East Fork Fire and Paramedic Districts Annual Refresher Training

1
East Fork Fire and Paramedic Districts Annual
Refresher Training

• Bloodborne/ Airborne
• Pathogens

2
Overview of Bloodborne Pathogens

• Epidemiology and symptoms of bloodborne diseases
• Transmission routes
• Body Substance Isolation
• Standard Precautions

• Engineering Controls
• PPE
• Warning Labels
• Infection Control Plan
• Occupational Exposure

3
Bloodborne Pathogens

• Bloodborne
• Present in human blood and certain body fluids
• Spread through contact with these fluids
• Pathogen
• Infectious agent
• Virus
• Bacterium
• Parasite

4
Blood and Other Potentially Infectious Materials
(OPIM)

• Blood, serum
• Any body fluid where there is blood
• Fluids (lung, heart, intestines, brain, spinal
  fluids, joints, fetus)
• Semen
• Vaginal secretions
• Saliva
• ANY BODY FLUID WHEN YOU CANT TELL WHAT IT IS

5
Bloodborne Pathogens

• Human Immunodeficiency Syndrome (HIV)
• Hepatitis A, B, C, D, E, ?,??
• Syphilis
• Malaria
• Brucellosis
• Arboviral Infections (West Nile)

6
HIV

• Virus that causes AIDS
• Spread by blood, sex, mother to baby,
  breastfeeding
• Attacks the immune system
• Will not survive outside the body very long

7
HIV

• You can not get HIV from sweat, saliva, tears, or
  urine from an infected person
• UNLESS
• these fluids contain blood or other fluids that
  carry the virus

8
HIV

• Symptoms
• Fever Night Sweats
• Sore Throat Thrush
• Nausea Weakness
• Headaches Weight Loss
• Swollen Lymph Fatigue
• Nodes
• Frequent Infections

9
HIV
10
HIV Transmission Routes

• Sexual Contact
• Accidental puncture from contaminated needle,
  glass, or other sharp object
• Sharing needles
• Contact between broken or damaged skin and
  infected body fluid
• Contact between mucous membrane (mouth, nose,
  eyes)

11
Viral Hepatitis- Overview
12
Hepatitis B Virus

• Risk of contracting Hepatitis B from a
  contaminated needle is 6 - 30
• May survive for days, weeks outside body

13
Hepatitis B Virus

• Symptoms of acute infection
• abdominal pain
• fever
• vomiting
• jaundice (skin
• eyes)
• loss of appetite
• dark urine

14
Hepatitis B Virus

• Concentration of HBV in various body fluid

15
Hepatitis B Virus

• Vaccine
• Protection from acute Hepatitis B
• Protection from HBV carrier state
• Protection from chronic liver disease
• caused by HBV
• Offered to employees unless previously
• vaccinated and immune or medically
• contraindicated
• Given in three doses (Day 0 1 month after 1st
  dose 6 months after 1st dose)

16
Hepatitis C Virus

• Incubation period Average 6-7 weeks, Range 2-26
  weeks
• Clinical illness (jaundice) 30-40 (20-30)
• Chronic hepatitis 70
• Persistent infection 85-100
• Immunity No protective
• antibody response identified

17
Hepatitis C Virus
18
Hepatitis C Virus

• Prevention
• Screening of blood, organ, tissue donors
• High-risk behavior modification
• Blood and body fluid precautions

19
Hepatitis C Virus

• Risk factors of transmission
• Transfusion or transplant from infected donor
• Injecting drug use
• Hemodialysis (yrs on treatment)
• Accidental injuries with needles/sharps
• Sexual/household exposure to anti- HCV-positive
  contact
• Multiple sex partners
• Birth to infected mother

20
MRSA Infection

• MRSA infection is caused by Staphylococcus
  aureus bacteria often called "staph." MRSA
  stands for methicillin-resistant Staphylococcus
  aureus. It's a strain of staph that's resistant
  to the broad-spectrum antibiotics commonly used
  to treat it. MRSA can be fatal

21
MRSA Infection

• Staph skin infections, including MRSA, generally
  start as small red bumps that resemble pimples,
  boils or spider bites. These can quickly turn
  into deep, painful abscesses that require
  surgical draining. Sometimes the bacteria remain
  confined to the skin. But they can also penetrate
  into the body, causing potentially
  life-threatening infections in bones, joints,
  surgical wounds, the bloodstream, heart valves
  and lungs

22
MRSA Infection

• The best way to prevent the spread of germs is
  for health care workers to wash their hands
  frequently, to properly disinfect hospital
  surfaces and to take other precautions, such as
  wearing gowns and gloves when working with people
  infected with resistant bacteria.

23
MRSA Infection

• Wash Hands
• Keep personal items personal
• Razors, shoes, towels, sheets
• Keep wounds covered
• Shower after physical training
• Sanitize linens

24
AIRBORNE PATHOGENS

• Airborne pathogens differ from bloodborne
  pathogens in that they are spread by inhaling the
  germ. An infectious person's coughing or sneezing
  can send tiny droplets of moisture into the air
  that contain the pathogen. Depending on the
  environment, these contaminants can remain
  airborne for several hours.
• There are three types of airborne pathogens
  Viral, Bacterial,   Fungal 
• Meningitis, influenza, pneumonia, and
  tuberculosis are all examples of diseases
  transmitted through the air. We will focus on
  tuberculosis, since that is a common airborne
  disease for which employees may be at risk. Many
  of the precautions you take to prevent
  tuberculosis will also lower the risk of
  infection from other airborne pathogens

25
Tuberculosis

• One of three people in the world is infected with
  TB
• Half of the 23 million refugees in the world are
  infected
• Three million people die each year of TB
• ?? 13 million people coinfected with HIV and
• TB

26
Tuberculosis

• Infectious disease caused by Mycobacterium
  tuberculosis
• Spread by airborne droplets, droplet nuclei, to
  5 microns in size
• Droplet nuclei generated when a person with TB
  disease coughs, sneezes, speaks or sings
• TB infection occurs when a person inhales the
  bacteria and it becomes established in the body

27
Tuberculosis
28
Tuberculosis

• Symptoms of Active TB Disease
• Persistent cough
• Productive cough
• Fever
• Weight loss
• Night sweats
• Coughing up blood
• Loss of appetite
• Fatigue

29
Tuberculosis

• Tuberculosis Infection - No Active Disease
• Cannot spread to others
• Positive skin test reaction
• X-ray negative
• No symptoms
• Potential for active TB disease
• May be offered prophylactic medication

30
Tuberculosis

• Sites of Active TB Disease
• Lungs (most common site)
• Other sites
• Larynx
• Lymph nodes
• Brain
• Kidney
• Bones
• Other locations
• Only pulmonary and laryngeal TB are infectious

31
Tuberculosis

• Work Places Identified by CDC with High Incidence
  of TB
• Health care settings
• Correctional institutions
• Homeless shelters
• Long-term care facilities for the elderly
• Drug treatment centers

32
Tuberculosis

• High Hazard Procedures characterized by potential
  to generate airborne secretions
• Aerosolized medication treatment
• Bronchoscopy
• Sputum induction
• Endotracheal intubation and suctioning
• Autopsies

33
Tuberculosis

• TB Infection Control Measures Work practice
  controls
• Early identification and isolation of
  suspected or confirmed TB cases
• Have suspected or confirmed TB cases wear
  masks during transport
• Caregivers wear half mask or N95 respirator
  (must be fit-tested)

34
Tuberculosis

• East Fork personnel shall wear ½ mask air
  purifying respirator when
• - Entering rooms housing persons with
• suspected or confirmed TB disease
• - Performing high hazard procedures
• on persons with suspected or
• confirmed TB disease
• - Transporting a person with
• suspected or confirmed TB disease

35
Tuberculosis

• Where respirators are required employers must
• Make sure employees use NIOSH-approved
• high-efficiency particulate respirators
• Have a respiratory protection program in
  accordance with OSHA
• Conduct annual fit-testing

36
METHODS OF COMPLIENCE

• Body Substance Isolation
• Engineering Controls
• Work Practice Controls
• Personal Protective Equipment
• House Keeping
• Laundry

37
Body Substance Isolation

• Treat blood all body
• fluids from every person
• as if they are infected with bloodborne
• pathogens

38
Engineering Controls

• Engineering controls shall be used to eliminate
  or minimize employee exposure.
• Plastic Sharps Containers
• Needles Syringes
• Retracting Needles
• Disposable Equipment

39
Engineering Controls
40
Work Practice Controls

• Work practice controls have been implemented to
  minimize exposure to bloodborne pathogens
• Supervisors shall be responsible for
  implementing, evaluating, and monitoring
  compliance with these work practice controls

41
Work Practice Control

• At a minimum, employees shall wear nitrile exam
  gloves and long pants
• Glasses/goggles are highly recommended

42
Work Practice Control

• Wash hands with liquid soap
• Do not use Kitchen Sink
• Wear long pants when on incidents or cleaning
• Change soiled/contaminated clothing
• Do not eat, drink, apply lip balm or contact
  lenses in an area likely containing exposure
  hazard

43
Work Practice Control

• Do not attempt to recap, bend, or leave needles
  on the floor, furniture, bench seat, or action
  deck once used. Immediately place used needles
  and other sharps in plastic sharps containers
• The one-handed recap can be used for
  non-contaminated needles (i.e. drawing up of
  medications prior to administration). This shall
  be in accordance with career field training

44
Work Practice Controls

• Clean and decontaminate equipment after use
• Use the hospital if possible
• Properly discard disposable equipment
• Place in Bio Hazard Bag

45
Personal Protective Equipment

• Gloves (Nitrile)
• Goggles/Face Shields
• Gowns/Aprons
• Pocket Mask
• ½ mask Air Purifying Respirator
• Contact Sta. 14 for PPE needs

46
House Keeping

• Keep the worksite in a clean and sanitary
  condition including
• Office
• Kitchen
• Living area
• Dormitories
• PPE
• Apparatus

47
House Keeping

• Clean and decontaminate apparatus on the 1st and
  15th of each month or after an incident using
  approved cleaning spray or a mix of 10 beach and
  water
• Use appropriate PPE when cleaning (follow MSDS)

48
Laundry

• Contaminated towels should be dropped off at the
  hospital and exchanged for clean towels
• Towels used for cleaning at the station shall be
  washed in hot water with soap and bleach
• A clean cycle shall be run following a load of
  contaminated towels
• Linens used for patient care shall not be
  laundered at the station

49
Labels
50
Employee Health

• All employees shall receive the Hepatitis A and B
  vaccination upon employment with East Fork Fire
  and Paramedic Districts
• All employees shall be screened for Hepatitis A,
  B,C, HIV, and TB at the annual physical

51
Employee Health

• Those members wishing to decline the vaccination
  may do so on a vacation declination form only
  after consultation with the Districts
  Occupational Medicine Provider

52
Exposure to Bloodborne/Airborne Pathogens

• Immediately wash the affected site with soap and
  water
• When no running water exists, initially clean the
  exposure with a bio-wipe that is stocked in all
  apparatus. Upon return to a site with running
  water, wash the site again.
• Notify supervisor Immediately
• Supervisor shall notify on duty Training Captain
  or Battalion Chief in their absence

53
Exposure to Bloodborne/Airborne Pathogens

• Training Captain or BC shall complete Exposure
  Matrix and Exposure Report
• Exposed member will be directed to go to CVMC for
  treatment
• Follow up will be visits will be at Occupational
  Health

54
Exposure to Bloodborne/Airborne Pathogens

• The Training Captain or Battalion Chief shall
  ensure the completion of a C-1, C-3, C-4 (Turned
  into HR) Exposure Determination Matrix, Exposure
  Report (to Exposure Control Officer)
• Supervisor shall enter the exposure into RMS

55
Training

• All employees shall do initial training at East
  Fork Orientation followed b a written exam
• All employees shall receive annual training
• Training and Safety Division shall keep records

56
Infection Control Plan

• Review District Infection Control Program
  Policy/Procedure
• Located in Safety Program binder

57
QUESTIONS

• Please direct any questions to the Training and
  Safety Division