Download CBT 621 - EMS Online

CBT/OTEP 621
Infectious Disease 2008
Copyright 2007 Seattle/King County EMS
Introduction
•
•
•
•
Bio-terrorism
Pandemic flu
Respiratory infections
Blood borne pathogens
Given the worldwide concern about
infectious diseases—as an EMS provider and
a citizen—you are responsible to help
recognize infectious disease, treat your
patients properly, and keep yourself safe.
Copyright 2008 Seattle/King County EMS
New Terms
body substance isolation (BSI) – An infection
control practice that assumes all body
substances are potentially infectious.
MRSA – Methicillin-resistant Staphylococcus
aureus is a type of staphylococcus or "staph"
bacteria that is resistant to many antibiotics.
personal protective equipment (PPE) –
Specialized clothing or equipment worn for
protection against health and safety hazards.
Copyright 2008 Seattle/King County EMS
MRSA
Methicillin-resistant Staphylococcus aureus
• Type of staph bacteria resistant to
common antibiotics
• Associated with hospitals/nursing homes
but an increasing epidemic of
EMS/community-acquired MRSA
• Multiplies rapidly causing infections
ranging from skin infections to septicemia
and toxic shock syndrome
Copyright 2008 Seattle/King County EMS
MRSA,
continued
• Best defense against MRSA is to wash your
hands often, especially after contact with
other people
• Thorough washing of hands with soap and
water or alcohol-based disinfecting gels is
effective against MRSA
Electron micrograph of MRSA
Image credit: CDC/ Janice Carr/ Jeff Hageman (public domain)
Copyright 2008 Seattle/King County EMS
Hepatitis C
• Caused by hepatitis C virus found in blood
of persons who have this disease
• Spread by contact with blood of infected
person
• Most common chronic bloodborne viral
infection in the US
• Can cause cirrhosis of the liver and liver
cancer
Copyright 2008 Seattle/King County EMS
Hepatitis C,
continued
Transmission:
•
•
•
•
Blood and other bodily fluids
Sharing needles with infected person
Sex with infected person
From woman to her baby during birth
Copyright 2008 Seattle/King County EMS
Hepatitis C,
continued
Prehospital presentation:
•
•
Infection generally produces no signs or
symptoms during early stages — may be
years
Symptoms may include fatigue, nausea,
vomiting, poor appetite, muscle and joint
pain, or low-grade fever
Copyright 2008 Seattle/King County EMS
Hepatitis C,
continued
Occupational risk:
•
After a needlestick or sharps exposure to
HCV positive blood, about 2 healthcare
workers out of 100 become infected
Prevention:
•
•
No effective vaccine for hepatitis C
Only way to protect yourself is to avoid
exposure to infected blood
Copyright 2008 Seattle/King County EMS
Personal Protective Equipment
• Treat potentially infectious patient as a
biological hazmat
• Avoid infection from fluids and airborne
particles
• Decontaminate equipment and surfaces
after use and wash your hands frequently
• Observe PPE measures on every incident
Copyright 2008 Seattle/King County EMS
Types of PPE
•
•
•
•
Fit-tested masks (N95 and N100 masks)
Eye protection (glasses, face shields, goggles)
Gowns (or suits)
Gloves
You must wear full PPE with any patient who
is potentially infectious especially those with
a history of a fever and cough.
Copyright 2008 Seattle/King County EMS
Donning PPE
Put on PPE before entering the patient area
Sequence for donning is MEGG:
1.
2.
3.
4.
Mask
Eye protection
Gown
Gloves
Copyright 2008 Seattle/King County EMS
Doffing PPE
• Remove PPE once call is complete or you
have left patient area
• Be careful not to contaminate yourself taking
it off
To remove PPE, reverse MEGG:
1.
2.
3.
4.
Gloves
Gown — hand washing min 20 sec.
Eye protection
Mask — hand washing min 20 sec.
Copyright 2008 Seattle/King County EMS
Hand Washing is Vital
• Single most effective way to prevent the
spread of disease
• Soap and water for at least 20 seconds or
with waterless alcohol-based gel
• After all patient contact, even if you wore
gloves
Copyright 2008 Seattle/King County EMS
Equipment Decontamination
After completing a response to an infectious
patient, decontaminate everything touched:
• Equipment that was exposed or
cross-contaminated
• Outside of kits
• Stethoscopes
• Radios
• AEDs, etc.
Copyright 2008 Seattle/King County EMS
HIV
• AIDS is caused by the Human
Immunodeficiency Virus (HIV)
• HIV attacks the cells of the immune system
• Immune system fails and patient becomes
susceptible to opportunistic diseases and
infections
Copyright 2008 Seattle/King County EMS
HIV,
continued
Transmission:
• Unprotected sex with an infected partner
• Infected blood given during a transfusion
(extremely rare)
• Sharing of needles by IV drug users
• An infected mother to her baby
• Occupational transmission usually by a
needlestick of infected blood
Copyright 2008 Seattle/King County EMS
HIV,
continued
Prehospital presentation:
• Dehydration and hypotension secondary to
diarrheal diseases
• Seizures or altered mental status
secondary to a nervous system infection
• Dyspnea secondary to a respiratory
infection (pneumonia, tuberculosis, etc.)
• Medication reactions
• End of life issues
Copyright 2008 Seattle/King County EMS
HIV,
continued
Occupational risk:
• Occupational risk of acquiring AIDS is
VERY LOW
Prevention:
• Prevention should focus on preventing
significant blood exposures (needlesticks)
• Post-exposure prophylaxis (PEP) if exposed
Copyright 2008 Seattle/King County EMS
Hepatitis B
• Caused by the hepatitis B virus (HBV),
which damages liver
• Vaccination against HBV has been available
since 1982
• Spread by contact with blood of person
infected with disease, or by sexual
transmission
Copyright 2008 Seattle/King County EMS
Hepatitis B,
continued
Transmission:
•
•
•
•
Sex with infected person
Blood and other bodily fluids
Sharing needles with infected person
From a woman to her baby during birth
Copyright 2008 Seattle/King County EMS
Hepatitis B,
continued
Prehospital presentation:
• Most signs/symptoms of Hep B are mild
• Unlikely that you will be called to respond
to an acute illness caused by this virus
• However you may on occasion see a
patient with end-stage liver cancer or
other complications from the disease
Copyright 2008 Seattle/King County EMS
Hepatitis B,
continued
Occupational risk:
• Significant for unvaccinated person
• Very low for vaccinated person
Prevention:
• Best way to prevent an occupational
exposure, in addition to protecting yourself
from blood exposure, is vaccination
Copyright 2008 Seattle/King County EMS
Tuberculosis (TB)
• Caused by small bacteria that travels from
the small airways to cells of lungs
• Less than 10% of people infected with TB
will develop active disease
• In others, bacteria hides, causing no disease
until host (patient) becomes immunocompromised or otherwise debilitated
Copyright 2008 Seattle/King County EMS
Tuberculosis,
continued
Transmission:
• Via small airborne particles expelled by
cough, sneezing, or speaking
• Particles are inhaled into small airways
• Prolonged exposure in confined space
confers highest risk
Copyright 2008 Seattle/King County EMS
Tuberculosis,
continued
Prehospital presentation:
• Cough, often productive of blood-tinged
sputum
• Fatigue and weakness
• Night sweats
• Low-grade fever
• Loss of appetite and weight loss
Copyright 2008 Seattle/King County EMS
Tuberculosis,
continued
Occupational risk:
• Occupational risk is low but has been very
difficult to quantify
Prevention:
• Maintain high index of suspicion among
patients who are at risk of having TB
• Take precautions if patients present with
suspicious signs and symptoms (PPE)
Copyright 2008 Seattle/King County EMS
SARS
• A virulent respiratory infection reported in Asia
• 2003: over 8,000 people worldwide, 700 died
• US: 192 possible cases (of these, 33
considered "probable"), no deaths
• A relatively high case fatality rate among
young, healthy people
Copyright 2008 Seattle/King County EMS
SARS,
continued
Transmission:
• Droplets spewed from the cough or
sneeze of an infected person
• Close person-to-person contact
• Touching object and then touching
mouth, nose, or eyes
Copyright 2008 Seattle/King County EMS
SARS,
continued
Prehospital presentation:
• Fever, headache
• Malaise, body aches, and diarrhea
• Cough and possible respiratory
symptoms
• Most develop pneumonia and may
require ventilatory assistance and
supplemental oxygen
Copyright 2008 Seattle/King County EMS
SARS,
continued
Occupational risk:
• Minimal due to lack of recent cases –
follow local and CDC guidelines for
identification of high-risk patients
Prevention:
• Wash hands, wash surfaces and use contact
precautions: gown, gloves, and protective
eyewear
Copyright 2008 Seattle/King County EMS
Influenza (flu)
• Caused by influenza virus which attacks
respiratory system
• Occurs seasonally from November to April in
northern hemisphere
• Structure of virus changes slightly but
frequently over time; this accounts for
appearance of different strains each year
Copyright 2008 Seattle/King County EMS
Influenza (flu),
continued
Transmission:
• Coughed droplets
• Touching contaminated surfaces (less
common)
Copyright 2008 Seattle/King County EMS
Influenza (flu),
continued
Prehospital presentation:
Sudden onset of:
•
•
•
•
•
High fever
Malaise
Headache
Dry cough
Body aches
Copyright 2008 Seattle/King County EMS
Influenza (flu),
continued
Occupational risk:
• Varies depending on the strain
Prevention:
• Hand washing, clean surfaces
• Place mask on patient or ask patient to
cover mouth when coughing
• Best prevention is the flu vaccine, which
must be taken yearly
Copyright 2008 Seattle/King County EMS
Norovirus
• Highly contagious virus responsible for
outbreaks of GI disease on cruise ships
• Norovirus is general name given to viruses of
this type
• Responsible for many cases of severe but
short-lived illnesses causing vomiting,
diarrhea, and stomach cramps
• "Stomach flu" and "food poisoning" are
typical infections of Norovirus
Copyright 2008 Seattle/King County EMS
Norovirus,
continued
Transmission:
•
•
Fecal-oral route
Food handler does not wash his hands
after using the bathroom; you then ingest
food contaminated with fecal matter
A person with Norovirus is considered
contagious from the time he or she starts
feeling ill to as long as two weeks after
recovery.
Copyright 2008 Seattle/King County EMS
Norovirus,
continued
Prehospital presentation:
• Nausea, vomiting and diarrhea
• Stomach cramps
• Low-grade, transient fever
• General feeling of malaise, headache, body
aches
Symptoms begin suddenly, may last one to
three days, and usually resolve on their
own. Because the disease is caused by a
virus, antibiotics are useless.
Copyright 2008 Seattle/King County EMS
Norovirus,
continued
Occupational risk:
• Community-acquired, usually situations
where large numbers share same food or
living space (cruise ships, college dorms)
• Several outbreaks of noroviruses among
staff at hospitals and nursing homes
Copyright 2008 Seattle/King County EMS
Norovirus,
continued
Prevention:
•
•
•
•
Wear gloves
Wash your hands thoroughly
Use protective eyewear and mask
Surfaces contacted by patient must be
thoroughly disinfected
If you become sick, wait two days after the
last of your symptoms before returning to
work.
Copyright 2008 Seattle/King County EMS
West Nile Virus
• First identified in Africa
• The virus causing the disease infects certain
types of birds (ravens, crows, and jays),
mosquitoes, horses, and other animals
• Humans are an incidental, rather than
primary, host
Copyright 2008 Seattle/King County EMS
West Nile Virus,
continued
Transmission:
•
WNV is transmitted through bite of
infected mosquito
•
WNV is NOT transmitted person-toperson except in rare case of blood
transfusion from infected person
Copyright 2008 Seattle/King County EMS
West Nile Virus,
continued
Prehospital presentation:
•
•
•
•
Fever
Headache
Fatigue
Rarely, a rash and swollen lymph nodes
Less than 1% of the people infected with
WNV will develop severe illness. These
people may present with high fever,
headache or altered LOC.
Copyright 2008 Seattle/King County EMS
West Nile Virus,
continued
Occupational risk:
• None
Prevention:
• Since WNV disease is not transmitted
person-to-person, no specific disease
prevention precautions are necessary at
work
Copyright 2008 Seattle/King County EMS
Risk
• In last 25 years, estimated 57 healthcare
workers in US have contracted HIV from a
documented occupational exposure
• Thousands of health care workers EVERY
YEAR contracted Hepatitis B from
occupational exposure, and it is estimated
that as many as 200 per year died (prior to
vaccine).
Copyright 2008 Seattle/King County EMS
Masks
• Don fit-tested mask before entering scene
• Place a mask on patient, if tolerated
• Fitted masks provide highest level of
protection
• Remove and dispose of mask without self
contamination
Copyright 2008 Seattle/King County EMS
Eye Protection
Wear eye protection on all calls — prepare for
unanticipated splashes:
•
•
•
•
•
•
•
Vomiting
Blood flicked from bloody hand
Violent spit
Glucometer strips
Splashing fluids
Respiratory infection
Violent cough or sneeze
Copyright 2008 Seattle/King County EMS
Gloves
• Wear medical gloves on all calls
• Most bodily fluids, such as vomit or urine, do
not typically carry blood borne viruses
• While working in rescue or extrication
environment where risk of both cut and body
substance exposure are present, wear latex
or nitrile inner gloves and other protective
outer gloves
Copyright 2008 Seattle/King County EMS
Limits of Gloves
• Gloves are for use during patient contact
• Wash your hands after all patient contact,
even if you wore gloves
• Gloves will not protect you from sharp
objects such as needles
Copyright 2008 Seattle/King County EMS
Sharps
• Needlesticks represent the greatest risk of
occupational blood borne transmission
• Many "exposures" involve cases in which
EMS providers inadvertently stuck
themselves with used needles
• Keep an eye on paramedics and needles,
and watch where you put your hands
Copyright 2008 Seattle/King County EMS
Needlestick
For needlestick exposures:
•
•
•
Wash area well with soap and water
Do NOT use bleach or other harsh
chemicals
Report the exposure immediately to your
officer for testing and possible postexposure prophylaxis (PEP)
Copyright 2008 Seattle/King County EMS
Skin/Mucus
For exposures to non-intact skin:
•
•
Wash with soap and water
Report exposure immediately to your
officer for testing and possible postexposure prophylaxis (PEP)
Blood on intact skin is not considered a
significant exposure. Non-intact skin
includes abrasions and cuts.
Copyright 2008 Seattle/King County EMS
Skin/Mucus,
continued
For exposures to mucus membranes:
•
•
Flush liberally with water
Report exposure immediately to your
officer for testing and possible postexposure prophylaxis
Copyright 2008 Seattle/King County EMS
Airborne
• Report possible exposure to your company
officer
• Hospital may notify exposed responders if
patient is diagnosed with an airborne disease
(e.g., TB or bacterial meningitis)
• Some diseases may require automatic and
immediate post-exposure prophylaxis
• Others may require post-exposure testing
and then treatment only if you become
positive
Copyright 2008 Seattle/King County EMS
PEP for HIV
• Any possible exposure to blood borne
disease must be reported immediately to
your company officer
• Post-exposure prophylaxis reduces already
very low risk of acquiring
• The medications taken for PEP are TOXIC
• If patient is HIV-negative, PEP medications
can be stopped
Copyright 2008 Seattle/King County EMS
Summary
• Hand washing is the most effective method
of preventing infectious disease
• Clean visible contamination first, and then
disinfect the surface
• Wear gloves when disinfecting equipment
• Occupational risk of acquiring AIDS is VERY
LOW
Copyright 2008 Seattle/King County EMS
Summary,
continued
• Best way to prevent an occupational
exposure to HBV, in addition to taking care to
protect yourself from blood exposure, is to
be vaccinated
• Remove gloves when you are done with
patient contact, before getting into your rig,
talking on the radio or driving
Copyright 2008 Seattle/King County EMS
Summary,
continued
• If you suspect TB, put a mask on patient (if
tolerated), and wear a mask yourself
• Needlesticks represent by far greatest risk of
occupational blood borne transmission
• If PEP is to be started, start IMMEDIATELY
after exposure, if at all possible within two
hours
Copyright 2008 Seattle/King County EMS