Standard Precautions for EMS Providers in the Prehospital Setting

1. International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Standard Precautions in the Prehospital Setting 22

2. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians Precautions Courtesy of Louis B. Mallory, MBA, REMT-P

3. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians Overview Bloodborne viral illnesses Most common for EMS exposure Signs and symptoms of tuberculosis Protective measures Potentially infectious materials precautions

4. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians Overview Appropriate personal protective equipment use Accidental exposure procedures Multidrug-resistant organisms Vaccines and immunizations

5. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians Standard Precautions Exposure does not mean infection. Exposure can be treated. Exposure does not mean infection. Exposure can be treated.

6. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians Standard Precautions Common bloodborne viral infections Hepatitis B (HBV) Hepatitis C (HBC) HIV infection Primary modes of exposure Contaminated blood Other potentially infectious materials (OPIM)

7. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians Potentially Infectious Other potentially infectious materials: CSF Synovial fluid Amniotic fluid Pericardial fluid Pleural fluid Body fluid with gross visible blood

8. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians Potentially Infectious Only with gross visible blood Tears Sweat Saliva Urine Stool Vomitus Nasal secretions Sputum

9. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians Viral Hepatitis Viral infections involving liver: Fecal transmission: Types A, E Bloodborne transmission: Types B, C, D Type D only with Type B Prevention is best treatment! Courtesy of Louis B. Mallory, MBA, REMT-P

10. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians Hepatitis B (HBV) Modes of exposure Contaminated blood Other potentially infectious materials (OPIM) Sexual transmission Direct contact with nonintact skin Health care risk of infection: 630% Needlestick exposure to HBV blood and no vaccination or immune response

11. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians Hepatitis B (HBV) High-risk groups Immigrants from areas HBV is prevalent Incarcerated Institutionalized IV drug users Male homosexuals Hemophiliacs Household contacts Hemodialysis

12. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians Hepatitis B (HBV) Clinical manifestation Acute hepatitis Chronic hepatitis Cirrhosis Liver cancer Chronic carrier risk: 510%

13. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians Hepatitis B (HBV) Health care protection Hepatitis B vaccines Does not contain antibodies Lifelong protection Effective immunity in 90% Hepatitis B immunoglobulin Contains antibodies Passive protection for 6 months Effective immunity in 70% Courtesy of Louis B. Mallory, MBA, REMT-P

14. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians Hepatitis C (HBC) Modes of exposure Contaminated blood Other potentially infectious materials (OPIM) Sexual transmission Direct contact with nonintact skin Health care risk of infection Needlestick exposure to HCV blood: 1.5%

15. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians Hepatitis C (HBC) Clinical manifestation Less severe than HBV Chronic carrier risk > HBV risk Liver failure, cirrhosis 1020% of carriers Health care protection Vaccine not available Immunoglobulin (IG) not shown effective

16. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians HIV Infection Modes of exposure Contaminated blood Other potentially infectious materials (OPIM) Sexual transmission Direct contact with nonintact skin HIV does not survive outside body No special cleaning agents are required Transmitted less efficiently than HBV

17. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians HIV Infection Health care risk of infection Needlestick exposure to HIV blood: 0.3% Mucosal or nonintact skin exposure: 0.09% Large amounts HIV blood

18. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians HIV Infection High-risk groups Male homosexuals Bisexuals IV drug users Transfused Blood, pooled-plasma HIV sexual contact

19. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians HIV Infection Clinical manifestation Immune system defective Higher risk of unusual infections Many are asymptomatic Chronic carrier risk: 100% All HIV infected can transmit HIV Current HIV treatment reduces risk

20. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians HIV Infection Health care protection Vaccine not available Antiretroviral drug regimen Prolongs life, does not cure May reduce risk of infection by significant exposure if administered within hours, not days Recommended for Highest Risk exposures Possible benefit for Increased Risk exposures Unlikely benefit for Low Risk exposures

21. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians Tuberculosis Mycobacterium tuberculosis Deadliest infectious disease globally Not highly communicable Mode of exposure Direct contact through air, cough, sneeze Preventive measure Place surgical mask on any suspected patient

22. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians Tuberculosis Health care risk of infection Up to 5% skin test positive in high-prevalence environment High-risk groups HIV infected Immigrants from TB prevalent Homeless Live in congregate settings

23. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians Tuberculosis Clinical manifestation Severe cough >3 weeks with two or more: Chest pain Bloody sputum Weakness or fatigue Unexplained weight loss Loss of appetite Fever, chill, night sweats Hoarseness Courtesy of Louis B. Mallory, MBA, REMT-P

24. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians Tuberculosis Health care protection TB infection (no active disease) Isoniazid (INH) or rifampin for 69 months TB disease Antibiotic agents Pearson

25. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians XDR-TB Extensively drug-resistant TB Resistant to: 2 first-line oral antibiotics AND 2 first-line IV antibiotics

26. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians Multidrug-Resistant Organisms Resistant to 2 first-line antibiotics Increasing since 1960s Hospital-associated infections MRSA most prevalent CA-MRSA (Community Acquired-MRSA)

27. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians Multidrug-Resistant Organisms Prehospital care personnel at low risk Gloves Handwashing Cleaning surfaces and equipment

28. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians Precautions for Prevention Be knowledgeable Bandage lesions Routine handwashing Immunizations Report exposures Courtesy of Louis B. Mallory, MBA, REMT-P

29. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians If exposed, wash exposed area Immediately. If exposed, wash exposed area Immediately.

30. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians Reporting Exposures Contact designated official Determines if exposure occurred Interacts with medical facility Coordinates needed tests Write incident report soon as possible EMS report may supplement, but not replace Know local laws Confidential exposure report form in U.S.

31. International Trauma Life Support for Emergency Care Providers , Seventh Edition John Campbell Alabama College of Emergency Physicians Summary Health-care workers are at risk of exposure to many contagious diseases Prevention: Health-care workers should be HBV immunized Knowledge of modes of exposure, adherence to barrier precautions, and postexposure medical follow-up reduce risk of infection