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Big Tree Volunteer Fire Company, Inc. 2013

Instructions Locate and print the associated knowledge assessment. While paging through this PowerPoint presentation, answer the questions. When complete, return completed knowledge assessment to Asst. Chief Makin or Asst. Chief Wagner. If you have any questions, please contact any Chief.

Overview * Infectious Diseases * Universal Precautions * Specific Disease Information * Exposures and Exposure Control Plan * Laws, Standards, Rules, Regulations, and Guidelines

Objectives  Differentiate and define the terms infectious disease and bloodborne pathogen.

 Identify circumstances in which universal precautions and body substance isolation should be used.

 Describe when and how decontamination procedures should take place.

Objectives  Identify methods of transmission, signs, symptoms, and, if they exist, pre- and post-exposure prophylaxis, and counseling for:  HIV Infection/AIDS  Hepatitis A, B, and C  Tuberculosis (TB)

 Be familiar with:  Common Sexually Transmitted Diseases  Meningococcal Diseases  Viral Hemorrhagic Disease  Measles, Mumps, Rubella (MMR)  Influenza

Objectives  List behaviors that increase the risk of exposure to bloodborne pathogens.

 Demonstrate exposure preparedness by identifying personal and employment issues to consider if a Bloodborne Pathogens exposure occurs.

 Define significant exposure.

 Identify options regarding treatment and counseling for an exposure.

 Identify whom, when, and how you should tell about an exposure.

 Identify rights to confidentiality; your rights, the patient’s rights, and the employer’s rights.

Infectious Disease (Activity) On your knowledge verification report, please complete Table #1 using the following diseases: ◊ AIDS/HIV

◊ Chickenpox

◊ Whooping Cough (Pertussis)

◊ Meningitis

◊ Influenza

◊ Herpes Zoster (Shingles)

◊ Mononucleosis

◊ Lice

◊ Hepatitis A (infectious)

◊ Measles

◊ Hepatitis C

◊ Hepatitis B (serum)

◊ German Measles

◊ Hepatitis D

◊ Non-A, Non-B Hepatitis

◊ Mumps (infectious parotitis)

Each disease will be used once.

◊ Herpes Simplex (cold sores)

Infection Control (Overview)  Universal Precautions  Personal Protective Equipment  Disposable Equipment  Disinfection & Decontamination

Universal Precautions  Treat all body fluids as potentially infectious  Wear appropriate personal protective equipment  Be consistent and vigilant

Universal Precautions ď śUniversal Precautions- Applies the same or universal approach to all persons. ď ś Body Substance Isolation (BSI)- The part of Universal Precautions that uses barriers to prevent exposure to infectious diseases.

Personal Protective Equipment  Gloves

Where are these items on the ambulance?

Where are they on 7-1?

 Eyewear Rescue 7?

 Mask  Gown

Engine 1?

Engine 2?

Personal Protective Equipment Ambulance #8

Rescue #7-1

Personal Protective Equipment Engine #1

Engine #2

Personal Protective Equipment Rescue #7

Other Infection Control Techniques  Personal Hygiene  Hand-hygiene  Immunization Program  Decontamination Procedures  Proper Waste Handling

Hand Hygiene  The most fundamental measure to control infection.

 Recommendations on hand-hygiene MMWR, Recommendations and Reports, October 25th, 2002/Vol. 51/No.RR16 Guideline for Hand Hygiene in Health Care SettingsRecommendations of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force

Hand Hygiene Indications for handwashing and hand antisepsis ď ś These recommendations are written for healthcare workers in hospital settings, but based on principles that apply to all healthcare workers.

ď śWhen hands are visibly dirty or contaminated with proteinaceous material or visibly soiled with blood, or other body fluids, wash hands with either a non-antimicrobial soap and water or an anitmicrobial soap and water.

Hand Hygiene Indications for handwashing and hand antisepsis  If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating hands…  Alternatively, wash hands with an antimicrobial soap and water in each of the following situations:  After contact with a patient’s intact skin (e.g. when taking a pulse or blood pressure, and lifting a patient)  After contact with body fluids or excretions, mucous membranes, nonintact skin, and wound dressings if hands are not visibly soiled  After removing gloves (PPE)  After each patient contact

 After contact with inanimate objects in the immediate vicinity of the patient (cleaning and decontaminating equipment)  After using the toilet or restroom  Before eating

 Before and after handling food

Hand Hygiene Indications for handwashing and hand antisepsis

“Wash hands with non-antimicrobial soap and water or with antimicrobial soap and water if exposure to Bacillus anthracis is suspected or proven. The physical action of washing and rinsing hands under such circumstances because alcohols, chlorhexidine, iodophors, and other antiseptic agents have poor activity against spores.�

Hand Hygiene Technique “When decontaminating hands with an alcohol-based hand rub, apply product to the palm of one hand and rub hands together, covering all surfaces of the hands and fingers, until hands are dry. Follow manufacturer’s recommendations regarding the volume of product to use.”

“When washing hands with soap and water, wet hands first with water, apply an amount of the product recommended by the manufacturer to hands, and rub hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse hands with water and dry thoroughly with a disposable towel. Use towel to turn off the faucet. Avoid using hot water, because repeated exposure to hot water may increase the risk of dermatitis.”

Disposable Equipment What disposable equipment is carried by the Big Tree Volunteer Fire Company?

 Head restraints  Straps (some)  Eyewear  Infection control kits (PPE+)  Cervical collars  Single patient stethoscope  IV supplies

 Airway equipment (e.g. BVMs, non-rebreathers, nasal cannulas, etc.)  Splints  Suction canisters and tubing

 CPR Pocket masks  Linens

Disinfection (Overview) Disinfection Techniques High-Level Intermediate

Low-level Environmental

Disinfection High-Level Disinfection  Destroys all forms of microbial life except high numbers of bacterial spores.  Methods:  Hot water pasteurization  Exposure to an EPA registered chemical sterilant, except for short contact time

Disinfection Intermediate Level Disinfection

 Destroys mycobacterium tuberculosis, most viruses, vegetative bacteria, and most fungi, but not bacterial spores.

 Methods:  Use of EPA-registered “hospital disinfectant” chemical germicides that claim to be tuberculocidal on the label  Hard-surface germicides as indicated above or solutions containing at least 500 ppm free available chlorine. (1:100 dilution of common household bleach)

Disinfection Low-Level Disinfection  Destroys some viruses, most bacteria, some fungi, but not mycobacterium tuberculosis or bacterial spores.  Methods  Use of EPA-registered “hospital disinfectants”

Disinfection Environmental Disinfection ď ś Surfaces in the environment such as floors, ambulance seats, countertops, and woodwork that are soiled (but not contaminated by blood or other potentially infectious body fluids) should be cleaned and disinfected with cleaners or disinfectant agents intended for environmental use.

Disinfection ď ś The level of disinfection required for any reusable equipment or any environment depends on its level of contamination as indicated previously. ď ś OSHA 1910.1030 requires that the employer shall launder all equipment required by paragraphs (d) and (e) at no cost to the employee.

Hepatitis Alphabet Viral Hepatitis-Overview Type of Hepatitis

Virus Source

Transmission Route

Chronic Infection






Pre/post exposure immunization


Blood/bloodderived body fluids

Percutaneous Permucosal


Pre/post exposure immunization


Blood/bloodderived body fluids

Percutaneous Permucosal


Blood donor screening; risk behavior modification


Blood/bloodderived body fluids Percutaneous



Pre/post exposure immunization; risk behavior modification





Ensure safe drinking wwater

Hepatitis Signs & Symptoms Jaundice Fatigue Abdominal pain Loss of appetite Intermittent nausea Vomiting

Hepatitis Vaccines and Prophylaxis  Vaccines currently exist for Hepatitis A and B, but not for C

 Hepatitis D is rare and occurs only in patients who develop acute or chronic Hepatitis B, so the vaccine for Hepatitis B effectively prevents Hepatitis D

 Although vaccination is the best protection, development of both Hepatitis A and B (and thus, D) can be reduced by post –exposure prophylaxis (PEP) with Immunoglobulin

 Vaccination for Hepatitis B has reduced the rate of development of the disease in healthcare workers

Hepatitis B Vaccination Program Required by OSHA 1910.1030 The employee has a right to refuse the vaccination. Documentation of the declination should be completed.

The vaccination series is usually given in a three part series. The second vaccine is given 30 days after the initial vaccine and the third vaccine is given 180 days after the initial vaccine. Following vaccinations, a blood titer to check antibody levels is recommended upon consultation with your physician.

Research indicates that for many workers antibody titers decrease in the years after vaccination. There is no evidence yet that these decreasing titers result in lowered immunity. Therefore, CDC does not currently recommend boosters.

HIV/AIDS  HIV  Human Immunodeficiency Virus

 AIDS  Acquired Immunodeficiency Syndrome

HIV is first…AIDS may follow

HIV/AIDS Changing Face of the Epidemic Use of AZT in pregnant women who are HIV positive or have AIDS has dramatically decreased maternal-child (perinatal) HIV transmission Use of combination therapies including antivirals and protease inhibitors has increased the time from infection (HIV positive status) and the development of AIDS (the syndrome with symptoms of opportunistic infections). The proportion of women, Hispanics, AfricanAmericans, and persons exposed to HIV through heterosexual contact living with AIDS continues to increase.

HIV/AIDS Which Health Care Providers are at risk? The level of risk to health care workers depends on: The prevalence of HIV among the patient population The nature and frequency of exposure The risk of transmission per exposure

HIV/AIDS Transmission Risks The virus must live in blood, certain body fluids (blood and blood products, semen, vaginal secretions, as well as cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids), or cells; it has to enter the body quickly and enter the bloodstream. This can happen several ways:  The most effective way is through a contaminated needle-stick injury. Risk of transmission by this route is estimated as approximately 0.3% (1 in 300)  Intact or unbroken skin should protect against infection. Open wounds, a cut, or any skin that is not intact (chapped, abraded, weeping, or having rashes) can permit the virus to enter the body. Risk of transmission by this route is estimated, on average, at less than 0.1% (1 in 1,000)  The mucous membranes of the eye, nose, or mouth can serve as a route for the infected fluids to transmit the virus. Risk of transmission by this route is estimated, on average, at 0.1% (1 in 1,000)

HIV/AIDS Behaviors & Practices that put you at risk Sharing drug needles and syringes with an infected person You can become infected by having sex (oral, anal, or vaginal) with someone who is infected with HIV

Children born to infected women may be infected before or during birth There is no current risk of becoming infected from donating blood, however if you received blood before 1985 you are at risk. Due to improved screening, the risk from transfusions is much less after this date

HIV/AIDS How the virus is not transmitted  Cannot be “caught” as the common cold can. Not spread through the air like cold viruses  No medical evidence of HIV transmission by casual, everyday contact such as sharing kitchens, bathrooms, laundries, eating utensils, beds, or living space with infected people  In nonsexual social situations, such as at work or through sharing air, food, and water  Insects such as mosquitoes show no evidence of being transmission vectors  HIV infection through contact with feces, nasal secretions, saliva, sputum, sweat, tears, urine, and vomitus is extremely low or nonexistent

HIV/AIDS Signs & Symptoms  No disease symptoms may be apparent for many years

 Loss of appetite  Weight loss  Fever

 Night sweats  Skin rashes or lesions  Diarrhea

 Fatigue  Lack of resistance to infection  Swollen lymph nodes

 As the syndrome takes hold, opportunistic infections of the skin, eyes, lungs, and nervous system

HIV/AIDS Disease Progression AIDS is the result of the progressive destruction of a person’s immune system. The destruction allows diseases that the body can normally fight to threaten the person’s health and life.

Particularly dangerous types of pneumonia (pneumocystis carinii pneumonia) and certain other infections often invade a body weakened by HIV. Patients may suffer rare cancers like Kaposi’s sarcoma.

HIV can also attack the nervous system and cause damage to the brain. This may take years to develop. The symptoms may include:  Memory loss  Indifference  Loss of coordination  Partial paralysis  Mental disorders

HIV/AIDS Treating the Infected Patient Treating an HIV/AIDS infected person in an emergency setting is the same as with any other patient. Treat the underlying symptoms the patient is presenting. There are no unique protocols for these patients. Compassion is essential as is in any patientprovider relationship.

HIV/AIDS Confidentiality The HIV epidemic has posed two powerful, and conflicting, legal and ethical obligations. The first obligation is in respect to the privacy of persons with HIV infection and the second is the duty to inform persons who may be exposed to HIV. The Ryan White Act HIV/AIDS Treatment Extension Act of 2009 addresses this issue in Part G. “The purpose of Part G is to facilitate informing EREs that they may have been exposed to potentially life-threatening infectious diseases, so they can make better informed decisions about subsequent measures such as diagnosis and, if necessary, prophylaxis or treatment. The medical facility that receives and treats the victim of an emergency or ascertains the cause of death may have or may be able to obtain the victim’s disease status information, which the emergency response service may lack. Part G provides a framework for medical facilities to inform EREs that they may have been exposed to one of the listed diseases.” -

Tuberculosis Epidemiology The number of TB cases in the U.S. increased in the mid-1980s, peaking in 1992, when TB cases and case rates again began decreasing in all populations, but not in all population subgroups. CDC reports:  1985-22,201 cases  1992-26,673 cases  1998-18,361 cases  1999-17,531 cases (6.4 infected individuals for every 100,000 people)  2000-16,377 cases  2001-15,989 cases (2% decline from 2000, the smallest decline in 9 years)  1997-1,166 TB related deaths  1999-856 TB related deaths

Only 5% of people in the United States who have been exposed ever develop active TB

Tuberculosis Methods of Transmission The disease is not a highly contagious disease. Transmission occurs by droplet spread from a person with the active disease:  Airborne  Most dangerous indoors  Ultraviolet light kills the bacterium outdoors  The bacterium can survive outside the body for long periods of time and even when dried Higher concentrations of TB cases are found in prisons, hospitals, homeless shelters, and nursing homes presumably because they are enclosed areas.

Tuberculosis Incubation & Communicable Period The incubation period is 4 to 8 weeks.

Infected individuals should be considered communicable until their symptoms have resolved under adequate therapy and until they have had three consecutive negative sputum AFB smears, which have been collected on different days.

Tuberculosis Signs & Symptoms Initial infection usually minimal. Disease usually lies dormant for many years before signs and symptoms appear, including: Night sweats

Headache Cough Weight loss (consumption) Hemoptysis or blood tinged sputum (classic symptom)

Any person who complains of a cough, especially a chronic cough, should be suspected of having TB

Tuberculosis Protection Universal Precautions & Body Substance Isolation

The 1994 CDC Guidelines specify standard performance criteria for respirators for exposure to TB. These criteria include:  The ability to filter particulates 1 µm in size in the unloaded state with a filter efficiency of >95%  The ability to be qualitatively or quantitatively fit tested in a reliable way to obtain a face-seal leakage of < 10%  The ability to fit the different facial sizes and characteristics of health care workers which can usually be met by making the respirators available in at least three sizes  The ability to be checked for face piece fit, in accordance with OSHA standards and good industrial hygiene practice, by health care workers each time they put on their respirator

Tuberculosis OSHA Recommendations All personnel should be given a baseline TB Mantoux (PPD [Purified Protein Derivative]) skin test when first employed and every six months thereafter at the employer’s expense. If an individual tests positive, a chest x-ray should be done to determine if the disease is active

Active TB (in which signs and symptoms have developed) should be treated immediately, usually with a combination of drugs to prevent the emergence of the drug-resistant strains

Tuberculosis Treatment & Management  After exposure and before any symptoms appear, the most common course is a one year treatment that usually consists of a daily dose of isoniazid (INH) to prevent the development of active TB  Younger people benefit most from this treatment

 If you have been exposed to multiple drug resistant TB (MDR-TB) , the physician also may augment INH with rifampin, pyrazinamide, and streptomycin or ethambutol  The bacterium is slow growing and can be metabolically dormant for long periods of time. The treatment, therefore, will last 9-18 months. The patient must complete the whole regimen of drug therapy, otherwise the bacteria may mutate into strains resistant to common drug therapies

Common Sexually Transmitted Diseases

• Chlamydia • Most frequently reported infectious disease in the U.S.

• Syphilis • Gonorrhea

Chlamydia Chlamydia is a sexually transmitted disease (STD) that is caused by the bacterium Chlamydia trachomatis. Because approximately 75% of women and 50% of men have no symptoms, most people infected with Chlamydia are not aware of their infections and therefore may not seek health care. When diagnosed, Chlamydia can be easily treated and cured. Untreated, Chlamydia can cause severe, costly reproductive and health problems including pelvic inflammatory disease (PID), which is the critical link to infertility, and potentially fatal tubal pregnancy. Up to 40 % of women with untreated Chlamydia will develop PID. Undiagnosed PID caused by Chlamydia is common. Of those with PID, 20% will become infertile; 18% will experience debilitating, chronic pelvic pain; and 9% will have a life-threatening tubal pregnancy. Tubal pregnancy is the leading cause of first-trimester, pregnancy-related deaths in American women.

Chlamydia Chlamydia may also result in adverse outcomes of pregnancy, including neonatal conjunctivitis and pneumonia. In addition, recent research has shown that women infected with chlamydia have a 3-5 fold increased risk of acquiring HIV, if exposed. Chlamydia is also common among young men, who are seldom offered screening. Untreated Chlamydia in men typically causes urethral infection, but may also result in complications such as swollen and tender testicles.

What is the magnitude of the problem? Chlamydia is the most frequently reported infectious disease in the United States. Though 526,653 cases were reported in 1997, an estimated 3 million cases occur annually. Severe under reporting is largely a result of substantial numbers of asymptomatic persons whose infections are not identified because screening is not available.

Chlamydia Treatment Single-dose antibiotic therapy promises to substantially enhance the likelihood of successful treatment- especially in adolescents- as compared to commonly used 7-day oral medication

Syphilis Syphilis is a complex sexually transmitted disease (STD) caused by the bacterium Treponema Pallidum. It has often been called the great imitator because so many of the signs and symptoms are indistinguishable from those of other diseases. How is Syphilis spread? The syphilis bacterium is passed from person to person through direct contact with a syphilis sore. Sores mainly occur on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex. Pregnant women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread by toilet seats, door knobs, swimming pools, hot tubs, bath tubs, shared clothing, or eating utensils.

Syphilis What are the signs and symptoms in adults? Stage 1 The time between picking up the bacterium and the start of the first symptom can range from 10â&#x20AC;&#x201C;90 days (average 21 days). The primary stage of syphilis is marked by the appearance of a single sore (called a chancre). The chancre is usually firm, round, small, and painless. It appears at the spot where the bacterium entered the body. The chancre lasts 1â&#x20AC;&#x201C;5 weeks and will heal on its own. If adequate treatment is not administered, the infection progresses to the secondary stage.

Syphilis What are the signs and symptoms in adults? Stage 2 The second stage starts when one or more areas of the skin break into a rash that usually does not itch. Rashes can appear as the chancre is fading or can be delayed for weeks. The rash often appears as rough, "copper penny" spots on both the palms of the hands and the bottoms of the feet. The rash also may appear as a prickly heat rash, as small blotches or scales all over the body, as a bad case of old acne, as moist warts in the groin area, as slimy white patches in the mouth, as sunken dark circles the size of a nickel or dime, or as pus-filled bumps like chicken pox. Some of these signs on the skin look like symptoms of other diseases. Sometimes the rashes are so faint they are not noticed. Rashes typically last 2â&#x20AC;&#x201C;6 weeks and clear up on their own. In addition to rashes, second stage symptoms can include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. A person can easily pass the disease to sex partners when first or second stage signs or symptoms are present.

Syphilis What are the signs and symptoms in adults? Latent Stage The latent (hidden) stage of syphilis begins when the secondary symptoms disappear. If the infected person has not received treatment, he/she still has syphilis even though there are no signs or symptoms. The bacterium remains in the body and begins to damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints.

Syphilis What are the signs and symptoms in adults? Third Stage In about one-third of untreated persons, this internal damage shows up many years later in the late or tertiary stage of syphilis. Late stage signs and symptoms include not being able to coordinate muscle movements, paralysis, no longer feeling pain, gradual blindness, dementia (madness) or other personality changes, impotency, shooting pains, blockage or ballooning of the heart vessels, tumors or "gummas" on the skin, bones, liver, or other organs, severe pain in the belly, repeated vomiting, damage to knee joints, and deep sores on the soles of the feet or toes. This damage may be serious enough to cause death.

Syphilis How is syphilis diagnosed? The syphilis bacterium can be detected by a health care provider who examines material from infectious sores under a microscope. Shortly after infection occurs, the body produces syphilis antibodies that are detected with a blood test. A syphilis blood test is accurate, safe, and inexpensive. A low level of antibodies will stay in the blood for months or years after the disease has been successfully treated, and antibodies can be found by subsequent blood tests. Because untreated syphilis in a pregnant woman can infect and possibly kill her developing baby, every pregnant woman should have a blood test for syphilis.

Syphilis What is the link between syphilis and HIV? While the health problems caused by the syphilis bacterium for adults and newborns are serious in their own right, it is now known that the genital sores caused by syphilis in adults also make it easier to transmit and acquire HIV infection sexually. There is a 2- to 5-fold increased risk of acquiring HIV infection when syphilis is present. Areas of the U.S. that have the highest rates of syphilis also have the fastest-growing HIV infection rates in women of childbearing age.

Syphilis Treatment One dose of the antibiotic penicillin will cure a person who has had syphilis for less than a year. More doses are needed to cure someone who has had it for longer than a year. A baby born with the disease needs daily penicillin treatment for 10 days. There are no home remedies or over-the-counter drugs that cure syphilis. Penicillin treatment will kill the syphilis bacterium and prevent further damage, but it will not repair any damage already done. Persons who receive syphilis treatment must abstain from sexual contact with new partners until the syphilis sores are completely healed. Persons with syphilis must notify their sex partners so that they also can receive treatment.

Syphilis Will syphilis recur? Having had syphilis does not protect a person from getting it again. Antibodies are produced as a person reacts to the disease, and, after treatment, these antibodies may offer partial protection from getting infected again, if exposed right away. Even though there may be a short period of protection, the antibody levels naturally decrease in the blood, and people become susceptible to syphilis infection again if they are sexually exposed to syphilis sores.

Gonorrhea What causes gonorrhea? Gonorrhea is caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply easily in mucous membranes of the body. Gonorrhea bacteria can grow in the warm, moist areas of the reproductive tract, including the cervix (opening to the womb), uterus (womb), and fallopian tubes (egg canals) in women, and in the urethra (urine canal) in women and men. The bacteria can also grow in the mouth, throat, and anus.

Gonorrhea How do people get gonorrhea? Gonorrhea is spread through sexual contact (vaginal, oral, or anal). This includes penis-to-vagina, penis-to-mouth, penis-to-anus, mouth-to-vagina, and mouth-to-anus contact. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. Gonorrhea can also be spread from Mother to child during birth. Gonorrhea infection can spread to other unlikely parts of the body. For example, a person can get an eye infection after touching infected genitals and then the eyes. Individuals who have had gonorrhea and received treatment may get infected again if they have sexual contact with persons infected with gonorrhea.

Gonorrhea What are the signs and symptoms of gonorrhea? Men: When initially infected, about 50% of men have some signs or symptoms. Symptoms and signs include

• a burning sensation when urinating • a yellowish white discharge from the penis • painful or swollen testicles.

Gonorrhea What are the signs and symptoms of gonorrhea? Women: In women, the early symptoms of gonorrhea are often mild, and many women who are infected have no symptoms of infection. Even when a woman has symptoms, they can be so non-specific as to be mistaken for a bladder or vaginal infection. The initial symptoms and signs in women include â&#x20AC;˘ a painful or burning sensation when urinating â&#x20AC;˘ a vaginal discharge that is yellow or bloody.

Women with no or mild gonorrhea symptoms are still at risk of developing serious complications from the infection. Untreated gonorrhea in women can develop into pelvic inflammatory disease (PID). Symptoms of rectal infection for both men and women include discharge, anal itching, soreness, bleeding, and sometimes painful bowel movements. Infections in the throat cause few symptoms.

Gonorrhea When do symptoms appear? In males, symptoms usually appear 2 to 5 days after infection, but it can take as long as 30 days for symptoms to begin. Regardless of symptoms, once a person is infected with gonorrhea, he or she can spread the infection to others if condoms or other protective barriers are not used during sex.

Gonorrhea What is the treatment for gonorrhea? Many of the currently used antibiotics can successfully cure uncomplicated gonorrhea in adolescents and adults. Penicillin is a common antibiotic that is no longer used to treat gonorrhea, because many strains of the gonorrhea bacterium have become resistant to penicillin. Because many people with gonorrhea also have Chlamydia, antibiotics for both infections are usually given together. Persons with gonorrhea should also be screened for other STDs. It is important to take all of the medication prescribed to cure gonorrhea, even if the symptoms or signs stop before all the medication is gone. Although medication will stop the infection, it will not repair any permanent damage done by the disease. Persons who have had gonorrhea and have been treated can also get the disease again if they have sexual contact with an infected person.

Meningococcal Disease • Meningitis • Viral • Bacterial

• Septicemia Meningococcal disease can produce both meningitis and septicemia

Meningitis Meningitis is an infection in the fluid of a person's spinal cord and the fluid that surrounds the brain. Meningitis is usually caused by a viral or bacterial infection. â&#x20AC;˘ Viral meningitis is generally less severe and resolves without specific treatment â&#x20AC;˘ Bacterial meningitis can be quite severe and may result in brain damage, hearing loss, or learning disability. Before the 1990s, Haemophilus influenzae type b (Hib) was the leading cause of bacterial meningitis, but new vaccines being given to all children as part of their routine immunizations have reduced the occurrence of invasive disease due to H. influenzae. Today, Streptococcus pneumoniae and Neisseria meningitidis are the leading causes of bacterial meningitis.

Meningitis What are the signs and symptoms of meningitis? In anyone over the age of 2 years: • High fever • Headache • Stiff neck

These symptoms can develop over several hours, or they may take 1 to 2 days. Other symptoms may include: • Nausea • Vomiting • Discomfort looking into bright lights (photophobia) • Confusion • Sleepiness In newborns and small infants, the classic symptoms of fever, headache, and neck stiffness may be absent or difficult to detect, and the infant may only appear slow or inactive, or be irritable, have vomiting, or be feeding poorly. As the disease progresses, patients of any age may have seizures.

Septicemia The U.S. CDC has summarized the data on meningoccemia below: Clinical Features Fever, headache and stiff neck in meningitis cases, and sepsis and rash in meningococcemia. Causative Agent Multiple serogroups of Neisseria meningitidis. Incidence Up to 2% in epidemics. During 1996-1997 213,658 cases with 21,830 deaths were reported in west African countries. 0.5-5/100,000 for endemic disease, worldwide in distribution. Disease Course 10â&#x20AC;&#x201C;15% of cases are fatal. Of patients who recover, 10% have permanent hearing loss or other serious resulting conditions. Transmission Occurs through direct contact with respiratory secretions from a nasopharyngeal carrier caseâ&#x20AC;&#x201C;patient. Risk Groups Risk groups include general population (for epidemics), infants and young children (for endemic disease), refugees, household contacts of case patients, military personnel, college freshmen (particularly those living in dormitories), and people exposed to active and passive tobacco smoke. The CDC is now recommending vaccination of college freshmen, particularly those who live in dormitories. Although most people exposed will not develop the disease, prophylactic antibiotic treatment is sometimes used.

Septicemia Treatment Treatment consists of antibiotic therapy. Post-exposure prophylaxis (PEP) For workers who have had intensive, unprotected (i.e., no mask) contact with infected patients (airway management, mouth-to-mouth resuscitation), CDC recommends rapid (within the first week) antibiotic therapy with rifampin, ciprofloxacin, or ceftriaxone. Asymptomatic exposed workers require no duty restrictions. Personnel who develop meningococcal infection should be excluded from duty until 24 hours after the start of effective therapy.

Viral Hemorrhagic Fever The term viral hemorrhagic fever (VHF) refers to a group of illnesses that are caused by several distinct families of viruses. While some types of hemorrhagic fever viruses can cause relatively mild illnesses, many of these viruses cause severe, life-threatening disease. Humans are not the natural reservoir for any of these viruses. Humans are infected when they come into contact with infected hosts. However, with some viruses, after the accidental transmission from the host, humans can transmit the virus to one another. Human cases or outbreaks of hemorrhagic fevers caused by these viruses occur sporadically and irregularly. The occurrence of outbreaks cannot be easily predicted. With a few noteworthy exceptions, there is no cure or established drug treatment for VHFs.

Viral Hemorrhagic Fever What carries viruses that cause viral hemorrhagic fevers? Viruses associated with most VHFs reside in an animal reservoir host or arthropod vector. They are totally dependent on their hosts for replication and overall survival. The multimammate rat, cotton rat, deer mouse, house mouse, and other field rodents are examples of reservoir hosts. Arthropod ticks and mosquitoes serve as vectors for some of the illnesses. However, the hosts of some viruses remain unknown â&#x20AC;&#x201C; Ebola and Marburg viruses are wellknown examples.

Viral Hemorrhagic Fever Where are cases of viral hemorrhagic fever found? Some hosts, such as the rodent species carrying several of the New World arena viruses, live in geographically restricted areas. Therefore, the risk of getting VHFs caused by these viruses is restricted to those areas. Other hosts range over continents, such as the rodents that carry viruses that cause various forms of hantavirus pulmonary syndrome (HPS) in North and South America, or the different set of rodents that carry viruses that cause hemorrhagic fever with renal syndrome (HFRS) in Europe and Asia. A few hosts are distributed nearly worldwide, such as the common rat. It can carry Seoul virus, a cause of HFRS; therefore, humans can get HFRS anywhere where the common rat is found. While people usually become infected only in areas where the host lives, occasionally people become infected by a host that has been exported from its native habitat. For example, the first outbreaks of Marburg hemorrhagic fever, in Marburg and Frankfurt, Germany, and in Yugoslavia, occurred when laboratory workers handled imported monkeys infected with Marburg virus. Occasionally, a person becomes infected in an area where the virus occurs naturally and then travels elsewhere. If the virus is a type that can be transmitted further by person-to-person contact, the traveler could infect other people. For instance, in 1996, a medical professional treating patients with Ebola hemorrhagic fever (Ebola HF) in Gabon unknowingly became infected. When he later traveled to South Africa and was treated for Ebola HF in a hospital, the virus was transmitted to a nurse. She became ill and died. Because more and more people travel each year, outbreaks of these diseases are becoming an increasing threat in places where they rarely, if ever, have been seen before.

Viral Hemorrhagic Fever How are hemorrhagic fever viruses transmitted? Viruses causing hemorrhagic fever are initially transmitted to humans when the activities of infected reservoir hosts or vectors and humans overlap. The viruses carried in rodent reservoirs are transmitted when humans have contact with urine, fecal matter, saliva, or other body excretions from infected rodents. The viruses associated with arthropod vectors are spread most often when the vector mosquito or tick bites a human, or when a human crushes a tick. However, some of these vectors may spread virus to animals, livestock, for example. Humans then become infected when they care for or slaughter the animals.

Some viruses that cause hemorrhagic fever can spread from one person to another. Ebola, Marburg, Lassa, and Crimeanâ&#x20AC;&#x201C;Congo hemorrhagic fever viruses are examples. This type of secondary transmission of the virus can occur directly, through close contact with infected people or their body fluids. It can also occur indirectly, through contact with objects contaminated with infected body fluids. For example, contaminated syringes and needles have played an important role in spreading infection in outbreaks of Ebola hemorrhagic fever and Lassa fever.

Viral Hemorrhagic Fever What are the symptoms of viral hemorrhagic fever illnesses? Specific signs and symptoms vary by the type of VHF, but initial signs and symptoms often include: • marked high fever • fatigue • dizziness • muscle aches • loss of strength and exhaustion

Patients with severe cases of VHF often show signs of bleeding under the skin, in internal organs, or from body orifices like the mouth, eyes, or ears. However, although they may bleed from many sites around the body, patients rarely die because of blood loss. Severely ill patients cases may also show shock, nervous system malfunction, coma, delirium, and seizures. Some types of VHF are associated with renal (kidney) failure.

Viral Hemorrhagic Fever How are patients with viral hemorrhagic fever treated? Patients receive supportive therapy, but generally speaking, there is no other treatment or established care for VHFs. Ribavirin, an anti-viral drug, has been effective in treating some individuals with Lassa fever or HFRS. Treatment with convalescent-phase plasma has been used with success in some patients with Argentine hemorrhagic fever.

Smallpox Smallpox is a serious, contagious, and sometimes fatal infectious disease. There is no specific treatment for smallpox disease, and the only prevention is vaccination. The name smallpox is derived from the Latin word for â&#x20AC;&#x153;spottedâ&#x20AC;? and refers to the raised bumps that appear on the face and body of an infected person. There are two clinical forms of smallpox. Variola major is the severe and most common form of smallpox, with a more extensive rash and higher fever. There are four types of Variola major smallpox: ordinary (the most frequent type, accounting for 90% or more of cases); modified (mild and occurring in previously vaccinated persons); flat; and hemorrhagic (both rare and very severe). Historically, variola major has an overall fatality rate of about 30%; however, flat and hemorrhagic smallpox usually are fatal. Variola minor is a less common presentation of smallpox, and a much less severe disease, with death rates historically of 1% or less.

Smallpox How is smallpox transmitted?

Generally, direct and fairly prolonged face-to-face contact is required to spread smallpox from one person to another. Smallpox can also be spread through direct contact with infected bodily fluids or contaminated objects such as bedding or clothing. Rarely, smallpox has been spread by virus carried in the air in enclosed settings such as buildings, buses, and trains. Humans are the only natural hosts of variola. Smallpox is not known to be transmitted by insects or animals. A person with smallpox becomes infectious or contagious after a rash appears. At this stage, the infected person is usually very sick and not able to move around in the community. After the appearance of a rash, the infected person is contagious until the last smallpox scab falls off.

Smallpox Incubation Period

(Duration: 7 to 17 days) Not Contagious Exposure to the virus is followed by an incubation period during which people do not have any symptoms and may feel fine. This incubation period averages about 12 to 14 days but can range from 7 to 17 days. During this time, people are not contagious. Initial Symptoms (Prodrome) (Duration: 2 to 4 days) Possibly Contagious The first symptoms of smallpox include fever, malaise, head and body aches, and sometimes vomiting. The fever is usually high, in the range of 101 to 104 degrees Fahrenheit. At this time, people are usually too sick to carry on their normal activities. This is called the prodrome phase and may last for 2 to 4 days.


Smallpox Early Rash

(Duration: about 4 days) Highly Contagious A rash emerges first as small red spots on the tongue and in the mouth. These spots develop onto sores that break open and spread large amounts of the virus into the mouth and throat. At this time, the person becomes contagious. Around the time the sores in the mouth break down, a rash appears on the skin, starting on the face and spreading to the arms and legs and then the hands and feet. Usually the rash spreads to all parts od the body within24 hours. As the rash appears, the fever usually falls and the person may start to feel better. By the third day of the rash, the rash becomes raised bumps. By the fourth day, the bumps fill with a thick, opaque fluid and often have a depression in the center that looks like a bellybutton. (This is a major distinguishing characteristic of smallpox.) Fever often will rise again at this time and remain high until scabs form over the bumps.

Smallpox Pustular Rash

(Duration: about 5 days) Contagious The bumps become pustules â&#x20AC;&#x201C; sharply raised, usually round and firm to the touch as if thereâ&#x20AC;&#x2122;s a small round object under the skin. People often say the bumps feel like BB pellets embedded in the skin. Pustules and Scabs (Duration: about 5 days) Contagious The pustules begin to form a crust and then a scab. By the end of the second week after the rash appears, most of the sores have scabbed over.

Smallpox Resolving Scabs

(Duration: about 6 days) Contagious The scabs begin to fall off, leaving marks on the skin that eventually become pitted scars. Most scabs will have fallen off three weeks after the rash appears. The person is contagious to other until all of the scabs have fallen off. Scabs Resolved Not Contagious Scabs have fallen off. Person is no longer contagious.

Measles, Mumps, Rubella (MMR) Measles Measles (Rubeola) is an acute, very communicable viral disease. Early signs and symptoms include fever, conjunctivitis, cough, and spots around the oral mucous membranes. The characteristic red, blotchy rash appears around the third day of illness, beginning on the face and then spreading. Diarrhea and middle ear infections are frequent complications. Tuberculosis (TB) can be worsened by coinfection with measles.

Mumps Mumps is an acute viral disease characterized by fever, swelling, and tenderness of one or more salivary glands. Prior to 1967, when a vaccine was licensed, between 100,000 and 200,000 cases were reported annually, mostly in schoolage children. Since 1995, fewer than 1,000 cases are reported annually in the U.S. Sterility in males past puberty is a possible result of the disease. Rubella (German Measles) Rubella is an acute viral disease, affecting people of any age. The disease is usually mild in infants and children, but is much worse in adults and is associated with fetal wasting and abnormal development. In 1969, the year of vaccine licensure, nearly 60,000 were reported in the U.S. Since 1992, fewer than 500 cases are reported annually.

Measles, Mumps, Rubella (MMR)

Measles, Mumps, Rubella (MMR) Treatment of MMR

Treatment for these viral diseases is supportive and typically treats the symptoms.

Prevention A combination vaccine for MMR is routinely administered in this country beginning in infancy. MMR immunization is not required for entry into any country, including the U.S. These diseases are still prevalent in countries that do not routinely immunize against them.

Influenza Influenza or â&#x20AC;&#x153;the fluâ&#x20AC;? is a viral respiratory infection, producing a more severe illness than most other viral respiratory infections. Signs and symptoms include moderate to high fever in adults, often higher in children, and the respiratory symptoms of cough, sore throat, and runny nose. Headache, muscle ache, and fatigue are prominent. Most people recover from the flu in 1-2 weeks, but some patients develop life-threatening complications, such as pneumonia. In an average year, flu results in more than 20,000 deaths and over 100,000 hospitalizations. The elderly and people with chronic health problems are more likely to develop serious complications than young, healthy people.


Influenza Prevention

Surveillance of emerging influenza virus strains usually allows the preparation of effective vaccines annually. 110 National Influenza Centers in 83 countries and four World Health Organization Collaborating Centers for Virus Reference and Research from FluNet, linking the global network of centers electronically and allowing each authorized center to enter data remotely every week and obtain full access to real-time epidemiological and virological information. People at high risk for developing severe complications from flu should be vaccinated.

BTVFC Occupational Exposure Protection Plan Policy Statement

The Big Tree VFC has established a written Exposure Control Plan that is available to all “active” and “active life” members at all times The Third Assistant Chief (9-3) of the Big Tree VFC shall serve as the Infection Control Coordinator of the program. When the Third Assistant Chief is absent, the following persons are responsible for administering the program: • 1st Assistant Chief (9-1) • EMS Captain (if not designated as 9-3) • EMS Lieutenant • AEMT=P, AEMT-CC, AEMT-I, or EMT in charge of the EMS call where the exposure took place. The Big Tree VFC is committed to full compliance with applicable laws and policies dealing with infection control. The fire company will develop plans leading to compliance for any deficient areas identified by this program.

BTVFC Occupational Exposure Protection Plan Member Responsibilities It is mandatory that each member learn the basics of infection control, including modes of disease transmission and exposure risks. Each member is responsible for ensuring compliance with the policies and procedures outlined in the Exposure Control Plan. All members shall attend an initial training course in bloodborne pathogens and a refresher annually thereafter.

BTVFC Occupational Exposure Protection Plan Big Tree VFC Responsibilities

• Designate the BTVFC Third Assistant Chief (9-3) as the Infection Control Coordinator • The Infection Control Coordinator will appoint a qualified individual to instruct all members on the epidemiology, modes of transmission, and prevention of HIV and other bloodborne infections. • The EMS officers will emphasize the need for routine use of universal blood and body fluid precautions on all patients. • Equipment and supplies will be provided to minimize the risk of infection with HIV and other bloodborne pathogens. This includes, whenever possible, needleless angios and IV medications. • Member adherence to recommended protective measures will be monitored. When monitoring reveals a failure to follow the recommended precautions, appropriate counseling, education, or retraining will be provided. If these measures are unsuccessful, appropriate disciplinary action will be considered. • Annually review and update this plan to incorporate new technologies, address legislative changes, or make revisions as deemed appropriate.

BTVFC Occupational Exposure Protection Plan Measures for Prevention •

The Big Tree VFC will routinely provide to each member the appropriate personal protective equipment (PPE) to reduce the risk of bloodborne disease exposure.

The Big Tree VFC will assure that PPE is readily accessible to all members in the appropriate sizes.

All PPE will be maintained in a sanitary manner.

All PPE will be properly cleaned, laundered, repaired, replaced, or disposed of as needed at no cost to the member.

All members will be required to follow universal precautions at all times prior to initiating patient care.

All members will be required, when possible, to wash their hands with warm water and soap after the removal of gloves that have come into contact with blood or other potentially infectious materials, even if the gloves appear to be intact, at the hospital emergency room, or by using antiseptic hand detergent that is found in the ambulance and trauma bag on Rescue #7 and flycar #7-1

All members will be required to remove contaminated PPE (i.e. jumpsuit, turnout gear) when possible, upon leaving the emergency scene and placing the equipment in a biohazard bag for washing, decontamination, or disposal.

All members will perform procedures involving blood or other infectious materials in a manner that minimizes splashing and spraying.

When using needles or other sharp objects, the member will not shear, bend, break, recap, or re sheath with two hands. Used needles will be placed directly in a sharps container on the ambulance.

BTVFC Occupational Exposure Protection Plan Immunizations/Vaccinations • Immunizations reduce the risk of contracting a communicable disease. The Big Tree VFC will provide the Hepatitis B vaccine to all members, free of charge, after initial training (which will include Hepatitis B, Hepatitis B vaccination, the efficacy, safety, method of transmission, and benefits of the vaccination, and the availability of the vaccine) within 10 days of initial swearing in of the company, unless (1) the member has previously received the complete Hepatitis B vaccination series, (2) antibody testing reveals that the member is immune or, (3) medical reasons prevent the member from being vaccinated. Any booster doses recommended by the U. S. Public Health Service also will be provided. • All medical evaluations and procedures will be performed by, or under, the supervision of a licensed physician, or an appropriately trained and licensed health care provider, and administered according to current recommendations of the U.S. Health Service. Members will receive their vaccinations through designated sites set up on a regular basis. • Vaccinations will be provided even of the member initially declines, but later accepts treatment. Members who decline the vaccination must sign a declination form. Refer to the SOG entitled “Physical Examinations” for more information.

BTVFC Occupational Exposure Protection Plan Exposure Determination

This is a listing of possible different levels of exposure that personnel may encounter: • Level I • • •

Possible affected personnel could include, but is not limited to, EMT, EMT-D, EMT-I, non first-aiders, drivers, firefighters, and fire police. Exposure is limited to merely being in the presence of a person suspected of having a communicable disease. This should be reported to the Infection Control Coordinator and an EMS Agency Exposure Notification Form should be filled out.

• Level II • • •

Possible affected personnel could include, but is not limited to, EMT, EMT-D, EMT-I, non first-aiders, drivers, firefighters, and fire police. This is an exposure to healthy, intact skin from a victim’s body fluids. This should be reported to the Infection Control Coordinator and an EMS Agency Exposure Notification Form should be filled out.

BTVFC Occupational Exposure Protection Plan Exposure Determination

• Level III •

Possible affected personnel could include, but is not limited to, EMT, EMT-I, non first-aiders, drivers, firefighters, and fire police.

This is an exposure involving contact with infected blood or body fluids through open wounds, mucous membranes, or parenteral routes (i.e. piercing mucous membranes or the skin barrier through needle-sticks, human bites, cuts, and abrasions).

Examples of a Level III exposure include: •

Needle-stick injury

Cut with a contaminated sharp object covered with blood or body fluids.

Contamination of a mucous membrane (i.e. splash to the eyes, nose, or mouth)

Contamination of blood or body fluids with non-intact skin (i.e. especially when the skin is chapped, abraded, or affected with dermatitis)

Any injury sustained while working with contaminated equipment.

BTVFC Occupational Exposure Protection Plan Injury Care Injuries involving unused, sterile needles should be reported to the Infection Control Coordinator the same way as any other minor injury. Care at the time of injury should consist of: •

Local wound care

Consideration of need for tetanus-diphtheria toxoid.

Level III Occupational Exposures with a KNOWN contamination source should be handled as follows: •

The hospital receiving the patient will be contacted and informed that a Level III Occupational Exposure has occurred.

The Infection Control Coordinator will contact the receiving hospital to find out whether the patient has an infectious disease. Determination of the risk will be based on medical information possessed by the medical facility treating the patient. New York State law does not permit testing for infectious disease without the permission of the patient. The medical facility must respond to the Department’s request in writing as soon as practical but not later than 48 hours after receipt of such request. Hospitals also have an affirmative responsibility to notify the designated officers of a possible exposure to infectious pulmonary tuberculosis.

The injured firefighter/provider should be interviewed regarding any history of Hepatitis, risk factors for exposure to Hepatitis B, and Hepatitis B immunization status. The following blood tests will be requested: •

Anti-Hep BsAg (antibody to Hepatitis B surface antigen)

HIV antibody

BTVFC Occupational Exposure Protection Plan Injury Care (conâ&#x20AC;&#x2122;t.)

Any personnel receiving a Level III exposure from an HIV positive patient should have an additional HIV antibody test done six weeks post exposure.

The HIV antibody test needs to be redone at 3, 6, and 12 month intervals. The results of these tests will be provided to the firefighter/provider with counseling from a physician. The results of these tests will remain in strict confidence between the firefighter/provider and the appointed Licensed Physician. The member will provide the Big Tree VFC with information necessary to comply with workerâ&#x20AC;&#x2122;s compensation laws and other fire company policies only. These tests will be done at the expense of the Big Tree VFC.

BTVFC Occupational Exposure Protection Plan Medical Surveillance

Big Tree VFC will provide all evaluations, procedures, vaccinations, and postexposure management to the member at a reasonable time and place, and according to standard recommendations for medical practice.

Record Keeping The Big Tree VFC will: •

Maintain accurate medical records for each member for at least the duration of membership plus thirty years.

Keep all member medical records confidential and not release them to any person within or outside the company except as required by law.

Maintain all training records for five years in compliance with Section 29, Code of Federal Regulations, 1910.20

BTVFC Occupational Exposure Protection Plan Medical Record Confidentiality

The Big Tree VFC will keep all medical records confidential and are not disclosed or reported without the members expressed written consent except as may be required by law. The Big Tree VFC emergency response personnel will use knowledge of a patient’s communicable disease status for patient care only, not infection control purposes. The same confidentiality standards apply to information regarding the communicable disease of members involved in emergency services response. This information is between the member and the attending physician. The sharing of this information through any other means, including the “grapevine”, is a violation of confidentiality standards. Appropriate disciplinary action will be taken towards individuals who violate these confidentiality standards.

BTVFC Occupational Exposure Protection Plan More information regarding the Big Tree VFC Occupational Exposure Protection Plan can be found in our Standard Operating Guidelines Manual located in the Watch Room at Station #2. Also located in the Watch Room is the Big Tree VFC Bloodborne Pathogens Exposure Control Book which contains the OSHA 1910.1030 Standard and the applicable Exposure Report Forms.

BTVFC Exposure Report

BTVFC Equipment Decontamination Procedures Cleaning and Decontaminating Spills of Blood

• Put on gloves (P2-High Risk) before the clean-up procedure. • Remove the visible material with absorbent towels or other appropriate means that will ensure that there is no direct contact with blood. • If splashing is anticipated, wear protective eyewear and a gown which provides a protective barrier. • Wash the surface with soap and water or a germicide and then apply a disinfectant and allow the surface to dry.

• Clean and disinfect soiled cleaning equipment or place in an appropriate biohazard bag for disposal. • Wash hands following the removal of gloves.

BTVFC Equipment Decontamination Procedure Periodic Cleaning of the Rescue Vehicles

â&#x20AC;˘ On a regular basis (i.e. weekly monthly) as determined by the frequency of vehicle use and obvious need, the floors, walls, interior, and exterior cabinets and drawers, benches, and other surfaces, should be thoroughly cleaned. On a weekly basis, on Mondays, the ambulance will be checked and cleaned. All equipment and working surfaces will be cleaned routinely after each EMS call.

BTVFC Equipment Decontamination Procedure Decontamination of Linen and Clothing Linen Handling- The removal of linen should focus on limiting dispersal of organisms into the air, proper containment, and hand washing. Linen should be rolled or folded during removal and by avoiding shaking or waving. Linen should be left at the hospital facility or it should be placed in a plastic bag for laundering by the hospital facility. Following the removal of the linen, hands should be washed. In the event that the linen is heavily soiled and not left at the hospital, gloved should be worn and the linen placed in a plastic bag. Management of Contaminated Clothing- Contaminated clothing should be handled similarly to linen. Clothing which has dried blood or other body fluid spatters should be removed as soon as practical (i.e. at the station house or home) If protective garb is not worn, and clothing becomes soaked with blood or other body fluids, the member should, to the extent possible under the circumstances, take steps to prevent direct contact with the skin. Ideally, the clothing should be removed from the body. Alternatively, a protective barrier can be placed between the skin and soaked area until the clothing can be changed. Detergent washing and drying in a dryer renders materials safe. Bleach can be used if it is compatible with the fabric. Dry cleaning is an effective decontamination method for clothing which cannot be laundered. Laundry facilities (washer and dryer) are available at Big Tree Station #2 to be used for any contaminated clothing.

BTVFC Equipment Decontamination Procedure Care of Specific Contaminated Equipment ARTICLE Airways (ET tubes, OPA, NPA) B/P Cuffs Backboards Bag Valve Masks Bulb Syringe Cannulas, Masks Cervical Collars Dressings & Paper products Electronic Equipment Emesis Basins Firefighter Protective Equipment Humidifiers Regulators and tanks KED Laryngoscope and blades Linens MAST Needles Penlights Pocket masks Restraints Resuscitators (BVM) Scissors Splints ` Stethoscope Stretcher Stylets Suction Catheters Suction Unit (Collection Jar) Jumpsuits

Cleaning Procedure 1 2 2 1 1 1 1 1 3 1 5 1 2 3 4 1 or 5 3 1 1 1 or 4 2 1 or 4 3 1 3 3 1 1 3 5

Cleaning Key (1) Dispose (2) Cleaning (3) Disinfection (1:10 bleach:water solution) (4) High-Level Disinfection (LPH) (5) Launder

BTVFC Equipment Decontamination Procedure Infectious Waste Disposal

Big Tree VFC will •

Treat any waste which has had contact with any body substance as regulated medical waste. Such waste will be placed in a red biohazard bag and left at the receiving hospital facility for ultimate incineration. Red biohazard bags are available on Big Tree #8 in the waste basket receptacles.

All sharps, used and unused, are included in the definition of regulated medical waste. Sharps containers will be secured when full and disposed of with other red bag waste. The ambulance is equipped with puncture resistant containers.

Disposal of intravenous bags, whether or not they have had contact with blood, will be disposed of with other red bag waste.

All other waste which has not had contact with a body substance may be disposed of in the general waste stream. White garbage bags are available on Big Tree #8.

Knowledge Assessment Please take the time to complete the knowledge assessment to the best of your ability.

Once completed, turn the knowledge assessment document into the 1 st Assistant Chief or 2 nd Assistant Chief.

If you have any questions, please contact the Infection Control Coordinator (9-3) or 1st Assistant Chief.