the Prince Georges County
    Fire/EMS Departments General Order 5-16,
    Infection Control Program

74
If an Exposure Occurs
  • General Post Exposure Evaluation Follow-Up
    Guidelines
  • Document route of exposure circumstances under
    which the exposure occurred
  • Identification documentation of source
    individual information

75
Prevention and Vigilance is Your Only Cure
76
Summary
  • Laws and Safety Regulations
  • How Infections Occur
  • Diseases that Cause Concern
  • Preventing Disease Transmission
  • If an Exposure Occurs
  • Exposure Control Plans

77
  • STILL HAVE QUESTIONS?
  • Please refer to the Infectious Control General
    Order 5-16 (new General Order 08-07).
  • If you are still not able find an answer, please
    contact the Emergency Operations Center at
    301-583-2200 to reach the on duty Infectious
    Control Training Instructor.
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