International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Standard Precautions in the Prehospital Setting 22

International Trauma Life Supportfor Emergency Care Providers

CHAPTER

seventh edition

Standard Precautions in the Prehospital Setting

22

International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians

Precautions

Courtesy of Louis B. Mallory, MBA, REMT-P


Overview

• Bloodborne viral illnesses– Most common for EMS exposure

• Signs and symptoms of tuberculosis– Protective measures

• Potentially infectious materials precautions


Overview

• Appropriate personal protective equipment use

• Accidental exposure procedures• Multidrug-resistant organisms• Vaccines and immunizations


Standard Precautions

Exposure does not mean infection. Exposure can be treated.


Standard Precautions

• Common bloodborne viral infections– Hepatitis B (HBV)– Hepatitis C (HBC)– HIV infection

• Primary modes of exposure– Contaminated blood – Other potentially infectious materials (OPIM)


Potentially Infectious

• Other potentially infectious materials:– CSF– Synovial fluid– Amniotic fluid– Pericardial fluid– Pleural fluid– Body fluid with

gross visible blood


Potentially Infectious

• Only with gross visible blood– Tears– Sweat– Saliva– Urine– Stool– Vomitus– Nasal secretions – Sputum


Viral Hepatitis

• Viral infections involving liver:– Fecal transmission: Types A, E– Bloodborne transmission: Types B, C, D

Type D only with Type B

• Prevention is best treatment!

Courtesy of Louis B. Mallory,MBA, REMT-P


Hepatitis B (HBV)

• Modes of exposure– Contaminated blood – Other potentially infectious materials (OPIM)– Sexual transmission– Direct contact with nonintact skin

• Health care risk of infection: 6–30%– Needlestick exposure to HBV blood

and no vaccination or immune response


Hepatitis B (HBV)

• High-risk groups– Immigrants from

areas HBV is prevalent

– Incarcerated – Institutionalized– IV drug users

– Male homosexuals– Hemophiliacs– Household contacts– Hemodialysis


Hepatitis B (HBV)

• Clinical manifestation– Acute hepatitis– Chronic hepatitis– Cirrhosis– Liver cancer

• Chronic carrier risk: 5–10%


Hepatitis B (HBV)

• Health care protection– Hepatitis B vaccines

Does not contain antibodies Lifelong protection Effective immunity in 90%

– Hepatitis B immunoglobulin Contains antibodies Passive protection for 6 months Effective immunity in 70%



Hepatitis C (HBC)


• Health care risk of infection– Needlestick exposure to HCV blood: 1.5%


Hepatitis C (HBC)

• Clinical manifestation– Less severe than HBV

• Chronic carrier risk > HBV risk– Liver failure, cirrhosis 10–20% of carriers

• Health care protection– Vaccine not available– Immunoglobulin (IG) not shown effective


HIV Infection


• HIV does not survive outside body– No special cleaning agents are required– Transmitted less efficiently than HBV


HIV Infection

• Health care risk of infection – Needlestick exposure to HIV blood: 0.3%– Mucosal or nonintact skin exposure: 0.09%– Large amounts HIV blood


HIV Infection

• High-risk groups– Male homosexuals– Bisexuals– IV drug users– Transfused

Blood, pooled-plasma

– HIV sexual contact


HIV Infection

• Clinical manifestation– Immune system defective– Higher risk of unusual infections– Many are asymptomatic

• Chronic carrier risk: 100%– All HIV infected can transmit HIV– Current HIV treatment reduces risk


HIV Infection

• Health care protection– Vaccine not available– Antiretroviral drug regimen

Prolongs life, does not cure May reduce risk of infection by significant exposure

if administered “within hours, not days”– Recommended for Highest Risk exposures– Possible benefit for Increased Risk exposures– Unlikely benefit for Low Risk exposures


Tuberculosis

• Mycobacterium tuberculosis– Deadliest infectious disease globally– Not highly communicable

• Mode of exposure– Direct contact through air, cough, sneeze

• Preventive measure– Place surgical mask on any suspected patient


Tuberculosis

• Health care risk of infection– Up to 5% skin test positive

in high-prevalence environment

• High-risk groups– HIV infected– Immigrants from TB prevalent– Homeless– Live in congregate settings


Tuberculosis

• Clinical manifestation– Severe cough >3 weeks with two or more:

Chest pain Bloody sputum Weakness or fatigue Unexplained weight loss Loss of appetite Fever, chill, night sweats Hoarseness Courtesy of Louis B. Mallory, MBA, REMT-P


Tuberculosis

• Health care protection– TB infection

(no active disease) Isoniazid (INH)

or rifampin for 6–9 months

– TB disease Antibiotic agents

© Pearson


XDR-TB

• Extensively drug-resistant TB– Resistant to:

2 first-line oral antibiotics AND 2 first-line IV antibiotics


Multidrug-Resistant Organisms

• Resistant to 2 first-line antibiotics• Increasing since 1960s

– Hospital-associated infections– MRSA most prevalent– CA-MRSA (Community Acquired-MRSA)


Multidrug-Resistant Organisms

• Prehospital care personnel at low risk– Gloves– Handwashing– Cleaning surfaces and equipment


Precautions for Prevention

• Be knowledgeable• Bandage lesions• Routine handwashing• Immunizations• Report exposures



If exposed,wash exposed area

Immediately.


Reporting Exposures

• Contact designated official– Determines if exposure occurred– Interacts with medical facility– Coordinates needed tests

• Write incident report soon as possible– EMS report may supplement, but not replace

• Know local laws– Confidential exposure report form in U.S.


Summary

• Health-care workers are at risk of exposure to many contagious diseases

• Prevention:– Health-care workers should be HBV

immunized– Knowledge of modes of exposure, adherence

to barrier precautions, and postexposure medical follow-up reduce risk of infection

Documents

International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Standard Precautions in the Prehospital Setting 22