Infectious Disease

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Infectious Disease
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Objectives

• Learn how infection spreads and how to protect
  yourself from disease.
• Identify multi-resistant organisms.
• Discuss influenza.
• Recognize current infectious diseases prevalent
  in the community.
• Discuss the role of EMS in public health.

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Introduction

• From the common cold to multi-resistant
  organisms, infectious disease is a topic that
  should be on every providers mind.
• Todays Advanced EMTs are faced with not only
  protecting themselves from microorganisms but
  also preparing for pandemic outbreaks and
  medication-resistant diseases.

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Introduction (contd)

• This topic will focus on the evolving threats
  that infectious disease poses to the Advanced EMT
  and discuss the key concepts in personal
  protection.

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Spreading Infection

• Infectious disease is defined as pathogenic
  microorganisms that can spread directly or
  indirectly from one person to another.
• Bacteria
• Viruses
• Parasites
• Fungi

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Spreading Infection (contd)

• Communicable disease is one that is transmitted
  easily from one person to another.
• Standard precautions help to prevent the
  transmission of disease.

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Standard Precautions are required to protect you
from disease.
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Spreading Infection (contd)

• Bloodborne diseases pose a particular threat to
  the Advanced EMT.
• Advanced skills such as intravenous therapy and
  medication administration require the use of
  needles and other sharps that can pose a serious
  risk of injury when not used safely.

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Communicable Diseases
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Epidemiology

• The Center for Disease Control and Prevention
  (CDC) estimates that roughly 82 of healthcare
  workers being exposed to bloodborne diseases
  occur as a result of needle or sharp-related
  incidents.
• Improved safety strategies have demonstrated a
  96 decline in the number of incidents since 1983.

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Hepatitis

• Translates into inflammation of the liver.
• Generally caused by a viral infection.
• Classified as hepatitis A, B, C, D, or E.
• A and E food and waterborne
• B, C, and D bloodborne
• CDC estimates roughly 80,000 new infections of
  hepatitis in the U.S. each year.

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Hepatitis (contd)

• Hepatitis virus seeks out healthy liver cells and
  invades them.
• Reproduction destroys these cells and causes an
  immune response in the liver.
• Liver destruction occurs both immediately and
  over a period of time while the disease persists.

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Hepatitis (contd)

• Chronic hepatitis
• Long term decline in the function of the liver
• Acute hepatitis
• Short term, flare ups
• Roughly 4.4 million Americans live with chronic
  hepatitis and are essentially asymptomatic

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Hepatitis (contd)

• Signs and symptoms
• Fatigue
• Abdominal pain
• Nausea
• Vomiting
• Jaundice

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HIV/AIDS

• Human immunodeficiency virus (HIV) is a
  bloodborne pathogen that potentially leads to
  acquired immune deficiency syndrome (AIDS).
• The CDC estimates that slightly fewer than
  700,000 Americans are infected with HIV.

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HIV/AIDS (contd)

• AIDS affects the immune system by destroying
  essential T cells thus leaving the body
  vulnerable to opportunistic infections.
• Most AIDS deaths are caused by secondary diseases
  such as respiratory infections and malignancies.

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HIV/AIDS (contd)

• Bloodborne disease transmitted through needle
  stick and sharp-related injuries.
• Only about 3 in 1000 needle stick injuries will
  actually transmit disease.

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HIV/AIDS (contd)

• Factors that contribute to the probability of
  transmission
• Amount of blood on or in the sharp
• How deep the needle penetrated
• Whether or not it penetrated an artery or vein
• How high the viral load in the patient

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Tuberculosis

• Spread by a bacterium known as Mycobacterium
  tuberculosis.
• Transmitted through respiratory droplets.
• Roughly ? of the worlds population is currently
  infected with the TB bacillus.

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Tuberculosis (contd)

• Vast majority have latent tuberculosis.
• Those at higher risk are drug users, HIV
  patients, and those in congregate settings.

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Tuberculosis (contd)

• Active TB develops in 5-10 of those exposed.
• Characterized by a massive immune response in the
  lining of the airway and parenchymal tissue.
• Inflammation and lung cell changes cause poor
  diffusion and destruction of lung tissue.

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Tuberculosis (contd)

• Signs and symptoms
• Blood tinges sputum
• Fever
• Weight loss
• Night sweats
• N-95 type respirator protects from droplet
  transfer of tuberculosis.

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Multidrug-Resistant Organisms

• Enhanced by partial and unfinished courses of
  antibiotic treatment.
• Bacteria is exposed to the medication but is not
  completely eradicated when the full course of
  treatment is not received.
• Remaining bacteria reproduce and develop
  resistance.

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MRSA

• Methicillin-Resistant Staphylococcus aureus
• About 25 of the population carries
  staphylococcus bacteria on their skin/nose.

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MRSA (contd)

• Transmitted by skin or respiratory contact
• Divided into two groups
• Hospital-acquired
• Community-acquired

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MRSA (contd)

• Remember as an EMS provider, you are exposed to
  Staphylococcus aureus and MRSA every day.
• MRSA can be transmitted by skin contact and/or by
  respiratory contact.
• Utilize the appropriate level of personal
  protective equipment to prevent the spread of
  bacteria.

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Hand washing is vital for preventing the spread
of disease.
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Handwashing

• When washing, remember the key elements to proper
  handwashing
• Warm flowing water and soap
• At least 15 seconds of scrubbing over all the
  surfaces
• Thorough rinsing

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Alcohol-based hand cleaner is effective and can
be used when soap and water are not available.
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Influenza

• Influenza (flu) is a viral infection that has
  multiple different classifications and
  subclassifications.
• Influenza A, B, C
• H1N1, H5, N1
• Various strains of influenza strike regionally
  each year.

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Influenza (contd)

• The Center for Disease Control and Prevention
  estimates that influenza kills somewhere between
  3,000 and 50,000 people each year in the United
  States.
• In 2009, Influenza A (H1N1) killed more than
  18,000 people and was found in 214 countries.
• The WHO designated H1N1 a pandemic.

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Influenza (contd)

• Influenza is quite virulent.
• Spread via airborne droplets and through contact
  with respiratory fluids.
• Immune response causes inflammation and changes
  in the lining of the respiratory tract.
• Cytokines and other chemicals released from
  infected cells cause S/S.

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Influenza (contd)

• Signs and symptoms
• Fever
• Fatigue
• Chills
• Muscle pains
• Cough

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Influenza (contd)

• EMS is at high risk to be exposed.
• Consider getting vaccinated each year.
• Protect yourself from respiratory droplet contact
  in patients with a high suspicion of influenza.
• Handwashing and decontamination are essential.

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EMS and Public Health

• EMS has developed a significant responsibility
  within public health.
• Especially in the context of infectious disease.
• EMS frequently partners with other health care
  entities to develop and enact strategies to
  prevent and stop the spread of infectious disease.

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EMS in the public health setting.
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EMS in the public health setting.
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EMS as an Agent of Public Health
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Summary

• It is imperative that all EMS providers protect
  themselves from, and prevent the spread of,
  infectious disease.
• As diseases become challenging to fight,
  partnerships continue to develop in health care
  to provide an optimal response.

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Summary (contd)

• EMS plays a vital role in developing and carrying
  out action plans against disease.