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 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

Risk Based PPE Usage: Obj ect ives  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

A Tiny Bit of Epidemiology  Not all infections can be spread from person to person.  Infectious diseases are 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 person. The mode of t ransmission is t he cont aminat ed wat er, t he bact eria don’ t 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” .

EMS Infect ious Disease Playbook  Planning resource produced by HHS –AS PR-Tracie  R eleased in 2017  Available in PDF at https:/ / www.ems.gov/ pdf/ AS PR-EMS -Infectious-Disease- 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.

EMS Playbook- Dispat ch Considerat ions  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

St andard Precaut ions  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.

St andard Precaut ions Cont .  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

Cont act Precaut ions - Excessive wound drainage ∙ MRSA ∙ Vancomycin -resistant  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

Cont act Precaut ions  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

Droplet Precaut ions - Meningitis ∙ Streptococcal and many other causes of pneumonia ∙  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

Droplet Precaut ions  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 opening windows.  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

Airborne Precaut ions - Measles ∙ TB (suspected or confirmed pulmonary or laryngeal) ∙  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

Airborne Precaut ions  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 opening windows  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)

Special Respirat ory Precaut ions - SARS ∙ MERS ∙ Novel influenza strains  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

Special Respirat ory Precaut ions  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 opening windows  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)

EVD/ VHF Precaut ions - Ebola ∙ Marburg virus ∙ Lassa fever ∙ Crimean -Congo Fever  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