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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
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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