Drill of the Month Developed by Gloria Bizjak

1. Drill of the MonthDeveloped by Gloria Bizjak Why We Use Body Substance Isolation Precautions

2. Why We Use Body Substance Isolation Precautions Student Performance Objective: Given information, resources, and opportunity for discussion and practice: • List and describe types of protective precautions. • Define BSI precautions and explain their purpose, importance, and requirements. • List personal protective equipment and describe its purpose. • Demonstrate techniques for donning, doffing, and disposing of PPE based on scenarios. EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency Medical Providers. Drill of the Month

3. Why We Use Body Substance Isolation Precautions Overview: • Types of Protective Precautions • BSI Precautions • Personal Protective Equipment • Donning, Doffing, and Disposing of PPE Drill of the Month

4. Types of Protective Precautions • Isolation precautions • In-hospital isolation infection control, 1975 • Disease specific precautions to prevent spread of infection • In-hospital precautions:patient in private room • Provider precautions: • Protective barriers: masks, gowns gloves • Wash hands • Special disposal/handling of contaminated articles Drill of the Month

5. Types of Protective Precautions • Isolation precautions • Includes other precautions (discussed later) • Standard precautions • Transmission-based precautions Drill of the Month

6. Types of Protective Precautions • Universal precautions (UP) • CDC 1987 (replaced CDC 1983 Guidelines for Isolation Precautions) • In-hospital practices to prevent transmission of bloodborne diseases • Emphasized that visible blood required barrier protection • Does not address disease-specific isolation precautions for nonbloodborne infections (in-hospital) Drill of the Month

7. Types of Protective Precautions • Universal precautions (UP) • Precautions: Gloves, gowns, masks, protective eyewear when contact with blood or body secretions containing blood is anticipated (not all the time as with BSI) • Applies toblood, body fluids containing visible blood, semen, vaginal secretions • Applies to tissues and specific body fluids: cerebrospinal, synovial, pleural, peritoneal, pericardial, amniotic Drill of the Month

8. Types of Protective Precautions • Universal precautions (UP) continued… • Precautions: Gloves, gowns, etc. as with previous slide, when contact with blood or body secretions containing blood is anticipated • Does notapply to feces, nasal secretions, sputum, sweat, tears, urine, vomit unless they contain visible blood • Does not apply to saliva except when visibly contaminated with blood or in the dental setting where blood-contaminated saliva is predictable Drill of the Month

9. Types of Protective Precautions • Body Substance Isolation (BSI) • Developed by nurses, colleagues working in large hospital epidemiology departments • Assumed allmoist body substances were potentially infectious • Not just blood as in UP • Wear gloves for anticipated contact Drill of the Month

10. Types of Protective Precautions • Body Substance Isolation (BSI) • Purpose: Reduce transmission of infectious material from any moist body substance regardless of presumed infection status • Blood: HIV, HBV • Feces: shigella, salmonella, escherichia-coli • Urine: e-coli Drill of the Month

11. Types of Protective Precautions • Body Substance Isolation (BSI) continued… • Purpose: Reduce transmission of infectious material from any moist body substance regardless of presumed infection status • Sputum: tuberculosis, resistant staphylococcus areus • Saliva: small and large droplets • Wound seepages/excretions • Other body fluids Drill of the Month

12. Types of Protective Precautions • Body Substance Isolation (BSI) • Precautions • Gloves when anticipating contact with moist body substances while caring for all patients • Immunization against infectious diseases transmitted by airborne or droplet (discussed later) • Measles • Mumps • Rubella • Varicella (chickenpox) • Other appropriate barriers: gowns, masks, eye protection Drill of the Month

13. Types of Protective Precautions • Standard precautions • CDC 1996 for in-hospital health care providers • Major features of UP and BSI • UP: gloves, gowns, masks, protective eyewear to reduce risk of transmission of bloodborne pathogens • BSI: gloves, immunization to reduce risk of pathogens from moist body substances Drill of the Month

14. Types of Protective Precautions • Standard precautions • Applied to all patients regardless of diagnosis or presumed infection status • Blood, all body fluids, secretions and excretions except sweat, regardless of whether or not they contain blood • Nonintact skin • Mucous membranes Drill of the Month

15. Types of Protective Precautions • Standard precautions • Precautions • Consider every person infectious • Wash hands and wear gloves • Wear other body protection: masks, goggles, face masks, gowns • Handle soiled linen with gloves; dispose of in biohazard waste container/bags • Handle patient care equipment with gloves; clean reusable equipment • Clean and disinfect equipment • Dispose of sharps in containers • Use face/mouthpieces, bag-valve-mask for resuscitation Drill of the Month

16. Types of Protective Precautions • Transmission-based precautions (also include BSI) • Airborne transmission • Small particle evaporated droplets or dust containing droplets • Remain suspended for a long time • Dispersed byair currents • Inhaled by or deposited on susceptible host • Included measles, varicella, Legionella, tuberculosis Drill of the Month

17. Types of Protective Precautions • Transmission-based precautions (also include BSI) • Airborne transmission precautions • Respiratory protection: High efficiency filter mask • Patient transport: Place a mask on the patient • Environmental control: Equipment cleaning, disinfection, sterilization Drill of the Month

18. Types of Protective Precautions • Transmission-based precautions (also include BSI) • Droplet transmission • Large droplet contact with conjunctiva or oral/nasal mucosa • Droplets generated during coughing, sneezing, talking • Requires close contact • Large droplets do not stay suspended for long • Large droplets travel short distance (possibly 3 feet) Drill of the Month

19. Types of Protective Precautions • Transmission-based precautions (also include BSI) • Droplet transmission • Precautions • Respiratory protection: Wear a mask when within 3 feet of patient • Protective eyewear: With possibility of splashing, talking, sneezing within 3 feet • Patient transport: Place a mask on the patient • Environmental control: Equipment cleaning, disinfection, sterilization Drill of the Month

20. Types of Protective Precautions • Transmission-based precautions (also include BSI) • Contact transmission • Direct contact • Skin-to-skin contact and physical transfer • Touching hands, face, other body parts • Provider-to-patient contact • Patient-to-patient or patient-to-other person contact Drill of the Month

21. Types of Protective Precautions • Transmission-based precautions (also include BSI) • Contact transmission • Indirect contact: Skin-to-object contact • Patient’s contaminated hand touches object • Provider touches contaminated object Drill of the Month

22. Types of Protective Precautions • Transmission-based precautions (also include BSI) • Contact transmission • Precautions • Wash hands; use gloves • Wear a gown • Clean and disinfect care/contact items • After patient use/touch • Before using on or with another patient, or use disposable items • Dispose of all patient contact items • Red medical waste/biohazard containers/bags • Sharps containers Drill of the Month

23. BSI Precautions • Definition • A method of infection control • Equipment, procedures to protect providers and patients from blood and body fluids, including airborne droplets • Purpose • Protects patients and providers • Impossible to identify that either has an infectious disease just by looking at them • Prevents exposure to blood, body fluid, and respiratory pathogens Drill of the Month

24. BSI Precautions • Need/Importance • Patient’s full medical history is not always available or forthcoming • Protects providers from patients and patients from providers • Expands principles of UP beyond bloodborne disease to include all moist body substances • Presumes all body substances carry infectious agents • Protects providers from both bloodborne and airborne pathogens Drill of the Month

25. BSI Precautions • Requirements • Must meet Occupational Safety and Health Administration (OSHA) guidelines • Employer responsibilities • Must develop written exposure control plan • Must provide training, immunizations, and personal protective equipment (PPE) • Must have policy for exposure to infectious substances • Baseline testing and periodic follow-up • Federal legislation allows provider notification of patient infection Drill of the Month

26. BSI Precautions • Requirements • Employee responsibilities • Participate in training • Follow exposure control plan Drill of the Month

27. Personal Protective Equipment (PPE) • Purpose • Match to exposure hazard for proper protection • Protect emergency services personnel • From sharp, pointed, jagged objects • From objects that may fall on your head or feet • From body substances and includes BSI precautions • Gloves • Other appropriate barriers: gowns, masks, eye protection • Immunization Drill of the Month

28. Personal Protective Equipment (PPE) • Hand washing: After patient contact when gloves are removed • Soap and warm water • Lather; scrub vigorously for 20 seconds (CDC guidelines) • Alcohol-based hand sanitizers • Apply to palms; rub hands together until dry (CDC guidelines) • Cover all surfaces of hands and fingers (CDC) • Not effective if hands are visibly soiled Drill of the Month

29. Personal Protective Equipment (PPE) • Gloves • Medical grade vinyl, rubber latex, or synthetic latex nitrile gloves • Change if torn or damaged; wash hands; reglove • Use new gloves for each patient • Dispose of gloves in biohazard waste container/bag Drill of the Month

30. Personal Protective Equipment (PPE) • Protective eyewear • Protects from splashing, splattering, spraying fluids/droplets • Types: should cover front and sides of face • Goggles: acceptable, but tend to fog • Safety glasses with side shields • Combo face shield and mask Drill of the Month

31. Personal Protective Equipment (PPE) • Face mask or particulate respirator • Surgical mask: Protects from blood or fluid splatter (intubation, suctioning) • N-95 or high efficiency particulate air (HEPA) mask: Protects from small particle droplets, e.g., tuberculosis Drill of the Month

32. Personal Protective Equipment (PPE) • Fluid resistant gown • Protects clothing or bare skin from splatter • Childbirth • Arterial bleeding • Multi-trauma • Pocket face mask, bag-valve-mask • Prevents mouth-to-mouth contact Drill of the Month

33. Donning, Doffing, Disposing of PPE • Demonstrate and practice the following using scenarios that follow • Wash or sanitize hands • Don PPE in proper order—why in this order? • Gown • Mask or respirator • Goggles or face shield • Gloves Drill of the Month

34. Donning, Doffing, Disposing of PPE • Demonstrate and practice the following using scenarios that follow • Doff PPE in proper order—why in this order? • Gloves • Goggles of face shield • Gown • Mask or respirator Drill of the Month

35. Donning, Doffing, Disposing of PPE • Demonstrate and practice the following using scenarios that follow • Dispose of PPE equipment • Sharps container • Biohazard containers/bags Drill of the Month

36. PPE Scenarios • The patient: • A bed-ridden 72-year-old woman • Coughing up bloody sputum for the past hour • The room has an odor of feces • Her daughter tells you the woman has been incontinent diarrhea for three days, her urine is brown • The daughter has been caring for and cleaning her mother, but there are no indications she used gloves or masks • She called 9-1-1 because the patient became unresponsive. PPE: __ Gloves __ Mask __ Protective eyewear __ Gown __ Pocket face mask/BVM Drill of the Month

37. PPE Scenarios • The patient: • A 21-year-old female auto crash victim • Thrown through the windshield because she was not wearing her seatbelt • Multiple lacerations on her face, hands, arms, torso, and thighs • You also suspect intoxication because of the odor of alcohol on her breath • She says she has to throw up PPE: __ Gloves __ Mask __ Protective eyewear __ Gown __ Pocket face mask/BVM Drill of the Month

38. PPE Scenarios • The patient: • A child who jumped from a tree pretending to be a super hero who could fly • He appears to have a fractured right forearm and fractured right ankle • No apparent external bleeding except from is gums where he knocked out two front teeth PPE: __ Gloves __ Mask __ Protective eyewear __ Gown __ Pocket face mask/BVM Drill of the Month

39. PPE Scenarios • The patient: • A 16-year-old teenager who cut his hand while trying to slice a bagel while staying with his grandparents • The grandparents don’t have a car to drive him to the hospital • They immediately put wads of paper towels on the wound and had him hold pressure and elevate it until you arrived PPE: __ Gloves __ Mask __ Protective eyewear __ Gown __ Pocket face mask/BVM Drill of the Month

40. PPE Scenarios • The patient: • A5-year-old boy bitten in the face by a neighbor’s dog • The dog is under the control of the owner; Animal Control has been contacted • The mother is hysterical and is cradling her son in her arms and has blood all over her • She has tried to clean and control the bleeding with a cold, wet washcloth • The boy’s wounds are bleeding mildly • The child is calm but cowering in his mother’s arms PPE: __ Gloves __ Mask __ Protective eyewear __ Gown __ Pocket face mask/BVM Drill of the Month

41. Why We Use Body Substance Isolation Precautions Student Performance Objective: Given information, resources, and opportunity for discussion and practice: • List and describe types of protective precautions. • Define BSI precautions and explain their purpose, importance, and requirements. • List personal protective equipment and describe its purpose. • Demonstrate techniques for donning, doffing, and disposing of PPE based on scenarios. EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency Medical Providers. Drill of the Month

42. Why We Use Body Substance Isolation Precautions Review: • List the types of protective precautions • Isolation precautions • Universal precautions • BSI • Standard • Transmission • Why do you think it is necessary to know history of protective precautions? Drill of the Month

43. Why We Use Body Substance Isolation Precautions Review: • Why do you think you need to know in-hospital precautions when you usually just drop patients at the ED? • What are the types of transmission precautions • Airborne • Droplet • Contact Drill of the Month

44. Why We Use Body Substance Isolation Precautions Review: • Describe the difference between airborne transmission and droplet transmissions • Describe the respiratory protection for each • BSI precautions • Define • What is its significant purpose? • What is the need and importance? • What are the requirements of a BSI plan/program? Drill of the Month

45. Why We Use Body Substance Isolation Precautions Review: • Personal Protective Equipment • List PPE commonly used in BSI • Describe the purpose or each piece of PPE • Donning, Doffing, Disposing of PPE • List PPE used for each scenario • Explain why it was used (what protection it provided) Drill of the Month

46. Why We Use Body Substance Isolation Precautions Review: • BSI Precautions • Personal Protective Equipment • Donning, Doffing, and Disposing of PPE Drill of the Month