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
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
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
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
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
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
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
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
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
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
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
78. Airborne Precautions
Standard Precautions
Surgical mask for fire/EMS use
6 foot distance
If task generates splash/spray use eye
protection
78
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