Communicable DiseasesEMT REFRESHER NCCP 2018

JTEMPLE

When are Standard Precautions used?

The use of Standard Precautions during patient care is determined by the

nature of the anticipated interaction with the patient.

For example:

IV start always requires gloves

Intubation requires gloves, face shield or mask and goggles.

Respiratory symptoms require mask, gloves and eye protection

Rash—gloves and mask

Trauma—gloves and face protection

What is Personal Protective Equipment?

(PPE)

Hand Hygiene

Gown

Gloves

Mask

Face shield

Eye protection

PAPRs

Epidemic5

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Pandemic6

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Handwashing

101

Wash Your Hands…RNs: 71 – 95%

DOCs: 60 – 80%Medics:

1 – 34%

EMS Handwashing

Urban EMS System – Minneapolis, MN: 6 month study

Medics:

1.1% prior to patient contact

62.8% after patient contact

19% before meals

59.5% after meals

CDC Recommendations

Remove all jewelry

Wet hands with running water, apply soap…

Scrub back of hands and under nails

Rub hands for at LEAST 20 seconds!

Rinse under running water

Dry with CLEAR towel or air dry

Alcohol based hand cleaner

At least 60% alcohol

Reduce germs, nor eliminate germs!

Do NOT kills viruses, just make living conditions

tough!

Hand sanitizer is not effective when hands are

visibly dirty!

EMS Vaccines (CDC Recommended)

Hepatitis B

Influenza (Seasonal)

MMR (Measles Mumps, Rubella)

Varicella

Pertussis

Seasonal Influenza

Three strains circulating in Iowa

H1N1 ( Influenza A-covered)

Influenza B (covered)

H3N2 (Influenza A-covered)

Influenza A is always more severe than B. Seasons in

which A viruses dominate tend to be more severe, with

more hospitalizations and deaths

Antiviral medications are effective if given as indicated

What is influenza

Respiratory illness:

Fever, cough, muscle aches, sore throat, tiredness

Complications:

Pneumonia and other bacterial illnesses

Treatment:

Antiviral medications (Tamiflu and Relenza)

Shorten the duration of fever and illness symptoms

Reduce risk of complications

Reduce risk of death

Influenza

Incubation phase

1-4 days

Adults are contagious from the day BEFORE

symptoms begin THROUGH 5-10 days after

onset.

Manufactured in eggs

Manufactured in eggs

Takes six months to

manufacture adequate

vaccine

Patient’s allergic to eggs

should not receive the

vaccine.

16

Influenza Vaccine

Most effective if given within 2-4 months of illness

90% effective in preventing illness in

the healthy

50-60% effective at preventing

hospitalization in elderly

80% effective at preventing death

17

Healthcare Flu Vaccination

Historic rates of 34% for healthcare workers

Leading cause of occupational illness and risk of spread to patients

In pandemic planning we need to increase

18

Influenza Vaccine (Injection)

Side effects

The viruses in the flu shot are killed (inactive), so you

CANNOT get the flu from the flu shot (CDC)

Soreness, redness or swelling where the shot was given

Fever (low grade)

Malaise

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Disease and Injury Surveillance

EMS is in a unique position!

First contact

Notice any trends

Common symptomatic presentations

Geographical areas

Reporting

Know who the contact is…EMA, Public Health

Know when to report (Policy)

Software keeps a watchful eye on this information!

Prevention

Flu Vaccine

PPE

Mask

Gloves

Eye protection

Hand hygiene

MRSA

Standard Precautions in most

cases is enough

Open/draining wounds may

require Contact Precautions

be used during transport

Basic Component of Contact Precautions

for EMS

Component Recommendations

Patient Transport Open/draining wounds are

covered and drainage contained

Gloves For touching intact skin or surfaces

and articles close to the patient

Gown For interactions that may result in

contamination of clothing

Patient care equipment Dedicated when ever possible and

clean and disinfect after use

Environmental control Follow procedures for cleaning

and disinfection of surfaces

Myths

The elderly, for the most part are the only people who contract sepsis.

Sepsis only affects people with pre-existing conditions.

Sepsis is the same thing as blood poisoning (septicemia).

Sepsis and septic shock are always fatal.

Incidence

Over 750,000 patients are diagnosed with sepsis

annually, with an increase of 90% in the number of

diagnoses over the last 10 years.

The cause for this is believed to be the rise of drug-

resistant bacteria

Mortality

In otherwise healthy individuals, the mortality rate for

sepsis is 5%

If severe sepsis develops, mortality rises sharply

If hypotension (the hallmark of septic shock) is present,

mortality rises to 50%

At-Risk Populations

Elderly, infants, surgical patients, chronically ill and immuno-

supressed patients are all at increased risk of contracting sepsis

because of compromised or diminished immune function.

The mortality rates for these catagories are also raised.

Definitions

a. Sepsis – a SIRS response triggered by infection

b. Septicemia – sepsis originating from an infection in the bloodstream

c. Systemic Inflammatory Response Syndrome –systemic (bodywide) immune response meeting two or more of the following criteria

i. Temperature above 100.4 ˚F , below 96.8 ˚F

ii. HR > 90 bpm

iii. RR > 20 or PaCO2 < 32 mmHg

iv. Extreme high/low WBC count

S/S of Sepsis

a. Chills, low grade fever,

shaking, body aches, N&V,

vertigo, other flu-like symptoms

b. Occasional AMS including

confusion, lethargy and

increased fatigue

Purpura/rash in

children with sepsis

caused by

meningococcal

infection

Influenza vs. Sepsis

Sepsis can be misdiagnosed as

the flu because symptoms are

nearly identical often. Try to rule

out sepsis when considering a

diagnosis of influenza.

Sources of Infection

Dirty wounds (debris)

Complex wounds (open fractures)

Burns

Puncture wounds

Impaled Objects

Crush Injuries

Infected Wounds

Assessment

a. ABCs, manage critical problems

b.Complete SAMPLE hx

i. How long has pt been ill?

ii.Is there any hx of infections?

iii. Prior medical complications/conditions?

iv. Any surgeries?

v. Pain or fever?

c. Complete physical exam

i. Sick/Not Sick

ii.Signs of infection?

EMS Patients were more likely to – Elderly

– Female

– From Nursing home

– Abnormal vital signs

• Tachycardia

• Hypoxia

• Hypotension

– Higher serum Lactate Levels

– Higher comorbid conditions

– Organ Dysfunction

– 4 times great chance of presenting in severe sepsis

SIRS Criteria (2 or more)

Can be due to infection or trauma:

Temp >38°C (100.4°F) or < 36°C (96.8°F)

Heart Rate > 90

Respiratory Rate > 20 or PaCO2 < 32 mm Hg

WBC > 12,000, < 4,000 or > 10% bands

www.survivingsepsis.

org

Sepsis Criteria SIRS + Suspected or known source of infection

Severe Sepsis Criteria

“Sepsis induced tissue hypoperfusion”

Lactic acidosis: lactate > 4 (?)

Hypoperfusion: SBP < 90 or SBP > 40 below baseline

Severe Sepsis Criteria“Sepsis induced tissue hypoperfusion”

Lactic acidosis: lactate > 4 (?)

Hypoperfusion: SBP < 90 or SBP > 40 below baseline

Urine < 0.5 mL/kg/hr for > 2 hrs despite adequate fluid resuscitation

PaO2/FiO2 < 250 without pneumonia

PaO2/FiO2 < 200 with pneumonia

Creatinine > 2 mg/dL

Bilirubin > 2 mg/dL

Platelet count < 100,000 L

Coagulopathy (INR > 1.5)

MODS Criteria

Evidence of > 2 organs failing

What is acute organ dysfunction and how do we asses

it?

Balk RA. Crit Care Clin 2000;16:337-352

Identifying Acute Organ Dysfunction

as a Marker of Severe Sepsis

Tachycardia

Hypotension

Altered CVP

Altered PCWP

Oliguria

Anuria

Creatinine

Platelets

PT/APTT

Protein C

D-dimer

Jaundice

Enzymes

Albumin

PT

Altered Consciousness

Confusion

Psychosis

Tachypnea

PaO2 <70 mm Hg

SaO2 <90%

PaO2/FiO2 300

Thank You!