Everyone Sign Roster

1
Everyone Sign Roster

• Sign-In Rosters
• Required for all CCVESA Providers.
• Please Print Name, MIEMSS I.D. , and Company
  Affiliation
• All completed rosters must be sent back to the
  EMS Training Coordinator.

2
Carroll County Volunteer Emergency
Services Association
Bloodborne Pathogen Exposure Control Plan
Bloodborne Pathogen 2012 Update
3
Training Objectives

• The purpose of this training is to
• Review OSHA Bloodborne Pathogen Standard.
• Using Case Studies to Review BBP diseases that
  you could come in contact with
• Review PPE needed to minimize exposure
• Review what constitutes an exposure incident
• Review Needle Stick exposures
• Review the appropriate actions to take and
  persons to contact in an emergency involving an
  Exposure
• Review procedures to follow if an exposure
  incident occurs
• Review of required documentation that MUST be
  completed following an exposure
• Review the post-exposure evaluation and follow up
  procedures

4
OSHA Standard

• Occupational Safety and Health Administration
• OSHA Standard 19 CFR 1910.1030
• Occupational Exposure to Bloodborne Pathogens
• Applies to all occupational exposure to blood or
  other potentially infectious materials.

5
OSHA Standard 19 CFR 1910.1030

• Each employer having employee(s) with the
  potential of exposure shall establish a written
  Exposure Control Plan
• Establish Exposure Determination
• Provide Personal Protective Equipment
• Establish good housekeeping procedures
• Provide Hepatitis B Vaccinations
• Establish Post-exposure Evaluation Follow-up
  procedures
• Communication of hazards to employees with
  appropriate Labels and Signs
• Provide Information and Training
• Recordkeeping

6
Annual BBP Training Records

• OSHA requires annual BBP training for all
  volunteer and employees
• Training records are to completed for each
  volunteer or employee upon completion of training
• These documents must be kept for at least three
  (3) years at the office of the EMS Training
  Coordinator

7
Annual BBP Training Records

• Training Records should include
• The dates of the training sessions
• The contents or a summary of the training
  sessions
• The names and qualifications of the persons
  conducting the training
• The names and job titles of all persons attending
  the training sessions

8

• Bloodborne Pathogens of Special Concern To
  Health Care Providers
• HBV Hepatitis B virus
• HCV Hepatitis C virus
• HIV Human Immunodeficiency virus
• InfluenzaH1N1
• Meningitis
• MRSA Staphylococcus Aureus (Staph)
• Tuberculosis

9
BloodBorne Pathogens

• Every patient is a threat to our safety
• Most common BBP are Hepatitis B/C and HIV
• Most common type of BBP exposure in EMS are a
  result of needlesticks.
• There are approximately 600-800k reported
  needlesticks of healthcare workers every year.

10
Types of BBP Exposures

• Percutaneous Exposures Occur Through Broken Skin
  and include
• needle stick with contaminated needle
• cut with a contaminated sharp object
• direct contact of contaminated blood or other
  infectious material with non-intact skin (skin
  that is chapped, abraded, afflicted with
  dermatitis, etc.)
• Mucotaneous Exposures Occur when infectious
  material contacts mucous membranes of the mouth
  or nose

11
What constitutes a BBP exposure?

• The transfer of a patients blood, other bodily
  fluids containing blood, or other potentially
  infectious material, to the providers
  bloodstream by direct transfer, via mucous
  membrane inoculations, or through openings in the
  skin.
• Simple handling of a patient does NOT constitute
  an exposure
• Small amounts of blood or other infectious
  material on intact skin do not constitute an
  exposure.

12
Important things to keep in mind

• Patient contact does not equal exposure
• It is NOT in your best interest to upgrade a
  near miss (for example, blood on intact skin or
  blood near but not on mucus membranes) to an
  actual exposure
• Exposure to blood does not necessarily (or even
  usually) result in exposure to disease
• Most exposures to disease do NOT result in
  infection
• You can greatly decrease your risk of
  occupationally acquired disease by following the
  guidance in this presentation.

13
CASE STUDY 1

• November 21.1930 Hrs
• Your unit is dispatched to a 1624 Main Street for
  a sick female patient

14
ARRIVAL ON SCENE

• Upon arrival you find a 42 year old female
  patient lying supine in bed. She thinks she may
  have the flu
• Patient c/o fever, some upper abdominal pain, and
  nauseated.
• Patient states she has felt extremely tired and
  has no desire to eat.

15
INITIAL ASSESSMENT

• Airway Patent
• Breathing Regular, RR 18
• Circulation HR 100 , skin warm diaphortic and
  her skin has a yellowish discoloring

16
PHYSICAL EXAM

• Head/Neck
• Pupils - PERRL
• Eyes slight jaundice in her eyes
• Chest
• Equal lung sounds and expansion
• Abdomen
• Soft, non-tender
• Dull pain across both upper quadrants

17
PHYSICAL EXAM

• Pelvis
• Stable
• Extremities
• PMS present all extremities
• Posterior
• No evidence of trauma

18
VITAL SIGNS

• BP 114/88
• HR 100 regular
• RR 18
• SpO2 96 Room Air

19
PATIENT HISTORY

• A NKDA
• M Tylenol for the fever
• P IV Drug Abuser 10 years ago
• L Not eating due to loss of appetite
• E Not feeling well for past couple of days

20

• What would you consider to be this patients
  chief medical problem?

21
PATIENT DIAGNOSIS

• Hepatitis B

22

• What should you have done prior to while in
  contact with this patient?

23
Hepatitis B

• -- Attempt to Avoid exposure
• Assume every patient is infected
• Prevention with use of universal precautions
  against Hepatitis B
• Use appropriate PPE/Gloves
• Follow all policies and procedure
• Get Hepatitis B Vaccination

24
Personal Protective Equipment (PPE)

• Gloves
• MINIMUM required PPE for all patients
• shall be worn at all times when participating
  directly or indirectly in patient care
• Shall also be worn during clean up activities,
  when handling any potentially contaminated items,
  and at any other time exposure to blood or other
  bodily fluids is possible.
• Remove contaminated gloves before touching
  equipment (e.g. portable radios), vehicle door
  handles, or anything else that may lead to
  further contamination. If this practically
  cannot be done, be certain to decontaminate as
  soon as possible.
• NEVER wear contaminated gloves in the front
  (driver/passenger) compartment of the medic unit.

25
Hepatitis B

• Infection of liver caused by Hepatitis B virus
  (HBV)
• Transmitted by contact with bodily fluids such
  as blood, saliva, and semen
• NOT transmitted by food or water, breastfeeding,
  sharing eating utensils, hugs or kisses

26
Hepatitis B

• Hepatitis B
• can be fatal
• is very easy to catch compared to other diseases
  spread by BBP
• Hepatitis B can survive outside the body
  up to one week!
• Is preventable through vaccination

27
Hepatitis B Symptoms

• Initial symptoms may be mild or absent!
• Tiredness
• Loss of appetite
• Fever
• Vomiting
• Yellow skin eyes (jaundice)
• Dark-colored urine.
• Light colored stool

28
Hepatitis B

• There are 1.4 million chronically infected
• Approximately 73K new cases each year
• 15-25 mortality

29
Highest risk of contracting Hepatitis B

• Those with multiple sexual partners (unprotected)
• IV drug abusers
• Infants born to infected mothers
• Regular household contact with chronically
  infected persons
• Hemodialysis patients

30
Hepatitis B Prevention

• Vaccine is the best prevention
• vaccine is 95 effective and in most cases,
  provides lifelong immunity to the person
  receiving it
• vaccine comes as a series of three shots.
• after the 1st IM shot is administered, a 2nd shot
  will be given 30 days later, and the 3rd dose is
  administered 6 months after the 2nd dose.
• Lab titers may be necessary to ensure that the
  vaccine is still working, and occasionally a
  person may need a booster shot to bring the
  number of antibodies in the body up to necessary
  levels.
• Safe handling of sharps and other potentially
  infected products

31
Hepatitis B Prevention

• Make sure you are vaccinated against
• Hepatitis B
• Vaccination (or formal declination) is mandatory
• The vaccine is safe. It is NOT a live virus
  vaccine, and cannot give you hepatitis B
• The protection is permanent and highly effective
• Vaccination requires 3 doses of vaccine over 4-6
  months and then a blood titer
• The titer is essential to verify you have
  responded to the vaccine are protected!
• Avoid exposure - prevention with universal
  precautions remains your best protection against
  Hepatitis B and all other BBP
• Assume every patient is infected
• Use appropriate PPE
• Follow all policies and procedures

32
Hepatitis B Vaccination

• Volunteer Members or Employees
• Hepatitis B vaccines are available at no cost to
  you within 10 days of initial assignment
• Vaccination will be provided by the CCVESA
  Physician

33
Hepatitis B Vaccination is encouraged unless

• Documentation exists that the volunteer or
  employee has previously received the series
• Antibody testing reveals that the volunteer or
  employee is immune
• Medical evaluation shows that vaccination is
  contraindicated

34
Hepatitis B Vaccination is declined by a
volunteer or employee

• They must sign a declination form
• Documentation of refusal of the vaccination is
  kept at the CCVESA Physicians facility
• Volunteers or employees who decline may request
  and obtain the vaccination at a later date at no
  cost.

35
HEPATITIS B VACCINE DECLINATION FORM

• HEPATITIS B VACCINE DECLINATION (MANDATORY)
• I understand that due to my occupational exposure
  to blood or other potentially infectious
  materials I may be at risk of acquiring Hepatitis
  B virus (HBV) infection. I have been given the
  opportunity to be vaccinated with Hepatitis B
  vaccine, at no charge to myself. However, I
  decline Hepatitis B vaccination at this time. I
  understand that by declining this vaccine, I
  continue to be at risk of acquiring Hepatitis B,
  a serious disease. If in the future I continue
  to have occupational exposure to blood or other
  potentially infectious materials and I want to be
  vaccinated with Hepatitis B vaccine, I can
  receive the vaccination series at no charge to
  me.
• Signed __________________ Date
  _________________

36
CASE STUDY 2

• October 15.2200 Hrs
• Your unit is dispatched to a Nursing Home _at_ 1122
  Pepper Lane for a sick male patient

37
ARRIVAL ON SCENE

• Upon arrival you are met by a staff member of the
  nursing, who directs you to the patients room
  and provides you with an appropriate MOLST form.
  She advises that he had fell and injured his
  right wrist and his attending physician wants him
  evaluated at the ER.

38
ARRIVAL ON SCENE

• Patient is a 88 year old male sitting up in a
  chair c/o injury to his right wrist
• You note that there is some deformity of the
  right wrist.
• Patient states he fell on to his right hand as he
  went down
• Patient has no other obvious injuries

39
INITIAL ASSESSMENT

• Airway Patent
• Breathing Regular, RR 22
• Circulation HR 110, skin is hot and dry, You
  notice a rash on his skin, with multiple
  boils/pimples and several pus-filled abscesses

40
PHYSICAL EXAM

• Head/Neck
• Pupils - PERRL
• Chest
• Equal lung sounds and expansion
• No bruising or deformities
• Abdomen
• Soft, non-tender
• No discoloration

41
PHYSICAL EXAM

• Pelvis
• Stable
• Extremities
• Deformity to right wrist
• Good PMS in all extremities
• Posterior
• No evidence of trauma

42
VITAL SIGNS

• BP 150/90
• HR 110
• RR 22
• SpO2 93

43
PATIENT HISTORY

• A Penicillin
• M Synthroid
• P Hypothyroid
• L Supper
• E Walking back to his room and lost his balance
  and fell to the floor

44

• What would you consider to be this patients
  chief medical problem?

45
FINAL DIAGNOSIS

• MRSA

46

• What should you have done prior to while in
  contact with this patient?

47
MRSA

• --Attempt to avoid exposure
• Assume every patient is infected
• Prevention with use of universal precautions
  against MRSA
• Use appropriate PPE/Gloves
• Follow all policies and procedure

48
MRSA

• MRSA was first discovered in 1961 in the United
  Kingdom.
• The first major outbreak in the US was in 1981
  and was noted in a large population of IV drug
  users.
• Since then, approximately 94k Americans are
  infected every year.
• More than 18k people will die in the hospital as
  a result of this organism.

49
MRSA

• Multiple drug-resistant strain of staph aureus
• Resistant to several common antibiotics and even
  antibiotics that have been developed within the
  past few years, making it extremely dangerous and
  difficult to treat.
• Grows on every single surface
• Survives outside the host for several months

50
MRSA Risks

• Outbreaks
•  
• IV Drug users
• Athletes
• Nursing homes
• Prisons

• Race/Population
• Age 65 years
• African Americans
• Males

51
MRSA- Complications

• Develops drug resistance within 72 hours of host
  invasion
• most common portals of entry include wounds, IV
  catheters, and the urinary tract.
• 75 all infections involve skin
• Boils/Pimples
• Fever
• Rashes
• Pus-filled abscesses

52
CASE STUDY 3

• January 5.1430 Hrs
• Your unit is dispatched to a 2750 North Avenue
  for a sick male patient

53
ARRIVAL ON SCENE

• Upon arrival you find a 34 year old male patient
  in bed who states I think I have the Flu
• Patient c/o runny nose, coughing, headache,
  chills and body aches all over.
• Patient also states I have been having some
  trouble breathing

54
INITIAL ASSESSMENT

• Airway Patent
• Breathing Regular, RR 24
• Circulation HR 90, skin is warm dry

55
PHYSICAL EXAM

• Head/Neck
• Pupils - PERRL
• Chest
• Equal lung sounds and expansion
• Abdomen
• Soft, non-tender

56
PHYSICAL EXAM

• Pelvis
• Stable
• Extremities
• Good PMS in all four extremities
• Posterior
• No evidence of trauma

57
VITAL SIGNS

• BP 114/88
• HR 90
• RR 24
• SpO2 98

58
PATIENT HISTORY

• A NKDA
• M Tyelnol as needed
• P None
• L Lunch, attempt a bowl of soup, but that was
  vomited back up
• E Has felt sick with Flu like symptoms for past
  24 hours

59

• What would you consider to be this patients
  chief medical problem?

60
FINAL DIAGNOSIS

• H1N1 VIRUS

61

• What should you have done prior to while in
  contact with this patient?

62
H1N1 Virus

• --Attempt to avoid exposure
• Assume every patient is infected
• Prevention with use of universal precautions
  against H1N1 Virus
• Use appropriate PPE/Gloves/mask
• Follow all policies and procedure
• Get Influenza/H1N1 Vaccination

63
Surgical Masks

• Surgical Masks
• Protect against large droplets produced by
  coughing or sneezing
• Most respiratory illness spread in this way
• Follow respiratory hygiene/cough etiquette
• Protect against splashes or sprays of blood or
  other body fluids when worn in combination with
  eye protection (mask plus shield or goggles)
• Wear during patient care activities or procedures
  where splashes or sprays are possible
• This includes all persons in vicinity of patient
  during bag-mouth ventilation, intubation or
  suctioning
• Effective use of face and eye protection
  dramatically reduces mucus membrane exposures.

64
Cough hygiene/respiratory etiquette

• Put a mask on all patients with cough, or other
  signs/symptoms of respiratory illness
• Non-rebreather if O2 by non-rebreather mask is
  indicated
• Nasal cannula with surgical mask - If O2 via
  nasal cannula is indicated
• Surgical mask alone for stable, alert patients
  with cough or S/S of respiratory illness when O2
  is not indicated, AND
• Put a mask on ALL providers (surgical or N95)
  within 3 feet of the patient when a mask also is
  indicated for the patient with cough or S/S of
  respiratory illness THIS IS MANDATORY FOR YOUR
  PROTECTION!

65
H1N1 Virus

• The H1N1 Virus is also referred to as Swine
  flu. It is called this because it has similar
  genes to the virus that infects pigs.
• Pandemic- thousands of patients affected
  worldwide
• 1st US case April 2009
• Similar to seasonal flu
• Human to Human transmission

66
H1N1 Risk Factors

• Age (Over 65 or under 5)
• Pregnant
• Chronic Medical Conditions
• Immunosuppressed
• Asthma

67
H1N1 Flu Virus Signs/Symptoms

• Stuffy or runny nose
• Sore throat
• Cough
• Fever
• Chills
• Headache
• Fatigue
• Body aches
• Vomiting
• Diarrhea
• Respiratory symptoms without a fever

68
Influenza/H1N1 Vaccination

• Why should health care providers - including
  first responders be vaccinated?
• Protect Your Patients
• Influenza can be fatal for our frail,
  immunocompromised patients
• Per the CDC - First responders are a high
  priority group for immunization
• Protect Yourself
• Protect Your family
• Vaccination makes sense at least through March
  (flu season lasts into May)

69
Seasonal Flu

• Affects 5-20 of the US population every year
• Peak season January and February
• 200K sick/hospitalized every year
• 36K Americans die annually

70
Seasonal Flu- Spread

• Airborne droplets
• usually the result of a cough or sneeze
• droplets land on the recipients face and then
  are inhaled into the nostrils.
• Contagious one day prior to S/S appearing and for
  5-7 days after sickness

71
Seasonal Flu- Risk Factors

• Children
• Children are susceptible due to having immature
  immune systems. Usually in those less than age
  5.
• Elderly
• The elderly, usually considered over 65 years of
  age, are also at a higher risk due to many times
  having previous medical conditions.
• Pregnant
• Asthmatics
• Diabetics

72
Seasonal Flu- Signs/Symptoms

• Fever
• Headache
• Dry cough
• Sore throat
• Muscle aches
• Lethargy
• Runny nose
• Nausea
• Vomiting
• Diarrhea
• Occasional

73
CASE STUDY 4

• September 15.O130 Hrs
• Your unit is dispatched to a 2900 South Bend Road
  for Motor Vehicle Collision

74
ARRIVAL ON SCENE

• Upon arrival you have a 28 year male patient,
  with multiple injuries from being ejected from
  the vehicle

75

• You are assisting with stabilization of this
  patient, and as an IV is being established the
  patient becomes combative secondary to a head
  injury and the IV needle comes out of the
  patient and you accidently get stuck in your left
  hand

76

• What action needs to be taken?

77
POST-EXPOSURE EVALUATION AND FOLLOW-UP

• Exposed provider should contact Member Company
  Exposure/Infection Control Officer
• Contact should be made immediately if not
  involved in an emergency response or immediately
  upon completion of the call of an emergency
  incident
• The Member Company Exposure/Infection Control
  Officer will contact the CCVESA Exposure Control
  Officer or designee Contact
• The CCVESA Exposure Control Officer or designee
  will contact
• Carroll Hospital Center
• Carroll Occupational Health
• - Carroll County Health Department

78
POST-EXPOSURE EVALUATION AND FOLLOW-UP

• Carroll Hospital Center, Carroll Occupational
  Health and/or County Health Department will
  report back the follow up procedures to the
  CCVESA Exposure Control Officer or designee
• The CCVESA Exposure Control Officer or designee
  will report back to the Member Company
  Exposure/Infection Control Officer
• The Member Company Exposure/Infection Control
  Officer will report back to the Exposed provider

79
POST-EXPOSURE EVALUATION AND FOLLOW-UP

• The exposed provider should receive an immediate
  confidential medical evaluation and follow-up
  conducted by Carroll Occupational Health if open
  .
• or at Carroll Hospital Center if Carroll
  Occupational Health is closed

80
CCVESA Exposure Control Officer

• Will ensure that the Health care professional
  evaluating the volunteer or employee after an
  exposure incident receives
• Description of volunteers or employees job
  duties relevant to the exposure incident
• Route(s) of exposure
• Circumstances of exposure
• If possible, results of source individuals blood
  test
• Relevant volunteer/employee medical records,
  including vaccination status

81
POST-EXPOSURE EVALUATION AND FOLLOW-UP

• If actual exposure did occur
• Clean, irrigate and dress area as appropriate
• Allow puncture wounds to bleed
• Irrigate mucus membranes copiously with water
  Ringers also is appropriate

82
POST-EXPOSURE EVALUATION AND FOLLOW-UP

• If provider and Source patient are transported to
  Carroll Hospital Center
• Advise Charge Nurse upon arrival that there has
  been an exposure and you would like the source
  patients blood tested.
• Carroll Hospital Center will obtain the source
  patients blood and have it tested

83
POST-EXPOSURE EVALUATION AND FOLLOW-UP

• If provider and source patient are transported to
  another hospital
• Advise Charge Nurse upon arrival that there has
  been an exposure and you would like the source
  patients blood tested.
• The Hospital will obtain the source patients
  blood and have it tested
• Results of the source patients blood test should
  be sent to Carroll Occupational Health
• If Carroll Occupational Health is Closed have the
  results sent to Carroll Hospital Center

84
POST-EXPOSURE EVALUATION AND FOLLOW-UP

• The member infection/exposure control officer
  should transport the exposed provider to Carroll
  Occupational Health for initial evaluation and
  treatment
• The member infection/exposure control officer
  should Advise the Charge Nurse upon arrival that
  you have provider that an exposure has occurred
  and the source patients blood is being tested at
  the receiving hospital

85
POST-EXPOSURE EVALUATION AND FOLLOW-UP

• In the event that Carroll Occupational Health is
  closed and the Source patient was transported to
  Carroll Hospital Center then
• The exposed provider will receive the initial
  evaluation and treatment at Carroll Hospital
  Center
• Results of the source patient and the provider
  will be sent to Carroll Occupational Health

86
POST-EXPOSURE EVALUATION AND FOLLOW-UP

• In the event that Carroll Occupational Health is
  closed and the Source patient was transported to
  another Hospital then
• The exposed provider should be transported to
  Carroll Hospital Center
• The member infection/exposure control officer
  should Advise the Charge Nurse upon arrival that
  you have provider that an exposure has occurred
  and the source patients blood is being tested at
  the receiving hospital
• The exposed provider will receive the initial
  evaluation and treatment at Carroll Hospital
  Center
• Results of the source patient and the provider
  will be sent to Carroll Occupational Health

87
Exposure Policy and Procedures

• Treatment for Providers possible BBP exposure
• Prompt evaluation and treatment
• Source patient blood testing
• PEP antiviral medications if indicated
• Baseline and serial blood tests for six months
  after the exposure for our provider
• Any other appropriate support, counseling or
  treatment
• The exposed provider must complete the exposure
  survey provided by the CCVESA Exposure Control
  Officer (required by federal regulation)

88
Exposure Policy and Procedures

• Remember If treatment with HIV antiviral
  medications (postexposure prophylaxis) is
  indicated following an exposure, they should be
  started as soon as possible within hours
  according to the CDC.
• All Carroll County EMS providers with suspected
  BBP exposure will receive initial treatment and
  evaluation at Carroll Hospital Center
• This applies only to BBP exposures
• The member infection/exposure control Officer
  will confer with the Exposure Control Officer and
  provide guidance

89
POST-EXPOSURE DOCUMENTATION
Carroll County Volunteer Emergency Services
Association Exposure Survey Must be Completed
for Any Type of Exposure and must be completed
by the exposed provider
90
Carroll County Volunteer Emergency Services
Association Exposure Survey Complete for Any
Type of Exposure
Exposed Provider Please complete carefully and include all requested information. Member Company infection Control Officer Please review for accuracy and completeness prior to submitting. This form is to be completed by the provider at the time of the incident and submit the required paperwork to CCVESA Exposure Control Officer.
1. ID ____________________Unit/Shift
____________ 2. Date of this Report__________
3. Date of exposure __________ Time_____ 4. If
this exposure occurred outside (Leave section 4
blank if the exposure was indoors) Ambient
Conditions Cold_____ Warm _____ Hot _____ Wet
_____ Dry _____ 5. If Inside or Outside (Fill
in regardless if indoors or outdoors) Lighting
Conditions Good_____ Fair _____ Poor _____ 6.
Type of Exposure _____ Blood _____ Other
(Describe)______ 7. Type of contact
_____Splash/Spill/Spray _____Droplet/Inhalation
Area of body exposed_____________ If Skin
exposed, any wounds, sores or abrasions? ____
_____ Dirty Needle Stick _____ Dirty IV Needle
Self-Sheathing? ___Y ___N _____ Dirty
Vacutainer Needle Self-Sheathing? ___Y ___N
_____ Dirty Lancette Needle Self-Sheathing?
___Y ___N _____ Dirty Needle Attached to Syringe
Self-Sheathing? ___Y ___N _____ Dirty Needle as
part of a Pre-loaded drug Self-Sheathing? ___Y
___N CCVESA Exposure Survey Page 1 of 4
04-01-10
91
_____ Glass _____ Broken Drug _____ Opening
glass vial _____ Other Glass on scene _____
Other Describe For all sharps exposures the
following MUST be completed Type of
Device (IV cath, etc)
__________________________
Brand or Model of Device (Protectiv, etc.)
__________________________
Manufacturer of Device (Johnson Johnson,
etc.) __________________________ Did
the design of the device or any other engineering
control factor play a role in this exposure? If
yes, in what way? 8. Information regarding the
type of scene to which you responded _____
Private Residence (House, any type) _____
Private Residence (Apartment, house divided into
apartments) _____ Store or Business
(Type___________) _____ Nursing Home or Assisted
Living Facility _____ Public area (Pedestrian)
ie mall, sidewalk _____ Road, Roadside etc. 9.
Information regarding Location where exposure
actually occurred _____ Private Residence
(House, any type) _____ Private Residence
(Apartment, house divided into apartments) _____
Store or Business (Type______) _____ Nursing
Home or Assisted Living Facility _____ Public
Area (Pedestrian I.E. outdoor mall or sidewalk)
_____ Road or Roadside _____ Inside of the
Medic Unit If the actual exposure occurred
inside the unit, how many people were in the
patient compartment at the time of the exposure,
NOT including the patient? _____


CCVESA Exposure Survey
Page 2 of 4 04-01-10
92
10. Patient Description at time of the exposure
(Check all that apply) _____ Medical Patient
_____ Trauma Patient _____ Alert/Cooperative
_____ Alert/Uncooperative or combative _____
Disoriented or Confused, cooperative _____
Disoriented or Confused, combative _____
Unconscious _____ Seizure Activity _____
flaccid _____ Other (Describe)__________ 11.
Your activity at the time of the exposure (Check
all that apply) _____ Airway Management (Direct
or invasive) _____ Using a Sharp _____
Preparing/Setting up the needle or device _____
Restraining/Holding the patient, not controlling
the needle _____ Finger Stick _____
Transferring blood for Glucometer Reading _____
Transferring blood to vacutainer _____
Controlling the needle, disposing of sharp _____
Not controlling needle, assisting with disposal
_____ Passing or Holding Sharps Disposal Box
_____ Other (Describe) __________ _____ Not
engaged in Patient contact (injured during clean
up, exchanging sharps box etc, describe___________
____ 12. PPE in use at time of exposure _____
Eye protection _____ Mask _____ Gloves
_____Standard _____Hi Risk Any
comments of quality/feel/ease of use of glove?
13. Individual Training Blood Borne
Pathogen ______Initial Blood Borne Pathogen
Training? Year of Training ________ ______Approx.
Date of last Update?
CCVESA Exposure
Survey Page 3 of 4 04-01-10
93
14. Provide a precise and complete explanation of
the circumstances surrounding this exposure and
describe exactly how and why this exposure
occurred ________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
_______________________ 15. Do you have any
suggestions for preventing future exposures of
this type? ______________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
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__________________________________________________
__________________________________________________
__________________________________________________
_____ 16. Are there any additional comments,
recommendations or clarifications you would like
to make? (Use back of page if additional room is
needed.) ________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
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__________________________________________________
_____ Thank you for taking the time to carefully
complete this survey. This survey is used to
evaluate how we do things and find ways we can
make our work safer. It also is used to maintain
a legally required record of exposures. Please go
back and make sure that all applicable
information has been provided before sending this
to the CCVESA Exposure Control Officer.
CCVESA Exposure Survey Page 4 of 4
04-01-10
94
POST-EXPOSURE DOCUMENTATION

• Exposed volunteer or employee must complete a
  Carroll County Volunteer Emergency Services
  Association Exposure Survey Form
• Exposed volunteer or employee will also be
  required to complete any Exposure forms that may
  required at any post exposure follow-up facility.
  
• Exposed volunteer or employee must complete a
  stations First Report of Injury
• Workers Compensation First Report of
  Injury/Illness Form must be completed and
  submitted by the appropriate member company
  personnel

95
Evaluating the Circumstances Surrounding an
Exposure Incident

• CCVESA Exposure Control Officer and member
  company Exposure/ Infection Control Officer will
  review the circumstances of all exposure
  incidents to determine
• Engineering controls in use at the time
• Work practices followed
• Description of the device being used (including
  type and brand)

96
Evaluating the Circumstances Surrounding an
Exposure Incident

• Determine..
• Protective equipment or clothing that was used at
  the time of the exposure incident (gloves, eye
  shields, etc.)
• Location of the incident (on the scene of an
  incident, inside a transport unit, in the
  station, etc.
• Procedure being performed when the incident
  occurred
• Volunteers or employees training level

97
Needle Sticks Most Dangerous Type of Blood
Exposures

• Some needle stick exposures are caused by needles
  sticking thru medical bags!
• Make sure the needle goes in the sharps
  container, the sharps container is snapped
  closed, and the bag compartment is zipped shut.
• Other needle sticks can be caused by not having
  sharps container at patients side and open ready
  to receive sharp.
• Protect yourself and your coworkers!

98
Most Needle Sticks Are Avoidable

• Protect yourself and your coworkers from
  preventable needle stick exposures by
• Locking the protective sheath over the needle
  during withdrawal
• Making sure the IV catheter goes into the sharps
  container
• Snapping closed the sharps container after sharp
  is deposited, and zipping closed the medical
  bags compartment top

99
IV Catheters

• Use only self sheathing IV catheters.
• Use devices only if you have been instructed on
  their proper use. If you dont know, ASK!
• IV Caths If you dont click em, they are not
  safe!

100
Needle Sticks Must be Reported Documented

• Effect immediately all percutaneous injuries
  from contaminated sharps must be documented in a
  Sharps Injury Log as per 29 CFR 1904

101
Sharps Injury Log

• CCVESA Exposure Control Officer will record all
  percutaneous injuries from contaminated sharps in
  a Sharps Injury Log as per 29 CFR 1904
• Incidences must include
• Date of the injury
• Type and brand of the device involved (syringe,
  IV needle, etc.)
• Department or work area where incident occurred
• Explanation of how the incident occured

102
Sharps Injury Log

• This log is reviewed as part of the annual
  program evaluation
• This log must be maintained for at least five (5)
  years following the end of the calendar year
  covered
• If a copy is requested by anyone, it must have
  any personal identifiers removed from the report

103
CASE STUDY 5

• April 29.1730 Hrs
• Your unit is dispatched to a 3520 Maple Road for
  a sick female patient

104
ARRIVAL ON SCENE

• Upon arrival you found a 85 year old female
  sitting in a chair c/o not feeling well
• She states that she has been very tired ,has not
  felt like eating, has had some abdominal pains.
• When she did try to eat something, she got
  nausated and vomited

105
INITIAL ASSESSMENT

• Airway Patent
• Breathing Regular, RR 14
• Circulation HR 88, Exposed skin is warm/dry and
  slightly jaundice

106
PHYSICAL EXAM

• Head/Neck
• Pupils - PERRL
• NOTE jaundice in her eyes
• Chest
• Equal lung sounds and expansion
• Abdomen
• Soft, non-tender

107
PHYSICAL EXAM

• Pelvis
• Stable
• Extremities
• Good PMS in all four extremities
• Posterior
• No evidence of trauma

108
VITAL SIGNS

• BP 150/92
• HR 88
• RR 14
• SpO2 94

109
PATIENT HISTORY

• A NKDA
• M none
• P Had hip replacement surgery in 1985, when she
  had to have a blood transfusion
• L attempted lunch 5 hours ago
• E Has had these symptoms for several days

110

• What would you consider to be this patients
  chief medical problem?

111
FINAL DIAGNOSIS

• Hepatitis C

112

• What should you have done prior to while in
  contact with this patient?

113
Hepatitis C Virus

• --Attempt to avoid exposure
• Assume every patient is infected
• Prevention with use of universal precautions
  against Hepatitis C
• Use appropriate PPE/Gloves
• Follow all policies and procedure

114
Hepatitis C

• Most common BBP infection in U.S.
• High rate among IV drug users.
• Mainly spread by exposure to blood and other
  bodily fluids containing blood
• Causes Infection of the liver, leads to high rate
  of chronic disease (75) and cancer
• Before early 1990s spread through blood
  transfusions
• Most infected people have no symptoms and do not
  know they are infected

115
Hepatitis C (HCV) Signs/Symptoms

• Initial symptoms may be mild or absent!
• Tiredness
• Loss of appetite
• Abdominal pain
• Nausea
• Vomiting
• Yellow skin eyes (jaundice)
• Urine that is dark in color

116
Hepatitis C (HCV) Treatment

• No vaccine currently available
• Hepatitis B vaccine will not protect you from
  Hepatitis C
• No postexposure prophylaxis currently recommended
  
• Treatment with antiviral medications recommended
  for some patients with chronic disease
• Not all people respond to treatment

117
Hepatitis C

• Leading cause of liver transplant
• Accounts for 20 of all acute viral hepatitis
  cases
• 85 result in chronic infections
• 5 mortality
• 19K new cases/year
• 4.1 million Americans

118
Hepatitis C- Risk Factors

• Blood transfusions prior to 1992
• Long-term kidney dialysis
• IV drug users
• Hepatitis C can survive outside the body
• for up to 16 days!

119
Hepatitis C- Signs/Symptoms

• Jaundice
• Dark Urine
• Fatigue
• Abdominal Pain
• Nausea
• Anorexia
• While these are common signs symptoms, 80 of
  those infected may not exhibit any signs or
  symptoms until very late stages.

120
CASE STUDY 6

• October 18.2230 Hrs
• Your unit is dispatched to a 13 East Landover
  Street for a sick male patient

121
ARRIVAL ON SCENE

• Upon arrival you find a 48 year old male patient
  sitting at the kitchen .
• The patient is c/o fever, chills and coughing for
  past three weeks
• The patient also c/o night sweats, loss of
  appetite and coughing up blood

122
INITIAL ASSESSMENT

• Airway Patent
• Breathing Regular, RR 30, coughing
• Circulation HR 78, skin is warm dry

123
PHYSICAL EXAM

• Head/Neck
• Pupils - PERRL
• Chest
• Equal lung sounds and expansion
• Abdomen
• Soft, non-tender

124
PHYSICAL EXAM

• Pelvis
• Stable
• Extremities
• Good PMS in all four extremities
• Posterior
• No evidence of trauma

125
VITAL SIGNS

• BP 100/68
• HR 78
• RR 30
• SpO2 90

126
PATIENT HISTORY

• A NKDA
• M none
• P none
• L 5 hours ago
• E Been feeling sick for past several weeks

127

• What would you consider to be this patients
  chief medical problem?

128
FINAL DIAGNOSIS

• Tuberculosis

129

• What should you have done prior to while in
  contact with this patient?

130
TUBERCULOSIS

• --Attempt to avoid exposure
• Assume every patient is infected
• Prevention with use of universal precautions
  against Tuberculosis
• Use N-95 mask
• Provide flow through ventilation in the patient
  compartment during transport
• Use appropriate PPE/Gloves/N-95 Mask
• Follow all policies and procedure

131
N-95 MASKS

• N95 Masks
• Protect against very small particles
• Wear whenever TB (tuberculosis), rubeola
  (measles), or varicella (chickenpox) is known or
  suspected
• Fit testing required to ensure proper fit
• If transporting a patient with suspected TB, use
  the exhaust fan AND by opening the windows to
  allow flow through ventilation

132
TUBERCULOSIS

• Bacterial disease caused by the infectious agent
  Mycobacterium tuberculosis
• Bacteria that cause TB are transmitted by
  infected airborne particles
• Infectious particles are produced when the
  infected person talks, coughs, or sneezes

133
TUBERCULOSIS

• Latent TB
• Person has a TB infection, but the bacteria
  remains in the body in an inactive state and
  causes no symptoms
• This is not contagious
• Active TB
• Person has TB with signs symptoms
• This person is contagious and can spread TB to
  others

134
ACTIVE TUBERCULOSISSigns Symptoms

• Unexplained weight loss
• Fatigue
• Fever
• Night sweats
• Chills
• Loss of appetite
• Coughing that lasts three or more weeks
• Coughing up blood
• Chest pain, or pain with breathing or coughing

135
TUBERCULOSIS

• Procedures performed that may increase the risk
  of exposure to TB
• Endotracheal intubation
• Suctioning
• Use of bag valve masks
• Administering aerosolized medications such as
  albuterol
• Enclosed in the patient compartment of the
  ambulance

136
TUBERCULOSISPREVENTION

• Avoid exposure - prevention with universal
  precautions remains your best protection against
  TB
• Use appropriate PPE
• Use N-95 mask
• Provide flow through ventilation in the patient
  compartment during transport
• Follow all policies and procedures

137
CASE STUDY 7

• August 24.1930 Hrs
• Your unit is dispatched to a 2432 West Lighthouse
  Lane for a sick male patient

138
ARRIVAL ON SCENE

• Upon arrival you find a 34 year old male patient
  lying in bed.
• Patient c/o fever for several days, weight loss
  and feeling weak

139
INITIAL ASSESSMENT

• Airway Patent
• Breathing Regular, RR 20
• Circulation HR 84, skin is cool dry, HR 84

140
PHYSICAL EXAM

• Head/Neck
• Pupils - PERRL
• Chest
• Equal lung sounds and expansion
• Abdomen
• Soft, non-tender

141
PHYSICAL EXAM

• Pelvis
• Stable
• Extremities
• Good PMS in all 4 extremities
• Posterior
• No evidence of trauma

142
VITAL SIGNS

• BP 114/88
• HR 84
• RR 20
• SpO2 92

143
PATIENT HISTORY

• A NKDA
• M none
• P Pneumonia, Lymphomia, swollen lymp nodes
• L Very light lunch at noon
• E Sitting around the house and felt he should be
  transported to the ER
• Patient states that approximately 10 years ago
  he was IV drug abuser

144

• What would you consider to be this patients
  chief medical problem?

145
FINAL DIAGNOSIS

• HIV Human Immunodeficiency Virus

146
HIV Human Immunodeficiency Virus

• --Attempt to avoid exposure
• Assume every patient is infected
• Prevention with use of universal precautions
  against HIV Human Immunodeficiency Virus
• Use appropriate PPE/Gloves
• Follow all policies and procedure

147
HIV Human Immunodeficiency Virus

• Spread by blood and certain other bodily fluids
• 0.3 risk of seroconversion following
  percutaneous occupational exposure
• Risk may be higher for certain exposures
• Hollow bore needle contaminated with visible
  blood
• Other objects visibly contaminated with blood,
  especially deep punctures

148
AIDS Acquired Immune Deficiency Syndrome

• Develops months to years after HIV infection
• Signs and symptoms of AIDS
• Fever
• Weight loss
• Swollen lymph nodes
• White patches in mouth (thrush)
• Cancer - Kaposis sarcoma, certain lymphomas
• Infections - pneumocystis pneumonia, TB
• NO CURE drugs may slow the progress of the
  disease

149
HIV Postexposure Prophylaxis

• Reduces the risk of infection up to 81
• Four week regimen with 2 - 3 antiviral drugs
• If the source patient blood tests negative for
  HIV, PEP is not recommended by the CDC
• If the source patient HIV status is not yet
  known, PEP may be offered or recommended.
• If the source patient is HIV positive PEP will in
  most cases be recommended.
• If indicated, PEP should be started as soon as
  possible after an exposure!

150
HIV/AIDS

• There are roughly 1.1 million Americans infected
• At least 21 are unaware or undiagnosed
• Spread by blood and bodily fluids
• Does not survive outside body
• Greatest risk factors are IV drug use and
  multiple unprotected sexual partners

151
HIV/AIDS

• Auto-immune disorder transmitted by blood and
  bodily fluids such as semen and vaginal
  secretions
• Almost always begins as HIV, but can progress
  into AIDS
• 21 of those with the disease are unaware and
  undiagnosed, therefore putting themselves and
  those they are in contact with at high risk

152
HIV/AIDS

• The virus does not survive outside the body for
  longer than 10 seconds
• Risks to EMS workers who come into contact with
  infection patients blood, most commonly from
  needle sticks
• Risk from needle stick is very low, only .3 of
  needle sticks result in HIV infections

153
Exposure Policy and Procedures

• Remember If treatment with HIV antiviral
  medications (postexposure prophylaxis) is
  indicated following an exposure, they should be
  started as soon as possible within hours
  according to the CDC.

154
CASE STUDY 8

• August 4.0930 Hrs
• Your unit is dispatched to a 1624 Main Street for
  a sick female patient

155
ARRIVAL ON SCENE

• Upon arrival you find a 19 year old female
  patient lying in bed c/o severe headache, a high
  fever 105, nausated and vomiting.
• Patient also c/o has loss of appetite, cannot
  sleep and bright lights bother her

156
INITIAL ASSESSMENT

• Airway Patent
• Breathing Regular, RR 24
• Circulation HR 110, skin is hot dry, and a
  skin rash noted

157
PHYSICAL EXAM

• Head/Neck
• Pupils - PERRL
• Signs indicating a stiff neck
• Chest
• Equal lung sounds and expansion
• Abdomen
• Soft, non-tender

158
PHYSICAL EXAM

• Pelvis
• Stable
• Extremities
• Good PMS in all 4 extremities
• Posterior
• No evidence of trauma

159
VITAL SIGNS

• BP 124/78
• HR 110
• RR 24
• SpO2 99

160
PATIENT HISTORY

• A NKDA
• M None
• P None
• L Supper last night
• E Has had a high fever for past two days

161

• What would you consider to be this patients
  chief medical problem?

162
FINAL DIAGNOSIS

• Meningococcal Meningitis

163

• What should you have done prior to while in
  contact with this patient?

164
Meningococcal Meningitis

• --Attempt to avoid exposure
• Assume every patient is infected
• Prevention with use of universal precautions
  against Meningococcal Meningitis
• Use N-95 mask
• Provide flow through ventilation in the patient
  compartment during transport
• Use appropriate PPE/Gloves/N-95 Mask
• Follow all policies and procedure

165
Other Diseases - Meningitis

• An inflammation of the membranes covering the
  brain and spinal cord.
• Caused by several different organisms
• Bacterial
• Neisseria meningitidis (Meningococcal)
• Streptococcus pneumoniae
• Haemophilus influenzae type B (Hib)
• Viral
• Several different viruses
• Most cases of meningitis are viral
• Meningococcal meningitis is the type that poses
  the greatest risk of death or serious disease.
• Immediately report to the Infection Control
  Officer any patient determined by you or reported
  by a hospital to possibly have meningitis.

166
Meningococcal MeningitisSigns Symptoms

• High fever
• Severe headache
• Stiff neck
• Vomiting or nausea
• Confusion or difficulty concentrating
• Seizures
• Sleepiness or difficulty waking up
• Sensitivity to light
• Lack of interest in drinking or eating
• Skin rash

167
Meningococcal Meningitis

• Meningococcal Meningitis FACTS you should know to
  help you keep things in perspective
• "Health care personnel are rarely at risk when
  caring for infected patients only intimate
  exposure to nasopharyngeal secretions (e.g. as in
  mouth to mouth resuscitation) warrants
  prophylaxis." (American Public Health
  Association)
• Fortunately, none of the bacteria that cause
  meningitis are as contagious as things like the
  common cold or the flu, and they are not spread
  by casual contact or by simply breathing the air
  where a person with meningitis has been. (CDC)
• "Despite the public fear, bordering on hysteria,
  that may follow a case of meningococcal disease,
  more than 95 percent of cases in the United
  States and other developed countries are
  sporadic. Thus, in the majority of instances, a
  second case does not follow a first one. (New
  England Journal of Medicine)

168
Meningococcal Meningitis

• At least 2, and perhaps as many as 10, of the
  population are carriers of this disease
• Notification from hospital staff regarding
  meningitis
• Must be reported immediately to the on-call
  Exposure Control Officer
• Historically, in the vast majority of cases
  patients have not had meningococcal disease or
  anything else that requires treatment or
  follow-up for our personnel
• Will be promptly investigated in close
  cooperation with the Carroll County Health
  Department
• Rarely warrants prophylaxis before appropriate
  testing and evaluation is done
• In most cases, further testing shows prophylaxis
  is not indicated.
• Prophylaxis will be provided if needed.
• Use of proper PPE reduces the already low risk if
  you do come in contact with an infected person

169
Four types of cleaning in the EMS setting

• 1. Cleaning
• This is the physical removal of obvious dirt,
  dust, and debris.
• It is the necessary first step before any other
  measures can be taken
• 2. Decontamination
• This is the most common type of cleaning that
  happens in EMS. This process removes most
  disease-producing organisms to make equipment
  safe for handling. It has limited effectiveness
  against more serious pathogens

170
Four types of cleaning in the EMS setting

• 3 Disinfection
• -This process destroys nearly all disease-
  producing organisms, however it does not
  work on bacterial spores.
• Spores are bacteria that have protection against
  extreme types of environments and can become
  activated