Introduction to Infectious Disease Control & Prevention

1. Introduction to Infectious Disease Control & Prevention

2. Today’s 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. Infectious Disease Control & Prevention

3. 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 Infectious Disease Control & Prevention

4. 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) Infectious Disease Control & Prevention

5. 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. Infectious Disease Control & Prevention

6. 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. Infectious Disease Control & Prevention

7. 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 MVA’s, or EMS assistance (lifting, etc.) • So, YES volunteers are required under this standard. Infectious Disease Control & Prevention

8. Infection Control Plan • Training & Education. • Health Maintenance. • Immunizations. • Exposure Management. • Cleaning and Disposal. Infectious Disease Control & Prevention

9. 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. Infectious Disease Control & Prevention

10. 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. Infectious Disease Control & Prevention

11. 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. Infectious Disease Control & Prevention

12. 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. Infectious Disease Control & Prevention

13. 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. Hepatitis A Infectious Disease Control & Prevention

14. 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. Hepatitis B Infectious Disease Control & Prevention

15. 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. Hepatitis C Infectious Disease Control & Prevention

16. 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. Infectious Disease Control & Prevention

17. 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. Infectious Disease Control & Prevention

18. 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. Infectious Disease Control & Prevention

19. 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. Infectious Disease Control & Prevention

20. 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. Infectious Disease Control & Prevention

21. 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. Infectious Disease Control & Prevention

22. 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. Infectious Disease Control & Prevention

23. 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. Infectious Disease Control & Prevention

24. 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. Infectious Disease Control & Prevention

25. 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 Infectious Disease Control & Prevention

26. Airborne Transmission • Aerosolized droplets spread into the air when patient… • Coughs • Speaks • Gags or vomits • Is suctioned • Sneezes Infectious Disease Control & Prevention

27. Fecal-Oral Transmission • Results from improper hand washing/hygiene • After a bowel movement, bacteria is transmitted to food or objects via the hands. Infectious Disease Control & Prevention

28. 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 Infectious Disease Control & Prevention

29. 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. Infectious Disease Control & Prevention

30. 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. Infectious Disease Control & Prevention

31. Disease Transmission Facts Suspect T.B. when… • Undiagnosed pulmonary or respiratory infection • Viral syndrome, night sweats, weight loss Infectious Disease Control & Prevention

32. Productive cough (green or yellow sputum) • Coughing up blood • Difficulty breathing • Respiratory failure Infectious Disease Control & Prevention

33. Prevention • Employee education • Hazard Communication • PPE • Labeling all infectious waste • Frequent hand washing • Cleaning equipment between patients. Biohazard Label Infectious Disease Control & Prevention

34. 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. Infectious Disease Control & Prevention

35. 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. Infectious Disease Control & Prevention

36. PPE Latex or non-latex gloves gloves… The minimum PPE for every patient contact. Infectious Disease Control & Prevention

37. PPE For splash hazards and large amounts of fluids… • Eye protection • Face mask • Gown, apron, or turnout gear • Shoe covers Infectious Disease Control & Prevention

38. PPE Highly infectious respiratory diseases… • Tuberculosis • Meningitis HEPA (high-efficiency particulate) respirator Infectious Disease Control & Prevention

39. 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. Infectious Disease Control & Prevention

40. 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 Infectious Disease Control & Prevention

41. 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. Infectious Disease Control & Prevention

42. 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 1:10 and 1:100 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. Infectious Disease Control & Prevention

43. Decontamination / Sterilization Disinfect equipment between patients… Infectious Disease Control & Prevention

44. 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. Infectious Disease Control & Prevention

45. Sharps • Far too frequently, EMT’s 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. Infectious Disease Control & Prevention

46. 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. Infectious Disease Control & Prevention

47. Sharp’s 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. Infectious Disease Control & Prevention

48. 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 Infectious Disease Control & Prevention

49. Regulated Medical Waste • Contaminated sharps • Pathological and microbiological wastes containing blood or other potentially infectious materials Infectious Disease Control & Prevention

50. 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. Infectious Disease Control & Prevention