Bloodborne Pathogen Training 2010

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Bloodborne Pathogen Training2010

• Advocate Condell EMS System
• Prepared by Sharon Hopkins, RN, BSN, EMT-P

2
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

3
Objective contd

• 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 PPEs 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

4
Objective contd

• 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

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Objective contd

• 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

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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

7
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

8
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

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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

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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

11
Training

• Employees must be provided information
• When first assigned a task with potential
  exposure
• Repeated annually
• During work hours
• When new tasks or procedures are added
• New exposure risk created must be addressed

12
Training Requirements

• Make copy of standard accessible to all
• Have a general discussion of bloodborne pathogen
  diseases and their transmission
• Review your departments exposure plan
• Review how to obtain/view a copy of your
  departments exposure plan 24/7
• Discuss how to recognize tasks and other
  activities that may involve exposure

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Training Requirements contd

• Discuss the use and limitations of methods for
  protecting or reducing exposure risk
• Engineering practices
• Work practice controls
• PPEs
• Provide information on the Hepatitis B vaccine
• Review how to handle a response to an emergency
  involving potential exposure

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Training Requirements contd

• Review the process when an exposure incident
  occurs
• Review your departments 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

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Definition Bloodborne Pathogen

• Microorganisms that
• are present in human blood
• can infect and cause disease in people who are
  exposed to blood containing the pathogen
• can be transmitted through contact with
  contaminated blood and body fluids

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Examples Bloodborne Pathogens

• Human Immunodeficiency Virus (HIV)
• Hepatitis B (HBV)
• Hepatitis C (HCV)
• Non A, Non B Hepatitis
• Syphilis
• Malaria
• Babesiosis
• Brucellosis

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Examples contd

• Leptospirosis
• Arboviral infections
• Relapsing fever
• Creutzfeld-Jakob disease
• Human T-lymphotrophic Virus Type 1
• Viral hemorrhagic fever

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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 cant tell if material is or is not
  infectious so treat all materials as if they are
  infectious!

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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

20
Controls in Place

• The objective of engineering controls and work
  practice controls is the same
• to reduce or minimize employee exposure to
  bloodborne pathogens

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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

22
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."

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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

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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

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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

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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

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Handwashing

• As soon as possible following an occupational
  exposure to blood or other potentially infectious
  materials
• After removal of gloves
• Before and after every patient contact
• After toileting
• Before and after preparing food
• Before and after eating or smoking
• After coughing or sneezing into hands or blowing
  nose

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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

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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

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Antiseptic Hand Cleaner

• Antiseptic hand cleaners may be used as an
  appropriate hand washing practice IF
• Your gloves remained intact
• You have had no occupational exposure to blood or
  other potentially infectious materials
• Material 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.

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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

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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 childrens reach
• Source Illinois Poison Center

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Personal Hygiene

• Personal hygiene involves using good judgment
  when working in areas with the potential for
  exposure

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• 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.

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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

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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

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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

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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

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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

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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
• Spray
• Spatter
• Droplets

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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.

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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.

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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

44
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

45
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.

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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.

47
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

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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 cant clean the surface if they cant 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

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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.

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Clean Up of Spills contd

• 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.

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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

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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.
  

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Housekeeping contd

• 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.

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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 manufacturers 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 110
  (one part bleach to 9 parts water) to 1100
  concentration

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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.

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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.

57
Waste Disposal

• Regulated waste refers to
• Any 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

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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.

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Recordkeeping contd

• 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.

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Recordkeeping contd

• 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.

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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

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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.

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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

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EMS System Policy contd

• 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

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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

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(No Transcript)
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• Early treatment can significantly reduce the
  chance of disease transmission!

68
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.

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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

70
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

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Disease Transmission

• Direct 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

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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

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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

74
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

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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

76
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

77
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

78
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

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Phases contd

• 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

80
Preventing Infection

• Break the cycle

Infectious agent
Means of transmission
Host
Routes of exposure
81
Selected Infectious Diseases

• Definition
• Incubation Period
• Transmission Mode
• Signs Symptoms
• Recommended PPEs
• Special Considerations

82
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

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HIV contd

• 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

84
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
• PPEs gloves, goggles, mask, avoidance of
  needlesticks

85
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.

86
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

87
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

88
HCV contd

• 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
• PPEs gloves, mask, goggles, avoidance of
  needle sticks

89
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

90
TB contd

• Signs and symptoms
• Fever
• Chills
• Weakness. fatigue
• Night sweats
• Weight loss
• Dyspnea
• Productive cough
• Chronic cough

91
TB contd

• PPEs
• 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

92
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

93
Chickenpox contd

• Contagious about 2 days prior to rash and until
  all vesicles have scabbed over
• Skin eruptions continue over 3 4 days
• PPEs gloves surgical mask on patient, mask on
  healthcare provider
• Vaccination added to childhood immunization
  schedule

94
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

95
Bacterial Meningitis contd

• PPEs gloves, mask (patient and provider)
• Vaccination provided in childhood immunization
  schedule
• Postexposure antibiotic prophylaxis provided
  after exposure

96
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

97
Flu contd

• 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

98
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

99
H1N1 contd

• Symptoms similar to regular flu
• Fever
• Cough
• Sore throat
• Body aches
• Chills
• Fatigue
• Critical situation
• Respiratory difficulty
• Cyanosis
• Pain, pressure in chest or abdomen

100
H1N1 contd

• PPE
• Gloves
• HANDWASHING
• Disinfecting surfaces after each call
• Frequently disinfect surfaces likely to have hand
  contact

101
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

102
3 Cs To Stay Healthy

• CLEAN COVER CONTAIN
• Wash your hands
• Cover your cough and sneeze
• Contain your germs
• Stay home if sick

103
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

104
Whooping Cough contd

• 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

105
Whooping Cough contd

• PPE gloves, surgical mask patient and provider,
  goggles, possible gown
• Complications often from the spasmodic forceful
  coughing
• Pneumothorax
• Rib fractures
• Hypoxia during coughing spells

106
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

107
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.

108
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

109
Results Of Contracting MRSA

• Skin infections, pimples, boils
• Pneumonia
• Bloodstream infections
• Potentially death

110
Transmission of MRSA

• Spread of MRSA skin infections is direct and
  indirect
• Close skin-to-skin contact
• Cuts or abrasions
• Poor hygiene
• Methods of Contraction
• Crowded living conditions
• Contaminated items or surfaces
• Weakened immune system

111
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

112
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

113
VRE

• Spread via contact
• Feces
• Contaminated equipment
• Healthcare workers 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

114
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

115
Question 1

• Who does the OSHA's Bloodborne Pathogens standard
  cover?
• 1. All employees, regardless of occupation or
  workplace
• 2. 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 clinics
• 4. Only employees who use needles on the job

116
Question 2

• Which label indicates that a biohazard is
  present?

117
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 fluid
• 3. Urine
• 4. Unfixed body organs going to the lab for
  analysis

118
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.

119
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 completed
• 2. At the end of each work shift, if the surface
  may have become contaminated since the last
  cleaning
• 3. Immediately or as soon as feasible following
  a spill of blood or other potentially infectious
  material
• 4. All of the above

120
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 FAQs

121
Resources

• www.lakecountyil.gov/Health/H1N1.htm
• Ready.illinois.gov
• www.flu.gov
• LCHD Flu Hotline [phone]

122
Bibliography

• Condell Medical Center EMS System Operational
  Guidelines Infield Policy Manual. January 2001
• Environmental Health Safety On-line Training
  Module. BBP. 2010.
• Region X SOPs 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