international trauma life support for emergency care providers chapter seventh edition standard...
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International Trauma Life Supportfor Emergency Care Providers
CHAPTER
seventh edition
Standard Precautions in the Prehospital Setting
22
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
Precautions
Courtesy of Louis B. Mallory, MBA, REMT-P
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
Overview
• Bloodborne viral illnesses– Most common for EMS exposure
• Signs and symptoms of tuberculosis– Protective measures
• Potentially infectious materials precautions
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
Overview
• Appropriate personal protective equipment use
• Accidental exposure procedures• Multidrug-resistant organisms• Vaccines and immunizations
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
Standard Precautions
Exposure does not mean infection. Exposure can be treated.
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
Standard Precautions
• Common bloodborne viral infections– Hepatitis B (HBV)– Hepatitis C (HBC)– HIV infection
• Primary modes of exposure– Contaminated blood – Other potentially infectious materials (OPIM)
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
Potentially Infectious
• Other potentially infectious materials:– CSF– Synovial fluid– Amniotic fluid– Pericardial fluid– Pleural fluid– Body fluid with
gross visible blood
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
Potentially Infectious
• Only with gross visible blood– Tears– Sweat– Saliva– Urine– Stool– Vomitus– Nasal secretions – Sputum
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
Viral Hepatitis
• Viral infections involving liver:– Fecal transmission: Types A, E– Bloodborne transmission: Types B, C, D
Type D only with Type B
• Prevention is best treatment!
Courtesy of Louis B. Mallory,MBA, REMT-P
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
Hepatitis B (HBV)
• Modes of exposure– Contaminated blood – Other potentially infectious materials (OPIM)– Sexual transmission– Direct contact with nonintact skin
• Health care risk of infection: 6–30%– Needlestick exposure to HBV blood
and no vaccination or immune response
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
Hepatitis B (HBV)
• High-risk groups– Immigrants from
areas HBV is prevalent
– Incarcerated – Institutionalized– IV drug users
– Male homosexuals– Hemophiliacs– Household contacts– Hemodialysis
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
Hepatitis B (HBV)
• Clinical manifestation– Acute hepatitis– Chronic hepatitis– Cirrhosis– Liver cancer
• Chronic carrier risk: 5–10%
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
Hepatitis B (HBV)
• Health care protection– Hepatitis B vaccines
Does not contain antibodies Lifelong protection Effective immunity in 90%
– Hepatitis B immunoglobulin Contains antibodies Passive protection for 6 months Effective immunity in 70%
Courtesy of Louis B. Mallory, MBA, REMT-P
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
Hepatitis C (HBC)
• Modes of exposure– Contaminated blood – Other potentially infectious materials (OPIM)– Sexual transmission– Direct contact with nonintact skin
• Health care risk of infection– Needlestick exposure to HCV blood: 1.5%
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
Hepatitis C (HBC)
• Clinical manifestation– Less severe than HBV
• Chronic carrier risk > HBV risk– Liver failure, cirrhosis 10–20% of carriers
• Health care protection– Vaccine not available– Immunoglobulin (IG) not shown effective
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
HIV Infection
• Modes of exposure– Contaminated blood – Other potentially infectious materials (OPIM)– Sexual transmission– Direct contact with nonintact skin
• HIV does not survive outside body– No special cleaning agents are required– Transmitted less efficiently than HBV
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
HIV Infection
• Health care risk of infection – Needlestick exposure to HIV blood: 0.3%– Mucosal or nonintact skin exposure: 0.09%– Large amounts HIV blood
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
HIV Infection
• High-risk groups– Male homosexuals– Bisexuals– IV drug users– Transfused
Blood, pooled-plasma
– HIV sexual contact
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
HIV Infection
• Clinical manifestation– Immune system defective– Higher risk of unusual infections– Many are asymptomatic
• Chronic carrier risk: 100%– All HIV infected can transmit HIV– Current HIV treatment reduces risk
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
HIV Infection
• Health care protection– Vaccine not available– Antiretroviral drug regimen
Prolongs life, does not cure May reduce risk of infection by significant exposure
if administered “within hours, not days”– Recommended for Highest Risk exposures– Possible benefit for Increased Risk exposures– Unlikely benefit for Low Risk exposures
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
Tuberculosis
• Mycobacterium tuberculosis– Deadliest infectious disease globally– Not highly communicable
• Mode of exposure– Direct contact through air, cough, sneeze
• Preventive measure– Place surgical mask on any suspected patient
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
Tuberculosis
• Health care risk of infection– Up to 5% skin test positive
in high-prevalence environment
• High-risk groups– HIV infected– Immigrants from TB prevalent– Homeless– Live in congregate settings
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
Tuberculosis
• Clinical manifestation– Severe cough >3 weeks with two or more:
Chest pain Bloody sputum Weakness or fatigue Unexplained weight loss Loss of appetite Fever, chill, night sweats Hoarseness Courtesy of Louis B. Mallory, MBA, REMT-P
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
Tuberculosis
• Health care protection– TB infection
(no active disease) Isoniazid (INH)
or rifampin for 6–9 months
– TB disease Antibiotic agents
© Pearson
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
XDR-TB
• Extensively drug-resistant TB– Resistant to:
2 first-line oral antibiotics AND 2 first-line IV antibiotics
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
Multidrug-Resistant Organisms
• Resistant to 2 first-line antibiotics• Increasing since 1960s
– Hospital-associated infections– MRSA most prevalent– CA-MRSA (Community Acquired-MRSA)
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
Multidrug-Resistant Organisms
• Prehospital care personnel at low risk– Gloves– Handwashing– Cleaning surfaces and equipment
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
Precautions for Prevention
• Be knowledgeable• Bandage lesions• Routine handwashing• Immunizations• Report exposures
Courtesy of Louis B. Mallory, MBA, REMT-P
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
If exposed,wash exposed area
Immediately.
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
Reporting Exposures
• Contact designated official– Determines if exposure occurred– Interacts with medical facility– Coordinates needed tests
• Write incident report soon as possible– EMS report may supplement, but not replace
• Know local laws– Confidential exposure report form in U.S.
International Trauma Life Support for Emergency Care Providers, Seventh EditionJohn Campbell • Alabama College of Emergency Physicians
Summary
• Health-care workers are at risk of exposure to many contagious diseases
• Prevention:– Health-care workers should be HBV
immunized– Knowledge of modes of exposure, adherence
to barrier precautions, and postexposure medical follow-up reduce risk of infection