EMS Infectious Disease Playbook Risk Based PPE Usage - Mike Deit - - PowerPoint PPT Presentation
EMS Infectious Disease Playbook Risk Based PPE Usage - Mike Deit schman, MPH, CPH, NDHP, NRP Execut ive Director Sout h Dakot a Healt hcare Coalit ion Current EMS Proj ect s Todays training Partnering with EMS Office for S
Mike Deit schman, MPH, CPH, NDHP, NRP Execut ive Director Sout h Dakot a Healt hcare Coalit ion
Todays training
Partnering with EMS Office for S tatewide Purchase PPE Proj ect
Partnering with Avera for Online PPE Training Video with free CEU’s
Partnering with EMS Office to fund S IM-S D
PPE Training Narcan Training/ Powdered Opiates Stop the Bleed Tourniquet Training
Identify PPE needs based on disease transmission risk categories:
St andard Precaut ions Cont act Precaut ions Droplet Precaut ions Airborne Precaut ions Special Respirat ory Precaut ions
Name common contact, droplet and airborne spread diseases
Understand difference between a surgical mask and a respirator
Describe proper PPE donning and doffing procedures
Not all infections can be spread from person to person.
Infectious diseasesare caused by pathogenic microorganisms, such as bacteria, viruses, parasites or fungi
Contagious diseases are infectious diseases that can be spread from person to person.
Mode of transmission is how a disease is spread. Heavily dependent upon HOW the infectious agent leaves the body in a way that can spread infection.
Legionnaires disease is caused by a respirat ory cont act wit h a wat er-borne
bact eria. Typically causes a severe pneumonia, but is not spread from person t o
leave t he body in a way t hat causes infect ion t o ot hers.
Mode of transmission determines PPE needs, i.e. “ risk based PPE” .
Planning resource produced by HHS –AS PR-Tracie
R eleased in 2017
Available in PDF at https:/ / www.ems.gov/ pdf/ AS PR-EMS
Playbook-June-2017.pdf. Just Google “ EMS Playbook” .
PDF version has hyperlinks to more resources than you will probably ever be able to read.
Approach is to present PPE on a continuum from S tandard Precautions to EVD- VHF based on disease risk.
S tarts with discussing risk assessment at the level of dispatch
Gathering information about possible communicable disease:
Fever Cough Vomit ing/ Diarrhea Travel (14-21 days)
During specific outbreaks using more focused questions
Possibly limit ing number of responders sent Doorway Assessment upon arrival
Risk – Bloodborne pathogens. Diseases causing infectious drainage. Common sense protection against “ germs” .
Example Diseases
AIDS – Spread person-person, but infect ious agent resides in t he blood. Mode of Transmission is infect ed blood or semen.
Zika –Typically spreads Mosquit o-Person. Infect ious agent resides in t he blood or semen. Mode of t ransmission is again blood or semen.
Ant hrax- Spread from cont act wit h infect ed animals. Pulmonary infect ions in people are not cont agious, but cut aneous ant hrax drainage can be.
Minor wound infect ions/ sores, cellulit is.
Gloves, handwashing, facial protection or gowns if manipulating airway or splash risk.
GOAL:
Apply common sense base set of PPE against disease transmission based on risk
Typically hand hygiene and gloves Add eye/ facial prot ect ion for pat ient s wit h respirat ory sympt oms during airway
int ervent ions
Gowns for pot ent ial splash exposures
EXAMPLES
enterococci (VRE) ∙ C. difficile ∙ norovirus ∙ other suspected infectious
diarrhea
GOAL - Provide impermeable barriers to infectious agents that are either that can easily be contracted or spread to other environments via fomites and surface contact
NEW PPE -
Disposable fluid-resist ant gown t hat prot ect s t he provider’s legs; consider
disposable fluid-resist ant coveralls if t here is a preference
Hand hygiene, gloves included as part of standard precautions
TRANS POR T CONS IDERATIONS –
Impermeable barrier in t he presence of excessive wound drainage, fecal
incont inence, or ot her discharges.
AMBULANCE DECONTAMINA TION
Any visibly soiled surface must first be decont aminat ed using an EP
A-regist ered hospit al disinfect ant
Medical equipment (st et hoscope, BP cuff, et c.) making pat ient cont act should be
disposable or cleaned and disinfect ed before use on anot her pat ient
Ot her visibly cont aminat ed equipment should similarly be cleaned and disinfect ed
EXAMPLES
Pertussis ∙ Rhinovirus ∙ Seasonal Influenza ∙ Strep Throat
GOAL • Additional respiratory protection against inhalation of larger infectious droplets during direct patient care activities.
NEW PPE - S urgical masks and possibly eye protection
P ATIENT CARE CONS IDERATIONS –
Provide a surgical mask for all pat ient s wit h acut e infect ious respirat ory sympt oms
who can t olerat e it
Provide t issues for secret ion cont rol and encourage cough et iquet t e pract ices Medical dist ancing Nebulizers increase droplet s
TRANS POR T CONS IDERATIONS
Consider ambulance airflow. Exhaust vent , driver compart ment Increase vent ilat ion by having air or heat on non-recirculat ing cycle and/ or
AMBULANCE DECONTAMINA TION (S ame as contact precautions)
Any visibly soiled surface must first be decont aminat ed using an EP
A-regist ered hospit al disinfect ant
Medical equipment (st et hoscope, BP cuff, et c.) making pat ient cont act should be
disposable or cleaned and disinfect ed before use on anot her pat ient
Ot her visibly cont aminat ed equipment should similarly be cleaned and disinfect ed
EXAMPLES
Chickenpox
GOAL - Provide respiratory protection against inhalation of infectious aerosols (agents that remain infectious over long distances when suspended in the air).
NEW PPE –R espirators for EMS (N-95)
P ATIENT CARE CONS IDERATIONS
Ensure st rict adherence wit h st andard precaut ions Ask t he pat ient t o wear a surgical mask if t hey are able t o t olerat e it Provide t issues for secret ion cont rol and encourage cough et iquet t e pract ices Nebulizers, suct ioning, int ubat ion increase aerosols –Facial Prot ect ion
TRANS POR T CONS IDERATIONS
Not ify t he receiving hospit al of t he need for negat ive pressure room Consider ambulance airflow. Exhaust vent , driver compart ment Increase vent ilat ion by having air or heat on non-recirculat ing cycle and/ or
N95 if can’ t isolat e cab of t he ambulance Int ubat ed should be vent ilat ed wit h a wit h a HEP
A filt er on exhalat ion port
AMBULANCE DECONTAMINA TION (S ame as contact precautions)
EXAMPLES
GOAL - Additional respiratory protection against inhalation of larger infectious droplets during direct patient care activities as well as impermeable barrier to reduce spread of highly pathogenic viruses on surfaces (standard + contact + airborne)
NEW PPE - S tandard + Contact + Airborne
P ATIENT CARE CONS IDERATIONS
Ensure st rict adherence wit h st andard precaut ions Ask t he pat ient t o wear a surgical mask if t hey are able t o t olerat e it Provide t issues for secret ion cont rol and encourage cough et iquet t e pract ices Nebulizers, suct ioning, int ubat ion increase aerosols –Ext ra Caut ion
TRANS POR T CONS IDERATIONS
Not ify t he receiving hospit al of t he need for negat ive pressure room Consider ambulance airflow. Exhaust vent , driver compart ment Increase vent ilat ion by having air or heat on non-recirculat ing cycle and/ or
N95 if can’ t isolat e cab of t he ambulance Int ubat ed should be vent ilat ed wit h a wit h a HEP
A filt er on exhalat ion port
Have a plan for family members wishing t o accompany t he pat ient t hat prevent s
crew exposures t o highly infect ious diseases
AMBULANCE DECONTAMINA TION (S ame as contact precautions)
EXAMPLES
GOAL - Provide maximal impermeable barrier and respiratory protection against highly pathogenic VHF viruses.
New PPE –Just in time training
S tate Plan
Waste is considered Level A and requires special disposal
Ambulance decon requires PPE
Personal items (e.g., j ewelry [including rings], watches, cell phones, pagers, pens) should ideally be removed and stowed. Long hair should be tied back
Inspect PPE prior to donning to ensure that it is in serviceable condition
Perform hand hygiene with ABHR; allow hands to dry before donning gloves
Put on first pair of gloves
Put on gown or coverall Ensure cuffs of inner gloves are tucked under the sleeve
Put on boot/ shoe protectors
Put on outer gloves. Ensure the cuffs are pulled over the sleeves
Put on respirator. • N95 mold to nose
Apply full face shield or goggles
After donning, the integrity of the ensemble should be verified.
PPE should be doffed in a designat ed removal area
Place all PPE wast e in a labeled, leak-proof biohazard bag.
Inspect t he PPE for visible cont aminat ion, cut s, or t ears before removal. Disinfect any visible cont aminat ion with an EPA- regist ered hospital disinfect ant wipe.
Disinfect out er-gloved hands or replace wit h new gloves
Inspect t he inner glove out er surfaces for visible cont aminat ion, cut s, or t ears. perform hand hygiene wit h ABHR on bare hands, and don a new pair of gloves
Gown –Unt ie or gent ly break fast eners. Avoid cont act wit h out er surface of gown during removal. Pull gown away from body, rolling inside out and t ouching only t he inside of t he gown.
Coverall – Tilt head back t o reach zipper or fast eners. Unzip or unfast en complet ely before rolling down while t urning inside
Remove goggles or face shield sliding fingers under st raps and sliding up and off away from face.
Disinfect gloves
Respirat or • N95 respirat or: Tip head slight ly forward, remove by sliding fingers under t he elast ic st raps and sliding t hem off t he ears/ head allowing t he mask t o fall away from t he face being careful not t o t ouch t he front of t he mask
Disinfect gloved hands. Remove and discard gloves
Perform hand hygiene
EMS Playbook
Infectious Agents in Healthcare S
guidelines for healthcare settings across the continuum of care.
ervices (EMS ) S ystems and 9-1-1 Public S afety Answering Points (PS APs) for Management of Patients Who Present with Possible Ebola Virus Disease (Ebola) in the United S tates.
The National Institute for Occupational S afety and Health. (n.d.). Considerations for S electing Protective Clothing used in Healthcare for Protection against Microorganisms in Blood and Body Fluids. This webpage provides considerations for the selection of PPE items based on their barrier properties and includes links to current standards and specifications for fluid-resistant and impermeable gowns and coveralls.