Communicable Diseases EMT REFRESHER NCCP 2018 JTEMPLE

Communicable Diseases EMT REFRESHER NCCP 2018 JTEMPLE

When are Standard Precautions used? The use of Standard Precautions during patient care is determined by the nature of the anticipated interaction with the patient. For example: IV start always requires gloves Intubation requires gloves, face shield or mask and goggles. Respiratory symptoms require mask, gloves and eye protection Rash gloves and mask Trauma gloves and face protection

What is Personal Protective Equipment? (PPE) Hand Hygiene Gown Gloves Mask Face shield Eye protection PAPRs

Epidemic 5 http://isiria.files.wordpress.com/2009/03/epidemic-nml.jpg

Pandemic 6 http://www.zmangames.com/boardgames/files/pandemic/notfinalpandemic_board.jpg

Handwashing 101

RNs: 71 95% Wash Your Hands Medics: 1 34% DOCs: 60 80%

EMS Handwashing Urban EMS System Minneapolis, MN: 6 month study Medics: 1.1% prior to patient contact 62.8% after patient contact 19% before meals 59.5% after meals

CDC Recommendations Remove all jewelry Wet hands with running water, apply soap Scrub back of hands and under nails Rub hands for at LEAST 20 seconds! Rinse under running water Dry with CLEAR towel or air dry

Alcohol based hand cleaner At least 60% alcohol Reduce germs, nor eliminate germs! Do NOT kills viruses, just make living conditions tough! Hand sanitizer is not effective when hands are visibly dirty!

EMS Vaccines (CDC Recommended) Hepatitis B Influenza (Seasonal) MMR (Measles Mumps, Rubella) Varicella Pertussis

Seasonal Influenza Three strains circulating in Iowa H1N1 ( Influenza A-covered) Influenza B (covered) H3N2 (Influenza A-covered) Influenza A is always more severe than B. Seasons in which A viruses dominate tend to be more severe, with more hospitalizations and deaths Antiviral medications are effective if given as indicated

What is influenza Respiratory illness: Fever, cough, muscle aches, sore throat, tiredness Complications: Pneumonia and other bacterial illnesses Treatment: Antiviral medications (Tamiflu and Relenza) Shorten the duration of fever and illness symptoms Reduce risk of complications Reduce risk of death

Influenza Incubation phase 1-4 days Adults are contagious from the day BEFORE symptoms begin THROUGH 5-10 days after onset.

Manufactured in eggs 16 Manufactured in eggs Takes six months to manufacture adequate vaccine Patient s allergic to eggs should not receive the vaccine.

Influenza Vaccine 17 Most effective if given within 2-4 months of illness 90% effective in preventing illness in the healthy 50-60% effective at preventing hospitalization in elderly 80% effective at preventing death

Healthcare Flu Vaccination 18 Historic rates of 34% for healthcare workers Leading cause of occupational illness and risk of spread to patients In pandemic planning we need to increase

Influenza Vaccine (Injection) Side effects 19 The viruses in the flu shot are killed (inactive), so you CANNOT get the flu from the flu shot (CDC) Soreness, redness or swelling where the shot was given Fever (low grade) Malaise

Disease and Injury Surveillance EMS is in a unique position! First contact Notice any trends Common symptomatic presentations Geographical areas

Reporting Know who the contact is EMA, Public Health Know when to report (Policy) Software keeps a watchful eye on this information!

Prevention Flu Vaccine PPE Mask Gloves Eye protection Hand hygiene

MRSA Standard Precautions in most cases is enough Open/draining wounds may require Contact Precautions be used during transport

Basic Component of Contact Precautions for EMS Component Patient Transport Gloves Gown Patient care equipment Environmental control Recommendations Open/draining wounds are covered and drainage contained For touching intact skin or surfaces and articles close to the patient For interactions that may result in contamination of clothing Dedicated when ever possible and clean and disinfect after use Follow procedures for cleaning and disinfection of surfaces

Myths The elderly, for the most part are the only people who contract sepsis. Sepsis only affects people with pre-existing conditions. Sepsis is the same thing as blood poisoning (septicemia). Sepsis and septic shock are always fatal.

Incidence Over 750,000 patients are diagnosed with sepsis annually, with an increase of 90% in the number of diagnoses over the last 10 years. The cause for this is believed to be the rise of drugresistant bacteria

Mortality In otherwise healthy individuals, the mortality rate for sepsis is 5% If severe sepsis develops, mortality rises sharply If hypotension (the hallmark of septic shock) is present, mortality rises to 50%

At-Risk Populations Elderly, infants, surgical patients, chronically ill and immunosupressed patients are all at increased risk of contracting sepsis because of compromised or diminished immune function. The mortality rates for these catagories are also raised.

Definitions a. Sepsis a SIRS response triggered by infection b. Septicemia sepsis originating from an infection in the bloodstream c. Systemic Inflammatory Response Syndrome systemic (bodywide) immune response meeting two or more of the following criteria i. Temperature above 100.4 F, below 96.8 F ii. HR > 90 bpm iii. iv. RR > 20 or PaCO2 < 32 mmhg Extreme high/low WBC count

S/S of Sepsis a. Chills, low grade fever, shaking, body aches, N&V, vertigo, other flu-like symptoms b. Occasional AMS including confusion, lethargy and increased fatigue

Purpura/rash in children with sepsis caused by meningococcal infection

Influenza vs. Sepsis Sepsis can be misdiagnosed as the flu because symptoms are nearly identical often. Try to rule out sepsis when considering a diagnosis of influenza.

Sources of Infection Dirty wounds (debris) Complex wounds (open fractures) Burns Puncture wounds Impaled Objects Crush Injuries

Infected Wounds

Assessment a. ABCs, manage critical problems b.complete SAMPLE hx i. How long has pt been ill? ii.is there any hx of infections? iii. Prior medical complications/conditions? iv. Any surgeries? v. Pain or fever? c. Complete physical exam i. Sick/Not Sick ii.signs of infection?

EMS Patients were more likely to Elderly Female From Nursing home Abnormal vital signs Tachycardia Hypoxia Hypotension Higher serum Lactate Levels Higher comorbid conditions Organ Dysfunction 4 times great chance of presenting in severe sepsis

www.survivingsepsis. org SIRS Criteria (2 or more) Can be due to infection or trauma: Temp >38 C (100.4 F) or < 36 C (96.8 F) Heart Rate > 90 Respiratory Rate > 20 or PaCO 2 < 32 mm Hg WBC > 12,000, < 4,000 or > 10% bands

Sepsis Criteria SIRS + Suspected or known source of infection

Severe Sepsis Criteria Sepsis induced tissue hypoperfusion Lactic acidosis: lactate > 4 (?) Hypoperfusion: SBP < 90 or SBP > 40 below baseline

Severe Sepsis Criteria Sepsis induced tissue hypoperfusion Lactic acidosis: lactate > 4 (?) Hypoperfusion: SBP < 90 or SBP > 40 below baseline Urine < 0.5 ml/kg/hr for > 2 hrs despite adequate fluid resuscitation PaO 2 /FiO 2 < 250 without pneumonia PaO 2 /FiO 2 < 200 with pneumonia Creatinine > 2 mg/dl Bilirubin > 2 mg/dl Platelet count < 100,000 L Coagulopathy (INR > 1.5)

MODS Criteria Evidence of > 2 organs failing What is acute organ dysfunction and how do we asses it?

Identifying Acute Organ Dysfunction as a Marker of Severe Sepsis Altered Consciousness Confusion Psychosis Tachycardia Hypotension Altered CVP Altered PCWP Tachypnea PaO 2 <70 mm Hg SaO 2 <90% PaO 2 /FiO 2 300 Oliguria Anuria Creatinine Jaundice Enzymes Albumin PT Platelets PT/APTT Protein C D-dimer Balk RA. Crit Care Clin 2000;16:337-352

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