Download Communicable Disease

PORT ARTHUR
FIRE DEPARTMENT
COMMUNICABLE DISEASE
2/4/2009
600-6
Page 1 of 7
Purpose
This protocol has been developed to comply with state and federal regulations regarding the
possible exposure of personnel to communicable diseases.
Policy
It is the policy of the Port Arthur Fire Department that Infection Control protocols and Body
Substance Isolation procedures be adhered to at all times in an effort to prevent possible exposure
of personnel to communicable diseases. It is also the policy of the Port Arthur Fire Department
that in the event that an employee is exposed to a communicable disease, the decontamination,
reporting, and testing procedures as listed in this protocol will be immediately initiated
Proceedure
Definitions
Blood-borne Pathogen: A transmissible organism that replicates in the blood. The major
transmission route is blood contact, but can also be from other body fluids that are directly or
indirectly linked with the blood such as semen, vaginal secretions, or any body substances
containing blood.
Exposure: An actual or potential inoculation of infectious substances (blood, etc.) occurs through
contact with mucous membranes (eyes, nose, mouth) or through breaks or punctures in the skin.
Diseases
Airborne diseases which emergency care providers may he exposed to when examining the throat
intubating or suctioning include:
I.
2.
3.
4.
Diphtheria
measles
Meningococcal Infections (Meningitis, Septcernia)
Pertussis
PORT ARTHUR
FIRE DEPARTMENT
5.
6.
7.
8.
COMMUNICABLE DISEASE
2/4/2009
600-6
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Plague
Rubella
Tuberculosis
Viral Hemorrhagic Fever (Lassa Fever, Ebola, Marburg)
Blood-borne diseases which emergency care providers may be exposed to by needle-stick or other
penetrating puncture of the skin with a needle or other item by splatter or aerosol into the eye,
nose, or mouth or any significant contamination of an open wound or non-intact skin with blood or
body fluid include:
1.
2.
3.
4.
5.
6.
7.
Acquired Immunodeficiency Syndrome (AIDS)
Human Immunodeficiency Virus Infection (HIV)
Malaria
Plague
Syphilis
Viral Hepatitis (Hepatitis B)
Viral Hepatitis (Non-A, Non-B)
The Center for Disease Control developed the strategy of “Universal Blood and Body Fluid
Precautions” to address concerns regarding the transmission of HIV in the health care setting. This
concept is often referred to as “Universal Precautions” or as “Body Substance Isolation” (BSI).
This strategy stresses that all patients should be assumed to be infectious for HIV and other
blood-borne pathogens. In the emergency medical setting “Body Substance Isolation” procedures
should be followed when first responders are exposed to blood, certain other body fluids
(Amniotic fluid, pericardial fluid, peritoneal fluid, pleural fluid, synovial fluid, cerebrospinal fluid,
semen, and vaginal secretions), or any body fluid visibly containing blood.
HIV and Hepatitis B transmission has not been documented from exposure to feces, nasal
secretions, sputum, sweat, tears, urine, and vomitus. Unless blood is mixed with these fluids they
can be considered low risk exposures. One major exception to this rule is in a dental setting where
saliva is likely to be contaminated with blood or at the scene of an automobile accident, assault, or
accident where the patient has injuries which might allow blood to contaminate the saliva.
Due to the unpredictable and emergent nature of exposures encountered by firefighters and
emergency medical personnel, it may make the identification of which body fluids are
hazardous and which are not, very difficult or impossible. Therefore, when firefighters and
emergency medical personnel encounter body fluids under emergency situations, they should
TREAT ALL BODY FLUIDS AS POTENTIALLY HAZARDOUS.
PORT ARTHUR
FIRE DEPARTMENT
COMMUNICABLE DISEASE
2/4/2009
600-6
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Immunization and Testing
Hepatitis A & B
Employees will be inoculated against Hepatitis A & B.
Tuberculosis
Employees will be skin tested for Tuberculosis infection annually unless they have received a prior
positive result. In the event that an employee is exposed to the active tuberculosis, they will report
to the City Department of Health for evaluation. If it is after regular business hours, report the next
business day for testing. Instructions on follow-up testing will be given by the Department of
Health. Any recommended prophylaxis/treatment and counseling will be provided if the situation
warrants.
Precautions to Prevent the Transmission of Communicable Diseases
All personnel should take precautions to prevent transmission by following these guidelines:
A. Needle and Sharps Disposal: All personnel should take precautions to prevent injuries
caused by needles, scalpel blades and other sharp instruments or devices during
procedures; when cleaning used instruments; during disposal of used needles; and when
handling sharp instruments after procedures. To prevent needle-stick injuries, needles
should not be recapped, purposely bent or broken by hand, removed from disposable
syringes, or otherwise manipulated by hand. After they are used, disposable syringes and
needles, scalpel blades and other sharp items should be placed in puncture-resistant
containers for disposal and placed in the appropriate disposal receptacle in the transporting
ambulance.
B. Hand Washing: Hands and other skin surfaces should be washed immediately and
thoroughly if contaminated by blood or other body. Hands should always be washed after
gloves are removed, even if the gloves appear to be intact. Hand washing should be
completed using appropriate facilities, such as utility or restroom sinks. Waterless
antiseptic hand cleaner is provided on all responding units to use when hand-washing
facilities are not available. When hand-washing facilities are available, wash hands with
warm water and soap.
PORT ARTHUR
FIRE DEPARTMENT
COMMUNICABLE DISEASE
2/4/2009
600-6
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C. Cleaning and Disinfecting of Equipment: Laryngoscope blades should be soaked in an
EPA registered “sterilant” chemical for a minimum of 10 minutes. Surfaces that come in
contact with intact skin (e.g. stethoscopes. blood pressure cuffs, splints) and have been
visibly contaminated with blood or bloody body fluids, should be cleaned WHILE
WEARING GLOVES with a “hospital disinfectant” chemical germicide that has a label
claim for tuherculocidal activity.
D. Cleaning and Decontaminating Spills of Blood: All spills of blood and body fluids
should be promptly cleaned up using an EPA approved germicide or a bleach solution
(mixed at 10 parts water to 1 part bleach concentration) WHILE WEARING GLOVES.
Solid material should first be removed with disposable towels, which will ensure against
direct contact with blood. If splashing is anticipated, protective goggles should be worn
along with the gown, which provides an effective barrier to the splashes. The area should
then be decontaminated with the germicide. Hands should be washed following removal of
gloves. The soiled cleaning equipment should be placed in a bio-waste bag and tied. This
bag should be given to the ambulance personnel or turned in to the nearest hospital
emergency room. Engine 3 and Engine 4 will have to make arrangements with the
Battalion Chief for the immediate disposal of medical waste if ambulance personnel are no
longer available.
E. Decontamination and Laundering of Protective Clothing: Protective work clothing
contaminated with blood or other body fluids should be placed and transported in bags or
containers that prevent leakage. Personnel involved in the bagging, transport or laundering
of contaminated clothing should wear gloves. Protective clothing should be washed and
dried according to the manufacturer’s instructions. Boots and helmets may be brush
scrubbed with soap and hot water to remove contamination. Station work uniforms and
shoes should he disposed of as described in paragraph D. Replacement of station work
uniforms and footwear shall be provided by the department.
F. Search the Scene: Prior to removal of protective equipment, personnel remaining on
scene after the patient has been cared for, should carefully search and remove contaminated
materials All items shall he disposed of as noted above.
Protective Equipment Available on the Apparatus
A. Gloves: Disposable gloves are provided on all apparatus and should be donned by all personnel
prior to initiating patient contact or any task involving exposure to blood or other body fluid. Extra
pairs are always available. For multiple trauma victims, GLOVESSHOULD BE CHANGED
BETWEEN EACH PATIENT CONTACT, IF THE EMERGENCY SITUATION ALLOWS.
Gloves should be removed and then disposed of in the responding/transporting ambulance. Used
gloves are not to be left lying around fire apparatus or stations.
PORT ARTHUR
FIRE DEPARTMENT
COMMUNICABLE DISEASE
2/4/2009
600-6
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B. Mask, Eyewear, and Gowns: Masks, eyewear, and gowns are present on all apparatus
(components of the Infection Control Kit). These protective barriers should be used in accordance
with the level of exposure encountered. Minor lacerations or small amounts of blood do not merit
the same extent of barrier use as required for severe trauma victims or massive arterial bleeding.
Mask and eyewear should be worn together, prior to any situation where splashes of blood or body
fluids are likely to occur. Gowns are available to protect clothing from splashes of blood. If large
splashes or quantities of blood are present or anticipated, gowns should be worn.
C. High Efficiency Particulate Air (HEPA) filter mask: Each apparatus is equipped with HEPA
masks for personnel use. These should be worn by personnel whenever a patient is suspected of
having active tuberculosis. A mask should also be placed over the patients mouth and nose.
D. Resuscitation Equipment: Because of the risk of salivary transmission of infectious diseases
and the theoretical risk of HIV and Hepatitis B transmission during artificial ventilation of trauma
victims, disposable airway equipment [e.g. Pocket Mask with a one way valve or Bag Valve Mask
(BVM) should be used. Disposable resuscitation equipment and devices should be used once and
then properly disposed of.
E. Infection Control items are available on each apparatus. When items are used they are to be
replenished immediately.
Reporting and Documenting Possible Exposure
If an employee believes that he/she may have been exposed to an infectious/contagious disease,
that person needs to follow the procedures listed below to report and document that possible
exposure.
Immediate Actions in the Field
1. The company officer will immediately notify the Battalion Chief on duty of the exposure.
2. If the employee was possibly exposed to a blood-borne pathogen, then A BASELINE
BLOOD SAMPLE MUST BE TAKEN. This may be done at either:
a. The hospital where the patient was transported to or:
b. The City Department of Health, during business hours.
3. The Report of Possible Exposure of Transporter form MUST BE FILLED OUT.
a. The Report of Possible Exposure of Transporter form will be turned into the
Emergency Room Triage Nurse, at the hospital where the patient was transported.
PORT ARTHUR
FIRE DEPARTMENT
COMMUNICABLE DISEASE
2/4/2009
600-6
Page 6 of 7
Request a photocopy of the form and retain the copy to turn in with the rest of your
documentation.
4. The City of Port Arthur Personnel Department-Safety Division Authorization for
Employee Medical Treatment should be filled out by the Battalion Chief.
5. A Supervisor’s Report of Accident Investigation form must also be completed by the
exposed employee’s immediate supervisor.
6. On the first business day following the possible exposure, the Deputy Fire Chief, or if
unavailable, the Fire Chief, should be notified.
Immediate Actions upon Returning to the Station
1. Immediately upon returning to your station:
a. Remove any soiled or contaminated clothing and place into a Bio-Hazard Bag.
b. Shower and put on a clean work uniform.
c. Alternatively, the employee may choose to decontaminate at the hospital’s
decontamination facilities.
2. Decontaminate and Launder Protective Clothing, as needed. If blood of other body fluids have
contaminated your bunker gear, take them to #1 Fire Station and have them washed. Standby
gear is available.
3. Refer to section 401-5 of the Port Arthur Fire Department Rules & Regulations/Operations
Manual. Complete and forward the necessary documentation in accordance with the
Injury/Exposure Reporting System Policy.
The Deputy Chief or Chief will notify the Fire Department Medical Director and act as a
departmental liaison with the Hospital and the City Department of Health. The hospital will
forward all necessary information concerning both the patient and employee in question, to the
City Department of Health. The Department of Health will then determine if an actual exposure
occurred. The employee will be notified at once of any test results and recommended
prophylaxis/treatment and counseling if the situation warrants.
Special Circumstances
Texas law allows the city Department of Health to request mandatory testing of persons suspected
of exposing firefighters, emergency medical personnel, or law enforcement officers to reportable
diseases, including HIV infection (Section 3.12, Chapter 81, Health & Safety Code). If probable
PORT ARTHUR
FIRE DEPARTMENT
COMMUNICABLE DISEASE
2/4/2009
600-6
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exposure is determined by the Department of Health, then the city Department of Health will
follow the specific procedures developed by the Texas Department of Health.
I. The Department of Health must give the person (source) prompt and confidential
written notice of the order to be tested. The source must be provided the factual basis
for ordering the test and referral to appropriate health care facilities for testing the
reportable disease, including HTV. The source must be advised of his/her right to
refuse to be tested but that refusal may result in a court determination of the necessity
for testing.
2. If the source refuses to be tested, he/she may be ordered by the court to be tested.
3. If the court determines that the possible exposure has occurred and testing is
appropriate, the court shall issue an order requiring counseling and testing of the
source.
4. The City Department of Health will inform the employee and the source of the test
results and the possible need for medical treatment and follow-up counseling services.
State law requires an employing governmental entity to pay for vaccinations and immunizations of
certain personnel who are exposed to contagious diseases during the course of employment. This
law also extends certain benefits to immediate family members of employees who may have been
exposed.
Confidentiality
The City of Port Arthur must provide equal access to appropriate services for all persons,
including those who may be infected with HTV or who have AIDS, in the custody or care of the
City of Port Arthur (this includes a suspect in custody of the Police Department or a patient).
All personnel as provided by law must treat all medical information, including information
concerning HI V/AIDS testing of employees or patients confidentially. Non-medical personnel
receiving such information shall keep this information confidential and not release it to others.
Failure to adhere to policy may result in both civil and criminal liabilities. (Section 8 1.046, Health
& Safety Code and Section 8 1. 103, Health & Safety Code as amended by Section 28, Chapter
1195, Acts of the 79th Legislature, Regular Session 1989)