Infection Control and Communicable Diseases By: Darryl Jamison Macon County EMS Training Coordinator

 ALWAYS WEAR GLOVES WITH EVERY PATIENT

Background

 Nurses—5,378  Health Aides—5,638  Technicians—3,182  Physicians—1,792  Therapists—1,082  Dental Workers—492  Paramedics—476  Surgeons—122  Other—5,050  Total—23,212

Healthcare Personnel with Documented and Possible Occupationally Acquired AIDS/HIV as of December 2001  Nurses—24/35  Laboratory Worker/Clinical—16/17  Physician (non-surgical)—6/12  Lab. Tech./Non-clinical—3/0  Housekeeper—2/13  Surgical Technician—2/2  Embalmer—1/2  Respiratory therapist—1/2  Dialysis Tech.—1/3  EMT/Paramedic—0/12  Surgeon—0/6

Post Exposure Evaluation and Follow-Up

Protocol for Obtaining Medical Treatment, Counseling, Baseline Blood Testing, and Prophylaxis  Contact the supervisor immediately.  Employees will be seen initially at AMC Emergency Dept. and will receive follow-up care and counseling from Macon County Health Department, with the exception of HIV exposure which should be followed up with primary care physician. This will include but not limited too, prophylactics.  Initial evaluation will be according to the protocol of the receiving medical facility, and CDC guidelines for Occupational Exposure of Healthcare Professional.  Each exposure shall be documented on a MCEMS Exposure Report Form and appropriate Workers’ Comp form. An appt. should be made ASAP, no longer than 24 hours p exposure.

Serological Testing of Exposed Employees  The exposed employees’ consent is required for collection and testing of blood for exposure. If baseline consent is denied, the exposed employee should be requested to have blood drawn and stored, usually for a period of 3 months, leaving the option open for the person to provide consent for serological testing at a later date.

Source Patient Consent for Blood Draw  By NC general statute the source patient has no right to refuse blood testing.  Should be made from the time of initial care within the hospital setting, if for some reason the exposure occurs at the scene, contact supervisor or training officer, and he/she will make contact with the source patient for testing arrangements.  Should also contact shift supervisor of the receiving facility for proper testing.

Medical Followup  The facility that provides initial baseline testing, and prophylactic treatment of exposed employees shall forward the information to the Macon County Health Department, within 24 hours if possible (ie. Weekends).  Macon County Health Department will provide additional treatment, exception for HIV exposure, and counseling, which should be done in person if possible.

Accident/Incident Review  T.O. will review the circumstances of the exposure to determine if procedures, protocols and/or training need to be repeated or revised to prevent a reoccurence of the incident.  The completed “Exposure Incident Report Form” should be completed and returned to the T.O. to initiate this process.

Post Exposure Highlights  Documentation of exposure routes and how exposure incident occurred.  Identification of documentation of source individuals infectivity, if possible  Collection and testing of employees or students blood for HBV and HIV serological status, consent required  Post-exposure prophylaxis when medically indicated  Counseling  Evaluation of reported illness

Housekeeping  Clean up kit.  A 1:10 dilution of 5.25% clorox and water.  Red bag  Use only tongs, forceps or brush and dust pan for cleaning up broken glass  Inspect and decontaminate on a regular basis reusable receptacles (ie, trash cans)  If visibly contaminated clean as soon as feasible.  Shall disinfect each shift, preferably after each call, anything that touches the patient and/or you touch will providing care after transfer.  Regulated medical waste shall be placed in a closable and labeled or color-coded container.  When discarding contaminated sharps, place them in a closable, puncture-resistant, appropriately labeled leak-proof container for that purpose.

Cont.  Sharps containers shall be placed where they are easily accessible, to the immediate area where sharps will be used.  Containers shall be kept upright throughout use, replaced routinely, closed when moved, and not allowed to overfill  When replaced, take to the hospital for disposal.

 NEVER recap any needles clean or contaminated  ALWAYS make sure that the safety mechanism is working  NEVER hand someone else YOUR needle  Immediately discard used needle after use  ALWAYS draw up your own medicine

Types of Safety Needles