Section II-7

Infection Control Policy

Purpose:  To establish an infection control policy for all Three Star Fire Department personnel who have the potential to be exposed to blood or other infectious materials.

Scope:    The goal of infection control is to prevent transfer of infection from the patient to emergency response personnel and their families, while simultaneously educating Three Star Fire Department members about infection hazards in the workplace.  The dangers faced by emergency response personnel are not always obvious.  The hazards of AIDS, hepatitis, and other communicable toxins are invisible but very dangerous.

Three Star Fire Department is committed to the safety of their personnel and in dealing with infection control. 

Vocabulary:

Normal Flora-Microorganisms in man that assist the body in maintaining health equilibrium by preventing overgrowth of harmful bacteria.

Bacteria-Organisms that need certain conditions for growth, reproduction and maintenance of life.

Virus-A packet of genetic material surrounded by a protein covering. Unable to grow or reproduce outside the living host.

Infectious-illness resulting from the invasion of the body by a bacteria, virus, fungi, or parasite. The term infectious only means caused by a pathogen

Communicable-is a disease that can be readily spread from one person to another under certain conditions. A disease can be infectious but not communicable.

Policy:

The infection control policy of the Three Star Fire Department applies to all personnel who have the potential for occupational exposure to blood or other infectious materials.

All personnel will wear disposable latex gloves, face shield, and mask, as appropriate when making contact with patients of a trauma or medical call where airborne pathogens, disease, blood, or other bodily fluids may become necessary and unavoidable.

Any uniform items that become soiled from bodily fluids must be sanitized immediately upon return to the fire station and before next emergency call.

All Department personnel are required to file a Infectious Exposure Form (Appendix 10) in the vent of exposure to a suspected or confirmed communicable disease or toxin.  Personnel will obtain these forms from the EMS Officer.  This form is to be completed and filed, ensuring that EMS Officer and Chief are notified immediately of the reported exposure.

Three Star Fire Department is not qualified in the handling of chemical, biological, radiation type hazardous material.  All personnel will stay clear of any suspected hazardous materials caused by intentional release, leaks, or the like.

Three Star Fire Departmentís EMS Officer will provide training to all personnel and will assure that all members receive education on precautionary measures, epidemiology, and modes of transmission.  Members will also receive training regarding the location and proper use of personal protective equipment, work practices, and precautions to be used in handling contaminated articles and infectious waste.

Infectious Diseases Most Commonly Encountered

Note: Duty to care: you cannot deny care to a patient who you suspect has a

communicable disease, even if you believe that the patient poses a risk to your

safety.

A. Meningitis:   Meningitis is difficult to determine in the prehospital environment. This infection can be due to a virus, bacteria, or tuberculosis, and involves an inflammation of the cover linings of the brain. Signs and symptoms can be fever, headache, stiff neck,

and/or altered mental status. Most forms of meningitis are not contagious, however

meningococcus meningitis is highly contagious and can be lethal.

B. Tuberculosis (TB):  TB is bacteria not a virus and is spread by droplets in the air that are expelled by an infected individual. Risk for exposure is dependent on the following: amount of time spent with the infected individual, the ventilation present at the time of exposure, and prevention measures used. All healthcare workers should receive a TB skin test (PPD) on an annual basis. Signs and symptoms of TB include: weight loss, night sweats, swollen lymph glands, and a cough that may be productive or nonproductive and persistent for 2-3 weeks.

C. Syphilis:  Syphilis is a bloodborne disease caused by bacteria. Syphilis is a sexually

transmitted disease, but may also be bloodborne. Signs and symptoms include a primary lesion or chancre may appear 3 weeks after exposure. 4-6 weeks later other symptoms may appear such as rash on soles of feet and palms of the hands. This may progress into a latent phase if not treated. Testing for the exposure would include a blood test.

D. Hepatitis B:  Hepatitis is a term which means inflammation of the liver. This disease is transmitted by blood to blood contact, sexual contact, or indirect contact with a contaminated object. Needle stick injuries present the greatest risk for infection with hepatitis B (6-30%). The incubation period for this disease is up to six months. Signs and symptoms begin with flu-like illness and then may or may not progress into common signs of yellow skin and itching, dark urine, which colored stools. There are two vaccines available to prevent Hepatitis B (Recombivax HB and Engerix-HB). The vaccine is given in a series of three doses. A titer test should be performed 1-2 months after completion of the vaccine series.

E. Hepatitis C:  Hepatitis C is another bloodborne disease and can be transmitted via blood-to-blood, sexual contact, or indirect contact with a contaminated object. This disease begins with signs and symptoms of fatigue, loss of appetite, malaise, headache, and nausea. The time frame from exposure to development of the disease can be as long as 200 days. There is no vaccine to protect against hepatitis C and there is no cure for this disease. Approximately 60-85% of infected persons develop long-term chronic liver disease.

F. HIV (Human Immunodeficiency Virus)/AIDS (Acquired Immune Deficiency Syndrome):   HIV is a virus, which attacks the immune system and destroys its ability to fight infection. Persons infected with HIV are considered to be communicable from the

time of infection. HIV that progresses to the later stage is termed AIDS. HIV is transmitted blood-to-blood contact, sexual contact, sharing IV drug needles, and infected mother to her infant. The time of infection to the time of development of this disease is two to ten years. Currently, there is no vaccine or cure for this disease. Common signs and symptoms of HIV are initial infection-fever, general malaise, flu like symptoms, swollen lymph glands followed by a phase in which no symptoms are present. Symptomatic phase-continued fatigue, chronic diarrhea, fever with night sweats, and swollen lymph glands. Progression into AIDS-pneumocystis carinii pneumonia, kaposiís sarcoma, CMV infection, and dementia. Most HIV infected persons are at high risk for TB.

Patient Handling Procedures

Communicable diseases can be transmitted in several ways (Direct, Indirect, and airborne):

A. Body fluids in the form of saliva, sputum, blood, urine, vomit, and fecal matter. First Responderís must limit exposure to these fluids and minimize risk of infection by wearing PPE.

B. Open sores, wounds, or any unnatural opening of the skin is a transmission point.

Members must note these high-risk areas on both the patient and themselves and not

allow any direct contact. Consider proper PPE.

C. Airborne particles of diseased materials may be encountered. A proper protective mask

should be placed on them as well as attending First Responder. Consider other indicated PPE.

D. Transmission can also occur through food, water, houseflies, ticks and mosquitoes.

E. The provider's eyes can be an area prone to the receipt of foreign matter. Using the

provided eye shield at all times during patient contact should protect them.

Note: Providers should wear the proper facemask covering both the mouth and nose,

eye shields, disposable gowns and medical gloves. All open sores or wounds should

be properly dressed at the start of the shift; and at any time that patient contact may

be suspected, should be redressed.

Decontamination Procedures

If the patient was not transported, all personal protective equipment will be properly disposed of. Soap should be provided for additional scrubbing to insure proper decontamination.

When patient is transported, the following procedure will be performed. The vehicle should remain in an unavailable status until personal equipment is disposed of and ambulance equipment is scrubbed using procedure outlined below:

A. Application of a disinfectant and gloves should be worn for all cleaning and

decontamination procedures.

1. Bleach (1:10 Dilution)

Contact time is between 10-30 minutes for high level disinfection. Bleach is a powerful germ-killing agent and is therefore recommended to clean up fresh (undried) blood spills. Caution should be exercised when using this solution around metal, electronic and electric equipment due to its corrosive behavior. A bleach solution can also decolorize fabrics.

2. Alcohol (70% Isopropyl)

Contact time is between 5-30 minutes for high level disinfection. It is a good skin antiseptic and does not corrode metal, but should be used with caution around electric and electronic equipment since it is flammable. It evaporates quickly.

3. Hydrogen Peroxide (3% Solution)

This solution is good for dissolving dried blood and body fluids from the surfaces of equipment. However, if this is used on heavily soiled equipment, cleaning and decontamination are still required.

4. Iodine Based Solutions

These are not recommended for the disinfection of equipment, but are excellent skin antiseptics.

B. Upon completion of each response, any disposable equipment should be discarded in the proper disposal containers. Filled portable suction containers should be given to ambulance service for proper disposal. 

C. Re-usable equipment (i.e. BP Cuffs, Stethoscopes, etc., should be disassembled, cleaned with disinfectant solutions, rinsed with water, then rinsed with 70% alcohol. All equipment should be dried completely prior to returning to service.

D. Stretchers, splints, and backboards should be cleaned with laundered cloths or paper towels wet with the properly diluted disinfectant solution after each patient use. The inside of the apparatus that EMS equipment is stored (i.e. Rescue 3 storage compartments), should be cleaned and disinfected on a regular basis.