Infection Control and Communicable Diseases

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Infection Control and Communicable Diseases

• By Darryl Jamison
• Macon County EMS Training Coordinator

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Universal Precautions

• ALWAYS WEAR GLOVES WITH EVERY PATIENT

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Background
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Adults Reported with AIDS and a History of
Healthcare Employment

• Nurses5,378
• Health Aides5,638
• Technicians3,182
• Physicians1,792
• Therapists1,082
• Dental Workers492
• Paramedics476
• Surgeons122
• Other5,050
• Total23,212

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Healthcare Personnel with Documented and Possible
Occupationally Acquired AIDS/HIV as of December
2001

• Nurses24/35
• Laboratory Worker/Clinical16/17
• Physician (non-surgical)6/12
• Lab. Tech./Non-clinical3/0
• Housekeeper2/13
• Surgical Technician2/2
• Embalmer1/2
• Respiratory therapist1/2
• Dialysis Tech.1/3
• EMT/Paramedic0/12
• Surgeon0/6

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Post Exposure Evaluation and Follow-Up
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Protocol for Obtaining Medical Treatment,
Counseling, Baseline Blood Testing, and
Prophylaxis

• Contact the supervisor immediately.
• Employees will be seen initially at AMC Emergency
  Dept. and will receive follow-up care and
  counseling from Macon County Health Department,
  with the exception of HIV exposure which should
  be followed up with primary care physician. This
  will include but not limited too, prophylactics.

• Initial evaluation will be according to the
  protocol of the receiving medical facility, and
  CDC guidelines for Occupational Exposure of
  Healthcare Professional.
• Each exposure shall be documented on a MCEMS
  Exposure Report Form and appropriate Workers
  Comp form. An appt. should be made ASAP , no
  longer than 24 hours p exposure.

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Serological Testing of Exposed Employees

• The exposed employees consent is required for
  collection and testing of blood for exposure. If
  baseline consent is denied, the exposed employee
  should be requested to have blood drawn and
  stored, usually for a period of 3 months, leaving
  the option open for the person to provide consent
  for serological testing at a later date.

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Source Patient Consent for Blood Draw

• By NC general statute the source patient has no
  right to refuse blood testing.
• Should be made from the time of initial care
  within the hospital setting, if for some reason
  the exposure occurs at the scene, contact
  supervisor or training officer, and he/she will
  make contact with the source patient for testing
  arrangements.
• Should also contact shift supervisor of the
  receiving facility for proper testing.

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Medical Followup

• The facility that provides initial baseline
  testing, and prophylactic treatment of exposed
  employees shall forward the information to the
  Macon County Health Department, within 24 hours
  if possible (ie. Weekends).
• Macon County Health Department will provide
  additional treatment, exception for HIV exposure,
  and counseling, which should be done in person if
  possible.

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Accident/Incident Review

• T.O. will review the circumstances of the
  exposure to determine if procedures, protocols
  and/or training need to be repeated or revised to
  prevent a reoccurence of the incident.
• The completed Exposure Incident Report Form
  should be completed and returned to the T.O. to
  initiate this process.

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Post Exposure Highlights

• Documentation of exposure routes and how exposure
  incident occurred.
• Identification of documentation of source
  individuals infectivity, if possible
• Collection and testing of employees or students
  blood for HBV and HIV serological status, consent
  required
• Post-exposure prophylaxis when medically
  indicated
• Counseling
• Evaluation of reported illness

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Housekeeping

• Clean up kit.
• A 110 dilution of 5.25 clorox and water.
• Red bag
• Use only tongs, forceps or brush and dust pan for
  cleaning up broken glass
• Inspect and decontaminate on a regular basis
  reusable receptacles (ie, trash cans)
• If visibly contaminated clean as soon as
  feasible.

• Shall disinfect each shift, preferably after each
  call, anything that touches the patient and/or
  you touch will providing care after transfer.
• Regulated medical waste shall be placed in a
  closable and labeled or color-coded container.
• When discarding contaminated sharps, place them
  in a closable, puncture-resistant, appropriately
  labeled leak-proof container for that purpose.

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Cont.

• Sharps containers shall be placed where they are
  easily accessible, to the immediate area where
  sharps will be used.
• Containers shall be kept upright throughout use,
  replaced routinely, closed when moved, and not
  allowed to overfill
• When replaced, take to the hospital for disposal.

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General Rules for Preventing Needlesticks

• NEVER recap any needles clean or contaminated
• ALWAYS make sure that the safety mechanism is
  working
• NEVER hand someone else YOUR needle
• Immediately discard used needle after use
• ALWAYS draw up your own medicine

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Types of Safety Needles