Emergency Medical Services Infection Control for Emergency First

Emergency Medical Services “Infection Control” for Emergency First Responders Body Substance Isolation March 04, 2020 Department of Emergency Services and Public Protection

Body Substance Isolation (BSI) “An infection control strategy that considers all body substances as potentially infectious. ” Similar to Universal Precautions. . But goes further in isolating workers from Pathogens Department of Emergency Services and Public Protection

“Two” Levels of B. S. I. – P. P. E. • “Standard” Level of B. S. I. – Everyday calls, First Responder Protection • “Isolation” Level of B. S. I. (special circumstances) – Full Body Protection – No Skin Exposed Department of Emergency Services and Public Protection

“Standard” Recommended P. P. E. • • • Gloves Eye / Face splash protection Splash Protection – Gowns N 95 or N-100 mask Disposable resuscitation equipment Department of Emergency Services and Public Protection

“Standard” P. P. E. – Gloves Department of Emergency Services and Public Protection

“Standard P. P. E. – Eye Protection Department of Emergency Services and Public Protection

“Standard” P. P. E. – Gowns Aprons Gowns Department of Emergency Services and Public Protection

“Standard” P. P. E. – Respiratory Respirators that filter out at least 95% of airborne particles during “worse case” testing using a “most-penetrating” sized particle are given a "95" rating. Those that filter out at least 99% receive a “ 99” rating. And those that filter at least 99. 97% (essentially 100%) receive a “ 100” rating. Department of Emergency Services and Public Protection

“Standard” P. P. E. – Kits Department of Emergency Services and Public Protection

Disposable Respiratory Devices Department of Emergency Services and Public Protection

“Isolation” P. P. E. • • Gloves – Double Glove Eye / Face splash protection – NO GOGGLES Gowns / Coveralls – Complete Body Coverage Hood – if not part of Splash Protection or PAPR Ensemble • Respiratory Protection: PAPR or N 95 (Powered Air Purifying Respirator) • Boot Covers – if not using a one piece suit • Disposable Resuscitation Equipment Department of Emergency Services and Public Protection

“Isolation” P. P. E. – Gloves Double Glove is highly recommended; First Pair put on first under sleeve cuff Second Glove over top on top of Sleeve Cuff Department of Emergency Services and Public Protection

“Isolation” P. P. E. – Eye Protection CDC is recommending full face shields or full hoods for eye protection. Googles / Glasses tend to “Fog” – Responders then place hands near the eyes to move goggles, thus potentially exposing to disease Department of Emergency Services and Public Protection

“Isolation” P. P. E. – Gown / Coveralls Department of Emergency Services and Public Protection

“Isolation” P. P. E. – Hoods offer more body protection, usually require PAPR air supply Department of Emergency Services and Public Protection

“Isolation” P. P. E. – Respiratory Powered Air Purifying Respirators (PAPR) are recommended for long duration work capacity and reliability Department of Emergency Services and Public Protection

“Isolation” P. P. E. – Boot Covers Knee high boot covers are recommended depending on the type of protective suit / coveralls being used Department of Emergency Services and Public Protection

“Isolation” P. P. E. – Ventilation Equipment Department of Emergency Services and Public Protection

Personal Protective Equipment • • • Proper usage Storage location(s) Proper removal On scene self decontamination Hand Washing Disposal Department of Emergency Services and Public Protection

Incident Operations & Recovery The Infection Control Process Department of Emergency Services and Public Protection

Incident Operations & Recovery • Four phases of response – Preparation for response – Response – Scene management – Post-response recovery Department of Emergency Services and Public Protection

Preparation Phase • IC Training • SOP/SOG Enforcement • Storage of PPE (vehicles & station) – Regular inventory, maintenance • Personal Hygiene – In and out of the station Department of Emergency Services and Public Protection

Response Phase • Evaluation of dispatch information – A. K. A. “Size-up” • Don PPE en route when possible • Prepare mentally • Confidentiality and the radio Department of Emergency Services and Public Protection

Scene Management Phase • Operations at scene – Use BSI / PPE – Limit patient contact – Use mechanical resuscitation devices – Do not recap needles – Handle sharps only when necessary Department of Emergency Services and Public Protection

In health care workers, 80% of exposures are due to sharps injuries. The greatest percentage of needle-stick accidents occur during recapping! Department of Emergency Services and Public Protection

Scene Management Phase • Operations at scene – Use mechanical clean up methods (e. g. Dust pan & brush) – Properly dispose of waste • Appropriate containers – Properly package contaminated gear • Transport to fire station safely Department of Emergency Services and Public Protection

Scene Management Phase • Public relations at the scene – Explain universal precautions • If patient is uncomfortable with gloves, etc. – Reasonable BSI (e. g. Coveralls for chest pains is overkill) Department of Emergency Services and Public Protection

Scene Management Phase • Public information at the scene – Patient’s medical status confidential • Do not broadcast – Use care when discussing patient’s information at scene • Medical information is “need to know” Department of Emergency Services and Public Protection

Post Response Phase • Proper disposal of PPE – Appropriate containers • Red “Bio” bags • Sharps containers – Designated decon area • Immediate decon (In house) • Storage for out-of-house decon Department of Emergency Services and Public Protection

Post Response Phase • Disinfection, Decon, & Cleaning – Four level’s of disinfection: • Low level – Routine ambulance cleaning • Intermediate – Typical post response • High level – (ie. Intubation equipment) • Sterilization – Destroys all micro-organisms Department of Emergency Services and Public Protection

Disinfection • Low level: – Routine housekeeping – Routine Cleaning – Removal of soil in absence of visible body fluids Department of Emergency Services and Public Protection

Disinfection • Intermediate level: – – – Destroys mycobacterium TB Vegetative Bacteria Most viruses & Fungi NOT Bacterial spores Typical method for ambulances Department of Emergency Services and Public Protection

Disinfection • Intermediate level: – Three types: • EPA registered Disinfectant • Commercially available hard surface germicides • Water-Chlorine Bleach (1: 100) – 2 cups bleach to 1 gal. water Department of Emergency Services and Public Protection

Disinfection • High level: – Destroys all forms of micro-organisms • Except large numbers of bacterial spores – Required for reusable instruments • Contact with mucous membranes (i. e. Laryngoscope blades) Department of Emergency Services and Public Protection

Disinfection • Sterilization: – Destroys all micro-organisms – Usually not practical for EMS Department of Emergency Services and Public Protection

Post Response Phase • Equipment Decontamination – Conducted in designated area – Use appropriate PPE – Gross Decon • Mild soap & water – Use appropriate level disinfectant – Air dry in clean storage area Department of Emergency Services and Public Protection

Post Response Phase • Cleaning of PPE - Uniforms – Decon ASAP upon returning – Store appropriately until laundering – Launder in designated front loading washer or commercially – Follow manufacturers instructions – No chlorine bleach on turnout gear – Do not bring home! Department of Emergency Services and Public Protection

Post Response Phase • Wash Hands and Exposed Skin Often • Wash Thoroughly • Wash with Anti-Bacterial Soap Department of Emergency Services and Public Protection

Station / Home Issues • Equipment Storage – Ensure proper storage equipment / supplies – Monitor usage levels for inventory Control – Monitor shelf life – Maintain SDS’s Department of Emergency Services and Public Protection

Station / Home Issues • Laundry Issues: – Commercial front loading washer • Automatic pre-metered detergent • Computerized cycles • High temperature • Water completely drains out • Again… Do not bring home! Department of Emergency Services and Public Protection

Station / Home Issues • Designated decontamination area – Separate room, properly marked, secure – Proper ventilation – Adequate drainage, including floor – Non-porous sink with hot & cold water – Automatic water for hand washing – Rack/shelves for drying – Appropriate supplies Department of Emergency Services and Public Protection

Program Evaluation • On-going risk assessment – Annual Re-Evaluation of: • Administrative controls (Management Policy) • Engineering controls (Physical changes to the workplace) • Work practice controls (Modified methods) • PPE • Vaccinations Department of Emergency Services and Public Protection

Program Evaluation • Annual record review – Safety committee • Sharps log • Injury log • Exposure reports Safety Committee Department of Emergency Services and Public Protection

Summary Questions & Answers Department of Emergency Services and Public Protection

NEVER FORGET Department of Emergency Services and Public Protection