This document provides information on updated disease notification responsibilities and immunization guidelines. It lists diseases that medical facilities must notify responders about after exposure. These include bloodborne, airborne, and droplet transmitted diseases like hepatitis, HIV, influenza, meningitis and more. The document discusses prevention of diseases through travel screening, herd immunity from vaccination, and recent disease case numbers. It provides guidance on healthcare worker vaccination and testing requirements.

1. 1
IC/EC, Inc.

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

59. New Vaccines/ Options
59

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

80. Ebola Outbreak -
2014
80

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

88. Handwashing
88

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