enhancing personal protection against airborne pathogens n.h. dept. of safety - bureau of ems...

ENHANCING PERSONAL PROTECTION AGAINST AIRBORNE PATHOGENS

N.H. DEPT. OF SAFETY - BUREAU OF EMS

AIRBORNE PATHOGENS WORKGROUP

UPDATED VERSION - 2009

5/09 NH Bureau of EMS - Airborne Pathogens 2

NOTE TO INSTRUCTORS• FOR YOUR CONVENIENCE WE HAVE INCLUDED SPEAKER’S

NOTES TO SOME SLIDES THAT FURTHER DISCUSS SOME TOPICS.

• TO ALERT YOU THAT A SLIDE HAS SPEAKER’S NOTES THE TITLE AT THE TOP OF THE SLIDE WILL BE IN ORANGE INSTEAD OF YELLOW.

• PLEASE FEEL FREE TO CONTACT US REGARDING QUESTIONS OR SUGGESTIONS ABOUT SPEAKERS NOTES FOR THIS PRESENTATION

• DELETE THIS SLIDE BEFORE PRESENTING TO AN AUDIENCE


INTRODUCTION

THIS EDUCATIONAL PROGRAM IS INTENDED TO...

• ENHANCE THE EMS PROVIDERS’ KNOWLEDGE OF RESPIRATORY COMMUNICABLE DISEASES AND,

• IMPROVE THEIR ABILITY TO PROTECT THEMSELVES AGAINST AIRBORNE PATHOGENS


INTRODUCTION

• THIS PROGRAM IS INTENDED TO BE ADDED TO EXISTING EXPOSURE CONTROL PLANS


COMMUNICABLE DISEASESDISEASES MAY BE TRANSMITTED FROM PERSON

TO PERSON BY SEVERAL ROUTES:• DIRECT CONTACT• INDIRECT CONTACT/FOMITES• BLOOD AND BLOODY BODY FLUIDS• VECTORS• DROPLET INFECTIONS• AIRBORNE INFECTIONS


HANDWASHING

THE SINGLE MOST IMPORTANT CONSIDERATION IN AVOIDING THE

SPREAD OF ANY DISEASE IS FREQUENT AND THOROUGH HANDWASHING


SARS

• SEVERE ACUTE RESPIRATORY SYNDROME (SARS) WAS THE DRIVING FORCE BEHIND THIS EFFORT

• SARS IS A DEADLY DISEASE FOR WHICH THERE IS CURRENTLY NO VACCINE AND NO CURE

• AS OF EARLY 2006 SARS WAS NOT A CURRENT THREAT ANYWHERE IN THE WORLD

• BUT SARS ISN’T THE ONLY DISEASE WE SHOULD BE WORRIED ABOUT….


HEADLINES

• April 2009 - Swine Flu Outbreak Could Result in Worldwide Pandemic

• 2006 - Ten children in Colorado dead from flu - AP

• 2005 - Boy, 7, dies of the flu: Outbreak grows; run on vaccine - San Francisco Chronicle

• 2005 - Flu Vaccine Shortage

• 2004 - College student dies as flu rises - Boston Globe

• 2003 - Bacterial meningitis cluster hits NH, 4 children in critical condition, 18 year old dead


THE FOLLOWING OTHER DISEASES ARE AMONG THOSE TRANSMITTED BY THE RESPIRATORY ROUTE

• INFLUENZA (INCLUDING SWINE FLU & AVIAN FLU)

• COMMUNITY ACQUIRED PNEUMONIA

• COMMON VIRAL UPPER RESPIRATORY INFECTION

• RHINOVIRUS

• MEASLES

• MENINGITIS

• TUBERCULOSIS

• INHALATIONAL ANTHRAX

• THE DISEASE WE DON’T KNOW ABOUT YET...


DO YOU WANT YOURSELF OR YOUR FAMILY EXPOSED TO ANY OF THOSE?

NO?YOU CAN PROTECT YOURSELF...

MOST OF THE DISEASES ON THE LAST SLIDE REQUIRE A RELATIVELY SIMPLE LEVEL OF PROTECTION, BUT…..

BECAUSE OF THE NATURE OF THE SARS VIRUS AND CONSIDERATIONS FOR PROTECTING AGAINST A NOVEL INFLUENZA EPIDEMIC A HIGHER LEVEL OF PROTECTION NEEDS TO BE IN THE PLAN


MASKS

TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (APPE) ARE AVAILABLE & PRACTICAL FOR EMS:

SURGICAL MASK N-95 MASK


MASKS

• A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS

• STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER

• SURGICAL MASK REQUIRES NO FIT TESTING


MASKS

• AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS, AND AVIAN FLU PATIENTS

• FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS, A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL

• FIT TESTING DETERMINES:– WHICH SIZE MASK TO WEAR,

– WHETHER A PROPER SEAL IS POSSIBLE

– WHETHER THE EMS PROVIDER HAS ANY MEDICAL CONTRAINDICATIONS TO USING AN N-95 MASK


MASKSA PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL

REASONS (SUCH AS A BEARD)

OTHER OPTIONS, SUCH AS AVOIDING PATIENT CONTACT OR USE OF A POWERED BREATHING

DEVICE MAY BE REQUIRED


HOW WILL YOU KNOW WHICH TO USE?

THE NH BUREAU OF EMS RECOMMENDS THAT THE USE OF AIRBORNE PPE (APPE) BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS



IN EARLY FALL OF 2003 A MULTI-DISCIPLINARY TEAM, SPONSORED BY THE NHBEMS CAREFULLY CONSIDERED THE ENVIRONMENT IN WHICH EMS PROVIDERS PRACTICE, AND RESEARCHED THE APPROPRIATE DEVICES FOR PROVIDERS’ USE.

THIS TEAM DEVELOPED GUIDELINES FOR NH EMS PROVIDERS

THESE GUIDELINES ARE CONSISTENT WITH OR EXCEED CURRENT CDC RECOMMENDATIONS


RATIONALE

• AT THIS TIME THERE’S NO WAY FOR EMS PROVIDERS TO ACCURATELY DETERMINE THE NATURE OF A PATIENT’S RESPIRATORY ILLNESS IN THE FIELD

• AN N-95 MASK IS AS EFFECTIVE AS (OR BETTER THAN) A SURGICAL MASK AT PROTECTING A HEALTHCARE PROVIDER FROM AIRBORNE PATHOGENS

• THE BEST WAY TO DEVELOP A GOOD HABIT IS TO PRACTICE IT OFTEN

• ADHERING TO THE “KEEP IT SIMPLE” (KISS) PRINCIPLE IS A GOOD IDEA



THEREFORE….

THE NHBEMS GUIDELINES ADVOCATE THE USE OF N-95 MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE


SO REMEMBER…

N-95 MASK FOR YOURSELF

&

SURGICAL MASK OR O2 MASK FOR YOUR PATIENT


YOU REALLY WANT ME TO PUT A SURGICAL MASK ON A PATIENT?

• YES, BASED ON THE CRITERIA WE’RE ABOUT TO DISCUSS

• IF THE PATIENT DOESN’T NEED O2 PUT A SURGICAL MASK ON THEM

• IF THEY DO REQUIRE OXYGEN APPLY A FACE MASK AT THE PROPER LITER FLOW

• OXYGEN FACE MASKS MAY BLOCK DROPLETS BUT PROBABLY NOT AIRBORNE PATHOGENS

• YOU MIGHT CONSIDER PUTTING A SURGICAL MASK OVER THE OXYGEN MASK

• DRAWBACK - CAN’T OBSERVE FOR CYANOSIS OF LIPS


WHEN SHOULD YOU BE THINKING ABOUT APPLYING

APPE?

• DISPATCH INFORMATION• SCENE SAFETY ASSESSMENT• PATIENT ASSESSMENT


WHEN SHOULD YOU CONSIDER APPLYING APPE?

DISPATCH INFORMATION– RESPIRATORY DISTRESS, SOB, DIFFICULTY

BREATHING– FEVER– RASH– “SICK PERSON” or “ILL CALL”

SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE



SCENE SAFETY ASSESSMENT• AT THE DOORWAY ENTERING THE ROOM

- IS THE SCENE SAFE?• IS THE PATIENT COUGHING?

– IF YES, YOU SHOULD APPLY YOUR MASK BEFORE PROCEEDING



PATIENT ASSESSMENT• IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF

COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE:

• DOES THE PATIENT HAVE A FEVER?• PT/CAREGIVER HAS TAKEN A TEMP• PT THINKS HE/SHE HAS A FEVER• EMS PROVIDERS TAKE A TEMP

• IS THE PATIENT COUGHING?• DOES THE PATIENT HAVE A RASH?


IF YES TO ANY OF THE PREVIOUS QUESTIONS…. • AND YOU HAVEN’T PUT APPE ON YET - YOU

SHOULD BE DOING IT NOW• ALSO, ASK IF THE PATIENT HAS BEEN OUTSIDE

THE USA WITHIN THE PAST 10 DAYS. IF SO, DOCUMENT WHERE THEY TRAVELED

5/09 26

APPE ALGORITHM

CHIEF COMPLAINT

TYPICAL PQRST QUESTIONS

IS PATIENT

COUGHING?

YES NO

MAY FEVER

APPLY PRESENT?

APPE

NO YES

DOES PT APPLY

HAVE RASH? APPE

YES NO

APPLY APPE MAY NOT

APPE BE NECESSARY


YOU MADE THE DECISION TO APPLY APPE NOW EVALUATE THE EFFECTIVENESS

• IS THE PATIENT’S MOUTH & NOSE COVERED?

• ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS?

• HAVE YOU EVALUATED THE SARS OR PANDEMIC FLU (PF) RISK?– ALERT LEVEL– CLINICAL CRITERIA– TRAVEL TO AT RISK AREA– CONTACT WITH ILL PATIENT


IF HIGH LIKELIHOOD OF PF*/SARS

• ENSURE N-95 MASKS ARE USED– BY FIT TESTED PERSONNEL– USING THE RIGHT SIZE MASK

• ALSO USING EYE PROTECTION, GLOVES, GOWN, CAP & BOOTIES

• AND OTHER PF/SARS PROTECTION

* PF – pandemic flu


OTHER PF/SARS PROTECTION

• LIMITATION OF PERSONNEL• ISOLATE THE PATIENT COMPARTMENT

OF THE AMBULANCE IF POSSIBLE• LIMITING SOME PROCEDURES (i.e. Nebulizer )

• HEPA FILTRATION - BVM, SUCTION• DISINFECTION PRACTICES• BIOHAZARD WASTE DISPOSAL

PRACTICES - MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE


OTHER CONSIDERATIONS

• ADVISE THE EMERGENCY DEPT. THAT RESPIRATORY PRECAUTIONS ARE IN PLACE, EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS

• ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE


CLEANING / DISINFECTION• AIR OUT PATIENT COMPARTMENT OF AMBULANCE• WEAR PPE DURING CLEANING & DISINFECTION PROCESS• WIPE UP FLUIDS USING PAPER TOWELS. DISCARD PAPER

TOWELS IN RED BAG.• SATURATE AREA WITH CLEANSING AGENT. WIPE AREA

REMOVING ALL POSSIBLE ORGANIC MATERIAL. REPEAT UNTIL AREA LOOKS CLEAN.

• SATURATE AREA WITH DISINFECTANT. ALLOW MINIMUM 10 MINUTES CONTACT TIME.

• WIPE UP DISINFECTANT, RINSE, AIR DRY.• DISPOSE OF CONTAMINATED MATERIALS AND PPE IN

BIOHAZARDOUS WASTE CONTAINER.• WASH YOUR HANDS !!!Adapted from Holdsworth & Associates © 1993 & CDC guidelines


CLEANING / DISINFECTION• DISINFECTANTS MUST BE LIQUID OR PUMP SPRAY AND

RATED AS TUBERCULOCIDAL• A SOLUTION OF 1 PART BLEACH TO 10 PARTS WATER IS

ACCEPTABLE IF MIXED AT THE TIME OF USE OR WITHIN THE PREVIOUS 24 HOURS.

• CONSULT CONTAINER LABEL, MSDS, OR MANUFACTURER’S SAFETY RECOMMENDATIONS BEFORE USING CHEMICALS.

Adapted from Holdsworth & Associates © 1993 & CDC guidelines


SAFE REMOVAL / DISPOSAL OF PPE

• SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL & DISPOSAL OF PPE.

• PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK, DISPOSABLE GOWNS, BOOTIES, ETC.) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING.

• ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS.

• MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED, FOLLOWED BY GLOVES.

• THOROUGH HANDWASHING WITH EITHER SOAP & WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED.


SUMMARY

BASIC INFECTION CONTROL PRACTICES - UNIVERSAL PRECAUTIONS, FREQUENT HANDWASHING, DISINFECTION, ETC. ARE AN IMPORTANT PART OF EMS PRACTICE

THIS PROGRAM’S EMPHASIS ON AIRBORNE PRECAUTIONS FOR CERTAIN PATIENTS IS A MODULE TO FIT INTO YOUR OVERALL EXPOSURE CONTROL PLAN

IF YOU FOLLOW THESE GUIDELINES THE LIKELIHOOD THAT YOU WILL CONTRACT PF/SARS ON THE JOB IS SIGNIFICANTLY DECREASED


SUMMARY

THIS PROGRAM IS INTENDED AS A BASELINE FOR ALL EMS PROVIDERS.

SOME AGENCIES MAY ELECT TO PROVIDE A MORE EXTENSIVE TRAINING PROGRAM TO ALLOW EMS PROVIDERS TO CHOOSE BETWEEN USING A SURGICAL MASK OR N-95 MASK.

THE NH BEMS CONSIDERS THAT AN ACCEPTIBLE OPTION.

IN THE ABSENCE OF SUCH TRAINING THE GUIDELINES SUGGESTED IN THIS TRAINING PROGRAM ARE STRONGLY RECOMMENDED.


THIS PROGRAM IS A WORK IN PROGRESS

• THE NH BEMS BELIEVES THIS INFORMATION TO BE ACCURATE AS OF MAY 2009

• AS INFORMATION CHANGES WE WILL REVISE THE PROGRAM AS NEEDED

• REFER TO NH BEMS WEBSITE FOR UPDATEShttp://www.nh.gov/safety/divisions/fstems/ems/index.html


FOR FURTHER INFORMATION PLEASE CONTACT

BILL WOOD

EMERGENCY PREPAREDNESS COORDINATOR

NH BUREAU OF EMS

33 HAZEN DRIVE

CONCORD, NH 03305

603-223-4228

[email protected]


WILL EMERGENCY PERSONNEL WEAR MASKS ?

Seattle Police force during the 1918 Spanish Flu epidemic that killed 500,000 Americans. This strain of influenza seemed to target those aged 20 - 40


QUESTIONS AND COMMENTS

5/09 40

THANKS….

MEMBERSHIP OF AIRBORNE PATHOGENS WORK GROUP FALL 2003

NH Fire Chiefs Assoc. vacantNH DHHS Nicola WhitleyPublic Health Elisabeth Talbot, MDNH Hosp. Assoc. Kathy BizarroHospital EMS Coordinators Doug MartinNH EMT Assn. Dennis RickeyNHPA Clay OdellPFFNH Andrew WhitePolice S&T vacantDispatch Assoc. vacantFire S&T Andy AndersonInfection Control Nurse Barbara AndersonEMS Instructor rep. Doug MartinOccupational Health provider Diane RobertsNH Municipal Assn. vacantNH Ambulance Association Tinker KiesmannNH EMS Medical Control Board Joseph Sabato, MDEMS Coord. Board rep. Diane RobertsVolunteer/rural services vacantEmergency physician Robert Gougelet, MDNH Bureau of EMS Bill WoodNH Bureau of EMS Kathy Doolan

enhancing personal protection against airborne pathogens n.h. dept. of safety - bureau of ems...

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