HomeMy WebLinkAboutSOG 302.01 REVISED 7-2017_Exposure Prevention and Infection Control302.01 — Exposure Prevention & Infection Control
Effective. 6/1/1999
Revised: 7/5/2017
Replaces: UOG 302.01
I. Guiding PhilosophX
Safety and accident prevention is everyone's job. National occupational safety and health
standards have traditionally held that roughly 95% of all workplace accidents are
by someone (by their action or inaction) at the employee, supervisor, manager, and/or at the
organizational level. We are committed to working together and doing our best to:
10 Minimize accidents, injuries and exposures.
10 Create and sustain a "11'lllllllllNIK �Sa 1PIE11VI1 IFIlllS`11' culture based on our managed -risk
philosophy.
II. Purpose
The purpose of this policy is to specify the procedures to be utilized by Beaumont Fire -
Rescue services personnel to minimize the risk of transmission of infectious disease.
III. Goals
The goals of this policy are to:
A. Outline modes of disease transmission.
B. Communicate methods of prevention or protection from exposure and/or
infection, expectations and related responsibilities.
C. Communicate protective equipment available on apparatus, expectations and
related responsibilities.
D. Reference reporting & documenting reportable exposures.
E. Communicate expectations and consequences concerning confidentiality.
IV. Definitions
A. Accident — Damage or injury that occurs because of a risk that is poorly managed.
B. Accountability — The obligation of an individual or organization to account for
and justify one's actions and/or decisions, to accept responsibility and associated
consequences, and to disclose the outcomes in a transparent manner.
C. Air -borne Disease — Spread when droplets of pathogens are expelled into the air
due to coughing, sneezing or talking. Many of these diseases require prolonged
exposure for infection to occur, posing only minimal threat to emergency
responders. However, there are preventive measures, such as wearing masks,
maximizing ventilation, or being vaccinated that help reduce these risks. Air-
borne diseases of concern to emergency responders include meningitis, chicken
pox, tuberculosis (TB), and influenza.
D. Blood-borne Disease — A transmissible organism that replicates in the blood. The
major transmission route is blood contact, but can also be from other body fluids
that are indirectly linked with blood such as: semen, vaginal secretions, or a body
fluid or substance containing blood.
E. Confirmed Exposure — Cases where both of the following are TRUE:
1. A reportable infectious disease is present, has been confirmed by medical
testing AND
2. A responder has had unprotected contact through a defined portal of entry.
F. Exposure — Unprotected contact with a reportable infectious disease resulting in a
medically -recognized risk of disease transmission or injury.
G. Fit for Duty — An individual is in a physical, mental, and emotional state which
enables him/her to perform the essential tasks of his/her work assignment in a
manner which does not threaten the safety or health of oneself, co-workers,
property, or the public at large.
H. HBV — Acronym for the Hepatitis B virus; a virus that infects the liver.
L HCV — Acronym for the Hepatitis C virus; a virus that infects the liver.
HIV — Acronym for the Human Immunodeficiency Virus; virus that causes
acquired immune deficiency syndrome (AIDS), the most advanced stage of HIV
infection.
K. Occupational Exposure to an Air -Borne Pathogen (TB, Meningitis, etc.) —
Unprotected contact with a reportable air -borne pathogen while on -duty resulting
in medically -recognized risk of disease transmission. For disease transmission due
to air -borne pathogens to occur an Exposure must include BOTH of the
following:
1. A confirmed exposure from a patient suffering from a reportable
infectious disease contractible through air -borne means.
2. Unprotected responder(s) (not wearing a mask) who have been proximate
enough to the patient described above to inhale droplets of pathogens.
SOG 302.01 — Exposure Prevention & Infection Control Page 2 of 1 1
L. Occupational Exposure to a Blood Borne Pathogen (HIV, HBV, HCV) —
Unprotected contact with a reportable blood borne pathogen while on -duty
resulting in medically -recognized risk of disease transmission. For disease
transmission due to blood borne pathogens to occur (HIV, HBV, HCV), an
Exposure must include BOTH of the following:
Confirmed presence of infectious body fluid
a. MAY 1WNS II.111L......I It ... 1111 I : Blood semen vaginal
................................................................................................................................................................................................�...........
fluids, breast milk, cerebrospinal fluid, peritoneal fluid, pleural
fluid or synovial blood.
b. 11,114I0 x ' IUB'1VI� '1Vl�llfi�„�i P '� �9c, �1VClll'1VI� llllll l�f i' IIIIII IIfW i' IU�llfi� lllllll13 : Saliva, vomitus, urine,
feces, sweat, tears respiratory secretions
(unless visibly bloody).
The risk of HBV or HCV transmission from non-bloody saliva is
negligible.
2. A Portal of Entry
a. Percutaneous (i.e. Needlestick)
b. Mucous Membranes (i.e. Mouth, Nose, Eyes)
c. Cutaneous with Non -Intact Skin (i.e. Open wounds that are not
covered or bandaged).
IF BOTI°°I FACTORS ARE IMOT IIPIIIT TI °°I I
�1140 RISK OF DISEASE TRAIMSIMISSIG1141
NO RISK OF TRANSMISSION MEANS THAT
A REPORTABLE EXPOSURE DID NOT OCCUR.
FURTHER EVALUATION IS NOT REQUIRED.
M. Personal Protective Equipment (PPE) — Specialized clothing or equipment
worn by an employee for protection against a hazard.
IMEIMBERS III UST DO TI IEIR PART TO REDUCE TI IE IS F
EXPOSURE BY US11MG PROTECTIVE IPIII IIIT AVAILABLE AT TI IE
STATIGIMS A14DII TI IEIR APPARATUS!
• The Department has authorized the use of first-aid equipment (band-aids,
bandages, etc.) to cover open wounds on members' bodies while on -duty as a
preventative measure.
• Remember to cover ALL cuts or weeping abrasions, including those on
lower extremities (in case of kneeling in contaminated fluids while
providing treatment).
Use the mask/eye shield combo provided to reduce the risk of body fluid
contact with mucous membranes.
SOG 302.01 — Exposure Prevention & Infection Control Page 3 of 1 1
N. Possible Exposure — Cases where either:
1. A reportable infectious disease may be present, but has not yet been
confirmed/denied by medical testing, or
2. A responder believes he/she may have had unprotected contact with a
reportable pathogen.
O. Preventable — When an individual, group or supervisor(s):
1. Commits errors and/or fails to react reasonably to the errors of others.
2. Should have known about a potential hazard, but didn't.
3. Have some responsibility for either:
a. Causing,
b. Failing to prevent, and/or
c. Contributing to an injury, accident or exposure occurrence.
P. Reportable Exposure — Includes the following:
1. Transmittal of reportable infectious body fluids (blood, semen, vaginal
fluids, breast milk, cerebrospinal fluid, peritoneal fluid, pleural fluid or
synovial blood) of a patient onto:
a. MUCOUS N1EN1MR . �E (mouth, nose, eyes) of the emergency
services provider.
b. -Iof the emergency services provider.
2. Any non -barrier protected contact of the emergency services provider
with:
a. The or .,1�° �I� . ���hl��r1 ��l��l� . of a patient.
b.released from a patient.
c. 11AZAIMBOUS HATERIMLS.
-------------------------------------------------------------
3. Any person to person contact in which a co -mingling of bloody respiratory
secretions (saliva and sputum) between the patient and the emergency
services provider may have taken place.
III,,,,,III,,,,, E T- F III E RESCUE MEMBERS WHI ,,,,,III,,,,, 'T11 III E III R PART TO
REDS 'III°°IIIE RlSl< OF EXPOSURE BY AD1°°IIIE III 'III°°IIIE GUlDE1,,,,,III N ES
EXPECTA`T1IONS COMMUNICATEDIII 'III°°III III S P 0 II,,,,,III
SOG 302.01 — Exposure Prevention & Infection Control Page 4 of 1 1
V. Modes of Transmission
A. HIV is transmitted through blood, vaginal fluids, and possibly breast milk. HIV is
transmitted:
1. By sexual contact (anal, vaginal, oral).
2. By sharing needles and syringes, particularly all paraphernalia involved in
the use of illegal intravenous drugs.
3. From an infected woman to her baby, either before or during birth, or
possibly through breast feeding.
4. Through contaminated blood or blood products (a very remote possibility
since implementation of screen of blood donors in 1985).
5. OCCUPATIONAL EXPOSURE TO,.0 0 NIA MIAlE,a BL00Q OR I.Q 0Q Y,
Q ,L..UI,D S , , NTA!NI„ ,G ,BL00QE AS THE RESULT OF SPILLS, STICKS, SPLASHES
OR OTHER MEANS.
B. Common diseases to which emergency responders might be exposed to by
EXAMINATION OF THE THROAT, INTUBATION, SUCTIONING, MOUTH-TO-MOUTH
RESUSCITATION:
1. Diphtheria
2. Measles
3. Meningococcal Infections (meningitis, septicemia)
4. Pertussis
5. Rubella
6. Tuberculosis
C. Common diseases to which emergency responders might be exposed by
NEEDLE STICK OR OTHER PENETRATING PUNCTURE OF THE SKIN
SPLATTER OR AEROSOL INTO THE EYE, NOSE OR MOUTH
SIGNIFICANT CONTAMINATION OF AN OPEN WOUND OR NON -INTACT SKIN WITH
BLOOD OR INFECTIOUS BODY FLUID:
1. Acquired Immunodeficiency Syndrome (AIDS)
2. Human Immunodeficiency Virus Infection (HIV Infection)
3. Viral Hepatitis (Hepatitis B)
SOG 302.01 — Exposure Prevention & Infection Control Page 5 of 1 1
4. Viral Hepatitis (Hepatitis C)
5. Syphilis
VI. Methods of Prevention or Protection from Exposure and/or Infection
A. E P SUPE PPE ENld°1 N Td .-jP �°j INAl.....................................................................................................................................................................................................................................................................................................................................................
1. Per State law, the City will provide immunizations for employees who are
exposed to contagious diseases during the course of employment at no
cost to the employee (TLGC Section 607.004 Preventive Immunizations &
Vaccinations).
2. Beaumont Fire -Rescue Services members are strongly encouraged to be
current in the following immunizations:
a. Influenza
b. Tetanus/Diptheria/Pertusis (Tdap)
c. Mumps/Measles/Rubella (MMR)
d. Pneumococcal Pneumonia
e. Chicken Pox (Varicella)
f Hepatitis A
g. Hepatitis B
Persons declining available vaccinations must complete the BFRS Vaccine
Declination Statement.
4. Employees interested in receiving vaccinations should contact the Public
Health Department.
5. If requested by the employee, the City will provide annual tuberculosis
skin testing.
6. Refusal to participate in immunization may limit available benefits.
In 1985, the Center for Disease Control developed the strategy of
"Universal Blood and Body Fluid Precautions" to address concerns
regarding transmission of communicable diseases in the health-care
setting. The concept, now referred to simply as "Universal Precautions,"
stresses that
2. In the emergency medical setting "universal precautions" should be
followed when responders are exposed to blood, infectious body fluids
(amniotic fluid, pericardial fluid, peritoneal fluids, pleural fluid, synovial
SOG 302.01 — Exposure Prevention & Infection Control Page 6 of 1 1
fluid, cerebrospinal fluid, semen, and vaginal secretions), or any bodesfluid
visibly containing blood .I...I........:ARE ..........°@ T@ ......"°@ @P
1.J..T! A.Z. f P°P°@ P.° . �I@ @ @D TO M�I� �IM�12@ THEE [ .. F.......V IU 1............
The unpredictable and emergent nature of exposures encountered by
emergency medical personnel may make differentiation between
hazardous body fluids and those which are not hazardous very difficult
and often impossible. Therefore, when emergency medical personnel
encounter body fluidsunder emergency situations, T,,t-,T,,,,,, ,„,,�
�;P
.FtlJl..A.S ...P°..Tf! .T].@=Y ...H.I.A.Z.A.R.P.O.I.I.S. 1
C. K P �U E P E EN.T1 N T�°� �U �°J P PE MUNI T1 N
............................................................................................................................................................................................................................................................................................................................................................................................................................................................
1. If you have feedback or suggestions related to the department's exposure
prevention and infection control program, please take advantage of the
following communications options to bring your ideas or concerns
forward:
a. Utilizing your chain of command
b. Communicating directly with the department's Emergency
Medical Program Manager and/or the Medical Services
Advisory Group
c. Using the Solutions Box
d. Communicating your feedback to the Joint Union -Management
Safety & Health Committee
2. Utilizing the options above should be your primary methods of helping to
improve both the exposure prevention program and responder safety and
health.
D. NEEQLK �°CARPS DI P I.
.......................................................................................................................................................................................................
All members will take precautions to prevent injuries caused by needles,
scalpel blades and other sharp instruments or devices during procedures;
when cleaning used instruments; during disposal of used needles; and
when handling sharp instruments after procedures.
2. To prevent needle stick injuries, needles.S H 0 U LP N 01„ B E R E C A P P E V
purposely bent or broken by hand, removed form disposable syringes, or
otherwise manipulated by hand.
After they are used, disposable syringes and needles, scalpel blades and
other sharp items should be placed in puncture -resistant containers for
disposal.
SOG 302.01 — Exposure Prevention & Infection Control Page 7 of 1 1
E. �--i 1 �°MNG.
................................................................................................................
1. Hands and other skin surfaces should be washed immediately and
thoroughly if contaminated by blood, other body fluids to which universal
precautions apply, or potentially contaminated articles.
2. Hands should always be washed after gloves are removed, even if the
gloves appear to be intact.
3. Hand washing should be completed using appropriate facilities, such as
utility and restroom sinks.
4. When hand washing facilities are available, wash hand with warm water
and soap.
Waterless antiseptic hand cleanser is provided on all responding units to
use when hand -washing facilities are not available.
F.CLEANING I I DISINFECTING ��
............ ..... ..... I
1. Laryngoscope blades should be soaked in an approved "sterilant" solution
for a minimum of 10 minutes.
2. Surfaces that come into contact with intact skin (e.g., stethoscopes, blood
pressure cuffs, splints) and have been visibly contaminated with blood or
bloody body fluids, should be cleaned ,ILE W,EARI,N G , „LQ ,,,,,,,,1 S., with
approved chemical germicide solution.
3. Surfaces should also be cleaned with an approved disinfectant.
G. LE,A N,I,N G A N D D E C 0 NIA MIN Al IN G S PILI. F B LP 0 D — All spills of blood and
blood -contaminated fluids should be promptly cleaned up using an approved
germicide (as supplied through the Logistics Section) EA R N G M E VICA L
_QHS., and in the following manner:
Viable material should first be removed with disposable towels which will
ensure against direct contact with blood.
2. If splashing is anticipated, protective goggles should be worn along with a
gown which provides an effective barrier to the splashes.
3. The area should then be decontaminated with germicide.
4. Hands should be washed following removal of gloves.
5. The soiled cleaning equipment should be placed in the bio -waste bag and
disposed of properly.
SOG 302.01 — Exposure Prevention & Infection Control Page 8 of 1 1
H. SEARCI°� AND CLEARING OF SCENE
..........................................................................................................................................................................................................................................
1. Removing all contaminated materials from a scene prior to departure is a
shared responsibility between Beaumont Fire -Rescue First Responders
and EMS transport agency personnel.
2. A good -faith effort should be undertaken to insure contaminated materials
are cleared from the scene. Debris should be disposed of as noted above.
I. DECONTAMINATION AND LAUNDERING OF STRUCTURAL FIREFIGI°JTING
..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
PROTECTIVE CLOTI°DING See IMI IIIU�I�IQ ilNSINl�I:�"II�IO Llil "Il�ENAN(Il
....................(—___________________________________________________________________�_�_�_�_�_�_�_�_�_�_�_�_�_�_�_�
OF � TiIIICA"�r1I�I� EtA 1, ih��I�illlil��h�illl�ill��I"l; ill �I'I PIINE E )
J. Preventability of exposures and associated follow-up will be determined as
outlined in �I, 6 I OIL IUB I � IE� I�I�1� 1 M I�rh�ll�ih ih IA311001 �'X1CJ%T�II1 illi
it XIII to Dill E illiEVIUM.
VII. Personal Protective Equipment Available on Apparatus
A. BANDAGES
1. First-aid equipment (band-aids, bandages, etc.) is provided to cover open
wounds on members' bodies while on -duty as a preventative measure.
2. Cover ALL cuts or weeping abrasions, including those on lower
extremities (in case of kneeling in contaminated fluids while providing
treatment).
Disposable gloves are provided on all apparatus and should be donned by
personnel prior to initiating any emergency patient care tasks involving
exposure to blood or other body fluids to which universal precautions
apply.
2. Gloves should be donned just prior to patient contact, to avoid
compromising the integrity of the gloves.
3. For multiple patients, GLOVES SHOULD BE CHANGED BETWEEN PATIENT
CONTACTS, IF THE EMERGENCY SITUATION ALLOWS.
4. When utilizing structural firefighting gloves, disposable exam gloves
should be worn under the "bunker" gloves to protect against fluid contact.
SOG 302.01 — Exposure Prevention & Infection Control Page 9 of 1 1
1. Masks and eye protection (for the purpose of infection control) may
consist of the medical masks/shield combos or goggles provided by the
department on units, or standard eye glasses with additional "side shields."
2. Masks and eye protection (for the purpose of infection control) shall be
worn when there is a risk of exposure to:
a. A11119,011NE ]WHIA"HOUS .11 TilPlRIAIL (i.e. tuberculosis,
pneumonia or other respiratory diseases, meningitis, and
pulmonary MRSA, etc.)
b. "WlRIASiliClES" OF BOil)Y FIX iliiliM (i.e. as when performing airway
maneuvers, suctioning, CPR or performing certain surgical
techniques)
Based on BFR experience, most reportable exposures are
attributable to providing advanced airway maneuvers.
Responders will utilize mask/shield combos provided in the
med bag, with the Lifepak unit, and on the apparatus to
reduce the risk of exposure.
111111°° 1lIZIE 1 IE IIf IIS 1181E A11::30U T A S11 "'T UA"'T 11 0114,
"'T""I111I,,,,,III ,IE "'T""111°°SIE Ilf:1llf:1lEIlf:1llf?OV111'. ) 1E IG
Gowns will be worn when large volumes of blood or body fluids are likely
to be contacted. This includes patients with extensive injuries, situations
requiring lavage with saline (or other fluids), and patients who are covered
with other potentially infectious substances.
D. VENTILATION EQ
Because of the theoretical and actual risk of transmission of infectious
disease via mouth-to-mouth ventilation and similar procedures, mouth to
mouth, mouth -to -nose, and mouth -to -mask ventilation is not encouraged.
2. Disposable airway and ventilation devices should be used, and disposed of
properly.
VIII. Reporting & Documenting Exposures
See � �1011.04 -1K1----
h l- t l--Ali-1-�__--,-------------------------_--------- _
SOG 302.01 — Exposure Prevention & Infection Control Page 10 of 1 1
IX. Confidentiality
A. The City of Beaumont must provide equal access to appropriate services for all
persons, including those who may be infected with HIV or who have AIDS, those
who are in the custody or care of the City of Beaumont (this includes a suspect in
custody of PD, or patient).
B. All medical information, including information concerning HIV/AIDS testing of
employees or patients must be treated confidentially by all personnel, as provided
by law. Non-medical personnel receiving such information shall keep this
information confidential and not release it to others. Handling of patient medical
information will adhere to iliMEt 102.0 4B Pilil0"FEl"""1"ElD iliUlE1,'hili1
iliF011IAT1CO1i111iliill`"i111"A1.____________________________________________________________________
C. Communication of medical information relating to Beaumont Fire -Rescue
personnel will adhere to 1,G 115.0 �illlE11 IM1liK"A1, I 1111MA11ON.
_,
D.
Failure to adhere to policy may result in both civil and/or criminal liabilities, and
discipline (up to and including indefinite suspension). (Section 81.046, Health &
Safety Code and Section 81.013, Health & Safety Code as amended by Section 28,
Chapter 1195, Acts of 71 st Legislature, Regular Session 1989).
SOG 302.01 — Exposure Prevention & Infection Control Page 1 1 of 1 1