Introduction to Infectious Disease Control

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Introduction to Infectious Disease Control
Prevention
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Todays Emergency Personnel face many hazards on
the job. One of these hazards is exposure to
communicable diseases that are spread by blood
and other bodily fluids. A generation ago, we did
not concern ourselves with bloodborne
diseases. Today we must. It takes a special
breed to be a firefighter or EMS provider, the
kind that is willing to risk their own well being
to help others.
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OSHA BBP Training

• What is a Blood Borne Pathogen, Infectious
  Disease or Communicable Disease.
• Review of Routes of Transmission.
• Personal Protective Equipment.
• Disinfection of Equipment
• Exposure Control Plan.
• Exposure Reporting.
• Vaccinations

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Bloodborne Pathogens Standard

• 29 CFR 1910.1030, Occupational Exposure to
  Bloodborne Pathogens
• Published December 1991
• Effective March 1992
• Scope
• ALL occupational exposure to blood and other
  potentially infectious material (OPIM)

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RISK MANAGEMENT

• Adopt official written risk management plan, that
  addresses policies and procedures.
• Develop a plan that addresses training PPE.
• Identify potential hazards to all job functions.

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Who is Covered?

• Both fire and ambulance based EMS providers, and
  others who are at risk for exposure to blood or
  other potentially infectious materials (OPIM) in
  the course of duty
• All members who have been identified as having
  occupational exposure must receive initial
  training before starting work.

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Are Volunteer Covered?

• The standard states that all fire and EMS
  providers are covered under this standard.
• Even if you are not EMS certified, there is still
  chances of being exposed at MVAs, or EMS
  assistance (lifting, etc.)
• So, YES volunteers are required under this
  standard.

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Infection Control Plan

• Training Education.
• Health Maintenance.
• Immunizations.
• Exposure Management.
• Cleaning and Disposal.

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Training Requirements

• Must have initial training before starting your
  occupation, includes volunteers.
• Must have annual in-service training.
• Exposure Control Plan (ECP)
• Engineering and Work Practice Controls
• Personal Protective Equipment (PPE)
• Vaccination, Post-Exposure Follow-up, Record
  keeping
• Training records must show your attendance, so if
  you do not sign the attendance sheet, your fault.

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Blood Borne Pathogen

• Microorganisms such as viruses or bacteria that
  are carried in blood and can cause disease in
  people.
• There are many different types of pathogens
  including malaria, syphilis, and brucellosis,
• Hepatitis B (HBV) and the Human Immunodeficiency
  Virus (HIV) are the two diseases specifically
  addressed by the OSHA Bloodborne Pathogen
  Standard.

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Infectious vs. Communicable

• Infectious is one that is caused by an organism
  entering the body.
• Communicable is one that can be passed from one
  person to another.

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Incubation Period

• The time frame from an exposure to the time a
  provider can develop and transmit a disease to
  others.
• Time frames vary disease to disease.
• In some cases medications can be administrated
  before the incubation period to prevent disease
  spread.

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Hepatitis A

• Person to person contact.
• Working in areas of poor hygiene.
• Occurs after floods or other major disasters.
• Ingestion of contaminated food or water.

• 10 to 15 of patients symptomatic have the
  disease up to 6 months.
• 20 to 25 require hospitalization.
• Severe liver infection.
• Vaccine can help.

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Hepatitis B

• Exposure to infected blood via open cuts and
  scrapes.
• Accidental sticks by contaminated needles.
• Unsafe sexual practices.

• Severe liver damage, cirrhosis.
• Chronic Hep B infection causes up to 80 of liver
  cancer.
• Second to tobacco use in causing cancer.
• Vaccine can help.

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Hepatitis C

• Contact with infected blood.
• Illicit injectable drug usage.
• Sexual contact with infected partners, or
  multiple partners.

• Severe liver damage, liver cancer.
• Estimated 4 million people in USA with Hep C.
• Causes 8000-10000 deaths annually.
• Vaccine will not help.

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Hepatitis B (HBV)

• In the US, approximately 300,000 people are
  infected annually. Of these cases, a small
  percentage are fatal.
• Inflammation of the liver," and, as its name
  implies, HBV is a virus that infects the liver.
• HBV is transmitted primarily through "blood to
  blood" contact.

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HBV

• HBV can lead to more serious conditions such as
  cirrhosis and liver cancer.
• There is no "cure" or specific treatment for HBV
• Many who contract the disease will develop
  antibodies which help them get over the infection
  and protect them from getting it again.

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HBV Symptoms

• Initially there is a sense of fatigue, possible
  stomach pain, loss of appetite, and even nausea.
• As the disease continues to develop, jaundice (a
  distinct yellowing of the skin and eyes), and a
  darkened urine will often occur.
• However, people who are infected with HBV will
  often show no symptoms for some time.

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HBV

• After exposure it can take 1-9 months before
  symptoms become noticeable.
• Loss of appetite and stomach pain, for example,
  commonly appear within 1-3 months
• But can occur as soon as 2 weeks or as long as
  6-9 months after infection.

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Human Immunodeficiency Virus (HIV)

• HIV, is a virus that can lead to acquired immune
  deficiency syndrome, AIDS.
• Once a person has been infected with HIV, it may
  be many years before AIDS actually develops.
• HIV attacks the body's immune system, weakening
  it so that it cannot fight other deadly diseases.
  

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HIV

• AIDS is a fatal disease, and while treatment for
  it is improving, there is no known cure.
• Estimates on the number of people infected with
  HIV vary, but estimates suggest that an average
  of 35,000 are infected every year.
• Many people who are infected with HIV may be
  completely unaware of it.

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HIV

• First stage happens when a person is actually
  infected with HIV. After the initial infection, a
  person may show few or no signs of illness for
  many years.
• Second stage, an individual may begin to suffer
  swollen lymph glands or other lesser diseases
  which begin to take advantage of the body's
  weakened immune system.
• Third stage, the body becomes completely unable
  to fight off life-threatening diseases and
  infections.

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HIV HBV

• If you believe you have been exposed to HBV or
  HIV, especially if you have experienced any of
  the signs or symptoms of these diseases, you
  should consult your physician or doctor as soon
  as possible.

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Bloodborne Transmission

• Bloodborne pathogens can be transmitted through
  contact with infected human blood and other
  potentially infectious body fluids such as
• Semen or Vaginal secretions
• Cerebrospinal fluid
• Amniotic fluid
• Saliva (in dental procedures).
• Any body fluid that is visibly contaminated with
  blood.

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Bloodborne Transmission

• INJECTION
• Needle sticks, broken glass, sharp objects
• OTHER DIRECT CONTACT
• Splashing of fluids into open cut or sore mucous
  membranes of eyes, nose, mouth
• INDIRECT CONTACT
• Touching a contaminated object/surface, then
  touching mouth, eyes, nose, open wound

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Airborne Transmission

• Aerosolized droplets spread into the air when
  patient
• Coughs
• Speaks
• Gags or vomits
• Is suctioned
• Sneezes

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Fecal-Oral Transmission

• Results from improper hand washing/hygiene
• After a bowel movement, bacteria is transmitted
  to food or objects via the hands.

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Does contact with BIOHAZARD material always lead
to infection?

• How old is pathogen?
• How extensive is contamination?
• Length route of exposure
• How quick was decontamination?
• Severity of exposure
• Virulence of pathogen
• Health of EMT
• Prophylactic drugs

CONTAMINATION
EXPOSURE
INFECTION
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Disease Transmission Facts

• TUBERCULOSIS
• Airborn, spread by droplets
• Pulmonary infection with symptoms developing
  within 2-10 weeks.
• Causes areas of scar tissue to develop in
  lungs, leading to loss of pulmonary function.

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Disease Transmission Facts

• Suspect T.B. when
• Crowded living conditions (jails, military)
• Has close relative with active T.B.
• Person who
• Has HIV
• On immunosuppressive drugs
• Prolonged steroid therapy
• IV drug users
• Recently had positive TB skin test.

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Disease Transmission Facts

• Suspect T.B. when
• Undiagnosed pulmonary or respiratory infection
• Viral syndrome, night sweats, weight loss

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Productive cough (green or yellow sputum)

• Coughing up blood
• Difficulty breathing
• Respiratory failure

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Prevention

• Employee education
• Hazard Communication
• PPE
• Labeling all infectious waste
• Frequent hand washing
• Cleaning equipment between patients.

Biohazard Label
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PPE

• Much of the responsibility for PPE rests with the
  employee.
• They are responsible for its use to protect
  themselves.
• The employer is required to repair, replace, and
  dispose of contaminated PPE at no cost to the
  employee.

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PPE

• PPE should be selected based on the type of
  exposure and the quantity of blood or OPIM which
  can be reasonably anticipated to be encountered
  during the course of the job duties.

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PPE

• Latex or non-latex gloves gloves
• The minimum PPE for every patient contact.

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PPE

• For splash hazards and large amounts of fluids
• Eye protection
• Face mask
• Gown, apron, or turnout gear
• Shoe covers

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PPE

• Highly infectious respiratory diseases
• Tuberculosis
• Meningitis
• HEPA (high-efficiency particulate) respirator

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Personal Protective Equipment - PPE

• Always wear personal protective equipment in
  exposure situations.
• Remove/replace PPE that is torn or punctured, or
  has lost its ability to function as a barrier to
  bloodborne pathogens.
• Remove PPE before leaving the work area.

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PPE

• If you are working in an area
• where there is likelihood of
• exposure,
• You should never
• Eat
• Drink
• Smoke
• Apply cosmetics or lip balm
• Handle contact lenses

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PPE Guidelines
This chart is intended as a guideline
ONLY. Appropriate use of PPE is recommended any
time skin or mucosa may be exposed to body fluids.
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Decontamination

• Equipment and tools must be cleaned and
  decontaminated before servicing or being put back
  to use.
• A solution of 5.25 household bleach / Clorox
  diluted between 110 and 1100 with water. The
  standard recommendation is to use at least a
  quarter cup of bleach per one gallon of water.
• Lysol or some other EPA-registered tuberculocidal
  disinfectant. Check the label of all
  disinfectants to make sure they meet this
  requirement.

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Decontamination / Sterilization

• Disinfect equipment between patients

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Decontamination
If you are cleaning up a spill of blood,
carefully cover the spill with paper towels or
rags (to prevent splashing). Then gently pour
your 10 solution of bleach over the towels or
rags, and leave it for at least 10 minutes.
This will help ensure that any bloodborne
pathogens are killed before you actually begin
cleaning or wiping the material up.
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Sharps

• Far too frequently, EMTs and Paramedics and
  others are punctured or cut by improperly
  disposed needles.
• This, of course, exposes them to whatever
  infectious material may have been on the needle.
• For this reason, it is especially important to
  handle and dispose of all sharps carefully in
  order to protect yourself as well as others.

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Needles

• Needles should never be recapped.
• Needles should be moved only by using a
  mechanical device or tool such as forceps,
  pliers, or broom and dust pan.
• Never break or shear needles.
• Needles shall be disposed of in labeled sharps
  containers only.

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Sharps Container

• Sharps containers shall be closable,
  puncture-resistant, leak-proof on sides and
  bottom, and must be labeled or color-coded.
• When moving sharps containers, the containers
  should be closed immediately before removal or
  replacement to prevent spillage or protrusion of
  contents during handling or transport.

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Regulated Medical Waste

• 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

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Regulated Medical Waste

• Contaminated sharps
• Pathological and microbiological wastes
  containing blood or other potentially infectious
  materials

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Disposing of Bio-Hazard Waste

• All regulated waste must be disposed in properly
  labeled containers or red biohazard bags.
• These must be disposed at an approved facility.
  Most departments or facilities that generate
  regulated waste will have some sort of contract
  with an outside disposal company that will come
  pick up their waste and take it to an approved
  incineration/disposal facility.

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Non-Regulated Medical Waste

• Non-regulated waste that is not generated by a
  medical facility such as EMS operations may be
  disposed in regular plastic trash bags if it has
  no body fluids, blood or other sources of
  bio-hazards.

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In Other Words
Do Not Bring Back to Quarters Any Waste From an
EMS Call Get Rid of It At The Hospital!!!
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Hepatitis B Vaccination

• Must be offered to employees/members that have
  routine exposure to BBP.
• Three shot series at no cost.
• Although must be offered, employee /member can
  decline vaccination. But should sign a
  declination release.
• But can still request shots at anytime.

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Hepatitis B Vaccination

• Vaccination made from yeast cultures.
• No risk of getting disease from shots.
• Help build up the body immune system to the
  virus.
• Once vaccination, no reason to get shots again.
• There are booster shots, but may only need in
  case of outbreak at a location.

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Hepatitis B Vaccination Declination Form
For Print Name                                 
                                   I understand
that due to my occupational exposure to blood or
other potentially infectious materials I may be
at risk of acquiring hepatitis B virus (HBV)
infection. I have been given the opportunity to
be vaccinated with hepatitis B vaccine, at no
charge to myself. However, I decline hepatitis B
vaccination at this time. I understand that by
declining this vaccine, I continue to be at risk
of acquiring hepatitis B, a serious disease. If
in the future I continue to have occupational
exposure to blood or other potentially infectious
materials and I want to be vaccinated with
hepatitis B vaccine, I can receive the
vaccination series at no charge to me.
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Exposure Control Plan

• An Exposure Control Plan is a written program
  that outlines the protective measures an employer
  will take to eliminate or minimize the employees
  exposure to blood or OPIM.
• At minimum the exposure control plan must
  include exposure determination which identifies
  job classifications and tasks where there is
  occupational exposure to blood or OPIM.

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Exposure Control Plan

• The exposure control plan must also contain
  information and procedures for evaluating the
  circumstances surrounding an exposure incident
  and documentation of how and when the plan will
  be implemented.

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Exposure Control Plan

• Annual review of the plan is required at minimum.
  
• The exposure control plan should also be reviewed
  whenever changes in tasks, procedures, or
  employee positions affect or create new
  occupational exposure.
• The plan must be accessible to all employees
  while on duty.

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Exposure Control Plan

• A hard copy of the plan must be provided within
  15 working days of an employees request for a
  copy.

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What Are Reportable Exposures

• Contact with infectious agents, such as body
  fluids.
• Percutaneous events These are when blood or
  other body fluids enter through the skin. (Needle
  sticks, bloody sharp object)
• Mucocutaneous events These are when blood or
  other body fluids enter through mucous membranes.
  (Fluids splashing into eye, nose or mouth)

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Exposure Reporting

• If you are exposed, however, you should
• Wash the exposed area thoroughly with soap and
  running water. Use non-abrasive, antibacterial
  soap if possible.
• If blood is splashed in the eye or mucous
  membrane, flush the affected area with running
  water for at least 15 minutes.
• Report the exposure to your supervisor/safety
  officer as soon as possible.

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Exposure Reporting

• Fill out an exposure report form. This form will
  be kept in your personnel file for 40 years so
  that you can document workplace exposure to
  hazardous substances.
• You may also go to your MD or Occupational Health
  to request blood testing or the Hepatitis B
  vaccination if you have not already received it.

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Exposure Reporting

• Document the route(s) of exposure and the
  circumstances under which the exposure incident
  occurred.
• Identify and document the source individual
  unless such documentation is impossible or
  prohibited by law.
• Test the source individual's blood for HBV and
  HIV as soon as possible after consent is
  obtained. If the source individual is known to be
  seropositive for HBV or HIV, testing for that
  virus need not be done.

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Exposure Testing

• Collect your blood as soon feasible, and test it
  after your consent is obtained
• You have to wait for 72 hours before blood can be
  tested.
• You have to meet with MD one on one to get test
  results, not allowed to give over the telephone.
• Then you need to be retested annually for at
  least 3-5 years.

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Preventionin advance

• Verify immune status
• Hepatitis B Vaccination (series of 3 shots, and
  titer)
• Use PPE
• Tuberculin Purified Protein Derivative (PPD) skin
  testing (at least annually).
• Proper Decontamination of equipment and clothing

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Needlestick Safety Prevention Act

• Signed into law November 6, 2000
• Revised Standard published in Federal Register
  Jan. 18, 2001
• Effective date April 18, 2001
• Enforcement of new provisions July 17, 2001

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Revisions to Standard

• Additional definitions.
• New requirements in the Exposure Control Plan.
• Solicitation of input from non-managerial
  employees.
• Sharps injury log.

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Engineering ControlsNew Definition

• means controls (e.g., sharps disposal
  containers, self-sheathing needles, safer medical
  devices, such as sharps with engineered sharps
  injury protections and needleless systems) that
  isolate or remove the bloodborne pathogens hazard
  from the workplace.

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Needleless Systems

• Device that does not use a needle for
• Collection of bodily fluids
• Administration of medication/fluids
• Any other procedure with potential exposure to a
  contaminated sharp

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Safety Needle Systems
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ECP New Provisions

• The ECP must be updated to include
• changes in technology that reduce/eliminate
  exposure
• annual documentation of consideration and
  implementation of safer medical devices
• solicitation of input from non-managerial
  employees

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Solicitation of Non-Managerial EmployeesNew
Provision

• Identification, evaluation, and selection of
  engineering controls
• Must select employees that are
• Responsible for direct patient care
• Representative sample of those with potential
  exposure

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Engineering and Work Practice Controls 1910.1030

• Employers must select and implement appropriate
  engineering controls to reduce or eliminate
  employee exposure.

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Other Things to be Done

• The employer must
• Identify worker exposures to blood or OPIM
• Review all processes and procedures with exposure
  potential
• Re-evaluate when new processes or procedures are
  used
• Evaluate available engineering controls (safer
  medical devices)
• Train employees on safe use and disposal
• Implement appropriate engineering
  controls/devices

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Engineering and Work Practice Controls

• The employer must
• Document evaluation and implementation in ECP
• Review, update ECP at least annually
• Review new devices and technologies annually
• Implement new device use, as appropriate and
  available

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Recordkeeping 1910.1030(h)

• Sharps Injury Log
• Only mandatory for those keeping records under 29
  CFR 1904
• Confidentiality
• Maintained independently from OSHA 200
• At a minimum, the log must contain, for each
  incident
• Type and brand of device involved
• Department or area of incident
• Description of incident

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Things to Review

• Is your training up-to-date.
• Who is your Health/Safety Officer?
• Does your agency have a Exposure Control Plan?
• Has the plan been reviewed annually?
• Does your agency have a occupational medicine
  provider?

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Fire Chief

• Ultimate responsibility for health safety of
  members.
• Ensures that FD has a Infection Control Plan.
• Although has little direct involvement in daily
  operations, must ensure that this is
  accomplished.

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Health / Safety Officer

• Has responsibility to ensure that FD has a
  effective occupational health and safety program.
• Might also be the Infection Control Officer.
• Appointed by Fire Chief.
• Who is HFDs HSO???????

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Infection Control Officer

• Ryan White Care Act of 1990 requires each FD to
  name a designated infection control officer.
• Primary responsibility to act as liaison between
  FD and treating facility.
• Ensures availability of PPE, maintain required
  records.

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Know Your Rights Responsibilities

• Your Agency Must
• Provide PPE necessary to do your job.
• Inform you of safety standards.
• Train you in proper procedures.

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Know Your Rights Responsibilities

• You Must
• Wear PPE when on scene of incident.
• Follow all safety standards and proper
  procedures.
• Please protect yourself so you can help others!!!

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Lets Be Careful Out ThereGo Home Safe At The
End of Your Shift