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Infectious Disease Exposure

Infectious Disease Exposure. EBHFD Ryan White Officer Brian W. Witz. http://hab.hrsa.gov/abouthab/ryanwhite.html. Ryan White HIV/AIDS Treatment Extension Act of 2009. PUBLIC LAW 111–87—OCT. 30, 2009 123 STAT. 2885 Public Law 111–87 111th Congress.

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Infectious Disease Exposure

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  1. Infectious Disease Exposure EBHFD Ryan White Officer Brian W. Witz http://hab.hrsa.gov/abouthab/ryanwhite.html

  2. Ryan White HIV/AIDS Treatment Extension Act of 2009. PUBLIC LAW 111–87—OCT. 30, 2009 123 STAT. 2885Public Law 111–87111th Congress ‘‘(a) ROUTINE NOTIFICATION OF DESIGNATED OFFICER.— ‘‘(1) DETERMINATION BY TREATING FACILITY.— If a victim of an emergency is transported by emergency response employees to a medical facility and the medical facility makes a determination that the victim has an airborne infectious disease, the medical facility shall notify the designated officer of the emergency response employees who transported the victim to the medical facility of the determination. ‘‘(2) (NOTIFICATION OF EXPOSURE.—If a medical facility makes a determination under paragraph (1) that the emergency response employee involved has been exposed to an infectious disease, the medical facility shall, in writing, notify the designated officer who submitted the request under subsection (c) of the determination. ‘‘(3) FINDING OF NO EXPOSURE.—If a medical facility makes a determination under paragraph (1) that the emergency response employee involved has not been exposed to an infectious disease, the medical facility shall, in writing, inform the designated officer who submitted the request under subsection (c) of the determination. ‘‘(4) INSUFFICIENT INFORMATION.— ‘(A) If a medical facility finds in evaluating facts for purposes of paragraph (1) that the facts are insufficient to make the determination described in such paragraph, the medical facility shall, in writing, inform the designated officer who submitted the request under subsection (c) of the insufficiency of the facts TIME FOR MAKING RESPONSE.—After receiving a request under subsection (c) (including any such request resubmitted under subsection (g)(2)), a medical facility shall make the applicable response specified in subsection (d) as soon as is practicable, but not later than 48 hours after receiving the request.

  3. Infectious Disease/Agent Exposure Flow Chart

  4. East Bloomfield-Holcomb Fire Department • Blood-Borne Pathogen Exposure Control Plan • Effective 3/18/07 • As recommended by the NY State Department of Health, Bureau of EMS Policy Statement #99-06 (dated 9/1/99), this plan is in compliance with the US Department of Labor, Occupational Health and Safety Administration’s (OSHA) Regulations Standards - 29 CFR: Blood borne pathogens - 1910.1030. Please refer to this OSHA document for specific details. • All members of the East Bloomfield-Holcomb Fire Department (hereafter referred to as the EBHFD) shall be provided with copies of this document, which is to be reviewed and updated as necessary by the EBHFD Infectious Control Officer (hereafter referred to as the Ryan White Officer). • A copy of the EBHFD Exposure Control Plan, as well as a copy of the form for reporting an exposure incident, can be found on the EBHFD website at: http://www.eastbloomfieldfiredept.org/news.htm • A copy of the OSHA Standards-29 CFR: Blood borne pathogens 1910.1030 document is available in the radio room bookcase of the EBHFD. An electronic copy of 1910.1030 can be viewed on the internet at: http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051

  5. Exposure Determination: OSHA - 1910.1030 (c)(2) • As defined in paragraph (b) of this document “Occupational Exposure” means “reasonably anticipated skin, eye, mucous membrane, or parenteral (piercing mucus membrane or skin barriers) contact with blood or other potentially infectious materials that may result from the performance of an employee's duties”; • All EBHFD Emergency Squad personnel (including EMTs’ and drivers) have the potential for occupational exposure. • In addition to Emergency Squad personnel, all EBHFD Fire Fighter personnel have the potential for occupational exposure.

  6. Schedule and Method of Implementation • Method of Compliance: OSHA - 1910.1030 (d) • All members of the EBHFD are required to attend the annual blood borne pathogen training session, as arranged for by the EBHFD Training Officer. • This training session must include, at minimum, information on “Universal Precautions”, “Engineering and Work Practice Controls”, “Personal Protective Equipment”, and “Housekeeping”, as defined in paragraphs (d) (1), (d) (2), (d) (3), and (d) (4), respectively, of the OSHA document. Personal Protective Equipment Engineering and Work Practice Controls Housekeeping Sanitizing the work environment 1. Safety glasses. These glasses, or a face shield, protect the eyes against splashing. Safety glasses are mandatory on all EMS calls. 2 HEPA (High Efficiency Particulate Air) mask. This mask is optional, and is usually worn only when a patient has a contagious airborne disease such as Tuberculosis, Measles, Chicken Pox, etc. 3 Nitrile gloves. Gloves are mandatory on all EMS calls. Protective sleeves, covering the arms from wrist to elbow, are also available if a firefighter has open cuts on his or her arms. Latex gloves are no longer used by this department due to the large number of people who have latex allergies.

  7. Schedule and Method of Implementation • Within 5 working days of acceptance as a member of the EBHFD, the new member must be informed of the following by the EBHFD Ryan White Officer: • Vaccination - In compliance with this regulation, the EBHFD “…shall make available the hepatitis B vaccine (HBV) and vaccination series to all [members] who have occupational exposure, and post-exposure evaluation and follow-up to all employees who have had an exposure incident.” • As per this regulation, the vaccine shall be made available at no cost to the EBHFD member, at a reasonable time and place, performed by or under the supervision of a licensed physician or by or under the supervision of another licensed healthcare professional; and • provided according to recommendations of the U.S. Public Health Service current at the time these evaluations and procedures take place, except as specified by this paragraph (f) of the OSHA document. http://www.cdc.gov/hepatitis/HBV/HBVfaq.htm#treatment

  8. Post-Exposure Evaluation and Follow-Up Following a report of an exposure incident, the EBHFD Ryan White Officer shall make immediately available to the exposed EBHFD member, a confidential medical evaluation and follow-up, including at least the following elements: 1. Documentation of the route(s) of exposure, and the circumstances under which the exposure incident occurred; this information is to be documented on the “Infectious Disease Exposure Evaluation” form, located in Section 6 of the EBHFD Emergency Squad Standard Operating Guidelines (SOGs) and on the EBHFD website: http://eastbloomfieldfiredept.org/news.htm 2. Identification and documentation of the source individual, unless the Ryan White Officer can establish that identification is infeasible or prohibited by state or local law 3. The source individual's blood shall be tested as soon as feasible and after consent is obtained in order to determine HBV and HIV infectivity. If consent is not obtained, the Ryan White Officer shall establish that legally required consent cannot be obtained. When the source individual's consent is not required by law, the source individual's blood, if available, shall be tested and the results documented.

  9. Post-Exposure Evaluation and Follow-Up (continued) 4. When the source individual is already known to be infected with HBV or HIV, testing for the source individual's known HBV or HIV status need not be repeated. 5. Results of the source individual's testing shall be made available to the exposed EBHFD member, and the member shall be informed of applicable laws and regulations concerning disclosure of the identity and infectious status of the source individual. 6. Collection and testing of blood for HBV and HIV serological status: the exposed EBHFD member's blood shall be collected as soon as feasible and tested after consent is obtained.

  10. Post-Exposure Evaluation and Follow-Up (continued) 7. If the EBHFD member consents to baseline blood collection, but does not give consent at that time for HIV serologic testing, the sample shall be preserved for at least 90 days. If, within 90 days of the exposure incident, the employee elects to have the baseline sample tested, such testing shall be done as soon as feasible. 8. Post-exposure prophylaxis, when medically indicated, as recommended by the U.S. Public Health Service 9. Counseling and evaluation of reported illnesses. PEP is a course of HIV medication which you can take if you have been at risk of HIV infection. The course of HIV medication lasts about 28 days and, if taken within 72 hours of putting yourself at risk, may be able to prevent you from becoming infected with HIV. PEP stands for Post Exposure Prophylaxis – in other words it is a form of protection (against HIV) that you can take after you have taken a risk or had a condom break on you.

  11. Communication of Hazards to Employees: OSHA - 1910.1030 (g) As provided for in this section of the OSHA document, and in accordance with all applicable subsections within, the EBHFD Training Officer must provide an annual training session (at no cost) to all EBHFD members, which includes information on the location of all materials affixed with fluorescent orange or orange-red “Biohazard” labels in the EBHFD.

  12. Recordkeeping:OSHA - 1910.1030 (h) • As provided for in this section of the OSHA document, and in accordance with all applicable subsections within, the EBHFD (Fire Chief for Firefighter members; Ryan White Officer for Emergency Squad Members) must maintain (or have access to) all records pertaining to the following: • Medical Records of Members- as outlined in section 1910.1030(h)(1) – including name, SS#, vaccination records, medical examination records, and other information as outlined in this section. As per this section, all medical record information must be kept strictly confidential • Training Records –as outlined in section 1910.1030(h)(2) – including dates of training session(s), summary of session contents, and the name/qualifications of person(s) providing the training • Sharps Injury Log – as outlined in section 1910.1030(h)(5), the Ryan White Officer “shall establish and maintain a sharps injury log for the recording of percutaneous injuries from contaminated sharps. The information in the sharps injury log shall be recorded and maintained in such manner as to protect the confidentiality of the injured employee”.

  13. Ryan White HIV/AIDS Treatment Extension Act of 2009 (Pub. L. 111-87) CDC List of Reportable, Potentially Life Threatening Diseases That Emergency Responders May Be Exposed To 1. Anthrax, cutaneous (the Bacillus anthracis bacterium) 2. Hepatitis B (HBV) - viral 3. Hepatitis C (HCV) - viral 4. Human immunodeficiency virus (HIV) – AIDS virus 5. Rabies (Rabies virus) 6. Smallpox – the smallpox virus 7. Viral hemorrhagic fevers (Lassa, Marburg, Ebola, Crimean-Congo, mumps, and other viruses yet to be identified) 8. Measles (Rubeola virus) #1-8 May be transmitted by contact or contamination with body fluids

  14. Ryan White HIV/AIDS Treatment Extension Act of 2009 (Pub. L. 111-87) CDC List of Reportable, Potentially Life Threatening Diseases That Emergency Responders May Be Exposed To 9. Tuberculosis (the Mycobacterium tuberculosis bacterium)—infectious pulmonary orolaryngeal disease; or extrapulmonary (draining lesion) 10. Varicella disease (Varicella zoster virus)—chickenpox, disseminated zoster #9-10 Routinely transmitted through aerosolized airborne means

  15. Ryan White HIV/AIDS Treatment Extension Act of 2009 (Pub. L. 111-87) CDC List of Reportable, Potentially Life Threatening Diseases That Emergency Responders May Be Exposed To 11. Diphtheria (the Corynebacterium diphtheriae bacterium) 12. Novel influenza A viruses (Avian flu) as defined by the Council of State and Territorial Epidemiologists (CSTE) 21 13. Meningococcal disease (the Neisseria meningitidis bacterium) 14. Mumps (Mumps virus) 15. Pertussis – (whooping cough: the Bordetella pertussis bacterium) 16. Plague, pneumonic (the Yersinia pestis bacterium) 17. Rubella (German measles; Rubella virus) 18. SARS-CoV (a corona virus) #11-18 Transmitted through aerosolized droplet means

  16. Ryan White HIV/AIDS Treatment Extension Act of 2009 (Pub. L. 111-87) CDC List of Reportable, Potentially Life Threatening Diseases That Emergency Responders May Be Exposed To • A US Health and Human Services (HHS) list of bioterrorist agents #19 List can be found at: http://emergency.cdc.gov/Agent/agentlist.asp

  17. Chickenpox The End Kaposi’s sarcoma from AIDS Mumps Small pox Measles Anthrax Respiratory diptheria Plague

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