TITLE: INFECTIOUS DISEASE AND DISINFECTION PROCEDURES Including SIGNIFICANT EXPOSURE

POLICY STATEMENT:

The following guidelines for the use of protective equipment and cleaning and disinfecting techniques has been established in accordance with the Centers for Disease Control.

GOAL/PURPOSE:

To ensure the protection of ambulance personnel and patients, and to break the chain of infection of certain diseases and provide guidance if a significant exposure occurs. Those communicable diseases are but not limited to; AIDS, Hepatitis, Pulmonary TB, Meningococcal Meningitis and Chicken Pox.

POLICY/PROCEDURE:

A. Treating and Exposure
The following procedures are to be used to treat and report an exposure to contaminated blood or body fluid.

1. If you are exposed percutaneously:

a. Wipe off blood or fluid and apply alcohol.
b. After arriving at the hospital, and as soon as patient care allows, wash your hands and the wound.
c. If the wound is such that requires sutures, seek prompt medical attention.
d. If you have received a puncture wound, seek medical attention to evaluate your tetanus immunization status.

2. If you are exposed mucocutaneously:

a. Flush you eye(s) or rinse your mouth with saline or water.
b. After arriving at the hospital, and as soon as patient care allows, wash your face.

B. Protective Measures
The best way to avoid exposures to body fluids is to use protective procedures on all responses. It is better to enter a situation with protective gear in place than to delay treatment while you put on protective clothing.

1. Guidelines for Use of Protective Gear:

a. Gloves
The following types of gloves must be available to pre-hospital personnel:

1. Heavy duty leather gloves for performing light extrication or assistant with extrication tasks.
2. Medical-grade gloves for patient care procedures that require dexterity and sensitivity but may involve contamination of the hands with blood or body fluids. Procedures include IV insertions, dressing and splinting opening injuries, and establishing airways.

b. Hepa Mask
Masks are usually not necessary in most situations. However, should personnel believe that blood or body fluids might be splashed in face, a medical-grade face mask will be available.

c. Eye protection
Plastic goggles are available for situations in which blood or body fluids could be splashed into the eyes, of such a design that allows clear vision and does not obstruct peripheral vision.

d. Protection of broken skin
Before reporting for duty, cover any cuts, abrasions, or insect bites with a Band-Aid or small dressing.

e. Airway management
Respiratory assist devices should be utilized whenever possible and are to be of a disposable type only.

2. Sharps
Special care should be taken when handling sharp needles, objects, and glass. Needles should not be recapped, bent or broken. Needles and other sharp objects should be disposed of properly in the heavy puncture-proof plastic containers in the ambulance.

3. Handwashing
Hands are to be thoroughly washed after each patient transport and as soon as patient care allows. In the field, waterless hand cleaners and alcohol are available for handwashing; hands are to be thoroughly cleaned as soon as the necessary facilities are available.

C. Cleaning Procedures
Non-critical types of equipment such as spinal immobilization devices, stretchers, pneumatic anti-shock garments, etc. are to be thoroughly cleaned with hot water and disinfectant detergents, such as a 1:10 dilution of bleach. The pneumatic anti-shock garment may also be placed in a standard washing machine using the hot water setting and laundry detergent, a 1:10 dilution of bleach, or hydrogen peroxide, but only after first wiping off blood or other fluids with hot soapy water or detergent disinfectant solution. Make sure that air valves are closed. After washing, the fabric may be air dried or placed in a dryer.

Critical items that come in contact with mucous membranes but are not disposable, such as laryngoscope blades require high level disinfection with a Cidex or 70% Isopropyl alcohol solution for at least thirty (30) minutes.

Always wear gloves when cleaning and disinfecting pre-hospital equipment.

1. Interior of Transport Vehicles
For the interior of transport vehicles, routine and consistent cleaning procedures with detergent disinfectants and hot water will provide adequate decontamination. The use of bleach is not recommended since repeated applications corrode metal and may damage some equipment.

2. Care of Clothing
Routine laundering practices are adequate to decontaminate clothing that is soiled with blood or body fluids, utilizing hot water (106 F) and detergent.

3. Ineffective Procedures
All disinfectants require a clean surface before they can work.

The spraying of disinfectants is not recommended. Sprays are applied unevenly so that the amount sprayed may not disinfect the area adequately. Spray disinfectants can cause electrical equipment to malfunction.

D. Types of Disinfectants and Antiseptics:

1. Bleach

a. Uses
As a powerful anti-microbial agent, bleach is recommended for cleaning up fresh un-dried blood spills or surfaces that are difficult to clean. Good disinfectant for plastic materials.

b. Concentration
1:10 dilution (5000ppm) = 1 cup of bleach to 9 cups water (slightly more than ½ gallon).

c. Contact time
Thirty (30) minutes.

d. Precautions
Highly corrosive to metal even at low concentrations. Can hamper the function of electrical connections and electronic equipment. Can decolorize fabrics. Undiluted and 1:10 dilutions can cause eye, skin and respiratory irritations.

2. Alcohol, 70% Isopropyl

a. Uses
Can be used around electrical connections and electronic equipment because it leaves no ionic residue and does not corrode metal. A good skin antiseptic; the primary anti-microbial ingredient of most waterless handwashing products.

b. Contact time
Five (5) to thirty (30) minutes for high-level disinfection.

c. Precautions
Equipment must be immersed for disinfection; not recommended for disinfection of surfaces that cannot be immersed since it evaporates quickly. Flammable; inactivated by the presence of blood and dirt; can stiffen and crack plastic. May dry and irritate the skin.

3. Glutaraldehyde, 2%

a. Uses
Powerful disinfectant; can kill bacterial, fungi, viruses. Most commonly utilized for respiratory equipment disinfection. Can work in the presence of blood and dirt. Acid glutaraldehydes do not corrode metal; most brands will not affect plastic or rubber.

b. Contact time
Ten (10) to thirty (30) minutes for high-level disinfection.

c. Precautions
Alkanalized glutaraldehydes will corrode and stain high-carbon metals such as stainless steel and leave residue on same. Unstable, expensive products that must be mixed freshly with each use to maximize effectiveness. Must never be used to disinfect environmental surfaces. Can cause burns on human skin and mucous membranes and are eye and respiratory irritants.

4. Hydrogen Peroxide

a. Uses
Good for dissolving dried blood and body fluids from the surfaces of equipment. Can be used as a skin and oral antiseptic.

b. Concentration
3%

c. Contact time
Reacts immediately upon contact.

d. Precautions
A 3% solution is not considered a disinfectant, so cleaning and decontamination are still required.

5. Iodophors

a. Uses
Excellent skin antiseptics

b. Concentration
Varies with product.

c. Contact time
Must dry in air for maximum effectiveness

d. Precautions
Not recommended for disinfecting equipment. Corrode metal, dissolve rubber, crack plastic and stain metals. Can irritate fresh, open wounds or burns.

6. Phenolics and Quaternary Ammonium Compounds

a. Uses
Common classes of hospital environmental disinfectants.

b. Concentration
See manufacturers recommendation.

c. Contact time
See manufacturers recommendation.

d. Precautions
Should not be used to disinfect equipment; leave ionic residues; if used consistently for routine cleaning, these compounds must be stripped periodically from all surfaces. Affect the function of electrical and electronic equipment. Must be used exactly in accordance with label instructions. Material Safety Data Sheets should be obtained for these products.

7. Detergent Disinfectants

a. Uses
For cleaning and decontaminating environmental surfaces, non-critical equipment and laundering. Available in grocery stores. The words "disinfectant" and "detergent" are clearly visible on the label. Registered with the EPA because they are labeled as disinfectants.

b. Concentration
See label instructions.

c. Contact time
See label instructions.

d. Precautions
See label instructions.

E. Significant Exposure

Definition: Significant Exposure means a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that resulted from the performance as an EMS provider.

1. Classifications of EMS Providers

a. EMS Students
b. Provisional EMT-I
c. Provisional EMT-P
d. Licensed EMT-B, EMT-I, EMT-P
e. Other ambulance service personnel

2. Procedure for Exposure Incident

a. Any EMS Students or EMS Systems member with significant exposure in the clinical setting (i.e. Emergency Department, ALS Unit,…) must report the incident to their educational supervisor/EMS System Coordinator.
b. Any EMT or other ambulance service/rescue personnel with significant exposure shall report the incident immediately to their agency supervisor, Director, Chief or Command Officer. The Individual must comply with the guidelines of their agency's "Exposure Control Program".
c. Complete a detailed incident report including, but not limited to the following:

1. documentation of the route(s) of exposure, and the circumstance under which the exposure incident occurred;
2. identification and documentation of the source individual.

d. Seek treatment at the emergency department of the hospital clinical site or where the source individual was transported, if transported to an emergency department.
e. If the patient was not transported to an emergency department, treatment should be sought at a local emergency department. NOTE: An EMS employer may require an individual to seek medical attention at a medical facility contracted with the EMS Agency to provide such services that is not an emergency department.
f. Complete follow-up care as directed.