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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 Page 1 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 Page 2 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 Page 3 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 Page 4 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. Page 5 - 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 Page 6 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 Page 7 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 Page 8 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 Page 9