California Fire Chiefs Southern EMS Section Designated Infection Control Officer Training
What will be discussed • Communicable Diseases Overview • Transmission of Diseases and Common Diseases • Designated Officer • Laws and Regulations • Designated Infection Control Officer • Exposure Control Plan • Education and Training requirements • Exposure Management • Record Management
Communicable Diseases Overview
Communicable Disease • An infectious disease that can be transmitted through direct contact, indirect contact, airborne or vectors.
Infectious Agent • Disease causing microorganism (pathogen)
Infectious Agents • Virus • Bacteria • Fungi • Spores • Parasite
Reservoir • Where a microorganism normally lives and reproduces
Portal of Exit • Pathogen’s route from the reservoir
Examples of Portals of Exit • Flu or cold - mucous secretions • Hepatitis A – stool • Valley Fever – spores become airborne when the soil is disturbed
Mode of Transmission • The way the pathogen gets from the reservoir to the new host
Direct Contact • Direct contact transmission requires physical contact between an infected person and a susceptible person, and the physical transfer of microorganisms. • Includes touching an infected individual, kissing, sexual contact, contact with oral secretions, blood or contact with body lesions.
Indirect Contact • Spread by inanimate objects contaminated by an infected person • Food/Water • Needles • Surfaces • Clothing • Transfused bloods • Respiratory droplets
Indirect Spread by Droplets Someone touches contaminated object Droplets with the infectious agent land on a table, doorknob etc.
Indirect Spread by Droplets Touch nose, mouth, eyes with contaminated hand
Direct TransmissionRespiratory Droplets • Droplets produced and propelled through coughing or sneezing come into contact with another person’s conjunctiva, mouth, or nasal mucosa • Do not circulate in air for long time or travel far (mostly < 3 feet)
Airborne Transmission • Droplet Nuclei • Residue after partial evaporation of droplets • Remain suspended in the air for long prolonged periods of time and disseminated by air currents in a room and can be inhaled by a susceptible host
Airborne Vs Droplet • Droplet Contact • droplet is large (>5 micrometers) and short distance • Direct contact with droplet • Airborne • Droplet is small (<5 micrometers) and can travel long distance • Susceptible person breaths it in
Vector-borne Transmission • Vector carries the germ from one place to another
Portal of Entry • Route through which the pathogen enters its new host
Portal of Entry Bites Ingestion Sexual contact Respiratory: Inhaled Germs Eyes and mucous membranes Breaks in Protective Skin Barrier
Susceptible Host • Person who can get sick when they are exposed to a disease causing pathogen
Susceptible Host • Provides a place for infectious agent to live and lacks sufficient resistance to prevent infection when exposed to a pathogenic agent
Host Risk Factors • Characteristics that increase the likelihood that a person will acquire a specific disease • Age • Host immunity and general health • Nutritional status • Disease/therapies that impair immunity
Susceptibility • Exposure does not mean person will become infected • Manifestation of clinical disease dependent upon: • Degree of pathogenicity • Dose of infectious agent • Resistance of host • Correct mode of entry
Defense Mechanisms • Skin • Respiratory system • Normal flora • GI/GU systems • Inflammatory Response
Break the Chain of TransmissionMaintain Good Health • Healthy eating • Plenty of rest • Maintain vaccinations • Flu • Tetanus • Hepatitis B
Break the Chain of TransmissionMaintain Good Health • Keep a clean environment • Clean contaminated surfaces with commercial germicidal cleanser or wipes • Clean telephones, computer keyboards, doorknobs, light switches in the station and headsets and handles on your apparatus
Break the Chain of TransmissionPrevent the Spread of Diseases • Respiratory illnesses such as influenza are spread by: • Coughing or sneezing • Not washing hands • To help stop the spread of germs • Limit close contact (<3 feet) with coughing person • Cover your mouth and nose when you cough or sneeze • Cough or sneeze into your upper sleeve, not your hands.
Break the Chain of TransmissionPrevent the Spread • Wash hands frequently with soap and warm water for at least 20 seconds • Wash all surfaces thoroughly, including wrists, palms, back of hands, fingers and under the nails • When soap and water is not available • CDC recommends alcohol based hand sanitizer with at least 60% alcohol • Wash with soap and water ASAP
Break the Chain of TransmissionPrevent the Exposure • Work Practices • Use sharps containers and needle safe devices • Cleaning contaminated clothing • Use personal protective equipment
Communicable Diseases Common Communicable Diseases
Disease Stages • Incubation Period • Time from exposure and first symptoms • Latent Period • After host is infected but cannot transmit to another host • May or may not have symptoms • Communicable Period • When infection can be transmitted to another • May or may not have symptoms
Communicable Disease • Disease Period • Time between first appearance of symptoms and resolution of symptoms • Resolution does not mean agent is destroyed • Window Phase • Period after infection has occurred and time in which antibodies are detected in a blood test (seroconversion - positive blood test) • Can infect during window phase
Viral Hepatitis • Inflammation of the liver • Types • Hepatitis A • Hepatitis B • Hepatitis C • Hepatitis D • Hepatitis E • Signs and Symptoms • fever • weakness • anorexia • abdominal discomfort • nausea • darkened urine • possible jaundice
Hepatitis A • Transmission • Fecal oral contact • Contaminated foods • Close personal contact • Virus can survive on an unwashed surface for 4 hours • Incubation period • 28 days (range 15-50 days)
Hepatitis A • Communicable Period • 2 weeks before to 1 week after clinical illness onset • Some adults and many children have no symptoms but can still spread the disease • Prevention • Hepatitis A vaccine CDC Recommendations: • All children at age 1 year, • Persons who are at increased risk, • Persons who are at increased risk for complications (Not Include Healthcare Workers)
Hepatitis A • Post Exposure • CDC recommendations for those not vaccinated: • Healthy persons 12 months to 40 years: Vaccination • > 40, < 12 months, immunocompromised or persons with chronic liver failure: Immune globulin (Ig)
Hepatitis B • Transmission • Blood borne • Needles: sharing needles, tattooing, acupuncture, needle sticks • Contact with blood or open sores • Sexual • semen, vaginal fluids • Perinatal • Can survive as dried, visible blood for > 7 days
Hepatitis B • Incubation Period • Symptoms begin an average of 90 days (range: 60–150 days) after exposure to HBV • Detection • Can be detected in an infected person’s blood in about 4 weeks (range: 1–9 weeks) after exposure • About ½ of patients will no longer be infectious by 7 weeks after onset of symptoms, and all patients who do not remain chronically infected by 15 weeks after onset of symptoms.
Hepatitis B • Prevention • Vaccine • Provide long lasting immunity, 95-98% of time • If not previously given the first dose must be offered within 10 days of assignment • Post-Vaccine titer testing 1-2 months after series • Personal Protective Equipment (PPE)
Hepatitis B • Post Exposure • CDC recommends HBIG and vaccine • Unvaccinated person: HBIG and vaccination series • Vaccinated: Vaccine booster
Hepatitis C • Transmission • Blood borne • Needles: sharing needles, tattooing, acupuncture, needle sticks • Contact with blood or open sores • Sexual • Rare • Perinatal Can survive outside the body at room temperature, on environmental surfaces, for at least 16 hours but no longer than 4 days.
Hepatitis C • Incubation Period • Up to 80% have no symptoms • If symptoms do develop, the average time period from exposure to symptom onset is 4–12 weeks (range: 2–24 weeks). • Detection • Can be detected in the blood as early as 2–3 weeks after infection
Hepatitis C • Prevention • PPE • Post Exposure • Source patient: baseline testing for anti-HCV. • For the exposed employee: baseline and follow-up testing • No recognized benefit from prophylactic IgG
Active Tuberculosis • Signs and Symptoms • Cough (productive or non-productive) • Purulent sputum • Fever, low grade • Night sweats • Weight loss • Fatigue • Hemoptysis
Tuberculosis • Transmission • Spread by airborne route and droplet nuclei • Transmission affected by • Infectiousness of patient • Environmental conditions • Duration of exposure • Most exposed persons do not become infected
Environmental Factors Increasing Risk of Infection • Exposure in small, enclosed spaces • Inadequate ventilation • Recirculating air containing infectious droplets • Inadequate cleaning and disinfection of equipment • Improper specimen-handling procedures