Bloodborne pathogens & infectious diseases


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Bloodborne pathogens & infectious diseases

  1. 1. Big Tree Volunteer FireCompany, Inc.2013
  2. 2. InstructionsLocate and print the associated knowledge assessment.While paging through this PowerPoint presentation,answer the questions.When complete, return completed knowledgeassessment to Asst. Chief Makin or Asst. Chief Wagner.If you have any questions, please contact any Chief.
  3. 3. Overview* Infectious Diseases* Universal Precautions* Specific Disease Information* Exposures and Exposure Control Plan* Laws, Standards, Rules, Regulations, and Guidelines
  4. 4. Objectives Differentiate and define the terms infectious disease and bloodborne pathogen. Identify circumstances in which universal precautions and body substance isolation should be used. Describe when and how decontamination procedures should take place.
  5. 5. Objectives Identify methods of transmission, signs, symptoms, and, if they exist, pre- and post-exposure prophylaxis, and counseling for:  HIV Infection/AIDS  Hepatitis A, B, and C  Tuberculosis (TB) Be familiar with:  Common Sexually Transmitted Diseases  Meningococcal Diseases  Viral Hemorrhagic Disease  Measles, Mumps, Rubella (MMR)  Influenza
  6. 6. Objectives List behaviors that increase the risk of exposure to bloodborne pathogens. Demonstrate exposure preparedness by identifying personal and employment issues to consider if a Bloodborne Pathogens exposure occurs. Define significant exposure. Identify options regarding treatment and counseling for an exposure. Identify whom, when, and how you should tell about an exposure. Identify rights to confidentiality; your rights, the patient’s rights, and the employer’s rights.
  7. 7. Infectious Disease (Activity)On your knowledge verification report, please complete Table #1 using the followingdiseases: AIDS/HIV Chickenpox Whooping Cough (Pertussis) Meningitis Influenza Herpes Zoster (Shingles) Mononucleosis Lice Hepatitis A (infectious) Measles Hepatitis C Hepatitis B (serum) German Measles Hepatitis D Non-A, Non-B Hepatitis Mumps (infectious parotitis) Herpes Simplex (cold sores)Each disease will be used once.
  8. 8. Infection Control (Overview) Universal Precautions Personal Protective Equipment Disposable Equipment Disinfection & Decontamination
  9. 9. Universal Precautions Treat all body fluids as potentially infectious Wear appropriate personal protective equipment Be consistent and vigilant
  10. 10. Universal PrecautionsUniversal Precautions- Applies the same or universal approach to all persons.  Body Substance Isolation (BSI)- The part of Universal Precautions that uses barriers to prevent exposure to infectious diseases.
  11. 11. Personal Protective Equipment Where are these items on the ambulance? Gloves Where are they on 7-1? Eyewear Rescue 7? Mask Engine 1? Engine 2? Gown
  12. 12. Personal Protective EquipmentAmbulance #8 Rescue #7-1
  13. 13. Personal Protective EquipmentEngine #1 Engine #2
  14. 14. Personal Protective EquipmentRescue #7
  15. 15. Other Infection Control Techniques Personal Hygiene Hand-hygiene Immunization Program Decontamination Procedures Proper Waste Handling
  16. 16. Hand Hygiene The most fundamental measure to control infection. Recommendations on hand-hygiene- MMWR, Recommendations and Reports, October 25th, 2002/Vol. 51/No.RR16 Guideline for Hand Hygiene in Health Care Settings- Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force
  17. 17. Hand HygieneIndications for handwashing and hand antisepsis These recommendations are written for healthcare workers in hospital settings, but based on principles that apply to all healthcare workers.When hands are visibly dirty or contaminated with proteinaceous material or visibly soiled with blood, or other body fluids, wash hands with either a non-antimicrobial soap and water or an anitmicrobial soap and water.
  18. 18. Hand HygieneIndications for handwashing and hand antisepsis If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating hands…  Alternatively, wash hands with an antimicrobial soap and water in each of the following situations:  After contact with a patient’s intact skin (e.g. when taking a pulse or blood pressure, and lifting a patient)  After contact with body fluids or excretions, mucous membranes, nonintact skin, and wound dressings if hands are not visibly soiled  After removing gloves (PPE)  After each patient contact  After contact with inanimate objects in the immediate vicinity of the patient (cleaning and decontaminating equipment)  After using the toilet or restroom  Before eating  Before and after handling food
  19. 19. Hand HygieneIndications for handwashing and hand antisepsis “Wash hands with non-antimicrobial soap and water or with antimicrobial soap and water if exposure to Bacillus anthracis is suspected or proven. The physical action of washing andrinsing hands under such circumstances because alcohols, chlorhexidine, iodophors, and other antiseptic agents have poor activity against spores.”
  20. 20. Hand Hygiene Technique “When decontaminating hands with an alcohol-based hand rub, apply product to the palm of one hand and rub hands together, covering allsurfaces of the hands and fingers, until hands are dry. Follow manufacturer’s recommendations regarding the volume of product to use.” “When washing hands with soap and water, wet hands first with water, apply an amount of the product recommended by the manufacturer tohands, and rub hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse hands with water and drythoroughly with a disposable towel. Use towel to turn off the faucet. Avoidusing hot water, because repeated exposure to hot water may increase the risk of dermatitis.”
  21. 21. Disposable EquipmentWhat disposable equipment is carried by the Big Tree Volunteer Fire Company? Head restraints Straps (some) Eyewear Infection control kits (PPE+) Cervical collars Single patient stethoscope IV supplies Airway equipment (e.g. BVMs, non-rebreathers, nasal cannulas, etc.) Splints Suction canisters and tubing CPR Pocket masks Linens
  22. 22. Disinfection (Overview)Disinfection Techniques High-Level Intermediate Low-level Environmental
  23. 23. DisinfectionHigh-Level Disinfection Destroys all forms of microbial life except high numbers of bacterial spores. Methods:  Hot water pasteurization  Exposure to an EPA registered chemical sterilant, except for short contact time
  24. 24. DisinfectionIntermediate Level Disinfection Destroys mycobacterium tuberculosis, most viruses, vegetative bacteria, and most fungi, but not bacterial spores. Methods:  Use of EPA-registered “hospital disinfectant” chemical germicides that claim to be tuberculocidal on the label  Hard-surface germicides as indicated above or solutions containing at least 500 ppm free available chlorine. (1:100 dilution of common household bleach)
  25. 25. DisinfectionLow-Level Disinfection Destroys some viruses, most bacteria, some fungi, but not mycobacterium tuberculosis or bacterial spores. Methods  Use of EPA-registered “hospital disinfectants”
  26. 26. DisinfectionEnvironmental Disinfection Surfaces in the environment such as floors, ambulance seats, countertops, and woodwork that are soiled (but not contaminated by blood or other potentially infectious body fluids) should be cleaned and disinfected with cleaners or disinfectant agents intended for environmental use.
  27. 27. Disinfection The level of disinfection required for any reusable equipment or any environment depends on its level of contamination as indicated previously. OSHA 1910.1030 requires that the employer shall launder all equipment required by paragraphs (d) and (e) at no cost to the employee.
  28. 28. Hepatitis Alphabet Viral Hepatitis-Overview Type of Transmission Chronic Virus Source PreventionHepatitis Route Infection Pre/post exposure A Feces Fecal-oral No immunization Blood/blood- Percutaneous Pre/post exposure B Yes derived body fluids Permucosal immunization Blood donor screening; Blood/blood- Percutaneous C Yes risk behavior derived body fluids Permucosal modification Blood/blood- Pre/post exposure D derived body fluids Permucosal Yes immunization; risk Percutaneous behavior modification Ensure safe drinking E feces Fecal-oral no wwater
  29. 29. Hepatitis Signs & SymptomsJaundiceFatigueAbdominal painLoss of appetiteIntermittent nauseaVomiting
  30. 30. Hepatitis Vaccines and Prophylaxis Vaccines currently exist for Hepatitis A and B, but not for C Hepatitis D is rare and occurs only in patients who develop acute or chronic Hepatitis B, so the vaccine for Hepatitis B effectively prevents Hepatitis D Although vaccination is the best protection, development of both Hepatitis A and B (and thus, D) can be reduced by post –exposure prophylaxis (PEP) with Immunoglobulin Vaccination for Hepatitis B has reduced the rate of development of the disease in healthcare workers
  31. 31. Hepatitis B Vaccination ProgramRequired by OSHA 1910.1030The employee has a right to refuse the vaccination. Documentation of thedeclination should be completed.The vaccination series is usually given in a three part series. The secondvaccine is given 30 days after the initial vaccine and the third vaccine is given180 days after the initial vaccine. Following vaccinations, a blood titer tocheck antibody levels is recommended upon consultation with yourphysician.Research indicates that for many workers antibody titers decrease in theyears after vaccination. There is no evidence yet that these decreasing titersresult in lowered immunity. Therefore, CDC does not currently recommendboosters.
  32. 32. HIV/AIDS HIV  Human Immunodeficiency Virus AIDS  Acquired Immunodeficiency Syndrome HIV is first…AIDS may follow
  33. 33. HIV/AIDSChanging Face of the EpidemicUse of AZT in pregnant women who are HIV positive or have AIDS has dramatically decreased maternal-child (perinatal) HIV transmissionUse of combination therapies including antivirals and protease inhibitors has increased the time from infection (HIV positive status) and the development of AIDS (the syndrome with symptoms of opportunistic infections).The proportion of women, Hispanics, African- Americans, and persons exposed to HIV through heterosexual contact living with AIDS continues to increase.
  34. 34. HIV/AIDSWhich Health Care Providers are at risk?The level of risk to health care workersdepends on:The prevalence of HIV among the patient populationThe nature and frequency of exposureThe risk of transmission per exposure
  35. 35. HIV/AIDSTransmission RisksThe virus must live in blood, certain body fluids (blood and bloodproducts, semen, vaginal secretions, as well as cerebrospinal,synovial, pleural, peritoneal, pericardial, and amniotic fluids), or cells;it has to enter the body quickly and enter the bloodstream. This canhappen several ways: The most effective way is through a contaminated needle-stick injury. Risk of transmission by this route is estimated as approximately 0.3% (1 in 300) Intact or unbroken skin should protect against infection. Open wounds, a cut, or any skin that is not intact (chapped, abraded, weeping, or having rashes) can permit the virus to enter the body. Risk of transmission by this route is estimated, on average, at less than 0.1% (1 in 1,000) The mucous membranes of the eye, nose, or mouth can serve as a route for the infected fluids to transmit the virus. Risk of transmission by this route is estimated, on average, at 0.1% (1 in 1,000)
  36. 36. HIV/AIDSBehaviors & Practices that put you at riskSharing drug needles and syringes with an infected personYou can become infected by having sex (oral, anal, or vaginal) with someone who is infected with HIVChildren born to infected women may be infected before or during birthThere is no current risk of becoming infected from donating blood, however if you received blood before 1985 you are at risk. Due to improved screening, the risk from transfusions is much less after this date
  37. 37. HIV/AIDSHow the virus is not transmitted Cannot be “caught” as the common cold can. Not spread through the air like cold viruses No medical evidence of HIV transmission by casual, everyday contact such as sharing kitchens, bathrooms, laundries, eating utensils, beds, or living space with infected people In nonsexual social situations, such as at work or through sharing air, food, and water Insects such as mosquitoes show no evidence of being transmission vectors HIV infection through contact with feces, nasal secretions, saliva, sputum, sweat, tears, urine, and vomitus is extremely low or nonexistent
  38. 38. HIV/AIDSSigns & Symptoms No disease symptoms may be apparent for many years Loss of appetite Weight loss Fever Night sweats Skin rashes or lesions Diarrhea Fatigue Lack of resistance to infection Swollen lymph nodes As the syndrome takes hold, opportunistic infections of the skin, eyes, lungs, and nervous system
  39. 39. HIV/AIDSDisease ProgressionAIDS is the result of the progressive destruction of a person’s immunesystem. The destruction allows diseases that the body can normally fight tothreaten the person’s health and life.Particularly dangerous types of pneumonia (pneumocystis cariniipneumonia) and certain other infections often invade a body weakened byHIV. Patients may suffer rare cancers like Kaposi’s sarcoma.HIV can also attack the nervous system and cause damage to the brain. Thismay take years to develop. The symptoms may include:  Memory loss  Indifference  Loss of coordination  Partial paralysis  Mental disorders
  40. 40. HIV/AIDSTreating the Infected PatientTreating an HIV/AIDS infected person in an emergency setting is the same as with any other patient.Treat the underlying symptoms the patient is presenting.There are no unique protocols for these patients.Compassion is essential as is in any patient- provider relationship.
  41. 41. HIV/AIDSConfidentialityThe HIV epidemic has posed two powerful, and conflicting, legal and ethicalobligations. The first obligation is in respect to the privacy of persons withHIV infection and the second is the duty to inform persons who may beexposed to HIV.The Ryan White Act HIV/AIDS Treatment Extension Act of 2009 addressesthis issue in Part G.“The purpose of Part G is to facilitate informing EREs that they may havebeen exposed to potentially life-threatening infectious diseases, so they canmake better informed decisions about subsequent measures such asdiagnosis and, if necessary, prophylaxis or treatment. The medical facilitythat receives and treats the victim of an emergency or ascertains the causeof death may have or may be able to obtain the victim’s disease statusinformation, which the emergency response service may lack. Part Gprovides a framework for medical facilities to inform EREs that they mayhave been exposed to one of the listed diseases.” -
  42. 42. TuberculosisEpidemiologyThe number of TB cases in the U.S. increased in the mid-1980s, peaking in 1992,when TB cases and case rates again began decreasing in all populations, but not inall population subgroups. CDC reports: 1985-22,201 cases 1992-26,673 cases 1998-18,361 cases 1999-17,531 cases (6.4 infected individuals for every 100,000 people) 2000-16,377 cases 2001-15,989 cases (2% decline from 2000, the smallest decline in 9 years) 1997-1,166 TB related deaths 1999-856 TB related deathsOnly 5% of people in the United States who have been exposed ever develop active TB
  43. 43. TuberculosisMethods of TransmissionThe disease is not a highly contagious disease. Transmission occursby droplet spread from a person with the active disease: Airborne Most dangerous indoors Ultraviolet light kills the bacterium outdoors The bacterium can survive outside the body for long periods of time and even when driedHigher concentrations of TB cases are found in prisons, hospitals,homeless shelters, and nursing homes presumably because they areenclosed areas.
  44. 44. TuberculosisIncubation & Communicable PeriodThe incubation period is 4 to 8 weeks.Infected individuals should be consideredcommunicable until their symptoms haveresolved under adequate therapy and until theyhave had three consecutive negative sputum AFBsmears, which have been collected on differentdays.
  45. 45. TuberculosisSigns & SymptomsInitial infection usually minimal. Disease usually liesdormant for many years before signs and symptomsappear, including:Night sweatsHeadacheCoughWeight loss (consumption)Hemoptysis or blood tinged sputum (classic symptom)Any person who complains of a cough, especially a chronic cough, should be suspected of having TB
  46. 46. TuberculosisProtectionUniversal Precautions & Body Substance IsolationThe 1994 CDC Guidelines specify standard performance criteria forrespirators for exposure to TB. These criteria include: The ability to filter particulates 1 µm in size in the unloaded state with a filter efficiency of >95% The ability to be qualitatively or quantitatively fit tested in a reliable way to obtain a face-seal leakage of < 10% The ability to fit the different facial sizes and characteristics of health care workers which can usually be met by making the respirators available in at least three sizes The ability to be checked for face piece fit, in accordance with OSHA standards and good industrial hygiene practice, by health care workers each time they put on their respirator
  47. 47. TuberculosisOSHA RecommendationsAll personnel should be given a baseline TB Mantoux (PPD [Purified Protein Derivative]) skin test when first employed and every six months thereafter at the employer’s expense.If an individual tests positive, a chest x-ray should be done to determine if the disease is activeActive TB (in which signs and symptoms have developed) should be treated immediately, usually with a combination of drugs to prevent the emergence of the drug-resistant strains
  48. 48. TuberculosisTreatment & Management After exposure and before any symptoms appear, the most common course is a one year treatment that usually consists of a daily dose of isoniazid (INH) to prevent the development of active TB  Younger people benefit most from this treatment If you have been exposed to multiple drug resistant TB (MDR-TB) , the physician also may augment INH with rifampin, pyrazinamide, and streptomycin or ethambutol The bacterium is slow growing and can be metabolically dormant for long periods of time. The treatment, therefore, will last 9-18 months. The patient must complete the whole regimen of drug therapy, otherwise the bacteria may mutate into strains resistant to common drug therapies
  49. 49. Common SexuallyTransmitted Diseases • Chlamydia • Most frequently reported infectious disease in the U.S. • Syphilis • Gonorrhea
  50. 50. ChlamydiaChlamydia is a sexually transmitted disease (STD) that is caused by thebacterium Chlamydia trachomatis. Because approximately 75% of womenand 50% of men have no symptoms, most people infected with Chlamydiaare not aware of their infections and therefore may not seek health care.When diagnosed, Chlamydia can be easily treated and cured. Untreated,Chlamydia can cause severe, costly reproductive and health problemsincluding pelvic inflammatory disease (PID), which is the critical link toinfertility, and potentially fatal tubal pregnancy.Up to 40 % of women with untreated Chlamydia will develop PID.Undiagnosed PID caused by Chlamydia is common. Of those with PID, 20%will become infertile; 18% will experience debilitating, chronic pelvic pain;and 9% will have a life-threatening tubal pregnancy. Tubal pregnancy is theleading cause of first-trimester, pregnancy-related deaths in Americanwomen.
  51. 51. ChlamydiaChlamydia may also result in adverse outcomes of pregnancy, includingneonatal conjunctivitis and pneumonia. In addition, recent research hasshown that women infected with chlamydia have a 3-5 fold increased risk ofacquiring HIV, if exposed.Chlamydia is also common among young men, who are seldom offeredscreening. Untreated Chlamydia in men typically causes urethral infection,but may also result in complications such as swollen and tender testicles.What is the magnitude of the problem?Chlamydia is the most frequently reported infectious disease in the UnitedStates. Though 526,653 cases were reported in 1997, an estimated 3 millioncases occur annually. Severe under reporting is largely a result of substantialnumbers of asymptomatic persons whose infections are not identifiedbecause screening is not available.
  52. 52. ChlamydiaTreatmentSingle-dose antibiotic therapy promises to substantiallyenhance the likelihood of successful treatment- especiallyin adolescents- as compared to commonly used 7-day oralmedication
  53. 53. SyphilisSyphilis is a complex sexually transmitted disease (STD) caused by thebacterium Treponema Pallidum. It has often been called the great imitatorbecause so many of the signs and symptoms are indistinguishable fromthose of other diseases.How is Syphilis spread?The syphilis bacterium is passed from person to person through directcontact with a syphilis sore. Sores mainly occur on the external genitals,vagina, anus, or in the rectum. Sores also can occur on the lips and in themouth. Transmission of the organism occurs during vaginal, anal, ororal sex. Pregnant women with the disease can pass it to the babies they arecarrying. Syphilis cannot be spread by toilet seats, door knobs, swimmingpools, hot tubs, bath tubs, shared clothing, or eating utensils.
  54. 54. SyphilisWhat are the signs and symptoms in adults?Stage 1The time between picking up the bacterium and the start of the firstsymptom can range from 10–90 days (average 21 days). The primary stage ofsyphilis is marked by the appearance of a single sore (called a chancre). Thechancre is usually firm, round, small, and painless. It appears at thespot where the bacterium entered the body. The chancre lasts 1–5 weeksand will heal on its own. If adequate treatment is not administered, theinfection progresses to the secondary stage.
  55. 55. SyphilisWhat are the signs and symptoms in adults?Stage 2The second stage starts when one or more areas of the skin break into a rashthat usually does not itch. Rashes can appear as the chancre is fading or canbe delayed for weeks. The rash often appears as rough, "copper penny" spotson both the palms of the hands and the bottoms of the feet. The rash alsomay appear as a prickly heat rash, as small blotches or scales all over thebody, as a bad case of old acne, as moist warts in the groin area, as slimywhite patches in the mouth, as sunken dark circles the size of a nickel ordime, or as pus-filled bumps like chicken pox. Some of these signs on theskin look like symptoms of other diseases. Sometimes the rashes are so faintthey are not noticed. Rashes typically last 2–6 weeks and clear up on theirown. In addition to rashes, second stage symptoms can include fever,swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss,muscle aches, and fatigue. A person can easily pass the disease to sexpartners when first or second stage signs or symptoms are present.
  56. 56. SyphilisWhat are the signs and symptoms in adults?Latent StageThe latent (hidden) stage of syphilis begins when the secondary symptomsdisappear. If the infected person has not received treatment, he/she still hassyphilis even though there are no signs or symptoms. The bacterium remainsin the body and begins to damage the internal organs, including the brain,nerves, eyes, heart, blood vessels, liver, bones, and joints.
  57. 57. SyphilisWhat are the signs and symptoms in adults?Third StageIn about one-third of untreated persons, this internal damage shows upmany years later in the late or tertiary stage of syphilis. Late stage signs andsymptoms include not being able to coordinate muscle movements,paralysis, no longer feeling pain, gradual blindness, dementia (madness) orother personality changes, impotency, shooting pains, blockage orballooning of the heart vessels, tumors or "gummas" on the skin, bones,liver, or other organs, severe pain in the belly, repeated vomiting, damage toknee joints, and deep sores on the soles of the feet or toes. This damagemay be serious enough to cause death.
  58. 58. SyphilisHow is syphilis diagnosed?The syphilis bacterium can be detected by a health care provider whoexamines material from infectious sores under a microscope. Shortly afterinfection occurs, the body produces syphilis antibodies that are detectedwith a blood test. A syphilis blood test is accurate, safe, and inexpensive. Alow level of antibodies will stay in the blood for months or years after thedisease has been successfully treated, and antibodies can be found bysubsequent blood tests. Because untreated syphilis in a pregnant womancan infect and possibly kill her developing baby, every pregnant womanshould have a blood test for syphilis.
  59. 59. SyphilisWhat is the link between syphilis and HIV?While the health problems caused by the syphilis bacterium for adults andnewborns are serious in their own right, it is now known that the genitalsores caused by syphilis in adults also make it easier to transmit and acquireHIV infection sexually. There is a 2- to 5-fold increased risk of acquiring HIVinfection when syphilis is present. Areas of the U.S. that have the highestrates of syphilis also have the fastest-growing HIV infection ratesin women of childbearing age.
  60. 60. SyphilisTreatmentOne dose of the antibiotic penicillin will cure a person who has had syphilisfor less than a year. More doses are needed to cure someone who has had itfor longer than a year. A baby born with the disease needs daily penicillintreatment for 10 days. There are no home remedies or over-the-counterdrugs that cure syphilis. Penicillin treatment will kill the syphilis bacteriumand prevent further damage, but it will not repair any damage already done.Persons who receive syphilis treatment must abstain from sexual contactwith new partners until the syphilis sores are completely healed. Personswith syphilis must notify their sex partners so that they also can receivetreatment.
  61. 61. SyphilisWill syphilis recur?Having had syphilis does not protect a person from getting it again.Antibodies are produced as a person reacts to the disease, and, aftertreatment, these antibodies may offer partial protection from gettinginfected again, if exposed right away. Even though there may be a shortperiod of protection, the antibody levels naturally decrease in the blood, andpeople become susceptible to syphilis infection again if they are sexuallyexposed to syphilis sores.
  62. 62. GonorrheaWhat causes gonorrhea?Gonorrhea is caused by Neisseria gonorrhoeae, a bacterium that can growand multiply easily in mucous membranes of the body. Gonorrhea bacteriacan grow in the warm, moist areas of the reproductive tract, including thecervix (opening to the womb), uterus (womb), and fallopian tubes (eggcanals) in women, and in the urethra (urine canal) in women and men. Thebacteria can also grow in the mouth, throat, and anus.
  63. 63. GonorrheaHow do people get gonorrhea?Gonorrhea is spread through sexual contact (vaginal, oral, or anal). Thisincludes penis-to-vagina, penis-to-mouth, penis-to-anus, mouth-to-vagina,and mouth-to-anus contact. Ejaculation does not have to occur forgonorrhea to be transmitted or acquired. Gonorrhea can also be spread fromMother to child during birth.Gonorrhea infection can spread to other unlikely parts of the body. Forexample, a person can get an eye infection after touching infected genitalsand then the eyes. Individuals who have had gonorrhea and receivedtreatment may get infected again if they have sexual contact with personsinfected with gonorrhea.
  64. 64. GonorrheaWhat are the signs and symptoms of gonorrhea?Men: When initially infected, about 50% of men have some signs or symptoms. Symptoms and signs include • a burning sensation when urinating • a yellowish white discharge from the penis • painful or swollen testicles.
  65. 65. GonorrheaWhat are the signs and symptoms of gonorrhea?Women: In women, the early symptoms of gonorrhea are often mild, and many women who are infected have no symptoms of infection. Even when a woman has symptoms, they can be so non-specific as to be mistaken for a bladder or vaginal infection. The initial symptoms and signs in women include • a painful or burning sensation when urinating • a vaginal discharge that is yellow or bloody.Women with no or mild gonorrhea symptoms are still at risk of developingserious complications from the infection. Untreated gonorrhea in women candevelop intopelvic inflammatory disease (PID).Symptoms of rectal infection for both men and women include discharge, analitching, soreness, bleeding, and sometimes painful bowel movements. Infectionsin the throat cause few symptoms.
  66. 66. GonorrheaWhen do symptoms appear?In males, symptoms usually appear 2 to 5 days after infection, but it can takeas long as 30 days for symptoms to begin. Regardless of symptoms, once aperson is infected with gonorrhea, he or she can spread the infectionto others if condoms or other protective barriers are not used during sex.
  67. 67. GonorrheaWhat is the treatment for gonorrhea?Many of the currently used antibiotics can successfully cure uncomplicatedgonorrhea in adolescents and adults. Penicillin is a common antibiotic that isno longer used to treat gonorrhea, because many strains of the gonorrheabacterium have become resistant to penicillin. Because many people withgonorrhea also have Chlamydia, antibiotics for both infections are usuallygiven together. Persons with gonorrhea should also be screened for otherSTDs.It is important to take all of the medication prescribed to cure gonorrhea,even if the symptoms or signs stop before all the medication is gone.Although medication will stop the infection, it will not repair any permanentdamage done by the disease. Persons who have had gonorrhea and havebeen treated can also get the disease again if they have sexualcontact with an infected person.
  68. 68. Meningococcal Disease • Meningitis • Viral • Bacterial • SepticemiaMeningococcal disease can produceboth meningitis and septicemia
  69. 69. MeningitisMeningitis is an infection in the fluid of a persons spinal cord and the fluidthat surrounds the brain. Meningitis is usually caused by a viral or bacterialinfection. • Viral meningitis is generally less severe and resolves without specific treatment • Bacterial meningitis can be quite severe and may result in brain damage, hearing loss, or learning disability.Before the 1990s, Haemophilus influenzae type b (Hib) was the leading causeof bacterial meningitis, but new vaccines being given to all children as partof their routine immunizations have reduced the occurrence of invasivedisease due to H. influenzae.Today, Streptococcus pneumoniae and Neisseria meningitidis are the leadingcauses of bacterial meningitis.
  70. 70. MeningitisWhat are the signs and symptoms of meningitis?In anyone over the age of 2 years: • High fever • Headache • Stiff neckThese symptoms can develop over several hours, or they may take 1 to 2 days.Other symptoms may include: • Nausea • Vomiting • Discomfort looking into bright lights (photophobia) • Confusion • SleepinessIn newborns and small infants, the classic symptoms of fever, headache, and neck stiffnessmay be absent or difficult to detect, and the infant may only appear slow or inactive, or beirritable, have vomiting, or be feeding poorly. As the disease progresses, patients of anyage may have seizures.
  71. 71. SepticemiaThe U.S. CDC has summarized the data on meningoccemia below:Clinical Features Fever, headache and stiff neck in meningitis cases, and sepsis and rash inmeningococcemia.Causative Agent Multiple serogroups of Neisseria meningitidis.Incidence Up to 2% in epidemics. During 1996-1997 213,658 cases with 21,830 deaths werereported in west African countries. 0.5-5/100,000 for endemic disease, worldwide in distribution.Disease Course 10–15% of cases are fatal. Of patients who recover, 10% have permanent hearingloss or other serious resulting conditions.Transmission Occurs through direct contact with respiratory secretions from a nasopharyngealcarrier case–patient.Risk Groups Risk groups include general population (for epidemics), infants and young children (forendemic disease), refugees, household contacts of case patients, military personnel, collegefreshmen (particularly those living in dormitories), and people exposed to active andpassive tobacco smoke.The CDC is now recommending vaccination of college freshmen, particularly those who live indormitories. Although most people exposed will not develop the disease, prophylactic antibiotictreatment is sometimes used.
  72. 72. SepticemiaTreatmentTreatment consists of antibiotic therapy.Post-exposure prophylaxis (PEP)For workers who have had intensive, unprotected (i.e., no mask) contactwith infected patients (airway management, mouth-to-mouthresuscitation), CDC recommends rapid (within the first week) antibiotictherapy with rifampin, ciprofloxacin, or ceftriaxone.Asymptomatic exposed workers require no duty restrictions. Personnel whodevelop meningococcal infection should be excluded from duty until 24hours after the start of effective therapy.
  73. 73. Viral Hemorrhagic FeverThe term viral hemorrhagic fever (VHF) refers to a group of illnesses that arecaused by several distinct families of viruses. While some types ofhemorrhagic fever viruses can cause relatively mild illnesses, many of theseviruses cause severe, life-threatening disease.Humans are not the natural reservoir for any of these viruses. Humans areinfected when they come into contact with infected hosts. However, withsome viruses, after the accidental transmission from the host, humans cantransmit the virus to one another. Human cases or outbreaks of hemorrhagicfevers caused by these viruses occur sporadically and irregularly. Theoccurrence of outbreaks cannot be easily predicted. With a few noteworthyexceptions, there is no cure or established drug treatment for VHFs.
  74. 74. Viral Hemorrhagic FeverWhat carries viruses that cause viral hemorrhagic fevers?Viruses associated with most VHFs reside in an animal reservoir host orarthropod vector. They are totally dependent on their hosts for replicationand overall survival. The multimammate rat, cotton rat, deer mouse, housemouse, and other field rodents are examples of reservoir hosts. Arthropodticks and mosquitoes serve as vectors for some of the illnesses. However, thehosts of some viruses remain unknown – Ebola and Marburg viruses are well-known examples.
  75. 75. Viral Hemorrhagic FeverWhere are cases of viral hemorrhagic fever found?Some hosts, such as the rodent species carrying several of the New World arena viruses, live ingeographically restricted areas. Therefore, the risk of getting VHFs caused by these viruses isrestricted to those areas. Other hosts range over continents, such as the rodents that carry virusesthat cause various forms of hantavirus pulmonary syndrome (HPS) in North and South America, orthe different set of rodents that carry viruses that cause hemorrhagic fever with renal syndrome(HFRS) in Europe and Asia. A few hosts are distributed nearly worldwide, such as the common rat. Itcan carry Seoul virus, a cause of HFRS; therefore, humans can get HFRS anywhere where thecommon rat is found.While people usually become infected only in areas where the host lives, occasionally people becomeinfected by a host that has been exported from its native habitat. For example, the first outbreaks ofMarburg hemorrhagic fever, in Marburg and Frankfurt, Germany, and in Yugoslavia, occurred whenlaboratory workers handled imported monkeys infected with Marburg virus. Occasionally, a personbecomes infected in an area where the virus occurs naturally and then travels elsewhere. If the virusis a type that can be transmitted further by person-to-person contact, the traveler could infect otherpeople. For instance, in 1996, a medical professional treating patients with Ebola hemorrhagic fever(Ebola HF) in Gabon unknowingly became infected. When he later traveled to South Africa and wastreated for Ebola HF in a hospital, the virus was transmitted to a nurse. She became ill and died.Because more and more people travel each year, outbreaks of these diseases are becoming an increasingthreat in places where they rarely, if ever, have been seen before.
  76. 76. Viral Hemorrhagic FeverHow are hemorrhagic fever viruses transmitted?Viruses causing hemorrhagic fever are initially transmitted to humans when theactivities of infected reservoir hosts or vectors and humans overlap. The virusescarried in rodent reservoirs are transmitted when humans have contact withurine, fecal matter, saliva, or other body excretions from infected rodents. Theviruses associated with arthropod vectors are spread most often when the vectormosquito or tick bites a human, or when a human crushes a tick. However, someof these vectors may spread virus to animals, livestock, for example. Humansthen become infected when they care for or slaughter the animals.Some viruses that cause hemorrhagic fever can spread from one person toanother. Ebola, Marburg, Lassa, and Crimean–Congo hemorrhagic fever virusesare examples. This type of secondary transmission of the virus can occur directly,through close contact with infected people or their body fluids. It can also occurindirectly, through contact with objects contaminated with infected body fluids.For example, contaminated syringes and needles have played an important rolein spreading infection in outbreaks of Ebola hemorrhagic fever and Lassa fever.
  77. 77. Viral Hemorrhagic FeverWhat are the symptoms of viral hemorrhagic fever illnesses?Specific signs and symptoms vary by the type of VHF, but initial signs andsymptoms often include: • marked high fever • fatigue • dizziness • muscle aches • loss of strength and exhaustionPatients with severe cases of VHF often show signs of bleeding under the skin, ininternal organs, or from body orifices like the mouth, eyes, or ears. However,although they may bleed from many sites around the body, patients rarely diebecause of blood loss. Severely ill patients cases may also show shock, nervoussystem malfunction, coma, delirium, and seizures. Some types of VHF areassociated with renal (kidney) failure.
  78. 78. Viral Hemorrhagic FeverHow are patients with viral hemorrhagic fever treated?Patients receive supportive therapy, but generally speaking, there is no othertreatment or established care for VHFs. Ribavirin, an anti-viral drug, has beeneffective in treating some individuals with Lassa fever or HFRS. Treatmentwith convalescent-phase plasma has been used with success in somepatients with Argentine hemorrhagic fever.
  79. 79. SmallpoxSmallpox is a serious, contagious, and sometimes fatal infectious disease.There is no specific treatment for smallpox disease, and the only preventionis vaccination. The name smallpox is derived from the Latin word for“spotted” and refers to the raised bumps that appear on the face and bodyof an infected person.There are two clinical forms of smallpox. Variola major is the severe andmost common form of smallpox, with a more extensive rash and higherfever. There are four types of Variola major smallpox: ordinary (the mostfrequent type, accounting for 90% or more of cases); modified (mild andoccurring in previously vaccinated persons); flat; and hemorrhagic (both rareand very severe). Historically, variola major has an overall fatality rate ofabout 30%; however, flat and hemorrhagic smallpox usually are fatal. Variolaminor is a less common presentation of smallpox, and a much less severedisease, with death rates historically of 1% or less.
  80. 80. SmallpoxHow is smallpox transmitted?Generally, direct and fairly prolonged face-to-face contact is required tospread smallpox from one person to another. Smallpox can also be spreadthrough direct contact with infected bodily fluids or contaminated objectssuch as bedding or clothing. Rarely, smallpox has been spread by viruscarried in the air in enclosed settings such as buildings, buses, and trains.Humans are the only natural hosts of variola. Smallpox is not known to betransmitted by insects or animals.A person with smallpox becomes infectious or contagious after a rashappears. At this stage, the infected person is usually very sick and not able tomove around in the community. After the appearance of a rash, the infectedperson is contagious until the last smallpox scab falls off.
  81. 81. SmallpoxIncubation Period(Duration: 7 to 17 days)Not ContagiousExposure to the virus is followed by an incubation period during whichpeople do not have any symptoms and may feel fine. This incubation periodaverages about 12 to 14 days but can range from 7 to 17 days. During thistime, people are not contagious.Initial Symptoms (Prodrome)(Duration: 2 to 4 days)Possibly ContagiousThe first symptoms of smallpox include fever, malaise, head and body aches,and sometimes vomiting. The fever is usually high, in the range of 101 to 104degrees Fahrenheit. At this time, people are usually too sick to carry on theirnormal activities. This is called the prodrome phase and may last for 2 to 4days.
  82. 82. Smallpox
  83. 83. SmallpoxEarly Rash(Duration: about 4 days)Highly ContagiousA rash emerges first as small red spots on the tongue and in the mouth.These spots develop onto sores that break open and spread large amounts of thevirus into the mouth and throat. At this time, the person becomes contagious.Around the time the sores in the mouth break down, a rash appears on the skin,starting on the face and spreading to the arms and legs and then the hands andfeet. Usually the rash spreads to all parts od the body within24 hours. As the rashappears, the fever usually falls and the person may start to feel better.By the third day of the rash, the rash becomes raised bumps.By the fourth day, the bumps fill with a thick, opaque fluid and often have adepression in the center that looks like a bellybutton. (This is a majordistinguishing characteristic of smallpox.) Fever often will rise again at this timeand remain high until scabs form over the bumps.
  84. 84. SmallpoxPustular Rash(Duration: about 5 days)ContagiousThe bumps become pustules – sharply raised, usually round and firm to thetouch as if there’s a small round object under the skin. People often say thebumps feel like BB pellets embedded in the skin.Pustules and Scabs(Duration: about 5 days)ContagiousThe pustules begin to form a crust and then a scab.By the end of the second week after the rash appears, most of the soreshave scabbed over.
  85. 85. SmallpoxResolving Scabs(Duration: about 6 days)ContagiousThe scabs begin to fall off, leaving marks on the skin that eventually becomepitted scars. Most scabs will have fallen off three weeks after the rashappears.The person is contagious to other until all of the scabs have fallen off.Scabs ResolvedNot ContagiousScabs have fallen off. Person is no longer contagious.
  86. 86. Measles, Mumps, Rubella (MMR)MeaslesMeasles (Rubeola) is an acute, very communicable viral disease. Early signs andsymptoms include fever, conjunctivitis, cough, and spots around the oral mucousmembranes. The characteristic red, blotchy rash appears around the third day ofillness, beginning on the face and then spreading. Diarrhea and middle earinfections are frequent complications. Tuberculosis (TB) can be worsened bycoinfection with measles.MumpsMumps is an acute viral disease characterized by fever, swelling, and tendernessof one or more salivary glands. Prior to 1967, when a vaccine was licensed,between 100,000 and 200,000 cases were reported annually, mostly in school-age children. Since 1995, fewer than 1,000 cases are reported annually in the U.S.Sterility in males past puberty is a possible result of the disease.Rubella (German Measles)Rubella is an acute viral disease, affecting people of any age. The disease isusually mild in infants and children, but is much worse in adults and is associatedwith fetal wasting and abnormal development. In 1969, the year of vaccinelicensure, nearly 60,000 were reported in the U.S. Since 1992, fewer than 500cases are reported annually.
  87. 87. Measles, Mumps, Rubella (MMR)
  88. 88. Measles, Mumps, Rubella (MMR)Treatment of MMRTreatment for these viral diseases is supportive and typically treats thesymptoms.PreventionA combination vaccine for MMR is routinely administered in this countrybeginning in infancy. MMR immunization is not required for entry into anycountry, including the U.S. These diseases are still prevalent in countries thatdo not routinely immunize against them.
  89. 89. InfluenzaInfluenza or “the flu” is a viral respiratory infection, producing a more severeillness than most other viral respiratory infections. Signs and symptomsinclude moderate to high fever in adults, often higher in children, and therespiratory symptoms of cough, sore throat, and runny nose. Headache,muscle ache, and fatigue are prominent.Most people recover from the flu in 1-2 weeks, but some patients developlife-threatening complications, such as pneumonia. In an average year, fluresults in more than 20,000 deaths and over 100,000 hospitalizations. Theelderly and people with chronic health problems are more likely to developserious complications than young, healthy people.
  90. 90. Influenza
  91. 91. InfluenzaPreventionSurveillance of emerging influenza virus strains usually allows thepreparation of effective vaccines annually. 110 National Influenza Centers in83 countries and four World Health Organization Collaborating Centers forVirus Reference and Research from FluNet, linking the global network ofcenters electronically and allowing each authorized center to enter dataremotely every week and obtain full access to real-time epidemiological andvirological information. People at high risk for developing severecomplications from flu should be vaccinated.
  92. 92. BTVFC Occupational ExposureProtection PlanPolicy StatementThe Big Tree VFC has established a written Exposure Control Plan that isavailable to all “active” and “active life” members at all timesThe Third Assistant Chief (9-3) of the Big Tree VFC shall serve as the InfectionControl Coordinator of the program. When the Third Assistant Chief isabsent, the following persons are responsible for administering the program:• 1st Assistant Chief (9-1)• EMS Captain (if not designated as 9-3)• EMS Lieutenant• AEMT=P, AEMT-CC, AEMT-I, or EMT in charge of the EMS call where the exposure took place.The Big Tree VFC is committed to full compliance with applicable laws andpolicies dealing with infection control. The fire company will develop plansleading to compliance for any deficient areas identified by this program.
  93. 93. BTVFC Occupational ExposureProtection PlanMember ResponsibilitiesIt is mandatory that each member learn the basics of infection control,including modes of disease transmission and exposure risks. Each member isresponsible for ensuring compliance with the policies and proceduresoutlined in the Exposure Control Plan. All members shall attend an initialtraining course in bloodborne pathogens and a refresher annually thereafter.
  94. 94. BTVFC Occupational ExposureProtection PlanBig Tree VFC Responsibilities• Designate the BTVFC Third Assistant Chief (9-3) as the Infection Control Coordinator• The Infection Control Coordinator will appoint a qualified individual to instruct all members on the epidemiology, modes of transmission, and prevention of HIV and other bloodborne infections.• The EMS officers will emphasize the need for routine use of universal blood and body fluid precautions on all patients.• Equipment and supplies will be provided to minimize the risk of infection with HIV and other bloodborne pathogens. This includes, whenever possible, needleless angios and IV medications.• Member adherence to recommended protective measures will be monitored. When monitoring reveals a failure to follow the recommended precautions, appropriate counseling, education, or retraining will be provided. If these measures are unsuccessful, appropriate disciplinary action will be considered.• Annually review and update this plan to incorporate new technologies, address legislative changes, or make revisions as deemed appropriate.
  95. 95. BTVFC Occupational ExposureProtection PlanMeasures for Prevention• The Big Tree VFC will routinely provide to each member the appropriate personal protective equipment (PPE) to reduce the risk of bloodborne disease exposure.• The Big Tree VFC will assure that PPE is readily accessible to all members in the appropriate sizes.• All PPE will be maintained in a sanitary manner.• All PPE will be properly cleaned, laundered, repaired, replaced, or disposed of as needed at no cost to the member.• All members will be required to follow universal precautions at all times prior to initiating patient care.• All members will be required, when possible, to wash their hands with warm water and soap after the removal of gloves that have come into contact with blood or other potentially infectious materials, even if the gloves appear to be intact, at the hospital emergency room, or by using antiseptic hand detergent that is found in the ambulance and trauma bag on Rescue #7 and flycar #7-1• All members will be required to remove contaminated PPE (i.e. jumpsuit, turnout gear) when possible, upon leaving the emergency scene and placing the equipment in a biohazard bag for washing, decontamination, or disposal.• All members will perform procedures involving blood or other infectious materials in a manner that minimizes splashing and spraying.• When using needles or other sharp objects, the member will not shear, bend, break, recap, or re - sheath with two hands. Used needles will be placed directly in a sharps container on the ambulance.
  96. 96. BTVFC Occupational ExposureProtection PlanImmunizations/Vaccinations• Immunizations reduce the risk of contracting a communicable disease. The Big Tree VFC will provide the Hepatitis B vaccine to all members, free of charge, after initial training (which will include Hepatitis B, Hepatitis B vaccination, the efficacy, safety, method of transmission, and benefits of the vaccination, and the availability of the vaccine) within 10 days of initial swearing in of the company, unless (1) the member has previously received the complete Hepatitis B vaccination series, (2) antibody testing reveals that the member is immune or, (3) medical reasons prevent the member from being vaccinated. Any booster doses recommended by the U. S. Public Health Service also will be provided.• All medical evaluations and procedures will be performed by, or under, the supervision of a licensed physician, or an appropriately trained and licensed health care provider, and administered according to current recommendations of the U.S. Health Service. Members will receive their vaccinations through designated sites set up on a regular basis.• Vaccinations will be provided even of the member initially declines, but later accepts treatment. Members who decline the vaccination must sign a declination form. Refer to the SOG entitled “Physical Examinations” for more information.
  97. 97. BTVFC Occupational ExposureProtection PlanExposure DeterminationThis is a listing of possible different levels of exposure that personnel mayencounter:• Level I • Possible affected personnel could include, but is not limited to, EMT, EMT-D, EMT-I, non first-aiders, drivers, firefighters, and fire police. • Exposure is limited to merely being in the presence of a person suspected of having a communicable disease. • This should be reported to the Infection Control Coordinator and an EMS Agency Exposure Notification Form should be filled out.• Level II • Possible affected personnel could include, but is not limited to, EMT, EMT-D, EMT-I, non first-aiders, drivers, firefighters, and fire police. • This is an exposure to healthy, intact skin from a victim’s body fluids. • This should be reported to the Infection Control Coordinator and an EMS Agency Exposure Notification Form should be filled out.
  98. 98. BTVFC Occupational ExposureProtection PlanExposure Determination• Level III • Possible affected personnel could include, but is not limited to, EMT, EMT-I, non first-aiders, drivers, firefighters, and fire police. • This is an exposure involving contact with infected blood or body fluids through open wounds, mucous membranes, or parenteral routes (i.e. piercing mucous membranes or the skin barrier through needle-sticks, human bites, cuts, and abrasions). • Examples of a Level III exposure include: • Needle-stick injury • Cut with a contaminated sharp object covered with blood or body fluids. • Contamination of a mucous membrane (i.e. splash to the eyes, nose, or mouth) • Contamination of blood or body fluids with non-intact skin (i.e. especially when the skin is chapped, abraded, or affected with dermatitis) • Any injury sustained while working with contaminated equipment.
  99. 99. BTVFC Occupational ExposureProtection PlanInjury CareInjuries involving unused, sterile needles should be reported to the Infection ControlCoordinator the same way as any other minor injury. Care at the time of injury shouldconsist of: • Local wound care • Consideration of need for tetanus-diphtheria toxoid.Level III Occupational Exposures with a KNOWN contamination source should be handled as follows: • The hospital receiving the patient will be contacted and informed that a Level III Occupational Exposure has occurred. • The Infection Control Coordinator will contact the receiving hospital to find out whether the patient has an infectious disease. Determination of the risk will be based on medical information possessed by the medical facility treating the patient. New York State law does not permit testing for infectious disease without the permission of the patient. The medical facility must respond to the Department’s request in writing as soon as practical but not later than 48 hours after receipt of such request. Hospitals also have an affirmative responsibility to notify the designated officers of a possible exposure to infectious pulmonary tuberculosis. • The injured firefighter/provider should be interviewed regarding any history of Hepatitis, risk factors for exposure to Hepatitis B, and Hepatitis B immunization status. The following blood tests will be requested: • Anti-Hep BsAg (antibody to Hepatitis B surface antigen) • HIV antibody
  100. 100. BTVFC Occupational ExposureProtection PlanInjury Care (con’t.)Any personnel receiving a Level III exposure from an HIV positive patientshould have an additional HIV antibody test done six weeks post exposure.The HIV antibody test needs to be redone at 3, 6, and 12 month intervals.The results of these tests will be provided to the firefighter/provider withcounseling from a physician. The results of these tests will remain in strictconfidence between the firefighter/provider and the appointed LicensedPhysician. The member will provide the Big Tree VFC with informationnecessary to comply with worker’s compensation laws and other firecompany policies only. These tests will be done at the expense of the BigTree VFC.
  101. 101. BTVFC Occupational ExposureProtection PlanMedical SurveillanceBig Tree VFC will provide all evaluations, procedures, vaccinations, and post-exposure management to the member at a reasonable time and place, andaccording to standard recommendations for medical practice.Record KeepingThe Big Tree VFC will: • Maintain accurate medical records for each member for at least the duration of membership plus thirty years. • Keep all member medical records confidential and not release them to any person within or outside the company except as required by law. • Maintain all training records for five years in compliance with Section 29, Code of Federal Regulations, 1910.20
  102. 102. BTVFC Occupational ExposureProtection PlanMedical Record ConfidentialityThe Big Tree VFC will keep all medical records confidential and are notdisclosed or reported without the members expressed written consentexcept as may be required by law.The Big Tree VFC emergency response personnel will use knowledge of apatient’s communicable disease status for patient care only, not infectioncontrol purposes.The same confidentiality standards apply to information regarding thecommunicable disease of members involved in emergency servicesresponse. This information is between the member and the attendingphysician. The sharing of this information through any other means,including the “grapevine”, is a violation of confidentiality standards.Appropriate disciplinary action will be taken towards individuals who violatethese confidentiality standards.
  103. 103. BTVFC Occupational ExposureProtection PlanMore information regarding the Big Tree VFC Occupational ExposureProtection Plan can be found in our Standard Operating Guidelines Manuallocated in the Watch Room at Station #2. Also located in the Watch Room isthe Big Tree VFC Bloodborne Pathogens Exposure Control Book whichcontains the OSHA 1910.1030 Standard and the applicable Exposure ReportForms.
  104. 104. BTVFC Exposure Report
  105. 105. BTVFC EquipmentDecontamination ProceduresCleaning and Decontaminating Spills of Blood• Put on gloves (P2-High Risk) before the clean-up procedure.• Remove the visible material with absorbent towels or other appropriate means that will ensure that there is no direct contact with blood.• If splashing is anticipated, wear protective eyewear and a gown which provides a protective barrier.• Wash the surface with soap and water or a germicide and then apply a disinfectant and allow the surface to dry.• Clean and disinfect soiled cleaning equipment or place in an appropriate biohazard bag for disposal.• Wash hands following the removal of gloves.
  106. 106. BTVFC EquipmentDecontamination ProcedurePeriodic Cleaning of the Rescue Vehicles• On a regular basis (i.e. weekly monthly) as determined by the frequency of vehicle use and obvious need, the floors, walls, interior, and exterior cabinets and drawers, benches, and other surfaces, should be thoroughly cleaned. On a weekly basis, on Mondays, the ambulance will be checked and cleaned. All equipment and working surfaces will be cleaned routinely after each EMS call.
  107. 107. BTVFC EquipmentDecontamination ProcedureDecontamination of Linen and ClothingLinen Handling- The removal of linen should focus on limiting dispersal oforganisms into the air, proper containment, and hand washing. Linen should berolled or folded during removal and by avoiding shaking or waving. Linen shouldbe left at the hospital facility or it should be placed in a plastic bag for launderingby the hospital facility. Following the removal of the linen, hands should bewashed. In the event that the linen is heavily soiled and not left at the hospital,gloved should be worn and the linen placed in a plastic bag.Management of Contaminated Clothing- Contaminated clothing should behandled similarly to linen. Clothing which has dried blood or other body fluidspatters should be removed as soon as practical (i.e. at the station house orhome) If protective garb is not worn, and clothing becomes soaked with blood orother body fluids, the member should, to the extent possible under thecircumstances, take steps to prevent direct contact with the skin. Ideally, theclothing should be removed from the body. Alternatively, a protective barrier canbe placed between the skin and soaked area until the clothing can be changed.Detergent washing and drying in a dryer renders materials safe.Bleach can be used if it is compatible with the fabric. Dry cleaning is an effectivedecontamination method for clothing which cannot be laundered.Laundry facilities (washer and dryer) are available at Big Tree Station #2 to beused for any contaminated clothing.
  108. 108. BTVFC EquipmentDecontamination ProcedureCare of Specific Contaminated EquipmentARTICLE Cleaning ProcedureAirways (ET tubes, OPA, NPA) 1B/P Cuffs 2Backboards 2Bag Valve Masks 1Bulb Syringe 1Cannulas, Masks 1Cervical Collars 1 Cleaning KeyDressings & Paper products 1 (1) DisposeElectronic Equipment 3Emesis Basins 1 (2) CleaningFirefighter Protective Equipment 5 (3) Disinfection (1:10Humidifiers 1Regulators and tanks 2 bleach:waterKED 3Laryngoscope and blades 4 solution)Linens 1 or 5 (4) High-LevelMAST 3Needles 1 Disinfection (LPH)Penlights 1 (5) LaunderPocket masks 1 or 4Restraints 2Resuscitators (BVM) 1 or 4Scissors 3Splints ` 1Stethoscope 3Stretcher 3Stylets 1Suction Catheters 1Suction Unit (Collection Jar) 3Jumpsuits 5
  109. 109. BTVFC EquipmentDecontamination ProcedureInfectious Waste DisposalBig Tree VFC will • Treat any waste which has had contact with any body substance as regulated medical waste. Such waste will be placed in a red biohazard bag and left at the receiving hospital facility for ultimate incineration. Red biohazard bags are available on Big Tree #8 in the waste basket receptacles. • All sharps, used and unused, are included in the definition of regulated medical waste. Sharps containers will be secured when full and disposed of with other red bag waste. The ambulance is equipped with puncture resistant containers. • Disposal of intravenous bags, whether or not they have had contact with blood, will be disposed of with other red bag waste. • All other waste which has not had contact with a body substance may be disposed of in the general waste stream. White garbage bags are available on Big Tree #8.
  110. 110. Knowledge AssessmentPlease take the time to complete the knowledge assessment to the best ofyour ability.Once completed, turn the knowledge assessment document into the 1 stAssistant Chief or 2 nd Assistant Chief.If you have any questions, please contact the Infection Control Coordinator(9-3) or 1st Assistant Chief.