12/23/2015. The Micro Killers: Protect You and Your Patients. Anthony Toto NREMT-P

Transcription

1 The Micro Killers: Protect You and Your Patients Anthony Toto NREMT-P Spokane County EMS EMS is in the business of treating and transporting the sick and injured. The health and welfare of each EMS provider is a joint concern of the employee, the operational chain of command, and every organization at large. 1

2 Yearly Requirement Many states require EMS Providers to be trained annually about their risk of exposure to blood borne pathogens and airborne contaminants This does not replace agency specific training Rights and Responsibilities The Right to a Safe Work Environment OSHA Health Act of 1970 HIV, HBV & TB are three recognized hazards for EMS and other health care workers WA State requires employers to have a written exposure control plan Does your state have this requirement? Do you know what your plan is? Rights and Responsibilities The Right to Exposure Follow-Up and Evaluation Immediate, confidential medical exam per the exposure plan Employee must initiate immediate self care Medical evaluation & follow up must be conducted my a licensed health care professional The Right to Confidentiality All diagnosis is confidential The Right to Fair Employment 2

3 Rights and Responsibilities The Responsibility to Follow Infection Control Standards BSI Annual Trainings The Responsibility to Enforce Infectious Disease Prevention Laws Employees who do not follow and enforce infectious disease laws and rules are subject to penalties and make themselves liable to court action Ryan White CARE Act Comprehensive AIDS Resources Emergency (CARE) Act Mandates the EMS personnel can find out whether they were exposed to life threatening diseases while providing care Prompt notification no later that 48 hrs. after determination is made to emergency responders that cared for the patient Who is Infected? Regard all patient contacts as potentially infective. Body Substance Isolation (BSI) must be observed at all times and will include all body fluids and other potentially infective material. 3

4 What is the single most important thing you can do to protect yourself and others from infections? Hand Washing 101 With soap and water for at least seconds Waterless alcohol gel hand cleaner when soap and water is not available Not sufficient if hands are visibly dirty or came in contact with fecal matter Wash before and after EVERY patient contact regardless if you wore gloves Protect yourself by: Anticipate type of exposure and choose the appropriate Personal Protective Equipment (PPE) Masks (N-95) Eye protection (mandatory on all patient contacts in WA) Coughing Patient Gowns Gloves (mandatory on all patient contacts) Change between each patient even on the same scene Decontaminate equipment and surfaces after every use Handwashing after equipment decontamination 4

5 What are we talking about? Pathogens Any organism that causes infection and disease What is an exposure? Specific eye, mouth, mucous membrane, nonintact skin, or parenteral contact with blood or other infectious materials that results from the performance of an employees duties Blood splattered on uniform does not constitute an exposure 5

6 Viral Hepatitis Inflammation of the liver caused by viruses The most common types are Hepatitis A (HAV), Hepatitis (HBV), and Hepatitis C (HCV). Is the leading cause of liver cancer and the most common reason for liver transplantation. Hepatitis A Caused by the Hep A Virus 2-6 weeks before symptoms occur Acute Liver Failure rarely occurs More common in the elderly Commonly spread by eating or drinking food contaminated with feces Prevented by handwashing and hepatitis A vaccine Hepatitis B Caused by the Hep B Virus Worlds most common liver infection Can lead to cirrhosis, failure, cancer and death Can survive 7 days in dried fluids & can be reconstituted with fluids Is 100 times more infectious than HIV It is preventable with vaccines 6

7 Transmission Needle Sticks Unprotected sex Personal Items Mother to newborn Caused by the HCV It is the most common chronic blood-borne viral infection in the United States Approx. 2.7 million people infected 70% 85% will develop chronic infection or liver disease Majority of infected persons might not be aware of their infection 2% healthcare workers become infected with HCV after an exposure Survives up to 4 days outside the body Hepatitis C Most commonly spread by direct contact of blood Transmission Average incubation period is 2-24 weeks 7

8 Signs and Symptoms Fever Fatigue Loss of appetite Nausea Vomiting Abdominal pain Dark urine Clay-colored bowel movements Joint pain Jaundice Prevention Universal Precautions Hepatitis B Vaccine Series of 3 injections over 6 months 97% effective in building antibodies No vaccine available against the HCV Treatments are available HIV (Human Immunodeficiency Virus) Is a member of the retrovirus family Attacks cells of the immune system Eventually so-called opportunistic organisms infect the body AIDS (acquired immune deficiency syndrome) is the late stage of HIV infection, when the immune system is severely damaged and has difficulty fighting diseases and certain cancers. 8

9 HIV Facts More than 1.2 Million people in US living with HIV Approx. 12.8% unaware of infection 2013 estimated 47,352 new diagnoses of HIV Overall 1,194,039 people in US have been diagnosed with AIDS Risk Groups LBTG IV Drug users African Americans, Hispanics Groups continue to experience most severe burden of HIV compared to other races and ethnicities Transmission Blood or other body fluids Unprotected sex with an infected partner Sharing of needles by IV drug users Infected mother to her baby Rare in Health Care Workers, < 0.05% after needle stick exposure Virus survives until dry Prevention Universal Precautions Post Exposure Prophylaxis (antiretroviral) believed to reduce the risk of infection if begun ASAP 9

10 To minimize the risk of exposures: Do not re-cap needles Dispose all sharps in a sharps container immediately after use Sharps container should be mounted at eye level or lower Empty the container when ¾ full Bloodborne Decontamination Wear Appropriate PPE Remove soil and organic matter (patient secretions and feces) using soap or detergent Sheets, gloves, and disposable gowns in biohazard container Use disinfectants on the stretcher and all surfaces that were close to the patient (countertops, cabinets, monitors). Disinfect personal equipment (pens, stethoscopes, safety glasses, clipboards etc.) Influenza TB Meningitis Norovirus Airborne Pathogens Surgical face mask? Non-Rebreather mask? N-95 or N-100 mask? 10

11 Influenza Influenza (commonly called "the flu ) is a respiratory illness caused by RNA viruses that infect many animals, birds, and humans These viruses are divided into three types, A, B, and C Influenza types A and B are responsible for epidemics of respiratory illness that occur almost every winter Influenza C viruses are more rare and usually causes either a very mild respiratory illness or no symptoms at all and does not cause epidemics Influenza Type A viruses are further divided into types based on differences in two viral surface proteins called the Hemagglutinin (H) and the Neuraminidase (N) There are 16 known H subtypes and 9 known N subtypes and can occur in many combinations. Contagious period (viral shedding) begins the day before symptoms appear and lasts for 5 to 7 days The amount of virus shed appears to correlate with fever; higher amounts shed when temperatures are highest Influenza can be spread in three main ways: Transmission Direct Transmission (an infected person sneezes mucus directly into the eyes, nose or mouth of another person) Airborne (inhales of the aerosols produced by a cough, sneeze or spit) Indirect Transmission (hand-to-eye, hand-to-nose, or hand-to-mouth from contaminated surfaces) 11

12 Fever / chills (100 F-103 F) Cough Sore throat Runny or stuffy nose Muscle or body aches Headaches Fatigue Secondary pneumonia Influenza Symptoms General Influenza Prevention Cover all coughs Washing your hands with soap and water (or alcohol-based hand cleaners), especially after you cough or sneeze Avoid touching eyes, nose or mouth Get vaccinated Tuberculosis Caused by Mycobacterium Tuberculosis Usually attacks the lungs, but can attack any part of the body such as the kidney, spine, and brain More than 2 billion people, equal to one-third of the world s population, are infected with TB. 1 in 10 people infected with TB bacilli will become sick with active TB in their lifetime Is a leading killer among people with HIV 12

13 Transmission Transmission via small airborne particles expelled by cough, sneezing, or speaking Prolonged exposure in confined space confers highest risk Latent Active + skin test Normal chest x-ray and a negative sputum test Does not feel sick Cannot spread TB bacteria to others Treatment usually consists of a single antibiotic + skin test May have an abnormal chest x-ray or positive sputum smear or culture May spread TB bacteria to others Treatment consists of combinations of several antibiotics Severe cough > 2 weeks Pain in chest with coughing Weakness, fatigue, general malaise Decreased appetite, weight loss Bloody sputum Fever Night sweats Active TB Symptoms 13

14 TB Surgical mask for the patient Respiratory/airborne/droplet PPE Airborne Ventilation during transport (exhaust fan and positive pressure) Airborne decon after transport Post Exposure Procedures Confirm the patient had active TB Confirm the EE has a negative PPD test on file Re-test (PPD skin test) in 8-10 weeks If +, send in for CXR and prophylactic treatment Meningitis Inflammation of the meninges Several different pathogens cause meningitis Spread through droplets from deep oral or pulmonary secretions Intubation, deep tracheal suctioning, nebulizer treatments 14

15 Meningitis Signs / Symptoms Fever Chills Vomiting Severe headache Nuchal rigidity Rash Malaise Muscle aches Lethargy Confusion Seizures Meningitis Precautions Respiratory/airborne / droplet PPE Airborne Ventilation during transport (exhaust fan and positive pressure) Airborne decon after transport Noroviruses A group of viruses that cause acute gastroenteritis Spreads through infected feces or vomit that is ingested Is possible for small droplets of vomitus to become aerosolized and come in contact with the mucous membranes. As few as 10 viral particles may be sufficient to infect an individual Often seen where large numbers of people share the same living space 15

16 Norovirus Precautions Think Norovirus if multiple patients with same symptoms Full PPE Airborne decon with a BLEACH solution after transport Other Infectious Pathogens C-Diff (Clostridium difficile) Decon with Bleach, wash with soap and water MRSA (Methicillin-resistant Staphylococcus aureus) UTI, Skin wounds, Respiratory infections VRE (Vancomycin-resistant Enterococci) are bacteria that are normally present in the human intestines and female genital tract but evolved and can cause infections Guidelines Transport and Decontamination Airborne Ventilate Exhaust fan and heat/air on to create a positive pressure environment Airborne Decon Wear Appropriate PPE Air out ambulance for 20 minutes Use disinfectants on the stretcher and all surfaces that were close to the patient (countertops, cabinets, monitors) Disinfect all personal equipment (pens, stethoscopes, safety glasses, clipboards etc.) 16

17 Exposure Guidelines If you have a possible exposure: Immediately clean affected area Follow your agency s policy and procedures for reporting After every patient contact, clean all equipment that has come in contact with the patient. Gurney Gurney Straps BP Cuff Stethoscope ECG Cables Pulse Ox Probes/Cable Clipboard/Pens POST-TEST 1. Airborne decontamination states that you should air out the ambulance for how long? A. 10 Minutes B. 40 Minutes C. 20 Minutes D. 5 Minutes 2. How long can the Hepatitis B Virus live outside the body? A. 1 Hour B. 7 Days C. 25 Minutes D. 5 Days 17

18 3. How many people are infected with TB? A. 1 Billion B. 1.5 Million C. 50 Million D. None of the above 4. How many viral particles from Norovirus does it take to make you sick? A. 10 B. 700 C D Hepatitis A is primarily transmitted by blood. A. True B. False SECRET QUESTION How long can HIV live outside the body? Special thanks to Sheila Crow Stitchin Dreams Embroidery wcsocrow@yahoo.com For providing our Secret Question prize 18

19 Questions? Contact: Samantha Roberts Fax: Updates Please EMS presentation, all certificates will be printed by participants or their agency. The certificate template will be available through the health training website at the same location as all presentation downloads. It will be posted the day after each monthly presentation. 19

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