Download Decontamination and Disposal

Millersburg Fire Company #1
Standard Operating Guideline
Chapter 2-Operations
Infectious Disease Control Program
SOG 3
Purpose
Due to the potential exposure of personnel to infectious and communicable diseases in
the performance of their duties, this guideline is provided to minimize the risk of
exposure as part of an Infectious Control Program.
Scope
The Infectious Disease Control Program consists of the following:
 Exposure avoidance and protection
 Initial and continuing education requirements
 Employee inoculations
 Personnel Protective equipment
 Decontamination procedures for personnel, clothing and equipment
 Handling and disposal of medical waste.
 Exposure reporting, notification and management, ensuring confidentiality.
 Methods of monitoring compliance.
In addition, exposure to a communicable or infectious disease shall be considered an
occupational health hazard, and any communicable or infectious disease contracted as a
result of a documented workplace exposure shall be considered occupationally related.
Universal Precautions and Personal Hygiene
Personnel are to assume that all patients are potential exposures and are to use
universal precautions anytime they handle patents.
In addition, personnel should ensure all broken skin is covered, and that they use
antiseptic hand wash solution immediately following contact with patients, and
shall wash with a disinfectant soap as soon as possible.
Personnel are not to place anything into their body, such as food or tobacco
products, until after they have washed.
Personnel are held individually responsible to ensure compliance with these
precautions, and in addition, Officers are to ensure compliance of subordinates.
Availability of PPE
Medical gloves are to be kept in each trauma bag, and in the cab of each
apparatus.
SOG 2.3
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Surgical masks are to be kept in each trauma bag.
Pocket masks are to be issued to each individual firefighter.
Antiseptic hand wash solution shall be kept in each trauma bag.
Large and small med waste (red) bags shall be kept in each trauma bag.
Use of PPE
At a minimum, personnel should wear medical gloves for medical calls, and
medical gloves and eye protection for trauma calls and cardiac arrests.
Medical gloves are to be used by personnel anytime they handle a patient. During
trauma incidents where there is potential for personnel not providing PT treatment
to become exposed to body fluids, they too should don medical gloves.
Surgical masks/eye protection is to be worn when there is a significant chance of
being exposed to the eyes or mucus membranes of the nose and mouth.
Pocket masks or BVM’s are to be used for artificial respiration. Mouth to mouth
respiration should not be performed.
Training
All new personnel shall be given training on Infectious Disease Control within
thirty (30) days of their acceptance date.
In addition, annual training shall include information on Infectious Disease
Control, for all personnel.
Inoculations
Personnel are to be offered Hepatitis “B” vaccinations at the time of their
acceptance. Personnel are to be given sufficient information to make an informed
decision, and are to complete the Fire Company form stating whether they wish to
accept or deny the vaccination.
Personnel accepting the vaccination will receive all injections from the approved
physician, and are responsible to coordinate scheduling of the series with that
physician.
Personnel at anytime whether they initially refused the vaccination may request
from the department to have such done, providing they are a member in good
standing and of active status.
SOG 2.3
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Decontamination and Disposal
Decontamination Areas
There will be areas dedicated for the sole use of decontamination of medical
equipment. These rooms are to be cleaned monthly and disinfected after each use,
and are to have cleaning and disinfecting supplies dedicated for their use.
 Bay three (Engine) area of drain
In addition, there will be areas designated in the fire station for cleaning and
disinfecting of protective clothing and equipment. These areas are to be
disinfected after each use.
 Bay three (Engine) area of drain
Medical Equipment Decontamination
Only reusable equipment such as C-collars, backboards, BP cuffs will be
decontaminated. Items such as airways, O2 masks, etc will be disposed of as
medical waste (red bag).
Equipment which has detachable disposable items, such as suction, BVM and
pocket mask units, will have the disposable portion disposed of and the remainder
decontaminated.
All visible body fluids shall be rinsed from items as soon as possible using COLD
water.
All items shall be disinfected using a solution of one (1) part chlorine bleach to
ten (10) parts water, or an approved disinfectant.
All items shall be hung to dry before re-use.
NOTE: Electronic items such as AED’s shall be rinsed with cold water, and then
have an approved disinfectant applied instead of bleach.
Clothing and Equipment Decontamination
All protective clothing such as bunker coats, pants, liners, and firefighting/leather
gloves that are grossly contaminated (over 5%) with blood or body fluids shall be
rinsed immediately with cold water to remove all visible fluids.
These items shall then be placed in a proper medical waste bag for professional
cleaning. If liners are not contaminated, they may be removed prior to the
garment being placed in the bag.
The Officer in charge should then coordinate decontamination of the items
with the professional cleaners of choice. It should be noted in the incident
report who and where the gear went to for cleaner.
SOG 2.3
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Any personal clothing items contaminated shall be handled in the same manner.
Protective clothing that is less than 5% contaminated may be spot cleaned using
the following procedures:
 Remove all visible fluids using cold water as soon as possible.
 Apply a solution of liquid oxygenated bleach to the affected areas. (do not use
chlorine bleach on fire retardant fabric)
 Gently rub the fabric together until lather appears.
 Rinse with cold water and allow to air dry.
NOTE: Do NOT use chlorine bleach on electronic items such as radios.
Non-porous items such as tools con be rinsed with cold water and disinfected with
chlorine bleach solution, or a commercial disinfectant.
Personal Decontamination
Personnel who have been grossly contaminated (greater than 5%) with body
fluids shall rinse off all visible fluids immediately with cold water.
Personnel will then be taken for medical evaluation.
Personnel who have had any contamination of body fluids in any opening of their
body shall have the area immediately flushed (if applicable) and be taken for
medical evaluation.
Disposal of Medical Waste
Any material for disposal which has come in contact with body fluids, or is
suspected to have come in contact with body fluids shall be disposed of in the
following manner:
 Gloves, gauze, and other non-sharps shall be collected at the scene and placed
in a medical waste bag, and if possible, placed into the ambulance with the
patient.
 If any sharps are left at the scene, the on-duty Upper Dauphin Emergency
Medical Services supervisor shall be notified, and is responsible for its
disposal.
 Any medical waste collected after EMS has left the scene, or at the station, is
to be placed in medical waste bags.
Exposure Reporting
If any personnel has had an exposure, as defined in this document, it is the
responsibility of the Officer in Charge of the incident to document the exposure
on the Infectious Exposure Form, and to ensure appropriate medical protocols are
followed. Once complete, this form will be submitted to the Office no later than
the next day.
SOG 2.3
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In addition, the OIC will document the exposure on the Incident Report.
Potential Exposure to Communicable Disease
In the event any personnel receives notification from a health or EMS
organization that department personnel were potentially exposed to a patient with
a communicable disease, they shall immediately do the following:
 Document as much information as can be derived from the person notifying
them including a call back number.
 Contact the Fire Chief or the department duty chief immediately and relay the
information to him.
 Attempt to determine which personnel were involved with the incident.
The duty officer will attempt to determine the validity of the information, through
the appropriate EMS provider involved with the incident, and in addition, attempt
to contact the attending physician.
If the report is valid, involved personnel will be contacted and advised to follow
the instructions of the DOH, Pinnacle Family Health Center, or attending
physician.
Levels of Exposure
Level I Exposure: Contact limited to merely being in the presence of a person
known to have, or highly suspected of having a communicable disease.
Level II Exposure: Contamination of any clothing, equipment and/or unprotected
intact skin, which means skin that, has no lacerations or other openings that could
be contaminated by the patient’s bodily fluids.
Level III Exposure: Any Contact with a patient’s bodily fluids or airborne
droplets (TB) through non-intact skin, needle stick, mucous membranes,
inhalation into respiratory system, or conjunctival (eye) membranes.
Post Exposure Procedures
1.
General procedure
a.
Wound care:
-
SOG 2.3
If the exposure is injection or needle stick, scrub wound
site with department supplied antimicrobial solution for
five (5) minutes.
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-
Level 1
Exposure
-
If the exposure is a mucous membrane contamination (eye
or mouth), rinse the contaminated membranes with normal
saline or water for at least five (5) minutes.
-
If the exposure is on intact skin, thoroughly wash the
contaminated area as soon as possible.
Re-don new gloves, if still involved with patient care.
b.
Immediately report exposure to your supervisor.
c.
Determine level of exposure (Level I, II, or III) and action required
according to exposure category (see below for Required Action for
Exposures).
d.
Complete an “Emergency Response Employee Report” before
completion of shift and forward to the Infection Control Officer. A
form shall be completed for all levels of exposure.
e.
Complete WC (workers’ compensation) documentation forms for
all levels of exposure. Complete WC forms before completion of
the shift, and forward to the Assistant Fire Chief.
a. Immediately report exposure to your supervisor.
b. Complete “Emergency Response Employee Report” form and
Worker’s Compensation forms.
c. Document employee’s name and incident number on incident logbook.
Example: Exposure Incident: Jim Casino 2844, #245 (incident #). Do
not log the details of the exposure.
d. No further action required.
Level 2
Exposure
a. Provide appropriate wound care (see above V.1.a general
procedure).
b. Immediately report exposure to your supervisor.
c. Complete “Emergency Response Employee Report” form and
Worker’s Compensation forms.
d. Document exposure in station logbook (same as above).
e. Decontamination of equipment and clothing required according to
infection control plan
SOG 2.3
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Level 3
Exposure
a. Provide appropriate wound care (see above V.1.a “General
Procedure)
b. Immediately notify your supervisor
c. Immediately contact Battalion Chief, if applicable.
d. Immediately contact Infection Control Officer.
1. If no contact, call the EMS Officer and/or the EMS Captain
2. If no contact, contact the on-call EMS Officer
3. If no contact, contact Pinnacle Family Health Center
e. Obtain immediate medical attention at a local emergency
department.
f. Immediately respond to the ER as the patient
1. Admit yourself as a patient (front window)
2. Inform Charge Nurse of a known or possible exposure and
have the exposure entered into the “Exposure Log”
g. Ensure your name, patient’s name, time reported to ER, and type
of exposure are
entered into the log.
h. Source patient testing – The lab staff will follow the standardized
Protocol Referred to as the “Blood/OPIM Exposure Source Patient
Testing Protocol for First Responders”. Which includes the
following tests:
1. Hepatitis C Antibody
2. Hepatitis B Surface Antigen
3. HIV
These tests are to be perform at the prescribed intervals unless
Otherwise directed by the Department Physician (Pinnacle Family
Health Center).
Level 3
Exposure
Continued
i. After appropriate treatment, employee will be referred, if
appropriate, to the Occupational Medical Group (Pinnacle Family
Heath Center) for follow-up medical treatment and long-term care.
j. Complete WC forms and Emergency Response Employee Report
Forms.
SOG 2.3
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k. Document exposure in station logbook same as Level I and Level
II (above)
EMERGENCY CONTACTS
Fire Chief
Douglas Snyder
1 st Assistant Chief
Donald Harris, Jr.
2nd Assistant Chief
Christopher Hardy
3rd Assistant Chief
Colby Challenger
Infection Control Officer
Randy Riegle
717-692-3735 home
717-773-3852 cell
717-692-3735 home
717-773-3853 cell
717-574-9072 home
717-773-3851 cell
717-979-6295 home
717-773-3850 cell
717-692-4837 work
717-756-6871 cell
Pinnacle Family Health Center
717-692-4761
Pinnacle Infection Control
717-231-8344
SOG 2.3
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Definitions
Body Fluids
Fluids that the body makes including, but not limited to, blood, semen, mucus, feces,
urine, vaginal secretions, breast milk, amniotic fluids, cerebrospinal fluids, synovial
fluids, pericardial fluid, and fluids that might contain concentrated HIV or HBV viruses.
Contaminated
Having come in contact with body fluids.
Exposure
Contact with an infectious agent, such as body fluids, through inhalation, percutaneous
inoculation, or contact with an open wound, non-intact skin, or mucus membrane.
Medical Waste
Items to be disposed of that have been contaminated with human waste, blood or body
fluids.
Sharps
Items which have the potential to puncture, such as needles and scalpels.
Douglas A. Snyder
January 15, 2011
_______________________________________________
Fire Chief
Date
SOG 2.3
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