Download 04.52 Infection Control Plan

HEALTH/SAFETY PROGRAM
Infection Control Program
Fire Department Town of Menasha
Standard Operating Guidelines
Page 1 of 9
May, 2009
Section 4
Last Revision 02/12
4.39 Purpose:
To provide a comprehensive infection control system that maximizes protection
against communicable diseases for all fire department personnel and the public
that they serve.
4.40 Scope:
This guideline applies to all fire department personnel that provide fire, rescue, or
emergency medical services.
The fire department recognizes that communicable disease exposure is an
occupational health hazard. Communicable disease transmission is possible
during any aspect of emergency response. The health and welfare of each
member is a joint concern of the member, the chain of command, and this fire
department. Although each member is ultimately responsible for their own health,
the fire department recognizes a responsibility to provide as safe a workplace as
possible. The goal of this program is to provide fire department personnel with the
best available protection from occupationally acquired communicable disease.
4.41 Provisions:
The following are the intended provisions of this guideline:
1. Provide fire, rescue, and emergency services to the public without regard to
known or suspected diagnoses of communicable disease in any patient.
2. Regard all patient contacts as potentially infectious. Universal precautions will
be observed at all times and will be expanded to include all body fluids and
other potentially infection material (body substance isolation).
3. Provide all fire department personnel with the training, immunizations, and
personal protective equipment needed for protection from communicable
disease.
4. Recognize the need for work restrictions based on infection control concerns.
5. Encourage participation in personnel assistance and critical incident stress
debriefing (CISD) programs.
6. Prohibit discrimination of any personnel for health reasons, including infection
or seroconversion, or both, with HIV, HBV, or HCV.
7. Regard all medical information as strictly confidential. No personnel health
information will be released without the signed written consent of that member.
HEALTH/SAFETY PROGRAM
Infection Control Program
Fire Department Town of Menasha
Standard Operating Guidelines
Page 2 of 9
May, 2009
Section 4
Last Revision 02/12
4.42 Definitions:
Blood – Human blood, human blood components, and products made from human
blood.
Body Fluids – Fluids that the body produces including, but not limited to, blood,
semen, mucus, feces, urine, vaginal secretions, breast milk, amniotic fluids,
cerebrospinal fluid, synovial fluid, pericardial fluid, sputum, and any other fluids
that might contain pathogens.
Cleaning Gloves - Multipurpose, multi-use gloves that provide limited protection
from abrasion, cuts, snags, and punctures during cleaning and that are designed
to provide a barrier against body fluids, cleaning fluids, and disinfectants.
Contaminated – The presence or the reasonable anticipated presence of blood,
body fluids, or other potentially infectious material on an item or surface.
Contaminated Sharps – Any contaminated object that can penetrate the skin
including, but not limited to, needles, lancets, scalpels, broken glass, jagged
metal, or other debris.
Decontamination – The use of physical or chemical means to remove, inactivate,
or destroy bloodborne, airborne, or foodborne on a surface or item to the point
where they are no longer capable of transmitting infectious particles and the
surface or item is rendered safe for handling, use, or disposal.
Disinfection – The process used to inactivate virtually all recognized pathogenic
microorganisms but not necessarily all microbial forms, such as bacterial
endospore.
Emergency Medical Care – The provision of treatment to patients, including first
aid, cardiopulmonary resuscitation, basic life support (first responder level),
advanced life support (paramedic level), and other medical procedures that occur
prior to arrival at a hospital or other medical care facility.
Exposure Incident – A specific eye, mouth or other mucous membrane, non-intact
skin, or parenteral contact with blood, body fluids, or other potentially infectious
material; inhalation of airborne pathogens; or ingestion of foodborne pathogens or
toxins.
Face Protection Device – Devices constructed of protective materials, designed
and configured to cover part or all of the wearer’s face or head.
HEALTH/SAFETY PROGRAM
Infection Control Program
Fire Department Town of Menasha
Standard Operating Guidelines
Page 3 of 9
May, 2009
Section 4
Last Revision 02/12
Hepatitis:
HBV – Hepatitis B virus
HCV – Hepatitis C virus
HIV – Human immunodeficiency virus
Immunization – The process or procedure by which a person is rendered immune.
Infection – The state or condition in which the body or a part of it is invaded by a
pathogenic agent (microorganism or virus) which, under favorable conditions,
multiplies and produces effects which are injurious.
Infection Control Officer – The person or persons within the fire department who
are responsible for managing the department’s infection control program and for
coordinating efforts surrounding the investigation of an exposure.
Leakproof Bags – Bags that are sufficiently sturdy to prevent tearing or breaking
and can be sealed securely to prevent leakage and that are red in color or display
the universal biohazard symbol (bio bags).
Mask – A device designed to limit exposure of the nasal, oral, respiratory, or
mucosal membranes to airborne pathogens.
Medical Gloves – Single-use examination gloves that are designed to provide a
barrier against body fluids.
Medical Waste – Items to be disposed of that have been contaminated with
human waste, blood, or body fluids; or human waste, human tissue, blood or body
fluids for which special handling precautions are necessary.
Mucous Membrane – A moist layer of tissue that lines the mouth, eyes, nostrils,
vagina, anus, or urethra.
Parenteral – Piercing of the mucous membranes or the skin barrier due to such
events as needle sticks, human bites, cuts, and abrasions.
HEALTH/SAFETY PROGRAM
Infection Control Program
Fire Department Town of Menasha
Standard Operating Guidelines
Page 4 of 9
May, 2009
Section 4
Last Revision 02/12
Pathogens – Microorganisms such as bacteria, virus, or fungus that is capable of
causing disease.
Airborne Pathogens – Microorganisms that can produce infection and/or cause
disease in humans after being inhaled.
Bloodborne Pathogens – Microorganisms that are present in human blood and
can cause diseases in humans.
Foodborne Pathogens – Microorganisms that are present in food or drinking
water and can cause infection and/or disease in humans.
Patient – An individual, living or dead, whose body fluids, tissues, or organs could
be a source of exposure to personnel.
Personal Protective Equipment (PPE) – Specialized clothing or equipment worn
by personnel for protection against a hazard.
Pocket Mask – A double-lumen device that is portable, pocket-size, and designed
to protect the emergency care provider from direct contact with mouth/lips or body
fluids of a patient while performing artificial respiration.
Post-Exposure Prophylaxis – Administration of a medication to prevent
development of an infectious disease following known or suspected exposure to
that disease.
Potentially Infectious Materials – Any body fluid that is visibly contaminated with
blood; all body fluids in situations where it is difficult or impossible to differentiate
between body fluids; sputum, saliva, and other respiratory secretions; and any
unfixed tissue or organ from a living or dead human.
Regulated Waste – Liquid or semi-liquid blood, body fluids, or other potentially
infectious materials; contaminated items that would release blood, body fluids, or
other potentially infections material in a liquid or semi-liquid state if compressed;
items that are caked with dried blood, body fluids, or other potentially infectious
materials and are capable of releasing these materials during handling;
contaminated sharps; and pathological and microbiological wastes containing
blood, body fluids, or other potentially infectious materials.
Resuscitation Equipment – Respiratory assist devices such as bag-valve masks,
oxygen demand valve resuscitators, pocket masks, and other ventilation devices
that are designed to provide artificial respiration or assist with ventilation of a
patient.
HEALTH/SAFETY PROGRAM
Infection Control Program
Fire Department Town of Menasha
Standard Operating Guidelines
Page 5 of 9
May, 2009
Section 4
Last Revision 02/12
Splash-Resistant Eyewear – Safety glasses, prescription eyewear with protective
side shields, goggles, or chin-length face shields that, when worn properly,
provide limited protection against splashes, spray, spatter, or droplets of body
fluids.
Universal Precautions – An approach to infection control in which human blood
and certain body fluids are treated as if known to be infectious for HIV, HBV, and
other bloodborne pathogens.
4.43 Infection Control Training and Education:
The fire department shall conduct initial and annual training and education
programs for all department personnel in accordance with state or federal
regulations. The training program shall include the following:
1. Use of personal protective equipment.
2. Standard operating guidelines for safe work practices in infection control.
3. Methods of disposal of contaminated articles and medical waste.
4. Cleaning and decontamination.
5. Exposure management.
6. Medical follow-up.
4.44 Infection Control Officer:
The designated Infection Control Officer for the fire department is the Health and
Safety Officer (HSO). In the absence of the HSO, the Fire Chief or the Deputy
Chief/Fire Marshal shall be responsible for the duties and responsibilities of the
Infection Control Officer. In the absence of these three personnel, the Division
Chief of Training, then Emergency Operations Captains will be responsible for
meeting the immediate needs of department personnel. The following are
responsibilities of the Infection Control Officer:
1. Responsible for maintaining a liaison with the fire department physician, the
health and safety officer, the infection control representative at health care
facilities, and health care regulatory agencies.
2. When notified of an exposure incident, the Infection Control Officer shall
ensure the following:
A. Notification, verification, treatment, and medical follow-up of
personnel.
B. Documentation of the exposure incident as specified in 4.56.
HEALTH/SAFETY PROGRAM
Infection Control Program
Fire Department Town of Menasha
Standard Operating Guidelines
Page 6 of 9
May, 2009
Section 4
Last Revision 02/12
3. Shall be a member of the department’s health and safety committee.
4. Shall examine compliance procedures and engineering controls to
ensure their effectiveness in accordance with the operational
requirements of the NFPA 1581 standards.
4.45 Health Maintenance:
The following infectious disease immunizations or infectious disease
screening shall be provided by the fire department:
1. Tuberculosis screening (PPD) annually.
2. Hepatitis C virus screen.
3. Hepatitis B virus vaccinations and titers.
4. Tetanus/diphtheria vaccine.
5. Measles, mumps, rubella (MMR) vaccine.
6. Polio vaccine.
7. Hepatitis A – to high risk personnel.
8. Varicella vaccine offered to all non-immune personnel.
9. Influenza vaccine offered to all personnel annually.
10. HIV screening available to all personnel.
11. HIV testing offered on a confidential basis as part of post-exposure
protocols and as requested by the department physician or department
member.
4.46 Health Maintenance Guidelines:
A. If a firefighter has a positive test for PPD, CDC guidelines for
management and subsequent chest radiographic surveillance shall be
followed.
B. All results from HIV tests shall be provided directly to the firefighter, shall
be maintained by the department physician as confidential documents,
and shall not be forwarded to any local, provincial, state, national, or
international database unless mandated by public health statues.
HEALTH/SAFETY PROGRAM
Infection Control Program
Fire Department Town of Menasha
Standard Operating Guidelines
Page 7 of 9
May, 2009
Section 4
Last Revision 02/12
C. Members who chose to decline immunizations offered by the department
shall be required to sign a written declination form.
D. Firefighters shall be allowed to recant their declinations at any time and
receive the offered immunizations.
E. In the event of any real or perceived occupational exposure, the
firefighter shall receive confidential medical evaluation and be offered
post-exposure prophylaxis where medically indicated, counseling, and
evaluation of the reported illness by the fire department physician or the
physician’s designee.
F. Confidential health data base shall be established and maintained for
each firefighter.
4.47 DO NOT GET EXPOSED:
Fire Department personnel should not expose themselves to potentially infectious
materials unless properly trained, issued preventative protective equipment and
have appropriate immunization. Firefighters or support staff on the scene of
emergency, where patients exist, shall not touch contaminated clothing, EMS
equipment or any potentially contaminated items. Although direct contact should
never occur, firefighters shall wear complete firefighting protective clothing,
including impervious gloves and face-shields. In non-fire situations, protective
medical gloves will be provided to wear under normal firefighting gloves.
4.48 Accidental Exposure:
A specific eye, mouth or other mucous membrane, non-intact skin, or parenteral
contact with blood, body fluids, or other potentially infectious material; inhalation of
airborne pathogens; or ingestion of foodborne pathogens or toxins. “Significantly
exposed” means sustained a contact, which carries a potential for transmission of
disease, by one or more of the following:
1. Transmission, into a body orifice or onto mucous membrane, of blood; semen;
vaginal secretions; cerebrospinal; synovial; pleural; peritoneal, pericardial or
amniotic fluid; or other body fluid that is visibly contaminated with blood.
2. Exchange, during accidental or intentional infliction of a penetrating wound,
including a needle puncture, of blood; semen; vaginal secretions;
cerebrospinal; synovial; pleural; peritoneal, pericardial or amniotic fluid; or
other body fluid that is visibly contaminated with blood.
3. Exchange, into an eye, an open wound, an oozing lesion, or where a
significant breakdown in the epidermal (skin) barrier has occurred, of blood;
semen; vaginal secretions; cerebrospinal; synovial; pleural; peritoneal,
pericardial or amniotic fluid; or other body fluid that is visibly contaminated
with blood.
HEALTH/SAFETY PROGRAM
Infection Control Program
Fire Department Town of Menasha
Standard Operating Guidelines
Page 8 of 9
May, 2009
Section 4
Last Revision 02/12
4.49 Post Exposure Procedures:
If personnel experience a exposure, the following procedures shall be followed to
minimize the potential impact of the exposure:
1. The exposed area shall be immediately and thoroughly washed using water on
mucosal surfaces and soap and running water on skin surfaces.
2. If soap and water are not available, waterless soap, antiseptic wipes, alcohol,
or other skin cleaning agents shall be used until soap and running water are
obtained.
3. Notify your company officer or the Incident Commander that an exposure or
potential exposure has occurred.
4. The firefighter that experienced a “significant” exposure or potential
“significant” exposure shall be sent to our department physician if available. If
the department physician is not available the firefighter can be sent to another
appropriate medical facility for the following:
A. Medical guidance, evaluation, and where appropriate, post-exposure
prophylaxis.
B. Appropriate, confidential, post-exposure counseling and testing.
5. The firefighter shall complete an "incident exposure record" and submit the
document to the Health and Safety Officer and Fire Chief for further analysis.
These records shall be kept on file for thirty (30) years.
4.50 Potentially Contaminated Personal Protective Equipment:
If your protective clothing should become exposed to potentially infectious
material, immediately remove it and place it in a plastic bag (red bio-hazard bags
in the 1st aid kit on the engines, rescue or ladder). Inform your company officer or
the Incident Commander of the exposure and turn all contaminated clothing to the
department office for cleaning or disposal.
4.51 Medical Equipment/Waste Disposal:
Any medical equipment or waste such as medical gloves, oxygen masks, gowns,
face shields, oral airways, bag valve masks or other equipment that has been
contaminated or potentially contaminated with potentially infectious materials shall
be disposed of by giving this equipment to Gold Cross Ambulance for transport and
disposal at an approved medical facility that properly disposes of this type of
equipment and waste. If time doesn’t permit giving the equipment/waste to Gold
Cross Ambulance, the contaminated or potentially contaminated equipment/waste
must be placed in a red “bio hazard” bag for transport to either Gold Cross
Headquarters facility or Theda Clark hospital for proper disposal.
HEALTH/SAFETY PROGRAM
Infection Control Program
Fire Department Town of Menasha
Standard Operating Guidelines
Page 9 of 9
May, 2009
Section 4
Last Revision 02/12
4.52 Non-Consensual Testing:
According to the 1992 Wisconsin Act 269, Section 968.38, firefighters may
request a non-consensual test for patients suspected of having HIV or sexually
transmitted diseases (STD). The purpose of the test is an attempt to identify if the
patient is currently a carrier of such diseases.