copyright 2009 seattle/king county ems overview of cbt 621 infectious disease complete course...

Copyright 2009 Seattle/King County EMS

Overview of CBT 621Infectious Disease

Complete course available at www.emsonline.net


Introduction

Given the worldwide concern about infectious Given the worldwide concern about infectious diseases—as an EMS provider and a citizen—you diseases—as an EMS provider and a citizen—you

are responsible to help recognize infectious are responsible to help recognize infectious disease, treat your patients properly, and keep disease, treat your patients properly, and keep

yourself safe.yourself safe.

Given the worldwide concern about infectious Given the worldwide concern about infectious diseases—as an EMS provider and a citizen—you diseases—as an EMS provider and a citizen—you

are responsible to help recognize infectious are responsible to help recognize infectious disease, treat your patients properly, and keep disease, treat your patients properly, and keep

yourself safe.yourself safe.

• Bio-terrorism • Pandemic flu• Respiratory infections• Blood borne pathogens


New Termsbody substance isolation (BSI) – An infection control practice that assumes all body substances are potentially infectious.

MRSA – Methicillin-resistant Staphylococcus aureus is a type of staphylococcus or "staph" bacteria that is resistant to many antibiotics.

personal protective equipment (PPE) – Specialized clothing or equipment worn for protection against health and safety hazards.


MRSA

Methicillin-resistant Staphylococcus aureus• Type of staph bacteria resistant to common antibiotics• Associated with hospitals/nursing homes • An increasing epidemic of EMS/ community-acquired MRSA• Multiplies rapidly causing infections ranging from skin infection to septicemia and toxic shock syndrome


MRSA, continued

• Best defense against MRSA is to wash your hands often, especially after contact with other people• Thorough washing of hands with soap and water or alcohol-based disinfecting gels is effective against MRSA

Electron micrograph of MRSA

Image credit: CDC/ Janice Carr/ Jeff Hageman (public domain)


Hepatitis C

• Caused by hepatitis C virus found in blood of persons who have this disease

• Spread by contact with blood of infected person

• Most common chronic bloodborne viral infection in the US

• Can cause cirrhosis of the liver and liver cancer


Hepatitis C, continued

Transmission:• Blood and other bodily fluids • Sharing needles with infected person • Sex with infected person • From woman to her baby during birth



Prehospital presentation:

• Infection generally produces no signs or symptoms during early stages — may be years

• Symptoms may include fatigue, nausea, vomiting, poor appetite, muscle and joint pain, or low-grade fever



Occupational risk:

• After a needlestick or sharps exposure to HCV positive blood, about 2 healthcare workers out of 100 become infected

Prevention:• No effective vaccine for hepatitis C• Only way to protect yourself is to

avoid exposure to infected blood


Personal Protective Equipment• Treat potentially infectious patient

as a biological hazmat• Avoid infection from fluids and

airborne particles• Decontaminate equipment and

surfaces after use and wash your hands frequently

• Observe PPE measures on every incident


Types of PPE

• Fit-tested masks (N95 and N100 masks)• Eye protection (glasses, face shields,

goggles)• Gowns (or suits)• Gloves

You must wear full PPE with any patient who You must wear full PPE with any patient who is potentially infectious especially those is potentially infectious especially those

with a history of a fever and cough.with a history of a fever and cough.

You must wear full PPE with any patient who You must wear full PPE with any patient who is potentially infectious especially those is potentially infectious especially those

with a history of a fever and cough.with a history of a fever and cough.


Donning PPEPut on PPE before entering the patient area Sequence for donning is MEGG:

1. Mask2. Eye protection3. Gown4. Gloves


Doffing PPE• Remove PPE once call is complete or you have left patient area • Be careful not to contaminate yourself taking it off

To remove PPE, reverse MEGG:

1. Gloves2. Gown — hand washing min 20 sec.3. Eye protection4. Mask — hand washing min 20 sec.

1. Gloves2. Gown — hand washing min 20 sec.3. Eye protection4. Mask — hand washing min 20 sec.


Hand Washing is Vital• Single most effective way to prevent the spread of disease

• Soap and water for at least 20 seconds or with waterless alcohol-based gel

• After all patient contact, even if you wore gloves


Equipment Decontamination

After completing a response to an infectious patient, decontaminate everything touched:

• Equipment that was exposed or cross-contaminated• Outside of kits• Stethoscopes• Radios• AEDs, etc.


HIV

• AIDS is caused by the Human Immunodeficiency Virus (HIV)

• HIV attacks the cells of the immune system

• Immune system fails and patient becomes susceptible to opportunistic diseases and infections


HIV, continued

Transmission:

• Unprotected sex with an infected partner • Infected blood given during a transfusion (extremely rare) • Sharing of needles by IV drug users • An infected mother to her baby • Occupational transmission usually by a needlestick of infected blood


HIV, continued

Prehospital presentation:• Dehydration and hypotension secondary to diarrheal diseases • Seizures or altered mental status secondary to a nervous system infection • Dyspnea secondary to a respiratory infection (pneumonia, tuberculosis, etc.) • Medication reactions • End of life issues


HIV, continued

Occupational risk:

• Occupational risk of acquiring AIDS is VERY LOW

Prevention:

• Prevention should focus on preventing significant blood exposures (needlesticks)

• Post-exposure prophylaxis (PEP) if exposed


Hepatitis B

• Caused by the hepatitis B virus (HBV), which damages liver

• Vaccination against HBV has been available since 1982

• Spread by contact with blood of person infected with disease, or by sexual transmission


Hepatitis B, continued

Transmission:

• Sex with infected person • Blood and other bodily fluids • Sharing needles with infected person • From a woman to her baby during birth




• Most signs/symptoms of Hep B are mild• Unlikely that you will be called to respond to an acute illness

caused by this virus• However you may on occasion see a patient with end-stage

liver cancer or other complications from the disease



Occupational risk:

• Significant for unvaccinated person• Very low for vaccinated person

Prevention:• Best way to prevent an occupational

exposure, in addition to protecting yourself from blood exposure, is vaccination


Tuberculosis (TB)• Caused by small bacteria that travels

from the small airways to cells of lungs

• Less than 10% of people infected with TB will develop active disease

• In others, bacteria hides, causing no disease until host (patient) becomes immuno-compromised or otherwise debilitated


Tuberculosis, continued

Transmission:

• Via small airborne particles expelled by cough, sneezing, or speaking

• Particles are inhaled into small airways • Prolonged exposure in confined space confers highest risk




• Cough, often productive of blood-tinged sputum • Fatigue and weakness • Night sweats • Low-grade fever • Loss of appetite and weight loss



Occupational risk:

• Occupational risk is low but has been very difficult to quantify

Prevention:

• Maintain high index of suspicion among patients who are at risk of having TB

• Take precautions if patients present with suspicious signs and symptoms (PPE)


SARS• A virulent respiratory infection reported in

Asia

• 2003: over 8,000 people worldwide, 700 died

• US: 192 possible cases (of these, 33 considered "probable"), no deaths

• A relatively high case fatality rate among young, healthy people


SARS, continued

Transmission:

• Droplets spewed from the cough or sneeze of an infected person

• Close person-to-person contact

• Touching object and then touching mouth, nose, or eyes


SARS, continued


• Fever, headache • Malaise, body aches, and diarrhea • Cough and possible respiratory symptoms • Most develop pneumonia and may require ventilatory

assistance and supplemental oxygen


SARS, continued

Occupational risk:

• Minimal due to lack of recent cases – follow local and CDC guidelines for identification of high-risk patients

Prevention:

• Wash hands, wash surfaces and use contact precautions: gown, gloves, and protective eyewear


Influenza (flu)• Caused by influenza virus which attacks

respiratory system

• Occurs seasonally from November to April in northern hemisphere

• Structure of virus changes slightly but frequently over time; this accounts for appearance of different strains each year


Influenza (flu), continued

Transmission:

• Coughed droplets • Touching contaminated surfaces

(less common)




• High fever • Malaise • Headache • Dry cough • Body aches

Sudden onset of:



Occupational risk:

• Varies depending on the strain

Prevention:

• Hand washing, clean surfaces • Place mask on patient or ask patient to cover mouth when

coughing • Best prevention is the flu vaccine, which must be taken

yearly


Norovirus

• Highly contagious virus responsible for outbreaks of GI disease on cruise ships

• Norovirus is general name given to viruses of this type

• Responsible for many cases of severe but short-lived illnesses causing vomiting, diarrhea, and stomach cramps

• "Stomach flu" and "food poisoning" are typical infections of Norovirus


Norovirus, continued

Transmission:• Fecal-oral route• Food handler does not wash his hands after

using the bathroom; you then ingest food contaminated with fecal matter

A person with Norovirus is considered A person with Norovirus is considered contagious from the time he or she contagious from the time he or she starts feeling ill to as long as two starts feeling ill to as long as two

weeks after recovery.weeks after recovery.

A person with Norovirus is considered A person with Norovirus is considered contagious from the time he or she contagious from the time he or she starts feeling ill to as long as two starts feeling ill to as long as two

weeks after recovery.weeks after recovery.



Prehospital presentation:• Nausea, vomiting and diarrhea • Stomach cramps • Low-grade, transient fever • General feeling of malaise, headache, body aches

Symptoms begin suddenly, may last one Symptoms begin suddenly, may last one to three days, and usually resolve on to three days, and usually resolve on

their own. Because the disease is caused their own. Because the disease is caused by a virus, antibiotics are useless.by a virus, antibiotics are useless.

Symptoms begin suddenly, may last one Symptoms begin suddenly, may last one to three days, and usually resolve on to three days, and usually resolve on

their own. Because the disease is caused their own. Because the disease is caused by a virus, antibiotics are useless.by a virus, antibiotics are useless.



Occupational risk:• Community-acquired, usually situations where large numbers share same

food or living space (cruise ships, college dorms)• Several outbreaks of noroviruses among staff at hospitals and nursing homes



Prevention:• Wear gloves• Wash your hands thoroughly• Use protective eyewear and mask• Surfaces contacted by patient must be thoroughly disinfected

If you become sick, wait two days after If you become sick, wait two days after the last of your symptoms before the last of your symptoms before

returning to work.returning to work.

If you become sick, wait two days after If you become sick, wait two days after the last of your symptoms before the last of your symptoms before

returning to work.returning to work.


West Nile Virus

• First identified in Africa

• The virus causing the disease infects certain types of birds (ravens, crows, and jays), mosquitoes, horses, and other animals

• Humans are an incidental, rather than primary, host


West Nile Virus, continued

Transmission:• WNV is transmitted through bite of infected mosquito

• WNV is NOT transmitted person-to-person except in rare case of blood transfusion from infected person



Prehospital presentation:• Fever • Headache • Fatigue • Rarely, a rash and swollen lymph nodes

Less than 1% of the people infected Less than 1% of the people infected with WNV will develop severe illness. with WNV will develop severe illness. These people may present with high These people may present with high

fever, headache or altered LOC.fever, headache or altered LOC.

Less than 1% of the people infected Less than 1% of the people infected with WNV will develop severe illness. with WNV will develop severe illness. These people may present with high These people may present with high

fever, headache or altered LOC.fever, headache or altered LOC.



Occupational risk:

• None

Prevention:

• Since WNV disease is not transmitted person-to-person, no specific disease prevention precautions are necessary at work


Risk

• In last 25 years, estimated 57 healthcare workers in US have contracted HIV from a documented occupational exposure

• Thousands of health care workers EVERY YEAR contracted Hepatitis B from occupational exposure, and it is estimated that as many as 200 per 200 per year diedyear died (prior to vaccine).


Masks

• Don fit-tested mask before entering scene

• Place a mask on patient, if tolerated• Fitted masks provide highest level of

protection• Remove and dispose of mask without

self contamination


Eye Protection

Wear eye protection on all calls — prepare for unanticipated splashes:

• Vomiting• Blood flicked from bloody hand• Violent spit• Glucometer strips• Splashing fluids• Respiratory infection • Violent cough or sneeze


Gloves• Wear medical gloves on all calls

• Most bodily fluids, such as vomit or urine, do not typically carry blood borne viruses

• While working in rescue or extrication environment where risk of both cut and body substance exposure are present, wear latex or nitrile inner gloves and other protective outer gloves


Limits of Gloves

• Gloves are for use during patient contact

• Wash your handsWash your hands after all patient contact, even if you wore gloves

• Gloves will not protect you from sharp objects such as needles


Sharps• Needlesticks represent the greatest risk

of occupational blood borne transmission

• Many "exposures" involve cases in which EMS providers inadvertently stuck themselves with used needles

• Keep an eye on paramedics and needles, and watch where you put your hands


Needlestick

For needlestick exposures:• Wash area well with soap and water• Do NOT use bleach or other harsh chemicals • Report the exposure immediately to your officer for testing and possible post-

exposure prophylaxis (PEP)


Skin/Mucus

For exposures to non-intact skin:• Wash with soap and water• Report exposure immediately to your officer for testing and

possible post-exposure prophylaxis (PEP)

Blood on intact skin is not considered a Blood on intact skin is not considered a significant exposure. Non-intact skin significant exposure. Non-intact skin

includes abrasions and cuts.includes abrasions and cuts.

Blood on intact skin is not considered a Blood on intact skin is not considered a significant exposure. Non-intact skin significant exposure. Non-intact skin

includes abrasions and cuts.includes abrasions and cuts.


Skin/Mucus, continued

For exposures to mucus membranes:• Flush liberally with water• Report exposure immediately to your officer for testing and

possible post-exposure prophylaxis


Airborne• Report possible exposure to your

company officer• Hospital may notify exposed responders

if patient is diagnosed with an airborne disease (e.g., TB or bacterial meningitis)

• Some diseases may require automatic and immediate post-exposure prophylaxis

• Others may require post-exposure testing and then treatment only if you become positive


PEP for HIV

• Any possible exposure to blood borne disease must be reported immediately to your company officer

• Post-exposure prophylaxis reduces already very low risk of acquiring

• The medications taken for PEP are TOXIC

• If patient is HIV-negative, PEP medications can be stopped


Summary• Hand washing is the most effective

method of preventing infectious disease

• Clean visible contamination first, and then disinfect the surface

• Wear gloves when disinfecting equipment

• Occupational risk of acquiring AIDS is VERY VERY LOWLOW


Summary, continued

• Best way to prevent an occupational exposure to HBV, in addition to taking care to protect yourself from blood exposure, is to be vaccinated

• Remove gloves when you are done with patient contact, before getting into your rig, talking on the radio or driving


Summary, continued

• If you suspect TB, put a mask on patient (if tolerated), and wear a mask yourself

• Needlesticks represent by far greatest risk of occupational blood borne transmission

• If PEP is to be started, start IMMEDIATELY after exposure, if at all possible within two hours

copyright 2009 seattle/king county ems overview of cbt 621 infectious disease complete course...

Documents

infected blood slide

ems provider

birth slide

incident slide

blood of infected person

liver cancer slide

hepatitis c virus

lowgrade fever slide