As long as EMS personnel care for the sick and injured, they run the risk of being exposed to a patient's blood or bodily flui

Loyola Emergency Medical Services System

BLOODBORNE PATHOGENS

AND EXPOSURES

HOW DO WE HANDLE THEM?

May 2008

EMT- Paramedic / EMT- Basic

Continuing Education

OBJECTIVES

1. Discuss caring for the patient with a communicable disease

2. Review the different types of pathogens potentially seen in the field

3. Review the Loyola Exposure Policy and Exposure packet

What is an Exposure?

As long as EMS personnel care for the sick and injured, they run the risk of being exposed to a patient's

blood or bodily fluids. Attention to personal safety is, and always will be, a vital concern for all EMS providers. The challenge, in EMS today, is to integrate personal safety with patient care needs. There is not a "one size fits all" protocol to scene safety. Many times personal safety concerns can override our ability to care for our patient

One of the most frightening experiences for any provider is the bloodboume exposure. Even though there have been many advancements in safety engineering, occupational exposures still occur. The good news is that significant advancements have been made in post-exposure prophylaxis medications and our ability to rapidly assess whether the source patient is actually infected with HIV or hepatitis C, so that the exposed provider can receive treatment more accurately and quickly.

First it is important to understand what defines and "exposure."

Occupational Exposure means: "reasonably anticipated" skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials. (29 CFR 191O.30(b)

The CDC defines an exposure as an event that might put the healthcare professional at risk for HIV, syphilis, or for hepatitis B or C infection. It is a percutaneous injury (needlestick or cut with a sharp edge) or contact of a mucous membrane or non-intact skin (e.g., exposed skin that is chapped, abraded or afflicted with dermatitis) that is exposed to blood, tissue or other potentially infectious bodily fluids. In addition to blood and body fluids containing visible blood, semen and vaginal secretions are also considered potentially infectious. Feces, nasal secretions, saliva, sputum, sweat, tears, urine, and vomitus are not considered potentially infectious unless they contain visible blood. 29CFR 1910.30(b).

A "non-exposure" occurs when emergency workers come in contact with potentially infectious materials (i.e. blood and bodily fluids) from a patient, but they are deemed without risk of disease transmission on the basis of the circumstances of the exposure. Often, non-exposures occur because of the proper use of standard precautions. The following examples are exposures that do not require formal reporting:

a. Exposure of blood on intact skin. Wash the exposed area as soon as possible

b. Blood on clothing or equipment. Change clothing and wash down equipment with the appropriate solution.

c. Being present in the same room as an infected person.

d. Touching the infected person

e.Talking to the infected person

The immediacy of reporting and potentially being medically evaluated for a blood-or-fluid-borne exposure is based on current recommendations, which suggest that post-exposure prophylaxis with antiviral drugs be started within hours of the exposure to optimize their effectiveness in preventing disease transmission to the provider.

All healthcare workers need to understand what constitutes an exposure and a non-exposure. Knowing the difference gives the providers peace of mind and can save emergency services personnel unnecessary medical evaluations. Each facility should have written policies and procedures in place to direct their providers when a potential exposure occurs. As a member of the Loyola EMS system you can refer to policy #700.1, Exposure Control Plan for Pre-hospital Providers (included in packet), for guidance or your individual department policy and procedure manual.

Once the determination is made that an exposure has occurred it is important to follow the guidelines given by your individual department or system to provide compliance with OSHA standards. ( Illinois Administrative Code, Title 77, Section 250.725).

What's Out There?

Infectious Disease: An organism that is causing disease in that person, it does not mean that it is a disease that is transmissible to another person. It is a microorganism's ability to cause an infection by invading the body and multiplying in the body's tissues.

Communicable Disease: An organism that is causing disease in that person and this disease is transmissible to another person under "certain circumstances".

Blood borne Disease: Blood borne pathogens are microorganisms such as viruses or bacteria that are carried in the blood and cause disease in people. There are many blood borne pathogens including malaria, syphilis, and brucellosis, but Hepatitis B (HBV), Hepatitis C (HCV) and the Human Immunodeficiency Virus (HIV).

Airborne Disease: Airborne diseases are spread when droplets of pathogens are expelled into the air due to coughing, sneezing or talking. It is one of the more common methods of transmission. The person inhales bacteria or viruses that have been suspended in air, on water droplets, or on dust particles. Airborne diseases of concern to emergency responders include: meningitis, chicken pox, tuberculosis and influenza.

Blood borne Diseases

Although there is a risk for exposure to a variety of infectious diseases, a few diseases have higher risk for EMT's and paramedics. Two of these diseases - hepatitis and HIV - are bloodbourne pathogens as well as sexually transmitted diseases. They can easily be transmitted if precautions are not taken when caring for the affected patient.

Hepatitis is a viral disease, in its simplest terms, means an inflammation of the liver. Currently there are several viruses associated with hepatitis that result in swelling and enlargement of the liver along with mild to severe liver damage. Some forms of hepatitis have been associated with chronic liver disease leading to liver failure or liver cancer. The different viruses have been labeled A, B, C, D, E, F and G.

Hepatitis A: Also known as infectious hepatitis is an enteric infection. Hepatitis A and E are considered enteric infections with spread of the disease most commonly by oral-fecal contamination. In areas of poor sanitation, or an area affected by natural disaster, the risk of contamination of drinking is increased by exposure to raw sewage. Sexual contact with an infected person can also transmit HA V. Hands should be thoroughly washed after every patient contact, and disinfect any equipment that may have been in contact with the infected patient. A vaccine is available and is highly effective against the disease. If you have been exposed to the virus, immune globulin (gamma globulin) can be administered both pre and post exposure, protecting from infection by HA V or HEV.

Hepatitis B: HBV is transmitted by contact with an infected person's blood or body fluids. Sexual contact with an infected person can result in contracting hepatitis B. Since the development of the hepatitis B vaccine, the numbers of cases of HBV have been decreasing. The incidence of HBV infections in certain high risk groups has increased-sexually active heterosexuals, homosexual men, and IV drug abusers. Because it is a blood borne pathogen, contamination by an infected patient's blood poses a significant risk for unvaccinated EMS personnel.

There is no "cure" or specific treatment for HBV, but many people who contract the disease will develop antibodies which help them get over the infection and protect them from getting it again. The Hepatitis B virus is very durable, and can survive in dried blood for up to 7 days. At minimum gloves are essential and proper hands washing and equipment decontamination is critical.

The symptoms of HBV are very much like a mild "flu". Initially there is fatigue, loss of appetite, stomach pain, and nausea. As it progresses the patient will develop jaundice. People who are infected will often show symptoms for some time. After exposure it can take 1-9 months before symptoms are noticeable.

Hepatitis C: Is known as the "silent epidemic". Current estimates show that 4-5 million people in the United States are infected with the Hepatitis C virus (HCV) with only a fourth of

those knowing they are infected. HCV is associated with a high incidence of chronic infection (over 85%). A chronic infection results in chronic liver disease in 70 percent of infected people and medical literature suggests that over the next 10 years the need for liver transplants will increase 500 percent.

HCV is transmitted by blood borne contamination or sexual contact. It was thought that HCV did not survive outside the body for any length of time but current information has shown that HCV can survive in dried blood for up to three weeks at normal room temperature. People at risk for contracting HCV include IV drug users, patients on hemodialysis, health care workers or people with multiple sexual contacts. Also at risk are those individuals who received blood or blood clotting factors prior to 1992.

EMS providers are at risk for exposure to HCV from needle-stick injuries or contact with a patient’s blood, even dried blood that may be left on improperly cleaned equipment. Currently there is no vaccine to protect against HCV. [1]

Human Immunodeficiency Virus: HIV is a fragile virus that cannot survive long outside the body. HIV attacks the body's immune system, weakening it so that it cannot fight other infections. It is estimated that the chances of contracting HIV in the workplace are less than 0.4%. Once a person has been infected with HIV, it may be many years before AIDS actually develops. HIV is a blood borne pathogen that can be transmitted through contact with infected blood or other potentially infectious body fluids. (i.e semen, vaginal secretions,CSF, amniotic fluid or saliva.). HIV is most commonly transmitted through sexual contact, sharing of needles, contact between broken or damaged skin and infected body fluids, and contact between mucous membranes and infected body fluids.

AIDS infection occurs in 3 stages. The first stage occurs when a person is actually infected with HIV. The person may show no signs or symptoms for many years. In the second stage a person may begin to suffer swollen lymph glands or lesser diseases which take advantage of the weakened immune system. The second stage is believed to lead to AIDS. The third and final stage the body becomes completely unable to fight off life-threatening diseases and infections.

The best protection against infection with HIV is using universal precautions. Wear gloves when examining any patient where blood is present or suspected. Take appropriate precautions whenever splashing or spattering of blood is likely. There has been no documented transmission of HIV in EMS personnel.

MRSA (Methicillin Resistant Staphylococcus Aureus) is a staphylococcus bacteria that has become resistant to many of the antibiotics that destroyed it, due to widespread use of antibiotics in hospitals and skilled nursing facilities. Currently MRSA infections are treated with Vancomycin. Unfortunately, reports indicate that a newer strain of staph—vancomycin resistant staphylococcus aureus is appearing.

The bacteria are spread between patients usually by health care workers who come in contact with an MRSA-infected patient and pick up the bacteria on their hands or clothing. The EMT or paramedic can transmit the disease by touching an infected patient without wearing personnel protective equipment. The signs and symptoms of an infection are dependent on the site and it may be difficult to determine the presence of MRSA in any given patient.

At a minimum, gloves should be worn whenever in contact with a patient suspected of having MRSA. If physical contact with the patient or contaminated bed linens or clothing is possible, or if body fluid exposure is possible, wear a gown or protective garment over clothing. When transporting the patient on a stretcher, cover the patient with a disposable sheet and tuck it under the patient

Clean any reusable equipment, such as a blood pressure cuff or stethoscope, with a disinfectant and place any disposable items and linen in a red biohazard bag.

Vancomycin- Resistant Enterococcus (VRE)

This bacteria is normally found in the intestines and rarely causes any problems. The bacteria is not very harmful unless it invades other areas of the body such as the urinary tract or circulatory system. VRE is typically found in hospitalized patients or those in skilled nursing facilities. The bacteria are spread by direct contact with a patient’s feces. EMS can come in direct contact with the patient’s feces or contaminated bed linen or clothing and inadvertently transmit the bacteria to another patient.

Universal precautions such as gloves are essential when treating a patient with VRE. It is important to disinfect all contaminated surfaces and equipment immediately after transporting the patient.

AIRBORNE DISEASES

Airborne diseases are spread when droplets of pathogens are expelled into the air due to coughing, sneezing or talking. Many of these diseases require prolonged exposure for infection to occur posing only a minimal threat to emergency responders.

TUBERCULOSIS: Is a disease caused by one species of Mycobacteria (mycobacterium tuberculosis), that can attack any part of the body, but most commonly the lungs. Other parts of the body that can be infected are the spine meninges, kidney, liver and spleen.

TB is an ancient disease accounting for large numbers of deaths and chronically ill persons throughout the world. It is transmitted by inhaling dried or moist droplets of infectious material coughed up or sneezed by the patient. The incidence of TB is increasing throughout the world in developing nations as well as in the United States. In the United States the populations at high risk include prisoners; homeless, recent immigrants, HIV positive patients, and institutionalized patients such as may be seen in nursing homes. Firefighters and EMS personnel are routinely exposed to all of these populations.

The patient with tuberculosis will present with fever chills, weakness and night sweats. The patient will experience weight loss and have complaints of shortness of breath and a productive cough. The sputum appears green to yellow in color. As the disease progresses, the sputum will contain blood and eventually the patient will develop respiratory failure. Incubation period is 4-12 weeks.

Universal precautions and respiratory isolation are important. Thoroughly disinfect your vehicle and equipment prior to another call.

Recently there has been the development of a multi-drug resistant strain of TB which is increasing in certain parts of the world. Tuberculosis exposures account for 29.8% of all communicable disease exposures.

INFLUENZA: Is a contagious respiratory disease. It is caused by a virus that affects the respiratory track (nose, throat and lungs) but is different from a cold and is not what most people refer to as “stomach flu.” Influenza symptoms come on suddenly and may include these symptoms:

· Fever

· Headache and body aches

· Tiredness

· Dry cough

· Sore throat and nasal congestion

Influenza is spread, or transmitted, when a person who has the virus coughs, sneezes, or speaks and sends influenza virus into the air and others inhale it. Although many people think of influenza as a type of cold, it is really a specific and serious disease. Disease complications and death are more common among young children, the elderly, and those with chronic illnesses. In the United States the number of influenza-associated deaths has increased since 1990. The virus enters the nose, throat and lungs of a person and begins to multiply, causing symptoms. A person can spread influenza starting one day before he or she feel sick. Adults continue to pass the influenza virus to others for another three to seven days after symptoms start. Children can pass the virus no longer than 7 days. Symptoms start one to four days after the virus enters the body.

Some persons can be infected with the virus but have no symptoms. During this time, those persons can still spread the virus to others. Rates of infection are highest among children, but the risks of complications, hospitalizations and deaths from influenza are higher among persons age 65 and older. [2] In nursing homes, up to 60% of the residents may be infected with a 30% fatality rate among the infected. On average, an estimated 200,000 people in the United States are hospitalized each year for respiratory and heart related illnesses associated with influenza virus infections. The most frequent complication of influenza is bacterial pneumonia. Viral pneumonia is a less common complication but has a high fatality rate. Reye’s syndrome is a complication that occurs almost exclusively in children. Patients suffer severe vomiting and confusion, which may progress to coma because of swelling of the brain. To decrease the chance of developing Reye’s syndrome, infants, children and teenagers should not be given aspirin for fever reduction or pain relief.

Influenza is caused by a virus so antibiotics do not cure it. The best prevention is to get an influenza vaccination each fall. Since influenza viruses change each year, influenza vaccines must be developed for each season, and an annual vaccination is needed for protection.

Frequent hand washing is your best protection and to stay home if you are symptomatic, and contact your physician.

Meningitis: It is not easy to spot the symptoms of meningitis. Often people confuse the early signs and symptoms of meningitis with the flu. Many times meningitis may come on the heels of a flu-like illness or infection. It is important to know the hall mark signs and symptoms of meningitis so the patient can receive rapid treatment.

Common Signs and Symptoms: Bacterial meningitis may develop within hours. Viral meningitis symptoms may also develop quickly or over several days.

Not all symptoms may appear or appear in the same order but the hallmark signs and symptoms of meningitis are fever, headache and neck stiffness.

· Sudden high fever

· Severe, persistent headache

· Neck stiffness and pain that makes it difficult to touch your chin to your chest

· Nausea and vomiting, sometimes along with diarrhea

· Confusion and disorientation (acting goofy)

· Drowsiness or sluggishness

· Eye pain or sensitivity to bright light

· Muscle or joint pain or weakness

Other Potential Signs and Symptoms of Meningitis

· Abnormal skin color

· Stomach cramps

· Ice-cold hands and feet

· Dizziness

· Reddish or brownish skin rash or purple spots

· Numbness and tingling

· Seizures

If your patient experiences two or more of these symptoms at the same time or if the symptoms are very severe or appear suddenly, the patient should seek medical treatment immediately.

The incubation period-the time from exposure to the infection to when the first symptoms develop-depends on the type of organism causing the infection. Babies, young children, older adults, and people with other medical conditions may not have the usual symptoms of meningitis.

In babies, the signs of meningitis may be a fever, irritability that is difficult to calm, decreased appetite, rash, vomiting, and a shrill cry. Babies also may have bulging soft spots on their heads that are not caused by crying and a stiff body. Babies with meningitis may cry when handled.

Young children with meningitis may act like they have the flu (influenza), cough, or have trouble breathing.

Older adults and people with other medical conditions may only have a slight headache and fever. They may not feel well and may have little energy.[3]

Common viruses that can cause meningitis can spread through coughing, sneezing, kissing or sharing eating utensils, a toothbrush, or a cigarette. Transmission of the disease is through direct contact with mucous membranes or droplet infection from airborne secretions. Mask and gloves are important. You are also at increased risk if you live or work with someone who has the disease. Some forms of bacterial meningitis are preventable by vaccinations.

Varicella-Zoster Virus: Varicella-zoster virus (VZV) is the cause of chickenpox and herpes zoster (also called shingles). Chickenpox follows initial exposure to the virus and is typically a relatively mild, self-limited childhood illness with a characteristic rash.

After the primary infection, VZV remains dormant in the sensory nerve roots for life. Upon reactivation, the virus migrates down the sensory nerve to the skin, causing the characteristic painful dermatomal rash. After resolution, many individuals continue to experience pain in the distribution of the rash (postherpetic neuralgia). Reactivation of the virus can occur if the person’s immune mechanisms are compromised. This may be caused by medications, illness, malnutrition, or by the natural declined in immune function with aging. Once reactivated the virus migrates along sensory nerves and produces sensory loss, pain and other neurologic complications.

The rate of occurrence is about 5 persons per 1000 population. Immunosuppression increases this risk. The risk of postherpetic neuralgia increases with age. Approximately 50% of patients older than 60 years may have temporary or prolonged pain syndrome.[4]

The frequency of VZV infection may decrease as the immunized children become adults.

Treatment options are based on the patient’s age, immune state, duration of symptoms, and presentation. Studies indicate that antiviral medications decrease the duration of symptoms and the likelihood of postherpetic neuralgia, especially when initiated within 2 days of the onset of the rash.

The varicella virus is seen more frequently in the winter and spring. The virus is generally spread by droplets as well as by direct contact. A person is considered contagious for approximately 2 weeks, generally starting about two days prior to the rash appearing, ending when all the vesicles have scabbed over. Children generally complain of a mild headache, decreased appetite, and have a moderate fever. Children tolerate chickenpox rather well and rarely develop a severe case of the disease or any complications associated with the disease.

But adults, especially those whose immune systems are compromised, can experience a severe and potentially fatal case of varicella. Complications associated with chickenpox include secondary infections of the vesicles. Pneumonia is a common complication of chickenpox in adults, newborns and patients with compromised immune systems.

When caring for the patient with the varicella virus one of the biggest protective mechanisms is having the disease as a child. Universal precautions such as gloves are recommended with direct patient contact. Those who have not developed an immunity or been vaccinated should use a face mask to provide protection from droplet infection.

FYI: There is a small but growing number of parents throughout the country who are using religious exemptions to avoid vaccinating their children because of their concern that they can cause other illnesses. Many states are seeing increases in the rates of unvaccinated children entering kindergarten. While overall it represents 3.7 million children, public health officials say its takes only a few people to cause an outbreak that can put lives at risk.[5]

Some parents say they are not convinced vaccinations help. Others fear the vaccinations will make their children sick and may cause autism.

All states have some requirement that youngsters be immunized against such childhood diseases including measles, mumps, chickenpox, diphtheria and whooping cough.

Twenty-eight states, including Florida, Massachusetts and New York, allow parents to not vaccinate their children for religious reasons only. Twenty other states, among them California and Texas, allow parents to cite personal or philosophical reasons. A small group of states allow medical reasons only. The rate of exemption requests is increasing.

In the past few years we have seen an increase in the numbers of outbreaks of diseases such as whooping cough, measles and mumps.

SO WHAT DO WE DO WHEN WE ARE EXPOSED?

The first thing is to determine if an exposure actually occurred.

1. When in doubt as to whether an exposure has occurred, the member should immediately report the incident as a potential exposure and seek immediate consultation with either the department’s infection control officer or the Emergency Department physician on duty.

2. Determine if immediate medical evaluation is needed.

3. The exposed person should register into the Emergency department, where the patient was brought, to be seen by a physician.

4. The person receiving the exposure should report directly to the charge nurse

5. The person must complete a Loyola EMS System Communicable Disease Exposure Form, and a copy of the form should be forwarded to the EMS office for followup.

6. Decisions if the source and the person exposed will require HIV and HB Ag levels to be drawn at this time.

7. Initiate source testing if needed according to the hospital policy of that facility.

8. Follow Loyola System policy 700.8 for post-exposure prophylaxis recommendations.

9. Persons that have not received a tetanus booster with the last 5 years should be updated.

TITLE: Exposure Control Plan for NUMBER: 700.1

Prehospital Providers

SECTION: Infection Control

EFFECTIVE DATE: 9/1/99 REVISED/REVIEWED: 3/26/08

PURPOSE:

To provide guidelines. policies and procedures designed to prevent or minimize occupational exposure of prehospital care providers to blood borne pathogens, airborne pathogens, or other potentially infectious materials.

To provide compliance with the applicable provisions of Occupational Exposure to Blood Borne Pathogens; as stipulated through the standards of 29 CFR 1920.20 and Illinois Administrative Code, Chapter I, section 250.75.

POLICY:

Providers in the Loyola Emergency Medical Services System must follow the exposure control plan to prevent or minimize occupational exposure of prehospital care to blood borne pathogens, airborne pathogens or other potentially infectious materials.

I. Definitions:

Prehospital care provider refers to anyone who could be "reasonably anticipated" as the result of

performing their job duties to face contact with blood and other potentially infectious materials. 29

CFR part 1910.30

Occupational Exposure means: "reasonably anticipated" skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of duties. 29 CFR 1910.30(b)

Blood means human blood, human blood component, and products made from human blood. 29 CFR 1910.30(b)

Blood Borne Pathogens means pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include but are not limited to hepatitis B virus (HBV) and human immune-deficiency virus (HIV). 29 CFR 1910.30(b)

Contamination means the presence of blood or other potentially infectious materials on an item or surface. 29 CFR 1910.30(b)

Decontamination means the use of physical or chemical means to remove, inactivate or destroy blood borne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use or disposal. 29 CFR 1910.30(b)

Other potentially Infectious Materials means the following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood. 29 CFR 1910.30(b)

II. Methods of Compliance:

1. Universal Precautions:

Universal precautions will be observed during patient care in order to prevent contact with blood and/or body fluids or other potentially infected materials. All blood or other potentially infectious materials will be considered infectious, regardless of the perceived status of the source/individual.

2. Engineering and Work Practice Controls:

Engineering and work practice controls will be utilized to eliminate or minimize exposure to prehospital care providers. Where occupational exposure remains after institution of these controls, personal protective equipment shall also be utilized.

The following engineering controls will be utilized:

A. Prehospital care providers must wash their hands with soap and water after treating patients, after removing gloves or other personal protective clothing, after

handling potentially infectious materials, and after cleaning or decontaminating equipment. Handwashing with soap and water will be performed for ten to fifteen seconds. If soap and water is not available at the scene, a waterless handwash may be used, provided that a soap and water wash is performed immediately upon return to quarters or hospital.

B. Prehospital care providers must wash their hands and other skin surfaces immediately and thoroughly if contaminated with blood or body fluids (refer to policy for notification and policy reporting of an exposure.)

C. Eating. drinking, smoking, handling contact lenses, or applying cosmetics or lip balm is prohibited at the scene of operations.

D. Needles and sharps used by prehospital care provider personnel shall be properly and immediately disposed of in an appropriate sharps container. Red, puncture resistant sharps containers are required and available for exchange on a 1:1 basis. Contaminated needles should not be removed by hand from syringes. Needles should not be recapped. If recapping is necessary, it should be performed using a one-handed technique - with the syringe being held and sliding it into the cap.

3. Personal Protection Equipment (PPE):

A. Prehospital care providers will use barrier precautions to prevent skin and mucous membrane contact with blood and other body fluids. This includes use of gloves, face masks with protective eye shields, goggles, gowns, and foot protection during procedures that generate splashing of blood and/or body fluids or where exposure of large volumes of blood and/or body fluids are anticipated.

B. Disposable gloves shall be worn by prehospital care providers whenever direct patient care is performed when there is a potential for blood and/or fluid exposure and when handling contaminated linen.

C. Masks with eye protective devices shall be worn wherever splashes, sprays, or droplets of blood or potentially infectious materials may be generated and eye, nose, or mouth contamination may occur.

D. Appropriate disposable protective clothing such as impervious gowns, caps and foot protection shall be worn during exposure situations depending on the exposure anticipated.

E. Mouth-to-mouth resuscitation with a barrier should be performed only as a last resort if no other equipment is available. Disposable resuscitation equipment will be available for exchange on a 1:1 basis.

F. If TB is suspected, place a high filtration isolation mask on the patient, or, if 02 is needed apply a non-rebreather mask.

4. Housekeeping

A. All equipment and work areas shall be cleaned and decontaminated after contact with blood or other potentially infectious material. It is recommended that heavy-duty utility gloves be used for cleaning, disinfection, or decontamination of equipment.

Disinfection will be performed with a department-approved disinfectant or with a 1:10 solution of bleach in water. All disinfectants will be tuberculocidal and EPA approved and registered.

Any damaged equipment will be cleaned and disinfected before being sent out for repair.

The manufacturer's guidelines will be used for the cleaning and decontamination of all equipment. Unless otherwise specified:

- Durable equipment (backboards, splints, MAST pants) will be washed with hot soapy water, rinsed with clean water, and disinfected with an approved disinfectant or 1:10 bleach solution. Equipment will be allowed to air dry.

- Delicate equipment (radios, cardiac monitors paddles, suction equipment, etc.) will be wiped clean of any debris using hot soapy water, wiped with clean water,

then wiped with disinfectant of 1:10 bleach solution. Equipment will be allowed to air dry.

Work surfaces will be decontaminated with an appropriate disinfectant after completion of procedures, and after spillage or contamination with blood or potentially infections materials. Seats on response vehicles contaminated with body fluids from soiled personal protective equipment also will be disinfected upon return to station.

Disinfection supplies are available at Loyola as well as its associate hospitals for ambulance/equipment disinfection at the hospital.

B. Contaminated broken glassware shall not be picked up directly with the hands but with a brush and dustpan or tongs.

5. Regulated Wastes₁Infectious and/or Biohazardous

A. Contaminated sharps and glass vials or tubes shall be discarded immediately in red sharps containers.

B. Disposable equipment or supplies that are contaminated with blood or body fluids shall be placed in red hazardous waste bags. If the original red bag becomes contaminated. it should be placed in a second red bag. Waste receptacles, lined with red plastic bags are located in several areas of the emergency department for contaminated wastes.

C. Each provider must have a plan in place for disposing of biohazardous wastes.

6. Linen

All laundry shall be treated as contaminated and handled per universal precautions guidelines. Personnel who have contact with contaminated linen shall wear gloves when disposing of this linen.

Wet laundry shall be placed in bags or containers that prevent leakage of fluids to the exterior and personnel contact.

Linen located in the ambulance is to be covered when not in use. Contaminated work clothes will be laundered by the employee according to OSHA standards, 29 CFR

1910.1030.

III. Hepatitis B Vaccine: (Responsibility of Employer)

All employees who have been identified as having exposure to blood or other potentially infectious materials should be offered the Hepatitis B vaccine, at no cost to the employee. The vaccine will be offered within 10 working days of their initial assignment to work involving the potential for occupational exposure to blood or other potentially infectious materials unless the employee has previously had the vaccine or wishes to submit to antibody testing which shows the employee to have sufficient immunity.

Employees who decline the Hepatitis B vaccine should sign a waiver, provided by the employer, which uses the wording in Appendix A of the OSHA standard.

Employees who initially decline to receive the vaccine, but who later wish to have it, may then have the vaccine provided at no cost.

IV. Communication of Hazards to Employees:

1. Labels and Signs:

A. Warning labels shall be affixed to containers of regulated waste. Red bags or red containers may be substituted for labels.

B. Labels shall display the universal biohazard symbol and the signal word "BIOHAZARD" and shall be fluorescent orange or orange-red or predominately so, with lettering or symbols in a contrasting color.

C. Labels shall be affixed to containers by string, wire, adhesive, or other method that prevents their loss or unintentional removal.

D. Regulated waste which has been decontaminated need not be labeled or color-coded.

E. Signs need only be posted at entrance ways to HIV and HBV research laboratory and production facilities.

Selection of Gloves:

The Center for Devices and Radiological Health, FDA. has responsibility for regulating the medical glove industry. Medical gloves include those marketed as sterile surgical or non-sterile examinations gloves made of vinyl or latex. General purpose utility ("rubber') gloves are also used in the healthcare setting, but they are not regulated by FDA since they are not promoted for medical use. There are no reported differences