Connecticut Fire Academy Emergency Medical Programs “Bloodborne Pathogens” OSHA 29 CFR 1910.1030 October 28, 2014

Connecticut Fire Academy

Emergency Medical ProgramsEmergency Medical Programs

““Bloodborne Pathogens”Bloodborne Pathogens”OSHA 29 CFR 1910.1030OSHA 29 CFR 1910.1030

October 28, 2014October 28, 2014


Introduction to Infection Control

Instructor: Title:


Module IModule I

Introduction

to

Infection Control


Why is Control Important?

1. This training is for the protection for first responders, their families and patients

2. Minimizes Personal & Organizational liability

3. Reduces Cost

4. Enhances Personal Safety, Personal Satisfaction & morale


Do first responders really have a greater risk of contracting infectious diseases as a result of their job ?


First Responders run a greater risk ofcoming in contact with blood, body fluids,tissues, airborne droplets and otherinfectious agents through accidental contactwith spills, splashes, contact etc..

What is the Risk?


• Nature of operations can often make it difficult to enforce proper precautions because of:

1. Stressful Conditions

2. Contact with High Risk Populations

3. Equipment Failure / Inappropriate Equipment

4. Lack of appropriate Personal Protective Equipment (P.P.E.)

Risk


• Laws: State and Federal

• Regulations: Dept. of Public Health

• Standards: OSHA

Infection Control ProgramsAre Required by:


Why is a comprehensive infection Why is a comprehensive infection control program important for control program important for

emergency response organizations ?emergency response organizations ?


• Comprehensive infection control is a major organizational undertaking, requiring a well defined structure or program.

• It ensures a comprehensive, integrated approach rather than reactionary, uncoordinated responses to infection control related incidents.


• A sound, pro-active infection control program is not preventive, but can lessen the liability for the department and responders, and helps to provide guidelines for dealing with related incidents.


Why is a comprehensive infectionWhy is a comprehensive infection

control program important forcontrol program important for

emergency response organizations ?emergency response organizations ?


What types of activities are includedWhat types of activities are included

in a comprehensive Infectionin a comprehensive Infection

Control ProgramControl Program ? ?


1. Entry Level Health Assessment

2. Immunization

3. On-going Health Assessment

4. Employee Assistance Programs (E.A.P.)

Health Maintenance


Which communicable diseases can beWhich communicable diseases can be

a threat to first responders ?a threat to first responders ?

Infection Control andPersonal Safety


• Fear of acquiring the Human

Immunodeficiency Virus ( HIV ) which can

lead to Acquired Immune Deficiency

Syndrome ( AIDS ) has focused increasing

attention on infection control.

Human Immunodeficiency Virus


Which posses a great occupationalWhich posses a great occupational

threat to emergency response personnel?threat to emergency response personnel?

Acquiring HIV Acquiring HIV

or or

Hepatitis B Virus ( HBV )?Hepatitis B Virus ( HBV )?


Statistically:

Hepatitis B (HBV) poses a much greater

occupational health risk than HIV.


Module IIModule II

Principles

of

Disease

Transmission


• Infection Control in the Workplace

• Introduction to a variety of Medical Terms

• You need to become familiar with these terms

Principles of Disease Transmission


How can we prevent infections? How can we prevent infections?

By interrupting the disease process.


Disease information for first response personnel.


Communicable Diseases can beCommunicable Diseases can be

readily passed from one person toreadily passed from one person to

another either directly or indirectly.another either directly or indirectly.

Communicable diseases may be either:

1. Bloodborne

2. Airborne

3. Direct Contact w/Contaminated Surface


Assessing the level of risk in a specificAssessing the level of risk in a specificexposure situation is sometimes exposure situation is sometimes

difficultdifficult and and confusingconfusing..


Even though some diseases pose a statistically greater risk, all patients should be treated as potentially infectious.

Remember:


Module IIIModule III

Health

Maintenance


What is it ?

Health Maintenance


Components of a Components of a Health MaintenanceHealth Maintenance

System:System:


Pre-employment Pre-employment ImmunizationsImmunizations


• What are they ?

• Who pays for them ?

Immunizations / Vaccinations


OSHA requires that Hepatitis B Vaccinations be made available to all employees with potential for occupational exposure.

1910.1030(f)(1)(i)


Appropriate and Approved PPersonal PProtective EEquipment (PPE) (PPE) is critical in reducing exposure and should be used whenever the potential for exposure reasonable exists.


Standard Precautions

“Precautions taken to prevent occupational risk exposure to blood

and other bodily fluids.”

Formerly known as “Universal Precautions”Formerly known as “Universal Precautions”


“An infection control strategy that considers all body substances as potentially infectious.”

Similar to Universal Precautions .. but goes further in isolating workers from Pathogens

Body Substance Isolation (BSI)


29 CFR 1910.1030 (d)(3)(x)29 CFR 1910.1030 (d)(3)(x)

Provision. When there is occupational exposure, the employer shall provide, at no cost to the employee, appropriate personal protective

equipment such as, but not limited to, gloves, gowns, laboratory coats, face shields or masks and eye protection, and mouthpieces,

resuscitation bags, pocket masks, or other ventilation devices. Personal protective equipment will be considered "appropriate" only if it does not permit blood or other potentially infectious materials to pass

through to or reach the employee's work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under

normal conditions of use and for the duration of time which the protective equipment will be used.

Universal PrecautionsOSHA still defines universal PrecautionsOSHA still defines universal Precautions


Eye protection Splash garment Mask Gloves

BSI vs. Universal Precautions?BSI vs. Universal Precautions?What does your Department have?What does your Department have?

Where is it located?Where is it located?

Body Substance Isolation (BSI)(BSI)


Module IV

Recommended

Personal Protective

Equipment


• Gloves: Gloves: Nitrile (avoid potential latex allergies) – Disposable

• Donning• Extra Pairs Available• First Responders should carry extra• Do Not Re-use

Recommended P.P.E.


• Single / Multiple Victims– danger of cross contamination

• Worn “Under” Firefighting / Law Enforcement Gloves• Cleaning Contaminated Areas / Equipment

• DO NOTDO NOT• Eat … Drink … Smoke …• Apply Cosmetics / Lip Balm• Handle Contacts

While Wearing Gloves

Glove Task Performance


• Disposal Procedures are determined by: Federal, State and Local regulations …

• Know Them

• Contaminated Articles should be enclosed in an impervious bag.

Proper Disposal of Gloves


Proper Disposal of Gloves


• Masks & Protective Eye Wear:Masks & Protective Eye Wear:– Prior to Patient Care– Splashes of Body Fluids

– Used with Level of Exposure encountered

– Reminder 29CFR1910.134 Reminder 29CFR1910.134 Fit TestingFit Testing

Recommended P.P.E.


• Masks “Standard B.S.I.”:Masks “Standard B.S.I.”:– “Standard” mask for B.S.I. is the N-95 level– These can be purchased as disposable mask or filters

that will fit existing full and half face mask.– All Mask require Fit Testing

• Reminder: 29CFR1910.134 Reminder: 29CFR1910.134 Fit TestingFit Testing

– Responders required to wear Respiratory Protection are also required to have a medical evaluation

• Reminder: 29CFR1910.134(e)Reminder: 29CFR1910.134(e)

– A medical questionnaire as identified is also required• Questionnaire: 29CFR1910.134 Appendix CQuestionnaire: 29CFR1910.134 Appendix C

Recommended P.P.E.


• Mask should be worn by the Responder and also placed on the patient when a potential for airborne transmission of a disease exists.

• Ensure the patient’s mask does not interfere

with their airway

Patient vs. Responder


Gowns

» CDC Guidelines

» Must be realistically applied

Recommended P.P.E.


• Fluid Resistant gowns are available

• Decision to use barrier clothing and type is normally left to the employee

• However: However: May be guided by CDC or Public Health Department for some specific diseases which require higher scrutinization of choices

Gowns Task Performance


• Resuscitation Equipment:– Disposable Resuscitation Equipment and

devices – primary choice

– Reusable Equipment needs to be thoroughly cleaned and decontaminated according to the manufacturer’s recommendations

Recommended P.P.E.


• Demand Valves with disposable face pieces

• Disposable Bag-Valve Mask

• Mouth to Mask

Recommended Equipment


• Emergency Response personnel should practice Body Substance Isolation

• Proper use of Personal Protective Equipment ensures effective infection control and minimizes personal risk

Summary


• “If it’s WET … Assume it’s Infectious”Wear Gloves:

• If there could be a splash to the faceWear Mask and Protective Eye Wear

• If there could be a splash to the bodyWear a Gown

Summary cont.


• Have a change of Clothing available• If patient has a persistent coughDon Mask and/or place mask on Patient

Ensure it does not interfere with airway

• Use Disposable Equipment if possible• Use ALL protective equipment

recommended to ensure maximum protection.

Summary cont.


Module VModule V

Key Elements of

Infection Control in

Incident Operations

and

Recovery


Key Elements of Infection Controlin Incident Operations and Recovery

Four phases of Emergency Operations:Four phases of Emergency Operations:

1. Preparation for Response

2. Response to Emergency Alarms

3. Operations at Emergency Incidents

4. Recovery from Emergency Incidents


• Require:– That written policies and procedures are

followed by ALLALL employees

• Ensure: – That Personal Protective Equipment (PPE) is

provided and stored properly

Preparation for ResponsePreparation for Response


• Have all storage areas checked regularly and keep it stocked properly

• Ensure Personnel Treat, Bandage and Treat, Bandage and ReportReport any personal wounds prior to responding

• Foster high level of Personal Hygiene

• TRAIN, TRAIN, TRAIN

Preparation for ResponsePreparation for Response


• Obtain Information from DispatchUse caution with information on radios etc.Use caution with information on radios etc.

Remember HIPPA Violations ?Remember HIPPA Violations ?

• Prepare yourself for Patient Contact

• Prepare Mentally

Think Infection ControlThink Infection Control

Response to Emergency AlarmsResponse to Emergency Alarms

Connecticut Fire Academy 57

• Body Substance Isolation (BSI)

• Wear Appropriate Personal Protective Equipment (PPE)

• Limit Number of Responders for Treatment

Response to Emergency IncidentsResponse to Emergency Incidents

Connecticut Fire Academy 58

Risk vs. Benefit

• Utilize BVM or Pocket Mask w/one-way valve for artificial ventilation

• Properly dispose of Biohazard Waste



• Use Extreme caution handling Sharps– Needles must not be Bent, Recapped or

Removed

– Sharps must be disposed of immediately– Containers need to be:

• Puncture resistant (impervious)• Labeled• Readily Available



Greatest Percentage ofGreatest Percentage of

Needle Stick Incidents occur from Needle Stick Incidents occur from recapping accidents.recapping accidents.

These Accidents These Accidents AREARE Preventable Preventable



Contaminated PPE / Medical Equipment should be Bagged

Red Bagor

Biohazard Bag



DO NOTDO NOT– Eat … Drink … Smoke …– Apply Cosmetics / Lip Balm … – Handle Contacts …– Use Your Cellphone

At Emergency Scene or While Wearing Gloves

Where likelihood of occupational exposure exists



• Wash Hands after patient contact is terminated– On Scene:

• Waterless Hand cleaner or antiseptic towelettes

– At Hospital or Upon Return to Station• Thorough washing with Soap and Warm Water

Proper and Frequent hand washing

cannot be over stressed in any phase of Infection Control



• Properly Dispose of Biohazard Waste:– Federal, State, Local Laws and Regulations

• Transporting Infectious Waste:– Contained in “Leak” proof container

• Decontaminate:– Clothing & Reusable Equipment

Recovery to Emergency IncidentsRecovery to Emergency Incidents


DecontaminationMethods and Procedures

The First Step in Decontamination is

cleaning with Soap and Water to

remove surface dirt and debris



• Low Level Low Level Disinfection:– Used for Routine Housekeeping

• Cleaning and removal of soil in absence of visible body fluids



• Intermediate Level Intermediate Level Disinfection:– Destroys:

• Mycobacterium Tuberculosis • Vegetative Bacteria • Most Viruses & Fungi

Does NotDoes Not Kill Bacterial Spores


• Intermediate Level Intermediate Level Disinfection:– Three Methods Used:

• Disinfectant / Chemical-Germicides– EPA Registered

• Hard-surface Germicides

• Water/Chlorine Bleach Solution– 1:100 dilution = ¼ cup chlorine per gallon of water

– Needs to sit at least 10 minutes to kill bacteria

– Needs to be thoroughly rinsed thereafter




• Intermediate Level Intermediate Level Disinfection:– Used for Equipment with Intact Skin Contact

• Stethoscopes• Blood Pressure Cuffs• Splints



• High Level High Level Disinfection:– Destroys AllAll Forms of Micro-Organisms

Except Large Numbers of Bacterial SporesExcept Large Numbers of Bacterial Spores



• High Level High Level Disinfection:– Two Methods Used:

• Hot Water Pasteurization– 176oF to 212oF (80oC to 100oC) for 30 minutes

• Immersion in EPA approved Chemical Sterilizing Agent for short time periods– 10 to 45 minutes, according to manufacturer’s Instructions



• High Level High Level Disinfection:– Used for Reusable Instruments / Devices that

have come in contact with mucous membranes

• Laryngoscope Blades• Airway Maintenance Equipment



• Sterilization– Destroys ALL Micro-Organisms– Usually Not Practical for Emergency Services


Module VIModule VI

Equipment

Decontamination

Procedures


Equipment Decontamination Procedures

• Transport Equipment to Designated Decontamination Area:– Separate Room– Properly Marked– Secured


• Designated Decontamination Area:• Should be equipped with:

– Ventilation / Air Handling System– Drainage, including floor drains– Non-Porous Sink w/ Hot & Cold Water– Proper Hand Washing Facilities– Racks / Shelves for Air Drying– Appropriate cleaning / disinfecting supplies




• Don Appropriate PPE

• Wash Contaminated Item of Dirt / Debris– Vigorous Soap and Water Scrub– If Surface Dirt / Debris is not removed .... is not removed ....

Subsequent disinfecting will not be effective


• After Washing:– Process Item with Type Decon Required:

• Low-level Disinfection• Intermediate-level Disinfection• High-level Disinfection• Sterilization

• Store Processed Items Properly:– In Designated Clean Storage Area



Module VIIModule VII

Safety Data Sheets (SDS)(formerly known as MSDS)

Clothing and Cleaning Procedures

Storing and Maintaining Equipment and Supplies


• Follow Manufacturer’s Recommendations– Proper Cleaning / Disinfecting procedures– SDS required to be maintained by Employer

• Cleaning / Disinfecting products– Check SDS Sheets

• Special Product Information• Recommended Safety Precautions

Safety Data SheetsSafety Data Sheets


• Properly Bagged at Location– Handle as little as possible– Determine if to be reused or destroyed

» If serious contamination to be destroyed

Double BagDouble Bag

• Decontaminate “As Soon As Possible”– PPE / Gear with Blood or Infectious materials

Clothing Cleaning Procedures


• Presoak Regular Clothing – Disinfectant / Detergent … Launder as Normal

• Manufacturer’s Recommendation for PPE

“Never Use Chlorine Bleach on ANY Gear;

It destroys or stresses the resistance of the fibers”

Clothing Cleaning Procedures


• Store Equipment & Supplies according to Manufacturer’s Recommendations

• Monitor Usage Levels for Inventory Control

• Monitor Shelf life of Equipment / Supplies– Expiration Dates

Storing and Maintaining


Module VIIIModule VIII

On Scene Public Relations

and

Public Information


• Be Sensitive to Public Opinion

• Infection Control Procedures by Responders– Can create anxiety or hostility

• If reactions are observed:– Explain the purpose of infection control procedures

Public Relations / Information


Most Importantly;Most Importantly;

All patient – related information must be All patient – related information must be considered Confidentialconsidered Confidential

HIPPA ! ! !HIPPA ! ! !



• Patient Information Release:• Only to Proper Authorities ….

– Receiving Hospital– Higher-level On-Scene EMS taking over the

Patient Care

“Know your policies and procedures”



Module IXModule IX

The Post

Exposure System


• Established to Protect Members– Components of a system vary:

• Notification• Verification• Treatment & Follow-up Care• Documentation

Post Exposure System


• Notification: How does it happen?How does it happen?

– Member Reports Possible Exposure

• To Supervisor or Designated Person

– Supervisor Observes Possible Exposure

• Member may be unaware

– Hospital notifies “Infection Control Officer”

• Infection Control Officer (ICO) (ICO) informs members affected



• Notification: How does it happen? How does it happen? (1)(1)

– Member Reports Exposure: “Chain of Command”

• ICO initiates Notification Request

– ICO “Infection Control Officer”“Infection Control Officer”

• Hospital provides information to ICO

• Member notified of results



• Notification: How does it happen? How does it happen? (2)(2)

– Member Reports Exposure: “Chain of Command”

• ICO initiates notification Request

• Hospital has insufficient data

• ICO request assistance from Public Health Officer

• Review of Case determines exposure hazard

• ICO notified of results

• Member notified of results



• Verification: “The Process”“The Process”– Deciding if an Exposure poses a risk to the

members physical or emotional health• If so: Member referred for appropriate treatment

Treatment is Not Limited to Actual or Significant Exposure Incidents

Perceived Exposure causes Emotional Stress

Employee may need referral to Stress Management Program (Employee Assitance Program)



• Verification: Who performs it?Who performs it?– Refer to Departments: – Standard Operating Guidelines (SOG’s) or – Standard Operating Procedures (SOP’s)

• Supervisor• ICO • Department Physician



• Treatment and Follow-Up Care– Treatment includes:

• Prophylaxis• Counseling• Long term follow-up



• Treatment and Follow-Up Care– Prophylaxis: Medical treatment given to

reduce chance of developing communicable disease

– Typical Exposures Examples include:• HIV• HBV• Bacterial Meningitis



• Treatment and Follow-Up Care– Treatment Protocols frequently updated– Timing and Urgency differs with disease – Consult:

– Policies and Procedures

– Infection Control Officer

– Physician

– USFA Guide

– 29CFR 1910.1030

– NFPA 1581 / Specific for Fire Service



• Treatment and Follow-Up Care– Counseling May Include

• Stress Management• Infection Control Education• Reduce Disease Spread w/Family • Spousal / Family Counseling• Retraining in Infection Control Practices



• Treatment and Follow-Up Care– Long-Term Follow-Up Care

• Observe Members for signs / symptoms• Repeat Testing such as HIV, TB, HEP B• Prophylaxis (some may be 6 to 12 months)



• Documentation:

If it’s not in writing, it didn’t happenIf it’s not in writing, it didn’t happen

– Formal System is Essential• Protects the health of the membersProtects the health of the members• Essential for Insurance and Comp ClaimsEssential for Insurance and Comp Claims• Limits Liability• Compliance monitoring / Quality assurance• OSHA Required



• Stress:

– The body’s non-specific response to any demand placed on it

– Pleasant or unpleasant

Stress Management / Infection Control


““A stressful incident can be any situationA stressful incident can be any situation

which causes strong emotional reactions which causes strong emotional reactions

which have the potential to interfere withwhich have the potential to interfere with

an emergency responder’s ability toan emergency responder’s ability to

function”function”



• Stress Reduction Options– Peer support groups, which may include:

• Emergency Medical Technicians• Paramedics / Firefighters• Law Enforcement• Other Emergency Response Personnel

– Individual Counseling• Qualified Professional

– Critical Incident Stress Debriefing (CISD)



• Stress Management Programs

• Purposes:– Help Response Personnel manage StressHelp Response Personnel manage Stress– Assist Personnel experiencing Negative Assist Personnel experiencing Negative

EffectsEffects– Resource and Referral NetworkResource and Referral Network– Family Education & Support ProgramsFamily Education & Support Programs



Communicable disease exposure is a real and significant threat to the health of First Responders

A Post-exposure system establishes effective procedures to protect the health of members exposed to communicable diseases

Summary


• Post Exposure System usually includes protocols for:

• Notification• Verification• Treatment & Follow-up Care• Documentation

Summary


The Supervisor is the Key Person in assuring the

effectiveness of the post exposure system.

Symptoms of excessive stress and / or burnout

should not be ignored. Stress reduction programs

and procedures should be available to all

employees and their families.

Summary


Module XModule X

Infection Control

in

Station

Facilities


• Infection Control Problem areas in the Station• Comical Spin on a serious subject• Emphasis on Proper Station / Living Quarters• Identified Problems graphically highlighted• Discuss Importance of “Information Control”

Infection Control in Station Facilities


Emergency Response facilities are subject to the

same health requirements as other public use

facilities …Restaurants, Hotels, etc.

Local Public Health agencies and hotel bureaus

are valuable resources for development of

infection control standards and procedures

Summary


The station areas most critical for infection control

are Kitchens, Sleeping Quarters, Bathrooms,

Storage Areas and Laundry Rooms.

Biohazard and General Waste disposal must

comply with all state and local regulations.

Summary


• Introduction to Infection Control• Principles of Disease Transmission• Health Maintenance• Personnel Protective Equipment• Incident Operations & Recovery• Post-Exposure• Station Issues• Putting it all Together

Course Summary

Documents

Connecticut Fire Academy Emergency Medical Programs “Bloodborne Pathogens” OSHA 29 CFR 1910.1030 October 28, 2014