Bloodborne Pathogens 2014 Annual CE Condell Medical Center

Bloodborne Pathogens 2014 Annual CE Condell Medical Center EMS System Site Code: 107200 E-1214 Prepared by: Sharon Hopkins, RN, BSN, EMT-P 1

Objectives n Upon successful completion of this module, the EMS provider will be able to: n 1. Define the involvement of federal agencies related to bloodborne pathogens. 2. Describe employer responsibilities to employees per OSHA Standards 3. Define bloodborne pathogen (BBP). 4. List an example of potential bloodborne pathogens. 5. Define the term standard precautions. n n 2

Objectives cont’d n n n 6. Define personal protective equipment (PPE) available for use. 7. Define & list examples of engineering controls. 8. Define & list examples of work place controls. 9. Describe benefits of hand washing versus use of antiseptic hand products 10. Recognize signs or labels used to indicate the presence of a bloodborne pathogen hazard. 3

Objectives cont’d n n n 11. List transmission routes of bloodborne pathogens in the workplace. 12. Describe the phases of the infectious process. 13. List factors affecting disease transmission 14. Describe characteristics of the immune system. 15. Discuss definition, incubation period, transmission route, signs and symptoms, and PPE to use for a variety of infectious diseases. 4

Objectives cont’d n n n 16. Describe components of housekeeping and when they are performed 17. Describe necessary recordkeeping related to bloodborne pathogens. 18. Review the CMC EMS System Operating Guideline (SOG) policy for infection control and exposure. 19. Describe the “Notification of Significant Exposure” form and how to complete and forward the form. 20. Successfully complete the post quiz with a score of 80% or better. 5

Why Take A BBP Program? Increase your awareness of hazards n Increase your knowledge base n Understand steps to take for prevention of contracting or spreading illness n Understand your role in the healthcare environment n Know how to make your environment as safe as possible for all n 6

Federal Agency Involvement n CDC ¨ Monitors national disease data ¨ Disseminates information to all health care providers n NIOSH works with OSHA ¨ Sets standards & guidelines for workplace and worker controls to prevent infectious diseases in workplace 7

Federal Agency cont’d n OSHA ¨ Occupational Safety and Health Administration ¨ Protects the health of workers ¨ Bloodborne Pathogen (BBP) Standards protects employees at risk of exposure to blood or other potentially infectious material (OPIM) ¨ Requires employers to develop written documents regarding implementation and training of the Standard 8

Employer Responsibilities – Written Exposure Control Plan must be in writing and accessible 24/7 n Plan is to be updated annually n Plan is to be written including all elements required by OSHA BBP Standard 29 CFR 1910. 1030 n Plan needs to be tailored to the individual requirements of your department n 9

Written Exposure Control Plan cont’d Identify hazards in the workplace n Identify which tasks could expose employees n Identify which employees could have potential exposure based on tasks expected n Identify and provide appropriate PPE n Train employee in use & care of PPE’s n Maintain PPE’s and replace worn or damaged PPE’s n 10

Written Exposure Control Plan cont’d n Implement various methods of exposure control ¨ Standard precautions ¨ Engineering and work practice controls ¨ Housekeeping n n Make available Hepatitis B vaccination Offer post-exposure evaluation and follow-up Evaluate circumstances surrounding an exposure Maintain recordkeeping 11

Bloodborne Pathogen (BBP) Microorganisms carried in blood that can cause disease in humans n Disease transmitted by contact with blood or body fluids of an infected person n Risk of exposure increases in presence of open wounds, active bleeding, or increased secretions n 12

Normal Flora Microorganisms that live in and on our bodies without causing disease n Part of host defenses n ¨ Help keep us free of disease ¨ Normal flora creates an environment not conducive to disease-producing microorganisms (pathogens) n Opportunistic pathogen ¨ Usually non-harmful pathogens that cause disease in unusual situations (i. e. : weakened immune systems) 13

Examples BBP HIV/AIDS n Hepatitis B (HBV) n Hepatitis C (HCV) n Hepatitis D (HDV) n Syphilis n Malaria n Brucellosis n 14

Other Potentially Infectious Agents n n n n n Cerebrospinal fluid Synovial fluid Pleural fluid Amniotic fluid Pericardial fluid Peritoneal fluid Semen Vaginal secretions Any body fluid contaminated with blood or saliva in dental procedures Body fluids in emergency situations that cannot be recognized – blood, saliva, vomit, urine 15

Exposure Potential Contact with another person's blood or bodily fluid that may contain blood n Mucous membranes – eyes, mouth, nose n Non-intact skin n Contamination via sharps or needles n 16

Most Common Exposures Needlesticks ü Cuts from contaminated sharps – scalpels, broken glass ü Contact with mucous membranes – eyes, nose, mouth, broken/cut/abraded skin with contaminated blood/fluid ü 17

Safe Practice Everyone’s got something that you don’t want Take precautions with every potential exposure – seen and unseen 18

Standard Precautions n n n Term includes universal precautions and body substance isolation (BSI) Includes a group of infection prevention practices applied to all patients in the delivery of healthcare ¨ Based on principle that everyone may have something you don’t want ¨ You can’t always “tell” what infectious process someone may have Application of Standard Precautions dictated by task being performed related to potential for exposure 19

Standard Precautions cont’d n Routine use of appropriate PPE taken to prevent exposure to any contact of blood or other body fluids ¨ Protects skin and mucous membranes ¨ Frequent handwashing performed n Hand sanitizer acceptable in absence of soap & water especially in absence of gross material ¨ Precautions taken to avoid needle sticks 20

Personal Protective Equipment PPE n The type of protective equipment appropriate for your job or research varies with the task and the degree of exposure you anticipate 21

PPE’s n Eye and face protection Hand protection (i. e. : gloves) Protective clothing (i. e. : gowns) n Employee needs to be informed: n n ¨ When and what PPE to use ¨ How to put PPE on, adjust it, wear it, and take it off ¨ Limitations of PPE ¨ Maintenance, care, useful life, and disposal of PPE 22

Using PPE’s n Why do you think hand washing is promoted so much? ¨ Most pathogens are transferred via our contaminated hands n n When wearing gloves, are you aware of when they come into contact with potential pathogens? Are you aware of what you do with your gloved hands and how many times you touch and potentially cross contaminate? 23

PPE Use n n Gloves – intact Utility gloves – broken glass & sharps Gowns – impervious to fluids Tyvek suit – gross contamination anticipated n n n Face shield – invasive procedures Goggles – shields front, sides, top of eyes Surgical mask – worn with eye protection Booties – to cover shoes/boots Head covering splashing 24

PPE’s n n n To be worn/used in potential exposure situations Removed & replaced if not functioning due to puncture or tearing Contaminated clothing removed as soon as possible PPE removed before leaving work area Handle contaminated laundry as little as possible Know where PPE’s are kept 25

PPE’s Can only be useful if worn n Know how to use your PPE’s n ¨ IF not sized and used appropriately, it’s like not using one at all 26

Removing Gloves n n n Place fingers of one hand under cuff of 2 nd glove and avoid contact with skin Slowly pull glove off turning it inside out as it removed Place removed glove into palm of gloved hand Slowly pull remaining glove off turning it inside out as you remove it and capturing 1 st glove inside 2 nd glove Dispose of properly Wash hands including wrist area 27

Engineering Controls n Devices that isolate or remove bloodborne pathogen hazards from the workplace to minimize exposure ü Sharps disposal containers ü Needleless systems ü Self-sheathing needles n Devices only good if & when they are used 28

Work Practices n Practices that reduce the likelihood of exposure by altering how a task is performed ¨ Handwashing (preferably frequent!!!) ¨ Recapping a needle with the one-handed technique, if at all ¨ Not eating or drinking in ambulance ¨ Disinfecting equipment and vehicle ¨ Changing from soiled clothing ¨ Keeping work area clean and decontaminated 29

Handling Sharps n Avoid recapping needles ¨ If n necessary, recap with the one handed technique Never break shear needles Use mechanical devices to move or pick up used needles (i. e. : forceps, pliers) Dispose of needles in labeled sharps container ¨ Do n not overfill sharps container To transport sharps container, close to prevent spilling 30

Handwashing Single, most effective means of work practice control that is highly effective n Performed before and after every patient exposure n Performed after removal of gloves n Performed prior to eating n Performed after toileting n Wash hands for 15 – 20 seconds including all surfaces of hands and up to wrists n 31

How Good Are You? n Frequently missed areas when hand washing performed 32

Antiseptic Hand Cleaner n Antiseptic hand cleaners may be used as an appropriate hand washing practice IF: ü Your gloves remained intact ü You have had no occupational exposure to blood or other potentially infectious materials ü Material can be left to air dry on your skin n Choose product with at least 60% alcohol base 33

Hazardous Material Labels Warning label of fluorescent orange or orange red with contrasting letter and symbols (universal symbol) n Must be used to identify presence of blood or other potentially infectious material n Use of red bags substitutes for use of labels n 34

Biohazard Labels cont’d n Affixed to ü Containers of regulated waste ü Containers of contaminated reusable sharps ü Refrigerators or freezers containing blood or OPIM ü Other containers used to store, transport, or ship blood or OPIM ü Contaminated equipment being shipped for servicing ü Bags of contaminated laundry 35

n. How do we get exposed? n. What is the infectious process? n. What are the risk factors? 36

Factors Affecting Transmission Correct mode of entry available for that pathogen n Virulence – strength or ability to infect or overcome body’s defenses n Number of organisms – minimal dose necessary to cause infection n Resistance of host – ability to fight off pathogen n 37

Modes of Transmission n n n n Bloodborne Airborne Droplet Fecal-oral Indirect Opportunistic* Sexual* *Sexual route and opportunistic not of concern to on-the-job EMS provider 38

Bloodborne Exposure n Direct or indirect contact with blood or infected body fluids ¨ Needle stick ¨ Splash on broken skin ¨ Splash on mucous membranes n Eyes, nose, mouth 39

Airborne Exposure n n Particles remain suspended in air a long time and float over a distance Most risk at less than 6 feet from source Transmitted via sneezing, coughing, talking, shedding of skin Patient to wear a surgical mask to minimize spread of disease ¨ TB, n polio, pneumonia, influenza, chicken pox Healthcare worker to wear N 95 to prevent exposure to particles 40

Droplet Exposure n n n Droplet of moisture expelled from upper respiratory tract and then inhaled into respiratory system or contact with mucous membranes Droplets too heavy to remain airborne for long Transmitted via sneezing, coughing, talking Most at risk within 3 feet of source Common cold, influenza, H 1 N 1, meningitis, rubeola (measles), whooping cough 41

Indirect Exposure n Contact with a contaminated object or surface and then material is transferred to your mouth, eyes, nose or open skin ¨ HBV can survive about 7 days dried on a surface ¨ HIV does not live long outside the body 42

Fecal-Oral Exposure Ingestion of contaminated food or water n Contaminated hands transfer microorganisms to all surfaces and objects touched n Recipient touches contaminated surface and then brings contaminated hands to face or ingests contaminated product n ¨ HAV, food poisoning 43

Phases of The Infectious Process n Latent period ¨ Host infected but not infectious; cannot transmit the agent n Communicable period ¨ May have some signs and can transmit to another host n Incubation period ¨ Time between exposure and presentation of signs and/or symptoms; can range from days to months to years 44

Phases Cont’d n Seroconversion ¨ The point in time when antibodies are developed and a previously negative lab test is now positive n Window phase ¨ Time between exposure to disease and seroconversion n Disease period ¨ Time from onset of signs and symptoms until resolution or death 45

Factors Affecting Disease Transmission n Mode of entry ¨ Point of entry available (i. e. : non-intact skin, mucous membrane) n Virulence ¨ Strength n Dose ¨ Number n of organism (ability to infect) of organisms Host resistance ¨ Is host healthy or not? 46

Stopping a Potential Infection n Break the cycle at any one of 4 points: Infectious agent Means of transmission Host Routes of exposure 47

The Immune System n n n Protects body from foreign invaders Needs to differentiate self from nonself Can recognize antigens of most bacteria and viruses as foreign material Series of actions put into motion to eliminate the foreign material or antigen The inflammatory response initiates defense mechanisms for release of special chemicals, processes and formation of antibodies all to fight disease 48

Infectious Disease Discussion The following slides discuss a few select diseases that may be problematic for the healthcare worker or at least something to be aware of n Reminder: n ¨ Assume all persons have something contagious that you don’t want! 49

Review Selected Infectious Diseases Definition Incubation Period Transmission Mode Signs & Symptoms Recommended PPE’s Special Considerations 50

HIV A fragile virus that attacks the immune system n Eventually leads to AIDS – a collection of signs and symptoms n Incubation is variable and can be in years n Transmission n ¨ Sexual contact ¨ Contact with contaminated blood ¨ Mother to newborn 51

HIV cont’d n Signs & symptoms ¨ Fatigue, fever, sore throat, lymphadenopathy, splenomegaly, rash, diarrhea, secondary infections, weight loss, dementia, psychosis n n n No vaccine PPE – gloves, goggles, mask, gown as needed to avoid blood contamination HIV rarely presents life threatening ¨ Is n more often a psychosocial challenge Antibodies develop in approximately 6 - 12 weeks post exposure ¨ Keep scheduled appointments for serial lab draws 52

Hepatitis B (HBV) Viral infection; can develop into chronic state; affects the liver n Incubation 4 - 25 weeks n Transmitted by direct contact with blood or body fluids n Complaints start as flu-like symptoms n ¨ Dark urine, light colored stools, fatigue, fever, jaundice, abdominal pain, loss of appetite, nausea/vomiting 53 ¨ Can begin 1 -9 months after exposure

Hepatitis B Virility n n n The CDC states that Hepatitis B Virus can survive for at least one week in dried blood on environmental surfaces or on contaminated instruments NOT spread via contaminated food or water, via breast feeding, coughing/sneezing/kissing, or sharing eating utensils PPE’s – gloves, goggles, mask, avoidance of needlesticks 54

Hepatitis B Vaccine n n Available since 1982 Highly effective means of protection from the virus ¨ Decline n n Must be offered within 10 days of assignment to task involving an exposure risk If employee declines, must sign declination form ¨ Kept n in number of cases most likely due to vaccine on file Employee may, at any time, request the hepatitis B vaccine after initial declination ¨ 3 injection series ¨ Given IM in deltoid ¨ Once started, 2 nd dose from 1 st dose is in 1 month; 3 rd dose 6 months 55

Hepatitis C (HCV) n Viral infection causing inflammation of liver ¨ Currently, most common chronic bloodborne infection in the USA Leading reason for need of liver transplant in the USA n Can lead to cirrhosis and cancer n ¨ 75 – 85% of infected people develop chronic infection n Incubation 2 -25 weeks 56

HCV cont’d n Transmission – contact with contaminated blood ¨ Most common exposure is to sharing needles and equipment for illicit drug injection n n Contagious throughout course of infection Symptom onset slow (up to 20 years for chronic infection) ü ü n n Loss of appetite Vague abdominal discomfort Nausea and/or vomiting Jaundice less common than with HBV No vaccine currently available PPE’s – gloves, mask, goggles, avoidance of needle sticks 57

Tuberculosis (TB) Bacterial infection most commonly affecting the lungs n TB infection n ¨ Person has the bacteria but is not ill; cannot spread disease n TB disease ¨ Person ill, can spread TB Incubation 4 -12 weeks n Transmission via airborne droplet n ¨ Prolonged exposure increases risk 58

TB cont’d n Signs and symptoms ¨ Fever ¨ Chills ¨ Weakness. fatigue ¨ Night sweats ¨ Weight loss ¨ Dyspnea ¨ Productive cough ¨ Chronic cough 59

TB cont’d n N 95 for healthcare worker PPE’s ¨ Respiratory isolation ¨ Tight fitting surgical mask on patient ¨ N 95 mask for providers n Obtain periodic skin testing ¨ If n positive, need chest x-ray Provide adequate ventilation while caring for and transporting the patient with suspected or positive diagnosis Surgical mask for patient 60

Chickenpox (Varicella) Viral infection n Transmitted via direct and indirect contact and airborne droplets n Incubation 10 - 21 days n Signs and symptoms n ¨ Sudden onset low-grade fever ¨ Mild feeling of not being well (malaise) ¨ Rash 61

Chickenpox cont’d Contagious about 2 days prior to rash and until all vesicles have scabbed over n Skin eruptions continue over 3 – 4 days n PPE’s – gloves; surgical mask on patient, mask on healthcare provider n Vaccination added to childhood immunization schedule n 62

Bacterial Meningitis Bacterial infection causing inflammation of the covering the brain and spinal cord n Transmitted via contact with respiratory droplets n Incubation – 2 – 10 days n Sudden onset high fever, headache, stiff neck, nausea with vomiting, irritability ¨Infants – poor feeding, irritability n 63

Bacterial Meningitis cont’d PPE’s – gloves, mask (patient and provider) n Vaccination provided in childhood immunization schedule n Postexposure antibiotic prophylaxis provided after exposure n 64

Influenza – The Flu n n Upper respiratory viral disease Transmitted via respiratory droplet or airborne in crowded, enclosed spaces Incubation usually 1 – 5 days Adults contagious 3 – 5 days after symptom onset ¨ Up n to 7 days in children Rapid onset high fever, headache, muscle aches, sore throat, dry cough 65

Flu cont’d PPE – Mask the patient (surgical mask) and provider (N 95) n Frequent handwashing n Daily cleaning of environment n ¨ Phones, door handles, steering wheels, counter tops, computers n Best protection – annual flu vaccine 66

General Advice n n Get vaccinated Cover mouth and nose when coughing or sneezing ¨ Use elbow not hand ¨ Throw tissue away after one use n n n Wash hands often Avoid touching eyes, nose, mouth with hands Practice good personal health ¨ Get plenty of rest ¨ Eat healthfully ¨ Manage stress ¨ Stay physically active 67

3 C’s To Stay Healthy n CLEAN – COVER – CONTAIN C Wash your hands C Cover your cough and sneeze C Contain your germs n Stay home if sick 68

Pertussis – Whooping Cough n n Highly contagious bacterial disease Incubation 7 – 10 days ¨ Range n n total 4 – 21 days Transmitted most commonly respiratory droplet and airborne Most at risk ¨ Infants prior to vaccination ¨ Aging population with lost immunity ¨ Those never vaccinated 69

Whooping Cough cont’d n Signs and symptoms in phases ¨ 1 st phase – sneezing, watery eyes, loss of appetite, listless, noticeable night cough ¨ 2 nd phase – in 10 -14 days paroxysms of coughing, thick mucous coughed up ¨ 3 rd phase – in 4 weeks coughing decreases in frequency; can last for months ¨ Vaccination – DTa. P n Immunity not life long; need repeat vaccination 70

Whooping Cough cont’d PPE – gloves, surgical mask patient and provider, goggles, possible gown n Complications often from the spasmodic forceful coughing n ü Pneumothorax ü Rib fractures ü Hypoxia during coughing spells 71

Staph Infections n n n Staphylococcus aureus, often referred to simply as "staph, " are bacteria commonly carried on the skin or in the nose of healthy people Approximately 25% to 30% of the population is colonized (bacteria are present, but not causing an infection) in the nose with staph bacteria One of the most common causes of skin infections in the United States Most of these skin infections are minor (such as pimples and boils) and can be treated without antibiotics Staph bacteria can also cause serious infections 72

MRSA – Methicillin-Resistant Staphylococcus Aureus Type of bacteria that is resistant to common antibiotics such as methicillin, oxacillin, penicillin and amoxicillin. n Consequently, MRSA infections can be far more difficult to treat quickly than traditional staph infections. n Occurs most frequently among persons in hospitals and healthcare facilities who have weakened immune systems. n 73

Community Associated MRSA n n n MRSA infections acquired by persons who have not been recently hospitalized or had a medical procedure (such as dialysis, surgery, catheters) are known as CA-MRSA (Community Associated MRSA) infections. CA-MRSA infections can be transmitted in settings such as workout facilities or locker rooms Are usually manifested as skin infections such as pimples and boils 74

Results Of Contracting MRSA Skin infections, pimples, boils ü Pneumonia ü Bloodstream infections ü Potentially death ü 75

Transmission of MRSA n Spread of MRSA skin infections is direct and indirect Close skin-to-skin contact ü Cuts or abrasions ü Poor hygiene ü n Methods of Contraction Crowded living conditions ü Contaminated items or surfaces ü Weakened immune system ü 76

MRSA n PPE ¨ Gloves ¨ Transport patient with a clean sheet n Do not use the sheet from the bed the patient was lying in, if possible ¨ Avoid placing laundry in contact with uniform; wear gown if contact made with uniform ¨ Handwashing 77

Vancomycin-resistant Enterococcus - VRE n n Bacteria normally found in intestines Produces disease when bacteria invade other areas ¨ Urinary n tract, wounds, blood Healthy individuals rarely at risk ¨ Healthy individuals can transmit VRE via indirect methods n Those at most risk – weakened immune systems and other health issues 78

VRE n Spread via contact ü Feces ü Contaminated equipment ü Healthcare worker’s hands n PPE ¨ Gloves ¨ Gown if clothing contact anticipated ¨ Handwashing – single most important process to control spread of VRE ¨ Disinfect equipment after calls n Prevents indirect spread of VRE 79

VRE n Spread via contact ü Feces ü Contaminated equipment ü Healthcare worker’s hands n PPE ¨ Gloves ¨ Gown if clothing contact anticipated ¨ Handwashing – single most important process to control spread of VRE ¨ Disinfect equipment after calls n Prevents indirect spread of VRE 80

Clostridium Difficile – C Diff n A spore-forming bacteria normally found in the human gut that is not usually a problem ¨ Overgrowth causes problems n Mild diarrhea to colitis to death n A common cause of antibiotic-associated diarrhea ¨ Antibiotic use increases risk 7 -10 fold while patient taking medication and up to 2 months after discontinuation n Incubation is generally 2 -3 days 81

C Diff cont’d n C diff shed in feces (fecal-oral route) ¨ Transmission is usually via healthcare worker hands ¨ Contaminated material, surfaces, devices contaminated with feces and not properly cleaned n Patients at highest risk ¨ Antibiotic exposure ¨ Long length of stay in healthcare setting ¨ Immunocompromised condition ¨ Advanced age 82

C Diff cont’d n Clinical symptoms ¨ Watery diarrhea ¨ Fever ¨ Loss n n of appetite ¨ Nausea ¨ Abdominal pain/tenderness Colonization = positive test but no symptoms Infection = positive test & clinical symptoms 83

C Diff cont’d n PPE’s ¨ Gloves during patient care ¨ Hand washing after removing gloves n Soap & water over alcohol based hand gels ¨alcohol does not kill C diff spores ¨ Gowns recommended for patient care n Prevents contamination to clothing 84

C Diff cont’d n Special considerations ¨ Adequate cleaning and disinfection of environmental surfaces after care of any patient with diarrhea ¨ Use EPA registered disinfectant with sporicidal claim for environmental surface disinfecting after cleaning surface of gross material n n 1: 10 bleach solution is effective Cavicide is effective Super Sani-cloth NOT effective Important: hand washing, barrier precautions, meticulous environmental cleaning of fecally contaminated surfaces 85

Housekeeping Pay attention to what you are doing n Disinfect equipment between every patient contact n Decontaminate infected equipment as soon as possible n Wear appropriate protective equipment when performing the above tasks n 86

Housekeeping cont’d n n To begin decontamination, clean surface of gross material ¨ Can use soap and water initially n Soap is an emulsifying agent ¨One liquid disperses into another liquid to allow the product to be removed n Metrizyme disintegrates blood & protein After surface cleaning, then apply disinfectant according to product directions ¨ Disinfectant must remain in contact with surface for prescribed time period to be effective 87

Housekeeping and Waste Disposal n n Keeping the worksite clean and sanitary is a necessary part of controlling worker exposure to bloodborne pathogens. Cleaning schedules and decontamination methods depend on: ¨ type of surface to be cleaned n Determine minimal vs frequent opportunity for hand contact to surface ¨ type of soil that is present ¨ particular tasks or procedures that are being performed 88

Cleaning and Decontamination Duties n n n Review product labeling for any special directions/precautions Wear appropriate PPE for task being performed Remove all blood and debris from surface to be cleaned ¨ Products can’t clean the surface if they can’t be in contact with the surface n Allow disinfectant to air dry ¨ Read label directions to determine length of time to leave surface wet based on need for disinfection 89

Example Products 1: 10 dilution 90

Product Labels cont’d n Ethyl or isopropyl alcohol products ¨ Short contact time due to rapid evaporation ¨ Used for small surfaces (i. e. : vial tops) ¨ Alcohol may discolor, harden, crack rubber & certain plastics if extended exposure over time ¨ Not practical for large surface disinfecting ¨ Not effective against C diff 91

Reading Product Labels n “Tuberculocidal” ¨ Does not interrupt or prevent transmission of TB (TB not acquired from environmental surfaces) ¨ Claim used to indicate germicidal potency of product ¨ Indicates intermediate level disinfectant ¨ Capable of inactivating broad-spectrum pathogens including BBP (i. e. : HBV, HCV, HIV) 92

Product Labels cont’d n Bleach ¨ Effective for C diff Won’t have diagnosis at time of transport n Assume C diff for any patient with diarrhea until proven otherwise n Can shed bacterium in stool if asymptomatic n ¨ Replace n cleaning solution frequently Contamination of solution and cleaning tools occurs quickly and can cross contaminate 93

Clean Up Involving Blood or Body Fluids n n n Wear appropriate Personal Protective Equipment (PPE). Carefully cover the spill with absorbent material, such as paper towels, to prevent splashing. Decontaminate the area of the spill using an appropriate disinfectant, such as a solution of one part bleach to ten parts water. When pouring disinfectant over the area always pour gently and work from the edge of the spill towards the center to prevent the contamination from spreading out. 94

Clean Up of Spills cont’d n n n Wait 10 minutes to ensure adequate decontamination, and then carefully wipe up the spilled material. Be very alert for broken glass or sharps in or around the spill. Disinfect all mops and cleaning tools after the job is done. Dispose of all contaminated materials appropriately. Wash your hands thoroughly with soap and water immediately after the clean up is complete. 95

Recordkeeping n Medical records must be kept for each employee with occupational exposure for the duration of employment plus 30 years, must be confidential and must include name and social security number; hepatitis B vaccination status (including dates); results of any examinations, medical testing and follow-up procedures; a copy of the healthcare professional's written opinion; and a copy of information provided to the healthcare professional. 96

Recordkeeping n Hepatitis B vaccination ¨ Maintain n employee status Training ¨ To be delivered annually ¨ Requires access to resource who can answer questions n In person or minimally via phone for instant access ¨ Records to include date of training, contents, signature of trainer and attendees 97

Exposure Incident n Considered occupational exposure if there is infiltration of mucous membranes or via open, non-intact skin ¨ If n in doubt, check it out Report all accidental exposures involving blood or body fluids ¨ ED physician of receiving facility ¨ Your immediate supervisor n n Immediately wash site with soap & water Flush/irrigate mucous membranes as necessary 98

Advocate CMC EMS System Policy Notification of significant exposure is to be reported immediately to the receiving hospital n Complete “Notification of Significant Exposure” form n ¨ Leave n in sealed envelope for EMS coordinator The ED MD on duty will advise the appropriate medical follow-up or need for consultation with private physician 99

EMS System Policy cont’d Follow-up fees responsibility of the provider n If ED care is rendered to the provider, they must sign-in as a patient in the ED n ¨ Guarantees proper documentation of the incident and of care rendered 100

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Bibliography n n n n n http: //www. metrex. com/education-MRSA#reducerisk http: //www. cdc. gov/HAI/organisms/cdiff/Cdiff_faqs_HCP. html http: //www. cdc. gov/niosh/docs/wp-solutions/2010139/pdfs/2010 -139. pdf http: //www. cdc. gov/hicpac/pdf/guidelines/eic_in_HCF_03. pdf H: CE, EMSCE PacketsOSHA Training and Reference Materials Library - OSHA's Revised Bloodborne Pathogens Standard. htm http: //www. osha. gov/Publications/osha 3151. html http: //www. osha. gov/pls/oshaweb/owadisp. show_document? p _table=standards&p_id=10051 www. osha. gov http: //www. cdc. gov/niosh/topics/bbp/genres. htmlhttp: //cid. oxfo rdjournals. org/content/46/Supplement_1/S 43. full 102

Bibliography cont’d n n n http: //www. nursingceu. com/post_tests/display_test/displ ay_test. php? cid=365&pid=3 www. physweekly. com/guide Condell Medical Center EMS System Operational Guidelines & Infield Policy Manual. January 2001 Environmental Health & Safety On-line Training Module. BBP. 2010. National Institute for Occupational Safety & Health. Work Place Solutions: Preventing Exposure to BBP Among Paramedics. April 2010. Region X SOP’s February 1, 2012; IDPH Approved January 6, 2012. 103