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IC/EC, Inc.
Ryan White Notification -
Update
New list of diseases
 This means that medical facilities have expanded
notification responsibilities.
 This means that departments have extended
vaccine/immunization responsibilities
 Authorizes the CDC to compile the list of
diseases/viruses that are covered (hospital must notify
responders of exposure).
2
The List - Published
 Bloodborne
 HCV
 HBV
 HIV
 Vaccinia virus
 Cutaneous Anthrax
 Rabies
 Viral hemorrhagic fevers
 Airborne
 Measles (Rubeola)
 Chickenpox
 Tuberculosis
3
Federal Register, 11/2/11
List Published
Droplet Transmitted
 N. Meningitis
 Diphtheria
 Mumps
 Pertussis
 Plague
 Rubella
 SARS-CoV
 Novel Influenza A viruses
4
Federal Register, 11/2/11
Prevention
 Travel history on
patient
assessment
especially with
respiratory
symptoms
○ SARS
○ Bird Flu
○ H1N1
○ MERS
○ Ebola
5
Immunizations/Vaccinations
 Hepatitis B vaccine
 Tdap booster x1
 MMR
 Chickenpox
 Flu vaccine
 TB Testing
6
CDC,1997, 2011
CDC Statement on
Records
 HICPAC and CDC have recommended that
secure, preferably computerized, systems should
be used to manage vaccination records for HCP
so records can be retrieved easily as needed
 Each record should reflect immunity status for
indicated vaccine-preventable diseases, as well as
vaccinations administered during employment
7
CDC, November, 2011
Obtain Your Records
 From –
 Your schools
○ High school
○ College
 Training programs
 Previous employer
8
Why this information is
important?
9
Disease Comeback
Heard Immunity
 No vaccine is 100% effective
 Herd Immunity occurs when nearly the
entire community is immunized.
 Disease/virus cannot take hold or gain
traction due to lack of vulnerable
patients.
10
Other Diseases - 2013
11
 Measles
 Mumps
 Rubella
 Chickenpox
 Pertussis
(whooping cough)
 187
 584
 9
 11,356
 28,639
Declination Forms
 If you do not wish to give your medical
information, you must sign a declination
form
12
Declination Forms
 Do not remove employee rights
 They document employer has met
his/her responsibility
13
MMR Vaccine
 If received between 1963 – 1967
 Revaccinate with 2 doses one
month apart
14
Measles Status Unknown
 No need to titer
 Just vaccinate
15
CDC, 11/25/12
Chickenpox Vaccine
 Unable to document immunity
 Just vaccinate
 Cost/benefit
16
CDC, Nov. 25, 2011
Shingles Vaccine
 CDC differs from the package insert
 Now age 50 and up
 Available even if person has had a
shingles outbreak
 Virus is alive in your system if you had
the Chicken Pox.
17
Healthcare Worker Duty
 To protect patients from infection
 To protect yourself
 To protect co-workers
18
HBV Infection Rate - US
 Universal vaccination
 Cases declined 89% from 1990-2011
 Healthcare worker infection infrequent
19
CDC, Nov.. 2011,2013,
Vaccine - HBV
 Need to complete all 3 shots
 1 dose = 30% - 55% protection
 2 dose = 75% protection
 3 dose = >90% protection
20
CDC, MMWR, Nov. 2011
Vaccine Protection
 Person who respond are protected for >
22 years
21CDC, December, 2013
Healthy People 2020
 Target to have 90% of HCWs vaccinated
against HBV
22
HCV Increased
 Due to improper infection control practices
 Outbreaks
 30 outbreaks
23
CDC – Testing Baby
Boomers
 Persons born between 1945 – 1965
should be tested for HCV –
 New York passed a law to have this in
place- Dec. 2013
24
New Rapid HCV Test
 OraQuick ®HCV
 FDA approved
 Takes 20 mins.
 No lab equipment required
 Very accurate- 99.8%
 Waiver granted 11/28/11**
 Screens for multiple genotypes
25
FDA. June 25, 2010, 2013
CDC Guidelines for Labs
 Rapid HCV – if positive
 Confirm with HCV-RNA (viral load)
26
CDC, May 7, 2013
Remember
A positive test for HCV by antibody testing does NOT
mean current infection
Source patient to have viral load test for confirmation
(HCV-RNA)
27CDC, Hep C Symposium Dec.,2011
Reminder -
 If you are exposed to a hepatitis C positive patient,
you should have a blood test in 2 weeks
 HCV-RNA (blood test)
 Cost - $65.00 - $100.00
28
Am. Assoc. for the Study of Liver Disease, Practice Guidelines, 2009
Hepatitis C – Early Treatment
 HCV-RNA positive
begin treatment
 12 -24 weeks –
○ 2014 now 8-12 weeks
29
Newer Drugs
Olysio
 Treatment Genotype 1
Solvadi
 Treatment Genotype 1 &
4
30
Cure more often and in less time 8 - 12 weeks
80% - 95+%
2014
Infected Healthcare Workers-
Occupational Infection-HIV
 1978 – December, 2010
 57* documented cases
○ 0 in fire/EMS personnel
○ 49 were sharps related exposures
○No new cases since 1999
31
CDC, 2012(CDC), NIOSH
Update - 2011
 Aids “cocktail” drugs = 96% unable to transmit the
disease
 HIV/AIDS – living 50 years
32
Dr. Fauci, NIH, May 2011
Result 3 Drug Cocktail
 Atripla – 84%- 0 HIV virus in blood in 48 weeks
 Stribild – 88% - 90% 0 in 48 weeks
 Truvada – 87% 0 in 48 weeks
33
CDC, Oct. 2012
Rapid HIV Test - currently available – using blood
OraQuick
Reveal
Uni-Gold
Multispot
Clearview
34
CDC January 2007
Reminder - Testing Issues -
Post Exposure
 If source patient is negative with rapid testing
= no further testing of health-care worker
 Use of rapid testing will prevent staff from
being placed on toxic drugs for even a short
period of time
35
•CDC, May , 1998, CDC June 29, 2001, September
2005
•Sept. 2013
Source is positive
 Test employee baseline
 Repeat at 6 weeks
 Repeat at 4 months using rapid test
36
CDC, Sept. 2013
Syphilis Cases
Part of post exposure
testing
 Post exposure follow up
if source is HIV positive
 More testing under new
Sexually transmitted
disease (STD)
guidelines
37
Highest States for cases -
2013
 California
 Texas
 New York
 Florida
38
CDC, MMWR , 2013
Risk Groups
 Men who have sex with men
 Inmates
 HIV infection
 Injection drug partners
 Sex workers
 Senior Communities
**Universal Syphilis screening should be conducted
on the basis of the local area & prevalence of
syphilis (CDC, STD guidelines, 2010)
39
40
Tuberculosis
 2013 lowest case number since 1953
 9,582 for 2013
 Goal to eliminate by 2020 - worldwide
41
CDC, MMWR, 2012;61:181-185
Multi-drug Resistant TB
 MDR-TB – 84% in foreign-born persons
 109 cases in 2010
 86 - 2012
 XDR-TB – 2 cases reported in 2007
 XDR-TB 1993 -2007 = 83 cases reported
○ 2008 = 0
○ 2009 = 0
○ 2011= 4 cases in foreign-born persons
○ 2013 = 2
○ Both are treatable !
42
Decrease in TB Cases
 National and global decrease due to -
 Direct Observed Therapy- DOT
43
Risk Assessment - CDC
 Based on number of
active-untreated TB
patients transported
in the past year
44
CDC, 2005
Risk Assessment - TB
 Low Risk
 Transported less than
3 TB patients
 Medium Risk
 Transported more than
3 TB patients
45
CDC TB Guidelines, 2005, pg. 134
Testing Issues
 Low Risk
 On hire
 Post exposure
 Medium Risk
 On hire
 Annual
 Post exposure
46
CDC/NFPA 1581
Department TB Risk
Assessment
 2013 – 0, low risk
47
 QFT-G (In-tube)
 FDA approved – October 2007
 Less time consuming to perform
 More accurate
 Cost effective - $33.67
48
New Version TB Blood
Test
Cost Benefit
 2 step testing
 Cost per test
 Return visits for
reading
 Repeats ?
 Blood test
 One draw
 No return visits
49
Post Exposure -
 Testing begins with the source patient!
 No need for you to have blood drawn
immediately – if at all
50
GFD Exposure Policy
 SOG 507.15 and 507.15(a)
 Exposure Incident- Specific eye,
mouth or other mucus
membrane, non-intact skin or
parenteral contact with blood or
other potentially infectious
materials that results from the
performance of ones duty.
51
GFD Exposure Policy
 Potentially infectious sources of
Infectious Diseases:
 Blood
 Semen
 Vaginal secretions
 CSF
 Synovial fluid
 Pleural fluid
52
GFD Exposure Policy
 Potentially infectious sources of
Infectious Diseases Continued:
 Peritoneal fluid
 Pericardial fluid
 Amniotic fluid
 Saliva
 Tissue
 Any fluid with blood contamination.
53
GFD Exposure Policy
 Exposure determination by DICO
 Documentation:
 Exposed member and senior medic
shall complete the “Infectious
Exposure Form and attach to PCR.
 Reviewed by Chief, Deputy Chief-
Operations and the Paramedic
Coordinator.
54
GFD Exposure Policy
 Source patient (if known) tested if
actual exposure occurs.
 Baseline testing offered to employee if
desired.
 Employee offered post exposure
prophylaxis in accordance of treatment
plan outlined by treating physician.
 Deputy Chief of Ops. Is the designated
officer to ensure policy is followed.
55
GFD Exposure Policy
 Interaction with Health Care Professionals,
written opinions offered:
 HBV
 Following exposure. Opinion limited to:
 Confirmation of vaccine or evaluation post
incident.
 The results of the evaluation and any testing.
 Employee informed about any medical
conditions resulting from exposure.
 NO PERSONAL Medical information.
 All HIPAA rules apply.
 Files kept for 30 years post employment.
56
GFD Exposure Policy
 Department offers PPE and by
policy must be used,
 Gloves
 Gowns
 Level B suits
 Goggles/face shields
 Hair covers
 Foot covers
 Use and clean equipment properly
57
Flu Vaccine - Annual
“Direct patient
care”
All healthcare
workers
58
New Vaccines/ Options
59
Over 65 - Vaccine
 Fluzone High dose
 4 times the amount of antigen
○ Quadrivalent
60
 Flublok
 No virus
 No eggs used in production
 No antibiotics/mercury
 DNA technology
61
New Flu Vaccine
FDA, 1/16/13
DNA Vaccines
 Direct injection of genetic material into a
living host causes a small amount of its
cells to produce the introduced gene
products
 Results in the specific immune activation of
the host against the gene delivered antigen
62
Universal Vaccine?
 New antibody identified inhibits many
strains of influenza
 CH65
63
Infectious Disease News, Aug. 24,2011
Announced 2/16/13
 Lower than any other HCW group in 3
studies
64
Flu Vaccine EMS
Participation
Work Restriction
 Restrict ill workers
from the workplace
 use sick time
○ protect co-workers
○ protect patients
65
CDC/NFPA 1581
Transmission – Based
Precautions
 Contact precautions
 Droplet precautions
 Airborne precautions
66
Contact Precautions
 Wear gloves
 Gown ?
 Clean and disinfect all contact items
 BP cuff, stethoscope etc,
67
CRE – New Resistant
Organism
 Carbapenem-Resistant
enterobacteriaceae
 High mortality rate
 Difficult to treat
 Contact Precautions
 Not acquired by healthy people
68
69
Droplet Precautions
 Standard Precautions
 Surgical mask use – patient
 Within 3 feet
70
Droplet Precautions
 Appropriate for –
 Influenza
 Pertussis
 Meningitis
 Mumps
71
Prevention
 Place surgical mask on patient
 If can not, place surgical mask on yourself
 Good handwashing
 Use good airflow in vehicle
72
IOM meeting June 3, 2010/ CDC
Remember
 Even the most elaborate PPE
requires proper removal !
Environmental Cleaning
 An EPA-registered hospital disinfectant or
1:100 bleach
 PPE to include;
 Face protection
 Gloves
 Consider leg covers/shoe covers (large
amount of fluids present)
COCA Conference CDC, August 5, 2014
74
Survival on Surfaces
 Can survive on surfaces for several
hours and then dies
75
Red Bag Waste
A Hazmat situation ?
 Can be incinerated
 Or Inactivated
76
77
Airborne Precautions
 Standard Precautions
 Surgical mask for fire/EMS use
 6 foot distance
 If task generates splash/spray use eye
protection
78
Airborne Diseases
 Chickenpox
 Measles
 Tuberculosis
79
Ebola Outbreak -
2014
80
Transmission
 Human – to – Human Transmission
 Direct contact through (broken skin or
mucous membranes) with blood,
secretions, organs of infected persons
 Contact with contaminated environments
WHO/CDC
Transmission
 Men who have survived the disease can
transmit the virus through their semen for
up to 7 weeks after recovery
 Present in breast milk
WHO
Prevention - Travel
 Travelers are screened for signs and
symptoms before flying
 If ill on a plane, the crew notified the pilot –
who notifies medical personnel at the
airport
 Medical team assesses and if needed hold
the patient at the airport
83
Travel History
 Travel history to
Africa or contact
with a know or
suspect Ebola
patient
 Symptoms-
 Fever>101.5
 Part of Patient
assessment
 Standard Precautions
 Contact Precautions
 Droplet Precautions
 Mask patient
Cleaning Post Transport
 EPA- approved hospital grade
disinfectant
 Bleach & Water @ 1:100 dilution
85
Red Bag Waste
A Hazmat situation ?
 Can be incinerated
 Or Inactivated
86
Risk Perception – Questions to
Consider
 What is the population in your area from
West Africa ?
 What companies in your area send
employees to West Africa ?
87
Handwashing
88
Handwash Study - EMS
 Study from Robert Woods Johnson
University Hospital
 1,500 EMS providers surveyed
 13% compliance
○ First responders
○ EMS providers
○ Paramedics
89
11/12/13

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Bbp 2014 15

  • 2. Ryan White Notification - Update New list of diseases  This means that medical facilities have expanded notification responsibilities.  This means that departments have extended vaccine/immunization responsibilities  Authorizes the CDC to compile the list of diseases/viruses that are covered (hospital must notify responders of exposure). 2
  • 3. The List - Published  Bloodborne  HCV  HBV  HIV  Vaccinia virus  Cutaneous Anthrax  Rabies  Viral hemorrhagic fevers  Airborne  Measles (Rubeola)  Chickenpox  Tuberculosis 3 Federal Register, 11/2/11
  • 4. List Published Droplet Transmitted  N. Meningitis  Diphtheria  Mumps  Pertussis  Plague  Rubella  SARS-CoV  Novel Influenza A viruses 4 Federal Register, 11/2/11
  • 5. Prevention  Travel history on patient assessment especially with respiratory symptoms ○ SARS ○ Bird Flu ○ H1N1 ○ MERS ○ Ebola 5
  • 6. Immunizations/Vaccinations  Hepatitis B vaccine  Tdap booster x1  MMR  Chickenpox  Flu vaccine  TB Testing 6 CDC,1997, 2011
  • 7. CDC Statement on Records  HICPAC and CDC have recommended that secure, preferably computerized, systems should be used to manage vaccination records for HCP so records can be retrieved easily as needed  Each record should reflect immunity status for indicated vaccine-preventable diseases, as well as vaccinations administered during employment 7 CDC, November, 2011
  • 8. Obtain Your Records  From –  Your schools ○ High school ○ College  Training programs  Previous employer 8
  • 9. Why this information is important? 9 Disease Comeback
  • 10. Heard Immunity  No vaccine is 100% effective  Herd Immunity occurs when nearly the entire community is immunized.  Disease/virus cannot take hold or gain traction due to lack of vulnerable patients. 10
  • 11. Other Diseases - 2013 11  Measles  Mumps  Rubella  Chickenpox  Pertussis (whooping cough)  187  584  9  11,356  28,639
  • 12. Declination Forms  If you do not wish to give your medical information, you must sign a declination form 12
  • 13. Declination Forms  Do not remove employee rights  They document employer has met his/her responsibility 13
  • 14. MMR Vaccine  If received between 1963 – 1967  Revaccinate with 2 doses one month apart 14
  • 15. Measles Status Unknown  No need to titer  Just vaccinate 15 CDC, 11/25/12
  • 16. Chickenpox Vaccine  Unable to document immunity  Just vaccinate  Cost/benefit 16 CDC, Nov. 25, 2011
  • 17. Shingles Vaccine  CDC differs from the package insert  Now age 50 and up  Available even if person has had a shingles outbreak  Virus is alive in your system if you had the Chicken Pox. 17
  • 18. Healthcare Worker Duty  To protect patients from infection  To protect yourself  To protect co-workers 18
  • 19. HBV Infection Rate - US  Universal vaccination  Cases declined 89% from 1990-2011  Healthcare worker infection infrequent 19 CDC, Nov.. 2011,2013,
  • 20. Vaccine - HBV  Need to complete all 3 shots  1 dose = 30% - 55% protection  2 dose = 75% protection  3 dose = >90% protection 20 CDC, MMWR, Nov. 2011
  • 21. Vaccine Protection  Person who respond are protected for > 22 years 21CDC, December, 2013
  • 22. Healthy People 2020  Target to have 90% of HCWs vaccinated against HBV 22
  • 23. HCV Increased  Due to improper infection control practices  Outbreaks  30 outbreaks 23
  • 24. CDC – Testing Baby Boomers  Persons born between 1945 – 1965 should be tested for HCV –  New York passed a law to have this in place- Dec. 2013 24
  • 25. New Rapid HCV Test  OraQuick ®HCV  FDA approved  Takes 20 mins.  No lab equipment required  Very accurate- 99.8%  Waiver granted 11/28/11**  Screens for multiple genotypes 25 FDA. June 25, 2010, 2013
  • 26. CDC Guidelines for Labs  Rapid HCV – if positive  Confirm with HCV-RNA (viral load) 26 CDC, May 7, 2013
  • 27. Remember A positive test for HCV by antibody testing does NOT mean current infection Source patient to have viral load test for confirmation (HCV-RNA) 27CDC, Hep C Symposium Dec.,2011
  • 28. Reminder -  If you are exposed to a hepatitis C positive patient, you should have a blood test in 2 weeks  HCV-RNA (blood test)  Cost - $65.00 - $100.00 28 Am. Assoc. for the Study of Liver Disease, Practice Guidelines, 2009
  • 29. Hepatitis C – Early Treatment  HCV-RNA positive begin treatment  12 -24 weeks – ○ 2014 now 8-12 weeks 29
  • 30. Newer Drugs Olysio  Treatment Genotype 1 Solvadi  Treatment Genotype 1 & 4 30 Cure more often and in less time 8 - 12 weeks 80% - 95+% 2014
  • 31. Infected Healthcare Workers- Occupational Infection-HIV  1978 – December, 2010  57* documented cases ○ 0 in fire/EMS personnel ○ 49 were sharps related exposures ○No new cases since 1999 31 CDC, 2012(CDC), NIOSH
  • 32. Update - 2011  Aids “cocktail” drugs = 96% unable to transmit the disease  HIV/AIDS – living 50 years 32 Dr. Fauci, NIH, May 2011
  • 33. Result 3 Drug Cocktail  Atripla – 84%- 0 HIV virus in blood in 48 weeks  Stribild – 88% - 90% 0 in 48 weeks  Truvada – 87% 0 in 48 weeks 33 CDC, Oct. 2012
  • 34. Rapid HIV Test - currently available – using blood OraQuick Reveal Uni-Gold Multispot Clearview 34 CDC January 2007
  • 35. Reminder - Testing Issues - Post Exposure  If source patient is negative with rapid testing = no further testing of health-care worker  Use of rapid testing will prevent staff from being placed on toxic drugs for even a short period of time 35 •CDC, May , 1998, CDC June 29, 2001, September 2005 •Sept. 2013
  • 36. Source is positive  Test employee baseline  Repeat at 6 weeks  Repeat at 4 months using rapid test 36 CDC, Sept. 2013
  • 37. Syphilis Cases Part of post exposure testing  Post exposure follow up if source is HIV positive  More testing under new Sexually transmitted disease (STD) guidelines 37
  • 38. Highest States for cases - 2013  California  Texas  New York  Florida 38 CDC, MMWR , 2013
  • 39. Risk Groups  Men who have sex with men  Inmates  HIV infection  Injection drug partners  Sex workers  Senior Communities **Universal Syphilis screening should be conducted on the basis of the local area & prevalence of syphilis (CDC, STD guidelines, 2010) 39
  • 40. 40
  • 41. Tuberculosis  2013 lowest case number since 1953  9,582 for 2013  Goal to eliminate by 2020 - worldwide 41 CDC, MMWR, 2012;61:181-185
  • 42. Multi-drug Resistant TB  MDR-TB – 84% in foreign-born persons  109 cases in 2010  86 - 2012  XDR-TB – 2 cases reported in 2007  XDR-TB 1993 -2007 = 83 cases reported ○ 2008 = 0 ○ 2009 = 0 ○ 2011= 4 cases in foreign-born persons ○ 2013 = 2 ○ Both are treatable ! 42
  • 43. Decrease in TB Cases  National and global decrease due to -  Direct Observed Therapy- DOT 43
  • 44. Risk Assessment - CDC  Based on number of active-untreated TB patients transported in the past year 44 CDC, 2005
  • 45. Risk Assessment - TB  Low Risk  Transported less than 3 TB patients  Medium Risk  Transported more than 3 TB patients 45 CDC TB Guidelines, 2005, pg. 134
  • 46. Testing Issues  Low Risk  On hire  Post exposure  Medium Risk  On hire  Annual  Post exposure 46 CDC/NFPA 1581
  • 47. Department TB Risk Assessment  2013 – 0, low risk 47
  • 48.  QFT-G (In-tube)  FDA approved – October 2007  Less time consuming to perform  More accurate  Cost effective - $33.67 48 New Version TB Blood Test
  • 49. Cost Benefit  2 step testing  Cost per test  Return visits for reading  Repeats ?  Blood test  One draw  No return visits 49
  • 50. Post Exposure -  Testing begins with the source patient!  No need for you to have blood drawn immediately – if at all 50
  • 51. GFD Exposure Policy  SOG 507.15 and 507.15(a)  Exposure Incident- Specific eye, mouth or other mucus membrane, non-intact skin or parenteral contact with blood or other potentially infectious materials that results from the performance of ones duty. 51
  • 52. GFD Exposure Policy  Potentially infectious sources of Infectious Diseases:  Blood  Semen  Vaginal secretions  CSF  Synovial fluid  Pleural fluid 52
  • 53. GFD Exposure Policy  Potentially infectious sources of Infectious Diseases Continued:  Peritoneal fluid  Pericardial fluid  Amniotic fluid  Saliva  Tissue  Any fluid with blood contamination. 53
  • 54. GFD Exposure Policy  Exposure determination by DICO  Documentation:  Exposed member and senior medic shall complete the “Infectious Exposure Form and attach to PCR.  Reviewed by Chief, Deputy Chief- Operations and the Paramedic Coordinator. 54
  • 55. GFD Exposure Policy  Source patient (if known) tested if actual exposure occurs.  Baseline testing offered to employee if desired.  Employee offered post exposure prophylaxis in accordance of treatment plan outlined by treating physician.  Deputy Chief of Ops. Is the designated officer to ensure policy is followed. 55
  • 56. GFD Exposure Policy  Interaction with Health Care Professionals, written opinions offered:  HBV  Following exposure. Opinion limited to:  Confirmation of vaccine or evaluation post incident.  The results of the evaluation and any testing.  Employee informed about any medical conditions resulting from exposure.  NO PERSONAL Medical information.  All HIPAA rules apply.  Files kept for 30 years post employment. 56
  • 57. GFD Exposure Policy  Department offers PPE and by policy must be used,  Gloves  Gowns  Level B suits  Goggles/face shields  Hair covers  Foot covers  Use and clean equipment properly 57
  • 58. Flu Vaccine - Annual “Direct patient care” All healthcare workers 58
  • 60. Over 65 - Vaccine  Fluzone High dose  4 times the amount of antigen ○ Quadrivalent 60
  • 61.  Flublok  No virus  No eggs used in production  No antibiotics/mercury  DNA technology 61 New Flu Vaccine FDA, 1/16/13
  • 62. DNA Vaccines  Direct injection of genetic material into a living host causes a small amount of its cells to produce the introduced gene products  Results in the specific immune activation of the host against the gene delivered antigen 62
  • 63. Universal Vaccine?  New antibody identified inhibits many strains of influenza  CH65 63 Infectious Disease News, Aug. 24,2011 Announced 2/16/13
  • 64.  Lower than any other HCW group in 3 studies 64 Flu Vaccine EMS Participation
  • 65. Work Restriction  Restrict ill workers from the workplace  use sick time ○ protect co-workers ○ protect patients 65 CDC/NFPA 1581
  • 66. Transmission – Based Precautions  Contact precautions  Droplet precautions  Airborne precautions 66
  • 67. Contact Precautions  Wear gloves  Gown ?  Clean and disinfect all contact items  BP cuff, stethoscope etc, 67
  • 68. CRE – New Resistant Organism  Carbapenem-Resistant enterobacteriaceae  High mortality rate  Difficult to treat  Contact Precautions  Not acquired by healthy people 68
  • 69. 69
  • 70. Droplet Precautions  Standard Precautions  Surgical mask use – patient  Within 3 feet 70
  • 71. Droplet Precautions  Appropriate for –  Influenza  Pertussis  Meningitis  Mumps 71
  • 72. Prevention  Place surgical mask on patient  If can not, place surgical mask on yourself  Good handwashing  Use good airflow in vehicle 72 IOM meeting June 3, 2010/ CDC
  • 73. Remember  Even the most elaborate PPE requires proper removal !
  • 74. Environmental Cleaning  An EPA-registered hospital disinfectant or 1:100 bleach  PPE to include;  Face protection  Gloves  Consider leg covers/shoe covers (large amount of fluids present) COCA Conference CDC, August 5, 2014 74
  • 75. Survival on Surfaces  Can survive on surfaces for several hours and then dies 75
  • 76. Red Bag Waste A Hazmat situation ?  Can be incinerated  Or Inactivated 76
  • 77. 77
  • 78. Airborne Precautions  Standard Precautions  Surgical mask for fire/EMS use  6 foot distance  If task generates splash/spray use eye protection 78
  • 79. Airborne Diseases  Chickenpox  Measles  Tuberculosis 79
  • 81. Transmission  Human – to – Human Transmission  Direct contact through (broken skin or mucous membranes) with blood, secretions, organs of infected persons  Contact with contaminated environments WHO/CDC
  • 82. Transmission  Men who have survived the disease can transmit the virus through their semen for up to 7 weeks after recovery  Present in breast milk WHO
  • 83. Prevention - Travel  Travelers are screened for signs and symptoms before flying  If ill on a plane, the crew notified the pilot – who notifies medical personnel at the airport  Medical team assesses and if needed hold the patient at the airport 83
  • 84. Travel History  Travel history to Africa or contact with a know or suspect Ebola patient  Symptoms-  Fever>101.5  Part of Patient assessment  Standard Precautions  Contact Precautions  Droplet Precautions  Mask patient
  • 85. Cleaning Post Transport  EPA- approved hospital grade disinfectant  Bleach & Water @ 1:100 dilution 85
  • 86. Red Bag Waste A Hazmat situation ?  Can be incinerated  Or Inactivated 86
  • 87. Risk Perception – Questions to Consider  What is the population in your area from West Africa ?  What companies in your area send employees to West Africa ? 87
  • 89. Handwash Study - EMS  Study from Robert Woods Johnson University Hospital  1,500 EMS providers surveyed  13% compliance ○ First responders ○ EMS providers ○ Paramedics 89 11/12/13