Everyone Sign R oster

1. Everyone Sign Roster • Sign-In Rosters • Required for all CCVESA Providers. • Please Print Name, MIEMSS I.D. #, and Company Affiliation • All completed rosters must be sent back to the EMS Training Coordinator.

2. Carroll County Volunteer Emergency Services Association Bloodborne Pathogen Exposure Control Plan Bloodborne Pathogen 2012 Update

3. Training Objectives • The purpose of this training is to • Review OSHA Bloodborne Pathogen Standard. • Using Case Studies to Review BBP diseases that you could come in contact with • Review PPE needed to minimize exposure • Review what constitutes an exposure incident • Review Needle Stick exposures • Review the appropriate actions to take and persons to contact in an emergency involving an Exposure • Review procedures to follow if an exposure incident occurs • Review of required documentation that MUST be completed following an exposure • Review the post-exposure evaluation and follow up procedures

4. OSHA Standard • Occupational Safety and Health Administration • OSHA Standard 19 CFR 1910.1030 • “Occupational Exposure to Bloodborne Pathogens” • Applies to all occupational exposure to blood or other potentially infectious materials.

5. OSHA Standard 19 CFR 1910.1030 • Each employer having employee(s) with the potential of exposure shall establish a written Exposure Control Plan • Establish Exposure Determination • Provide Personal Protective Equipment • Establish good housekeeping procedures • Provide Hepatitis B Vaccinations • Establish Post-exposure Evaluation & Follow-up procedures • Communication of hazards to employees with appropriate Labels and Signs • Provide Information and Training • Recordkeeping

6. Annual BBP Training Records OSHA requires annual BBP training for all volunteer and employees Training records are to completed for each volunteer or employee upon completion of training These documents must be kept for at least three (3) years at the office of the EMS Training Coordinator

7. Annual BBP Training Records Training Records should include The dates of the training sessions The contents or a summary of the training sessions The names and qualifications of the persons conducting the training The names and job titles of all persons attending the training sessions

8. Bloodborne Pathogens of Special Concern To Health Care Providers • HBV: Hepatitis B virus • HCV: Hepatitis C virus • HIV: Human Immunodeficiency virus • Influenza…H1N1 • Meningitis • MRSA Staphylococcus Aureus (Staph) • Tuberculosis

9. BloodBorne Pathogens • Every patient is a threat to our safety • Most common BBP are Hepatitis B/C and HIV • Most common type of BBP exposure in EMS are a result of needlesticks. • There are approximately 600-800k reported needlesticks of healthcare workers every year.

10. Types of BBP Exposures • Percutaneous Exposures Occur Through Broken Skin and include • needle stick with contaminated needle • cut with a contaminated sharp object • direct contact of contaminated blood or other infectious material with non-intact skin (skin that is chapped, abraded, afflicted with dermatitis, etc.) • Mucotaneous Exposures Occur when infectious material contacts mucous membranes of the mouth or nose

11. What constitutes a BBP exposure? • The transfer of a patient’s blood, other bodily fluids containing blood, or other potentially infectious material, to the provider’s bloodstream by direct transfer, via mucous membrane inoculations, or through openings in the skin. • Simple handling of a patient does NOT constitute an exposure • Small amounts of blood or other infectious material on intact skin do not constitute an exposure.

12. Important things to keep in mind… Patient contact does not equal exposure It is NOT in your best interest to “upgrade” a near miss (for example, blood on intact skin or blood near but not on mucus membranes) to an actual exposure Exposure to blood does not necessarily (or even usually) result in exposure to disease Most exposures to disease do NOT result in infection You can greatly decrease your risk of occupationally acquired disease by following the guidance in this presentation.

13. CASE STUDY 1 • November 21….1930 Hrs • Your unit is dispatched to a 1624 Main Street for a “sick female patient”

14. ARRIVAL ON SCENE • Upon arrival you find a 42 year old female patient lying supine in bed. She thinks she may have the “flu” • Patient c/o fever, some upper abdominal pain, and nauseated. • Patient states she has felt extremely tired and has no desire to eat.

15. INITIAL ASSESSMENT • Airway: Patent • Breathing: Regular, RR 18 • Circulation: HR 100 , skin warm & diaphortic and her skin has a yellowish discoloring

16. PHYSICAL EXAM • Head/Neck • Pupils - PERRL • Eyes – slight jaundice in her eyes • Chest • Equal lung sounds and expansion • Abdomen • Soft, non-tender • Dull pain across both upper quadrants

17. PHYSICAL EXAM • Pelvis • Stable • Extremities • PMS present all extremities • Posterior • No evidence of trauma

18. VITAL SIGNS • BP: 114/88 • HR: 100 regular • RR: 18 • SpO2: 96% Room Air

19. PATIENT HISTORY • A: NKDA • M: Tylenol for the fever • P: IV Drug Abuser 10 years ago • L: Not eating due to loss of appetite • E: Not feeling well for past couple of days

20. What would you consider to be this patient’s chief medical problem?

21. PATIENT DIAGNOSIS Hepatitis B

22. What should you have done prior to & while in contact with this patient?

23. Hepatitis B -- Attempt to Avoid exposure • Assume every patient is infected • Prevention with use of universal precautions against Hepatitis B • Use appropriate PPE/Gloves • Follow all policies and procedure • Get Hepatitis B Vaccination

24. Personal Protective Equipment (PPE) • Gloves • MINIMUM required PPE for all patients • shall be worn at all times when participating directly or indirectly in patient care • Shall also be worn during clean up activities, when handling any potentially contaminated items, and at any other time exposure to blood or other bodily fluids is possible. • Remove contaminated gloves before touching equipment (e.g. portable radios), vehicle door handles, or anything else that may lead to further contamination. If this practically cannot be done, be certain to decontaminate as soon as possible. • NEVER wear contaminated gloves in the front (driver/passenger) compartment of the medic unit.

25. Hepatitis B • Infection of liver caused by Hepatitis B virus (HBV) • Transmitted by contact with bodily fluids such as blood, saliva, and semen • NOT transmitted by food or water, breastfeeding, sharing eating utensils, hugs or kisses

26. Hepatitis B • Hepatitis B… • can be fatal • is very easy to catch compared to other diseases spread by BBP • Hepatitis B can survive outside the body up to one week! • Is preventable through vaccination

27. Initial symptoms may be mild or absent! Tiredness Loss of appetite Fever Vomiting Yellow skin & eyes (jaundice) Dark-colored urine. Light colored stool Hepatitis B Symptoms

28. Hepatitis B • There are 1.4 million chronically infected • Approximately 73K new cases each year • 15-25% mortality

29. Highest risk of contracting Hepatitis B • Those with multiple sexual partners (unprotected) • IV drug abusers • Infants born to infected mothers • Regular household contact with chronically infected persons • Hemodialysis patients

30. Hepatitis B – Prevention • Vaccine is the best prevention • vaccine is 95% effective and in most cases, provides lifelong immunity to the person receiving it • vaccine comes as a series of three shots. • after the 1st IM shot is administered, a 2nd shot will be given 30 days later, and the 3rd dose is administered 6 months after the 2nd dose. • Lab titers may be necessary to ensure that the vaccine is still working, and occasionally a person may need a booster shot to bring the number of antibodies in the body up to necessary levels. • Safe handling of sharps and other potentially infected products

31. Hepatitis B Prevention • Make sure you are vaccinated against Hepatitis B • Vaccination (or formal declination) is mandatory • The vaccine is safe. It is NOT a live virus vaccine, and cannot give you hepatitis B • The protection is permanent and highly effective • Vaccination requires 3 doses of vaccine over 4-6 months and then a blood titer • The titer is essential to verify you have responded to the vaccine & are protected! • Avoid exposure - prevention with universal precautions remains your best protection against Hepatitis B and all other BBP • Assume every patient is infected • Use appropriate PPE • Follow all policies and procedures

32. Hepatitis B Vaccination • Volunteer Members or Employees • Hepatitis B vaccines are available at no cost to you within 10 days of initial assignment • Vaccination will be provided by the CCVESA Physician

33. Hepatitis B Vaccination is encouraged unless… • Documentation exists that the volunteer or employee has previously received the series • Antibody testing reveals that the volunteer or employee is immune • Medical evaluation shows that vaccination is contraindicated

34. Hepatitis B Vaccination is declined by a volunteer or employee… • They must sign a declination form • Documentation of refusal of the vaccination is kept at the CCVESA Physician’s facility • Volunteers or employees who decline may request and obtain the vaccination at a later date at no cost.

35. HEPATITIS B VACCINE DECLINATION FORM • HEPATITIS B VACCINE DECLINATION (MANDATORY) • I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring Hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with Hepatitis B vaccine, at no charge to myself. However, I decline Hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring Hepatitis B, a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with Hepatitis B vaccine, I can receive the vaccination series at no charge to me. • Signed: __________________ Date: _________________

36. CASE STUDY 2 • October 15….2200 Hrs • Your unit is dispatched to a Nursing Home @ 1122 Pepper Lane for a “sick male patient”

37. ARRIVAL ON SCENE • Upon arrival you are met by a staff member of the nursing, who directs you to the patient’s room and provides you with an appropriate MOLST form. She advises that he had fell and injured his right wrist and his attending physician wants him evaluated at the ER.

38. ARRIVAL ON SCENE • Patient is a 88 year old male sitting up in a chair c/o injury to his right wrist • You note that there is some deformity of the right wrist. • Patient states he fell on to his right hand as he went down • Patient has no other obvious injuries

39. INITIAL ASSESSMENT • Airway: Patent • Breathing: Regular, RR 22 • Circulation: HR 110, skin is hot and dry, You notice a rash on his skin, with multiple boils/pimples and several pus-filled abscesses

40. PHYSICAL EXAM • Head/Neck • Pupils - PERRL • Chest • Equal lung sounds and expansion • No bruising or deformities • Abdomen • Soft, non-tender • No discoloration

41. PHYSICAL EXAM • Pelvis • Stable • Extremities • Deformity to right wrist • Good PMS in all extremities • Posterior • No evidence of trauma

42. VITAL SIGNS • BP: 150/90 • HR: 110 • RR: 22 • SpO2: 93%

43. PATIENT HISTORY • A: Penicillin • M: Synthroid • P: Hypothyroid • L: Supper • E: Walking back to his room and lost his balance and fell to the floor

44. What would you consider to be this patient’s chief medical problem?

45. FINAL DIAGNOSIS MRSA

46. What should you have done prior to & while in contact with this patient?

47. MRSA --Attempt to avoid exposure • Assume every patient is infected • Prevention with use of universal precautions against MRSA • Use appropriate PPE/Gloves • Follow all policies and procedure

48. MRSA • MRSA was first discovered in 1961 in the United Kingdom. • The first major outbreak in the US was in 1981 and was noted in a large population of IV drug users. • Since then, approximately 94k Americans are infected every year. • More than 18k people will die in the hospital as a result of this organism.

49. MRSA • Multiple drug-resistant strain of staph aureus • Resistant to several common antibiotics and even antibiotics that have been developed within the past few years, making it extremely dangerous and difficult to treat. • Grows on every single surface • Survives outside the host for several months

50. MRSA – Risks Outbreaks • IV Drug users • Athletes • Nursing homes • Prisons Race/Population • Age 65+ years • African Americans • Males