Date post: | 28-Dec-2015 |
Category: |
Documents |
Upload: | hannah-samantha-parks |
View: | 221 times |
Download: | 5 times |
Chapter 6Infection Control
2
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Overview
Infection Control Legal Obligations Causes of Disease Disease Transmission Portal of Entry Susceptibility to Disease Defense against Disease Preparing for Infection Control
3
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Infection Control
An infection is a disease caused by some type of microorganism (microscopic life form)
Each microorganism has a particular mode of transmission
Infection control measures can help prevent the spread of infectious diseases
4
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Infection Control
Personal safety– Measures must be taken to prevent EMTs from
acquiring an infectious disease on the job– Risk management
• Assessment for potential dangers– Risk profile
• Potential for disease process within the community
5
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Infection Control
Patient safety– EMTs should “do no harm” to the patient;
precautions should be taken to bring no infectious disease to the patient
– Stress can cause the patient’s body to be more susceptible to infection
– Immunocompromised patients are highly susceptible to infections that would not make a healthy person sick
6
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Infection Control
Family safety– EMTs who are exposed to infectious diseases at
work may inadvertently bring them home– Children have immature immune systems– Elderly patients may have declining immune
systems– EMTs need to take precautions to avoid becoming
disease carriers
7
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Legal Obligations
U.S. Centers for Disease Control and Prevention (CDC) – Monitors outbreaks of infections – Advises affected groups how to handle the
situation and control the spread of disease
8
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Legal Obligations
Occupational Health and Safety Administration produces standards for infection control practice in EMS– Bloodborne Pathogens Rule (29 CFR 1910.1030)
The National Fire Protection Association addresses the issue of infection control– (NFPA 1581)
9
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Legal Obligations
The safety officer or infections control officer– Responsible for reviewing publications for new
rules and standards that could affect EMS operations• Publications from agencies such as the CDC, OSHA,
and the NFPA
10
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Legal Obligations
Reporting exposure– The EMT who believes that she has been exposed
to a potentially infectious material must seek medical treatment and follow-up
– Notify safety or infection control officer– Follow departmental procedures– All incidents must be reported immediately in case
prophylaxis is needed
11
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Legal Obligations
Notifications by hospitals– Hospital is obligated under the Ryan White Law to
notify the EMS agency’s designated officer if:• A patient transported by EMS to the hospital is found to
have an infectious disease that may have posed a danger to EMS providers
12
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Stop and Review
Who are some of the people impacted by infection control?
Which federal agency is responsible for producing standards for infection control practice in EMS?
List elements in the 29 CFR 1910.1030 standard.
13
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Causes of Disease
Microorganisms that can cause infection and disease are classified into three major groups:– Fungi– Bacteria– Viruses
14
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Disease Transmission
Disease transmission occurs between people by:– Direct contact (person to person)– Indirect contact (via a contaminated object)
15
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Disease Transmission
Contact transmission– Occurs through direct contact with a substance
harboring an infectious agent, such as blood or another body substance
16
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Disease Transmission
Airborne transmission– The most common means of disease
transmission is via droplets in the air
17
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Disease Transmission
Vehicle transmission– An indirect method of
disease transmission in which food or water is a carrier of the disease-causing organism, e.g., Salmonella
18
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Disease Transmission
Vector-borne transmission– Transmission through a living creature such as an
animal or insect called a vector• Example: ticks and mosquitoes transmit Lyme disease
and malaria
19
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Portal of Entry
Means of entry for the organism is called the portal of entry
Mucous membranes are a common portal of entry– Mouth– Nose – Eyes
Nonintact skin is another common but often protectable portal of entry
20
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Susceptibility to Disease
Actual illness caused by exposure to an infectious agent is dependent on:– Strength of the organism (virulence)– Strength of the person’s immune system
To cause an illness, the organism must be virulent enough to overcome the resistance of the host
21
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Susceptibility to Disease
The immune system is very effective against small numbers of microorganisms
If the dose is large, then these defenses can become overwhelmed and illness may result
The contagious EMT can transmit the disease and poses a potential danger to family, friends, coworkers, and patients
22
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Susceptibility to Disease
One method of protection is isolation An EMT should not work whenever suffering
from a contagious illness
23
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Stop and Review
What are some of the more common infectious diseases an EMT may encounter?
In what two ways are diseases transmitted? What is meant by the term portal of entry?
24
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Defense against Disease
Skin represents the first barrier to disease– Unless there is a break in the skin, it serves as a
relatively impenetrable barrier to most infectious microogranisms
A healthy body is the best defense against disease– Less expensive to prevent disease than to treat it
25
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Defense against Disease
Immunizations– Some are given once in a lifetime– Others require periodic boosters to maintain
immunity– OSHA requires that every EMT have the
opportunity to receive the hepatitis B vaccine– There is no vaccine to protect against:
• TB• HIV
26
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Defense against Disease
Hand hygiene– Hand hygiene/washing can significantly aid in
preventing the spread of disease– Type of soap (antiseptic or antibacterial) is not as
important as hand washing technique– Scrubbing is the most important action in hand
washing
27
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Defense against Disease
Hand hygiene/washing– After every patient contact and before the next
patient contact, the EMT must wash her hands– Open wounds should be covered, as they are a
portal of entry for an infection
28
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Defense against Disease
Personal protective equipment (PPE)– EMS has a “dress up” philosophy: when
you need it, you put it on– Treat all body fluids as if they are
potentially infectious
29
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Defense against Disease
Personal protective equipment– Body substance isolation has been replaced with
more accurate terminology (standard precautions)– Standard precautions describes the need to
assume that all patients potentially have some form of infectious disease, and protective measures should be considered standard for every patient encounter
30
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Defense against Disease
Barrier devices– Any article that creates a physical partition
between the EMT and the environment
Barrier devices: Gloves– One-time use only– Different sizes should be made available
to the EMT– Hands must be washed after wearing gloves
31
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
32
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Defense against Disease
Barrier devices: Goggles– Eyes represent one of the EMT’s largest exposed
mucous membranes– Eyes remain vulnerable to splashes of body fluids
if they are unprotected– Use goggles or protective safety glasses– Eyeglasses require side splash protection to
prevent accidental exposure
33
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
34
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Defense against Disease
Barrier devices: Masks– Provide protection from blood and other body
fluids splashing into the open mouth of the EMT– Masks also provide protection from inhaling
airborne infectious particles– Due to the increased incidence of resistant
tuberculosis, patients presenting with a cough necessitate the EMT wearing a mask
35
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
36
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Defense against Disease
Barrier devices: Pocket mask– An EMT must always consider her own protection
by using a pocket mask to ventilate a patient– If a pocket mask is not available, the EMT should
have a transparent shield device– Either device allows effective ventilation while
preventing direct contact of the rescuer’s mouth with a patient’s oral secretions
37
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Defense against Disease
Barrier devices: Gowns– Childbirth– Severe arterial bleeding
38
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Defense against Disease
Donning and removing protective apparel– Don mask and eye protection first, followed by
gown, if necessary, and gloves last– Doffing should be done in reverse order– In cases of gross contamination, assistance
should be obtained in disrobing
39
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Stop and Review
What is one of the most effective personal defenses against disease transmission?
What is meant by the term personal protective equipment?
Define the term standard precautions. When would a pocket mask be used?
40
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Preparing for Infection Control
Review infection control manual At the start of every shift or tour of duty,
ensure:– An adequate supply of gloves, gowns, and
masks is available– Floors are routinely mopped with a cleaning
solution that includes a disinfectant such as bleach
– Interiors are also regularly cleaned
41
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
House rules– Follow good health practices while at quarters,
such as the EMS station or firehouse
Responding to a call– Prearrival information from dispatch can alert
the EMT to what kind of additional PPE might be needed
Preparing for Infection Control
42
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
On the scene– The patient’s chief complaint should prompt the
EMT to consider additional PPE• A patient with a rash or cough may have a contagious
disease
– PPE should be readily available– It is not good practice to leave PPE in the
ambulance if it is needed on scene
Preparing for Infection Control
43
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Needle disposal– Single largest risk of occupational exposure to
bloodborne diseases is by accidental needle stick– EMTs must be familiar with how to handle sharps
such as needles, syringes, and scalpel blades
Preparing for Infection Control
44
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
The sharps container– All used sharps go in the sharps container!– The sharps container should be easily accessible– Do not force sharps into container– The scene must be clear of all sharps; don’t leave
needles, etc., lying around– Don’t stick sharps into the squad bench; they go
directly into the sharps container!
Preparing for Infection Control
45
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
46
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Disposal of waste– A biohazard is any material that is potentially
contaminated with biological waste– Bloody bandages and other contaminated waste
must be disposed of properly before leaving the scene
– Biohazards need to be placed in a red plastic bag that is clearly marked with a biohazard sign
Preparing for Infection Control
47
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
48
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
After the call– Remove contaminated clothing– The importance of thorough hand washing after a
call cannot be overemphasized; do this before smoking, applying makeup, eating, etc.
– If a sink with running water is not immediately available, use either a waterless, alcohol-based cleaning gel or an antiseptic cloth made for that purpose
Preparing for Infection Control
49
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Documentation– Documentation of infectious disease can be
divided into patient reporting and exposure reporting
– When documenting a patient’s condition, all pertinent signs and symptoms must be listed, even if they do not appear to be related to the chief complaint
Preparing for Infection Control
50
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Cleaning up: Decontamination– Low level—if there is no visible blood or body
fluids, then the equipment is simply wiped down with hospital disinfectant designed for low-level disinfection
– High level—requires sterilization• Designed to kill all microorganisms on the surface• Typically most equipment that EMTs use is not sterilized• Most equipment is disposable
Preparing for Infection Control
51
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Cleaning up: Emergency equipment cleanup– Intermediate decontamination
• For equipment that touches a patient’s skin• Use germicide or bleach and water solution (1:100
mixture) to kill pathogens
– High-level decontamination • For equipment that comes in contact with a patient’s
mucous membranes
Preparing for Infection Control
52
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Cleaning up: Cleaning areas– Emergency departments have a “dirty” utility room
• For disposing liquid waste • For cleaning certain prehospital equipment, e.g.,
bedpans, backboards
– Cleaning areas are well lighted and well ventilated – All drains from sinks, hoppers, toilets, and floor
empty into a separate sewer system
Preparing for Infection Control
53
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Cleaning up: Cleaning the ambulance– Rules for cleaning the ambulance are the same as
for cleaning equipment– Scrub the surfaces with soap and water to remove
grossly visible contamination– Disinfect with either a bleach solution or a
germicide– Air out the ambulance afterwards for 10–15
minutes to dry
Preparing for Infection Control
54
© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Stop and Review
When would high-level disinfection be required?
If a patient is found to have an infectious disease that may have posed a danger to EMS providers, what is the hospital obligated to do?
Under what law are hospitals obligated to do this?