SECTION: Infection Control

EFFECTIVE DATE: 9/1/99REVISED/REVIEWED

POLICY:

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.

PROCEDURE:

1. Handwashing with soap and water will be performed for ten to fifteen seconds.

2. 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.

3. Prehospital care providers must wash their hands and other skin surfaces immediately and thoroughly if contaminated with blood or body fluids.

SECTION: Infection Control

EFFECTIVE DATE: 9/1/99REVISED/REVIEWED: 9/1/99

PURPOSE: To minimize the spread of secretion-borne infection, exam gloves are required to be worn by all EMS personnel having contact with blood or other secretions. This includes invasive procedures as well as handling of bed pans, emesis basins or other equipment used in managing patient secretions/excretions.

POLICY:

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

NOTE:

Only exam gloves will be made available by hospitals, not surgical gloves. All three sizes of exam gloves are to be available. If a provider agency feels that surgical gloves are necessary, they must purchase them.

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 in barrier effectiveness between intact latex and intact vinyl used to manufacture gloves. Thus, the type of gloves selected should be appropriate for the task being performed.

The following general guidelines are recommended:

1. Use sterile gloves for procedures involving contact with normally sterile areas of the body.

2. Use examination gloves for procedures involving contact with mucous membranes, unless otherwise indicated, and for other patient care or diagnostic procedures that do not require the use of sterile gloves.

3. Change gloves between patient contacts.

4. Do not wash or disinfect surgical or examination gloves for reuse. Washing with surfactants may cause "wicking," i.e., the enhanced penetration of liquids through undetected holes in the glove. Disinfecting agents may cause deterioration.

5. Use general-purpose utility (i.e., rubber household gloves) for housekeeping chores involving potential blood contact and for instrument cleaning and decontamination procedures. Utility gloves may be decontaminated and reused but should be discarded if they are peeling, cracked, or discolored, or if they have punctures, tears, or other evidence of deterioration.

SECTION: Infection Control

EFFECTIVE DATE: 9/1/99REVISED/REVIEWED: 9/1/99

PURPOSE: To minimize the exposure to infections the use of protective devices such as goggles an/or shields is required for such invasive procedures as intubation, suctioning and so on. In addition, anytime that patient secretions might be splashed or sprayed into the area of the face, appropriate measures should be used. When emergency medical response personnel or others must transport patients with confirmed or suspected active TB, a surgical mask should be placed on the patient, if possible. Because of the inability to ensure administrative and engineering controls in emergency transport situations and vehicles, the prehospital providers should wear respiratory protection.

POLICY:

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

NOTE:

The goggles and/or facial shields will not be exchangeable items. Ideally each individual will have their own piece of such equipment and sharing should be minimized. Thorough cleaning after use is required.

SECTION: Infection Control

EFFECTIVE DATE: 9/1/99 REVISED/REVIEWED: 9/1/99

PURPOSE: To minimize the risk of transmission of infectious diseases via contaminated linens.

POLICY:

All linens will be exchanged with the hospital and clean ones used for each patient.

PROCEDURE:

1. Linens will be exchanged on a 1:1 basis.

2. If the patient transported has a suspected or known contagious disease, the linens must be bagged according to the receiving hospital’s policies and procedures.

3. For those departments using special blankets which cannot be supplied by the hospital, cleaning of these supplies must meet recommended guidelines.

SECTION: Infection Control

EFFECTIVE DATE: 9/1/99 REVISED/REVIEWED: 9/1/99

PURPOSE: To reduce the risk of disease transmission from patient to patient, all used non-disposable airway equipment must be cleaned after each patient use.

POLICY:

Prehospital personnel must dean used non-disposable airway equipment after each patient use.

PROCEDURE:

1. Laryngoscope Blades should be thoroughly scrubbed and cleaned with bleach or other disinfecting solution. Scrubbing is recommended to loosen mucous and particulate matter to allow for thorough cleaning and disinfection.

2. Bag Valve Mask - use of non-disposable BVM is prohibited.

NOTE: Hospitals are to make appropriate supplies and cleaning solutions available for use by prehospital personnel.

Prehospital personnel must clean dirty equipment in areas designed by each hospital for this purpose.

SECTION: Infection Control

EFFECTIVE DATE: 9/1/99REVISED/REVIEWED: 9/1/99

PURPOSE: To reduce the risk of disease transmission from patient to personnel and from patient to patient.

POLICY:

The ambulance and its equipment must be kept clean. The ambulance and its equipment should be cleaned regularly. In addition, cleaning of surfaces should be carried out before the ambulance may be put back into service.

Solutions must be strong enough to be tuberculocidal.

All cleaning solutions for the ambulances are to be purchased by the provider agencies and comply with OSHA Standards.

SECTION: Infection Control

EFFECTIVE DATE: 9/1/99 REVISED/REVIEWED: 9/1/99

PURPOSE: To provide any prehospital emergency services provider, (EMT, ambulance personnel, paramedic, emergency services provider agency firefighters and police) involved in prehospital care activities while on duty that expose them to blood or body fluids of another person, an access to appropriate care and follow up as stipulated through the standards of 29 CFR 1920.20 and Illinois Administrative Code, Chapter I, Section 250.725.

POLICY:

Emergency services providers rendering care or assistance to persons in the prehospital field have two mechanisms by which to request notification if an exposure occurred while performing their normal job duties.

1. Recording of the exposure on the Loyola EMS System Ambulance Report form. The yellow, EMS office copy is picked up from the recording room daily and monitored for any documentation of exposures by the Loyola EMS Office Staff. In addition, the person receiving the exposure must complete a Loyola EMS System Communicable Disease Exposure Form.

2. A person receiving exposure should report directly to the charge nurse of the Emergency Department. A copy of the exposure form should be forwarded to the EMS office for follow-up.

3. The events surrounding when the exposure occurred should be reviewed by the physician in the Emergency Department on duty at the time of the incident. Decisions if the source and the person exposed will require HIV and HBSAg levels to be drawn should be made at this time. (See E below)

PROCEDURE:

1. The exposed person will register into the Emergency Department to be seen by a physician.

2. Exposures sustained from a needle stick or percutaneous exposure to serum or other potentially infectious body fluids should receive appropriate wound care and tetanus prophylaxis if needed. Persons that have not received a tetanus booster within the last 5 years should be given 0.5 cc Diphtheria/Tetanus Toxoid (DT) intramuscularly.

3. Initiate source testing if needed according to hospital policy.

4. Post exposure prophylaxis for Hepatitis (recommendations only)

A. Known Source (Positive HBsAg):

1. If prehospital care provider has previously received a complete series of Hepatitis B vaccine, no prophylaxis is required in the Emergency Department.

2. If the exposed has not received the Hepatitis vaccine, the first of three doses should be administered in the ED. Recombivax HB (1 cc) intramuscularly. The completion of the vaccine will be done through the employee/employer agreement. The exposed should also receive Hepatitis B immune globulin (HBIG) 0.06 cc/kg or 5 cc intramuscularly.

B. Known Source (Unknown HBSAg status):

1. If the exposed has received the Hepatitis vaccine in the past nothing further is needed.

2. If the exposed has not received any Hepatitis vaccine previous to the exposure the first injection of the Hepatitis vaccine should be administered, Recombivax HB (1 cc) intramuscularly in the ED. Series completion should be handled through the employer.

C. Unknown Source:

1. Follow as above for therapy to be initiated in the ED at the time of the exposure in Known Source (D.1 .a.)

D. Post exposure prophylaxis for HIV, Known and Unknown Source:

1. Source and person exposed should have the HIV testing initiated in the ED at the time of the exposure.

2. Test results will be forwarded by confidential mail to the ordering physician. For all prehospital exposures the Project Medical Director's name should be used.

5 Follow Up Care

A. Wound: Examine the wound and check for evidence of infection (redness, discharge, tenderness, etc.). The exposed person should return to the ED for care if these signs and symptoms present.

B. Tests Results: All positive source test results for communicable diseases that are received by the EMS office will be followed up by a notification phone call and notification letter within 72 hours after receiving knowledge of the confirmed diagnosis. Notification will be given to the component head of the prehospital provider unless otherwise specified by the prehospital provider agency.

6. Notification Procedure

A. All exposures with a reportable communicable disease will be logged in the Prehospital Communicable Disease Log.

B. A notification letter will be sent simultaneously with phone call procedures as above will also be initiated when any prehospital provider comes into contact with any of the following communicable diseases that are required by 77 Illinois Administrative Code, Chapter I, Section 250.725 c., 1-20.

1. Rubella (including congenital rubella syndrome)
2. Measles
3. Tuberculosis
4. Invasive meningococcal infections (meningitis or meningococcemia)
5. Mumps
6. Chicken Pox
7. Herpes Simplex
8. Diphtheria Rabies (human)
10. Anthrax
11. Cholera
12. Plague
13. Polio (Poliomyelitis)
14. Hepatitis B
15. Typhus (louse borne)
16. Small Pox
17. Hepatitis Non A/Non B
18. Acquired Immunodeficiency Syndrome (AIDS)
19. Aids Related Complex (ARC)
20. Human Immunodeficiency Virus (HIV)

C. Internal Notification via Infection Control Department

1. Infection Control will notify the EMS office of all patients with confirmed diagnoses as listed in 6B with the Notification of Exposure of Communicable Diseases/Infection Control form admitted through the Emergency Department.

2. Once the form is received in the EMS office, it is dated and timed. Medical records is contacted and patient chart is reviewed for any information relating to prehospital care and potential for exposure during patient contact. As per 77 Illinois Administrative Code, Section 250.725, e. 2.

3. The notification process as described in 6 (A and b) of this policy will then be followed.