LO4 step 1

1.4 has a nice chart to use as well

government agencies for protection of health of general public on a national level

• health canada

• public health agency of Canada

role of public health department

• protection from disease

• prevention of epidemics

• management of outbreaks

blood borne pathogens

• microorganisms in human blood

• can cause disease

• HBV, HIV

• cannot go through skin

host defence mechanisms

• skin

• mucous membranes (tears, lining)

• cells in respiratory tract produce lysozymes that destroy bacteria

• macrophages trap and destroy bacteria

• goblet cells line GI tract and make it too acidic or alkaline for bacteria

• immune system has proteins that kill viruses

communicable disease

can be transferred from one person to another in certain circumstances

airborne transmission

• transmission when expelled from respiratory tract

• float in air for long enough to be inhaled by another person

• TB, measles, varicella

droplet transmission

• transmission in large respiratory droplets

• only travel about 1-2 meters

• can be inhaled or enter through mucus membranes

• can be picked up off of surfaces

• cause symptoms of acute respiratory illness

contact transmission

• picked up from the environment

• transferred to non-intact skin or mucous membranes

• pink eye, impetigo

vehicle transmission

• transmitted when contaminated food is ingested

• direct contact with contaminated blood (used needle)

vector borne transmission

• transferred to humans through a carrier (flea)

• infection occurs when bitten or stung by carrier

bacteria

• grow and reproduce outside of human cells

• need an environment with proper temperature and nutrients

• can multiply inside of host

virus

• smaller than bacteria

• can only multiply inside of host

• cannot survive in an exterior environment

fungi

• usually acquired via contact with decaying matter

• can be acquired through airborne spores

• often infect people with compromised immune systems

parasites

• live on or in another living creature

• Protozoa- single celled

• helminths- invertebrates with long bodies (worms)

virulence

the ability for an organism to invade and create disease in the host

mode of entry

most organisms need the correct mode of entry to infect

host resistance

ability to fight off infection

incubation period

• stage between exposure and symptoms

• organism multiplies during incubation

communicable period

• the period where a person can transmit the disease

• some diseases are communicable before symptoms are present

contaminated

• an object that has microorganisms on or in it

reservoir

• where organisms can live and multiply

health department responsibilities

• collection of data

• contact follow up

• immunization clinics

• outbreak investigations

routine practices components

• hand hygiene

• PPE

• sharps safety

• patient accommodation and transport considerations

• routine equipment cleaning

• routine vehicle cleaning and disinfection

when should hands be washed

• beginning and end of shift

• before and after patient contact

• before and after using PPE

• before invasive procedures

• after cleaning

• before leaving hospital

• before and after handling food

• before and after smoking

• after personal body functions

respirator mask should be used when

• coughing patient

• febrile patient without a known source

• patient with communicable disease

• blood or fluid splash is likely

• when aerosolization is likely

• when cleaning after infected patient

• when cleaning large amounts of fluid

when should gloves be used

• patient is febrile with no known source

• contact with membranes or non intact skin

• when non intact skin is on hands

• invasive procedures

• treating a patient with known communicable disease

• when cleaning vehicle

PPE order

• gown

• mask

• eye protection

• gloves

remove gloves first

prevention of injuries from sharps

• communication

• count number of sharps used

• dispose of sharps properly

• never leave sharps to be disposed by someone else

• never carry uncapped sharps in pockets

• never pass exposed sharps

• remain clear of person using sharp

• do not recap needles

• never bend or break a needle

post-exposure medical followup

• immediately seek medical care after exposure

• exposure to blood borne pathogens should aways be followed up on

• start with examination of source

exposure to blood borne pathogens can occur from

• contaminated needlestick

• blood/OPIM splattered into eye, nose or mouth

• blood/OPIM in contact with open area of skin

• cut with contaminated sharps

• human bites

infection control and prevention manual

• proper education and training

• compliance monitoring

• work restriction guidelines

assessment of infectious disease patients

• evaluate scene for danger

• initial assessment - ABCs

• prioritize treatment

• get history (travelling) and physical exam

• typical C/C are fever, nausea, rash, chest pain, trouble breathing

general treatment for infectious disease

• first focus on life threatening

• watch for dehydration and use IV

• dispose of sharps properly

• clean everything

measles (rubeola)

• highly communicable viral disease

• fever, conjunctivitis, and coryza

• onset of coughing, rash, and whitish grey spots on mouth

• transmission is airborne, droplets, and direct contact with secretions

  • communicable period is when symptoms appear

rubella

• viral

• low grade fever, headache, runny nose, swollen lymph glands, rash

• can cause deformities for pregnant women

• deafness, retardation, cataracts, heart defects

• transmission occurs by direct contact with nasopharyngeal secretions (droplets)

• incubation period is 12-24 days from exposure

• infected people can remain infectious 7 days after rash appears

mumps

• viral disease

• fever, swelling of one of the salivary glands, inflammation of testicles

• transmission occurs from droplets and direct contact with saliva

• incubation period is 16-18 days

• communicable period lasts 9 days after swelling

• wear gloves and do routine cleaning after treatment

• work restriction will apply

chickenpox

• highly contagious viral disease

• slight fever, photosensitivity, vesicular rash, scabbing of rash

• can lead to shingles when virus takes up residence in the ganglion of a nerve

• transmission by direct contact and droplets, also vesicular fluid

• incubation period is 10-21 days

• communicable period starts 1-2 days before rash and lasts 5 days after vesicles are apparent

• use surgical mask on patient, wear gloves

pertussis (whooping cough)

• disease caused by bacteria

• irritating cough, becomes paroxysmal after 1-2 weeks

• transmission through direct contact with discharges from mucus membranes, airborne droplets

• incubation period is 7-10 days

• highly communicable before paroxysmal, then negligible within 3 weeks

• patient wears mask, antibiotic treatment, good handwashing, and routine cleaning

meningitis

• inflammation of membranes that cover brain and spinal cord (meninges)

• bacterial (communicable) and viral (not)

• transmitted through droplets and direct contact with oral or nasal secretions

• sudden onset fever, severe headache, stiff neck, kerning sign, brudzinski sign, photosensitivity, pink rash that becomes purple

• almost always change in mental status

• projectile vomiting

• incubation is 2-10 days

• communicable as long as bacteria is present

kerning sign

patient cannot extend at knee when thigh is flexed because of stiffness in hamstring

brudzinski sign

passive flexing of the leg on one side causes similar movement in opposite leg

tuberculosis TB

• bacterial

• not highly communicable

• typical (communicable), atypical and extra pulmonary (not)

• persistent cough for over 3 weeks, nights sweats, headache, fever, fatigue, weight loss, hemoptysis, hoarseness, chest pain

• transmission by airborne droplets

• incubation period is 4-12 weeks

• only communicable when active lesion develops in the lungs and bacteria is expelled by coughing

• wear n95, give patient mask

pneumonia

• inflammation of the lungs caused by bacteria, viruses, fungi, or another organism

• leading cause of death in paediatric patients, infants

• many types

bronchiolitis

• infection of the lungs and airway, usually in patients 3-6 months in age

• usually viral

• coughing and wheezing with tachypnea and tachycardia

• transmission by airborne droplets

bronchitis

• inner walls of bronchioles become infected and inflamed

• soreness in chest and throat, congestion, wheezing, dyspnea, slight fever

• chronic bronchitis is coughing for 3 months per year, at least 2 consecutive years

laryngitis

• inflammation of voicebox from overuse, irritation, infection

• hoarseness, weak voice, sore and dry throat, cough

• usually viral, sometimes bacterial

croup

• inflammation of larynx and airway below it

• strongest during nighttime

• lasts 3-7 days

• loud harsh cough, fever, noisy inhalation, hoarseness, dyspnea

• viral

• primarily 5 years of age or younger

• spread by droplets

epiglottis

• life threatening causes the epiglottis and supraglottic tissue to swell

• usually 2-7 years of age

• difficulty breathing and swallowing, with stridor and drooling

• bacterial and is communicable by droplets

common cold

• viral

• upper respiratory infection

• cough, runny nose, sore throat, congestion, watery eyes

• no fever

• transmitted by droplets, coughing, hand to hand contact

respiratory syncytial virus

• leading cause of lower respiratory infection in vulnerable population

• sneezing, runny nose, nasal congestion, cough, fever

• moves to lower respiratory causing pneumonia, bronchiolitis, tracheobronchitis

• direct contact with droplets that don’t extend over 1m and direct contact with contaminated items

• incubation period 2-8 days

• wear gloves, wash hands, routine cleaning

mononucleosis

• caused by Epstein Barr virus

• virus grows in epithelium of oropharynx and sheds into saliva

• transmission through direct contact with saliva and blood transfusion

• incubation period is 4-6 weeks

• sore throat, fever, secretions from larynx, swollen lymph glands, malaise, anorexia, headache, muscle pain, enlarged liver and spleen

influenza

• virus

• 1 billion cases per year

• one of the top 10 causes of death in Canada

• droplet transmitted

• incubation 1-4 days

• communicable from day before symptoms to 5 days after onset

• fever, shaking chills, headache, muscle pain, malaise, loss of appetite, coughing, nasal discharge, hoarseness

• patient wears mask, respirator, routine cleaning

• history of travel outside of country should be reported

gonorrhea

• bacterial infection

• sexually transmitted, contact with pus from mucous membranes

• incubation period 2-7 days

• communicable until treated

• pus from urethra, pain urinating (male)

• mild inflammation of cervix followed by signs and symptoms of an acute abdomen

• may infect anus or throat

• gloves, thorough handwashing

syphilis

• bacterial infection causes chancres

• direct contact with infectious fluids from lesions

• can be transmitted from mother to fetus

• incubation 10 days - 3 months

• communicable is variable

• secondary infection causes patchy hair loss, skin rash, swollen lymph glands

• third stage can cause cardiac, ophthalmic, auditory or CNS complications

• gloves and handwashing

genital herpes

• chronic recurring viral illness

• type 1 (oral), type 2 (genital)

• vesicles around genitals and mouth

• incubation 2-12 days

• lesions are communicable for 4-7 days

• mother can pass to child during birth

• use gloves and handwashing

chlamydia

• bacterial

• asymptomatic in women at first

• pelvic inflammatory disease often occurs (women)

• may lead to epididymitis, prostatitis, proctitis, proctolitis

• transmission through sexual contact

• perinatal infection can cause premature rupture of membranes, stillbirth and premature birth

• incubation period is 7-14 days

• communicable period is unknown

• treat with antibiotics, wear gloves and handwashing

scabies

• parasite

• transmission through skin to skin contact

• incubation period 4-6 weeks

• communicable until eggs and mites are gone

• nocturnal itching, rashes on hands, wrists, axillary folds, ankles, toes, genitals, buttocks and abdomen

• wear gloves and handwashing, work restrictions may be ordered

lice

• head, body, and pubic louse

• parasitic insects

• acquired through direct contact with lice or eggs

• incubation 8-10 days until hatching

• communicable as long as lice and eggs are present

• gloves, handwashing, routine cleaning

viral hepatitis

• inflammation of liver caused by virus

• 6 types, ABC account for 90 percent of cases

Hepatitis B virus infection

• transmitted through sexual contact, blood transfusion, contaminated needles

• can survive in blood for 7 days outside of body

• incubation from 60-150 days

• symptoms start at 90 days

• loss of appetite, nausea, vomiting, general fatigue, malaise, fever, abdominal discomfort,

• second phase urine turns dark, jaundice, yellowing of sclera

• use gloves, get vaccinated, good handwashing

Hepatitis C virus infection

• transmission through blood transfusion, sexual contact, organ donation

• incubation 2-24 weeks

• same symptoms of HBV

• most common chronic blood borne disease

• use gloves, needle safety, hand washing, routine cleaning

hepatitis d virus infection

• host needs HBV for infection

• HDV is a parasite for HBV

• transmission through percutaneous exposure, rarely passed to fetus

• incubation 30-180 days

• blood is infectious during all stages

• use gloves, needle safety, handwashing, routine cleaning

• do not put hands where you can’t see them

hepatitis G

• usually accompanied by HBV, HCV or HIV

• transmitted through blood or blood products

• may not be an actual hepatitis virus

human immunodeficiency virs infection HIV

• primarily STD, also transferred rarely from mother to baby as long as treated

• can rarely be transmitted through blood transfusion

• HIV pathogen envelopes infected cells and attacks organs and immune systems

• 4-6 week incubation before envelope

• acute illness, malaise, swollen lymph glands, headache, rash

• use gloves, handwashing, routine cleaning, needle safety

acquired immunodeficiency syndrome AIDS

• end stage disease process caused by HIV

• makes patient very weak to bacterial, viral, and fungal infection

• incubation occurs between start of HIV to development of AIDS

• standard procedures for prevention

• if exposed take HIV test

gastroenteritis

• nausea and vomiting, fever, abdominal cramps, diarrhea

• can cause dehydration

• many types of infections and irritations in GI tract

Hepatitis a virus infection

• most common version of hep

• transmission through fecal oral route

• incubation 2-4 weeks

• communicable period starts toward end of incubation until after patient becomes jaundiced

• phase 1, fatigue, loss of appetite, fever, nausea, abdominal pain

• phase 2, jaundice, dark urine, pale clay coloured stool

• standard cleaning

hepatitis e virus infection

• 50 percent of hep cases in developing countries

• transmission through fecal oral route

• can rarely be transmitted through sexual contact and transfusion

• incubation 15-60 days

• signs and symptoms are same as other hep

• standard precautions, wash infected equipment

West Nile virus

• transmission through bite from mosquito

• needle stick is also possible

• incubation 2-6 days

• 20 percent of the time, headache fever, weakness, joint pain, vomiting, diarrhea rash

• be careful with sharps

Lyme disease

• bacterial

• transmitted through tick bites

• affects skin, heart, joints, and NS

• some patients asymptomatic

• incubation 3-32 days

• stage 1, round red skin lesion

• early disseminated stage, flulike symptoms

• within 2-8 weeks, meningoencephalitis, cranial and peripheral neuropathy

• cardiac involvement in untreated patients

• third phase, arthritis, memory impairment, depressed mood, severe fatigue

• wear long sleeves and pants in tick infested areas

• find and remove ticks within 72 hours

hantavirus

• transmitted through rodents, feces, urine, saliva

• flu-like symptoms that can escalate into life threatening breathing problems

• ‘begins with sudden onset fever escalates to cardiogenic shock and lung involvement

• often transmitted through inhalation

• incubation 12—16 days

• routine cleaning of vehicle

rabies

• causes fatal encephalomyelitis upon reaching brain

• once symptoms develop death follows in the next 7-14 days

• transmitted through bite, can also be through aerosol inhalation, contamination of mucous membranes

• incubation 2-8 weeks depends on severity and location of bite

• flulike symptoms

• paralysis, mental decline, coma

tetanus

• transmission through puncture wounds or contaminated street drugs where spores enter body

• incubation 3-14 days

• painful muscle contractions near wound, rigid in neck, face, jaw and trunk muscles

• may require airway and ventilation support en route

• use gloves, get immunized

methicillin resistant staphylococcus aureus

• transmitted through unwashed hands, breaks in skin

• incubation period 4-45 days

• may be colonized or infected

• localized skin abscesses and cellulites, empyemas, and endocarditis

• sepsis occurs with s aureus infection

• standard practices

vancomycin resistant enterococci

• common normal microorganism in the genitourinary tract

• VRE can be found in urinary tract and blood stream infections and is prevalent in livestock

• can be colonized (can’t) or infected (can transmit)

• transmission with direct contact with wound drainage and an open cut or sore allows organism in

• use a gown if contact might be made with drainage

severe acute respiratory syndrome SARS

• viral infection

• transmission by close personal contact, direct contact with respiratory secretions or bodily fluids

• incubation is 10 days

• dry cough, pneumonia, fever of greater than 38C, headache, discomfort, body aches

• need travel history and history of facilities that have contact with SARS

• patient should wear surgical mask, wear respirator

• notify EMS officials if made contact

• 10 day quarantine

avian influenza

• transmission through direct contact with infected birds

• fever, sore throat, cough, muscle aches, eye infections

• may lead to pneumonia or severe respiratory distress

• patient should wear a mask, respirator

• antiviral drugs can be administered to reduce effects

• get immunization

middle eastern respiratory syndrome

• viral respiratory illness

• can be spread through close contact

• fever, cough, shortness of breath

viral hemorrhagic fevers

• caused by virus

• transmitted by direct contact either blood and bodily fluids

• fever, headache, muscle pain, weakness, diarrhea, vomiting

• incubation 8-21 days

• gloves, mask, eye protection, face shield, gown

zika virus

• transmitted usually by mosquitos, also sexual contact, blood and tissue products

• 1 in 4 people show retro orbital pain, low fever, headaches, joint pain, swelling, rash

• incubation 3-14 days

• virus RNA can be found in serum, saliva, urine, semen, vaginal secretions

congenital zika syndrome

• defects that come after zika virus

• microcephaly, partially collapsed skull, abnormal brain development, hypertonia and spasticity and seizures, club feet, feet abnormalities

critical equipment

• items that come into contact with mucus membranes

• use of chemical sterilants is minimum

• laryngoscope blades, tracheal tubes, etc.

semicritical equipment

• items that come into direct contact with skin

• clean with solutions that claim to kill HBV

• bleach and water at 1:100

• stethoscope, uniforms, PPE, etc.

noncritical equipment

• cleaning surfaces, floors, ambulance seats, work surfaces

• hospital grade cleaner or water bleach combination

general cleaning routine

1. strip used linens and put in appropriate place

2. dispose of all used disposable equipment

3. wash contaminated areas with soap and water or designated cleaner

4. disinfect all non disposable equipment

5. clean the stretcher with germicidal solution

6. clean up all other contamination with germicidal solution

7. create a schedule for routine cleaning

8. have written procedure on how to clean each piece of equipment

9. focus on frequently touched items

modes of transmission

1. physical contact

2. droplets

3. airborne

portals of entry

• mucous membranes

• respiratory stsem

• digestive system

• broken skin

susceptible host

• immune deficiency

• diabetes

• burns

• surgery

• age

infectious agents

• bacteria

• fungi

• parasites

• prions

reservoirs

• people

• water

• food

portals of exit

• blood

• secretions

• excretions

• skin

chain of infection (no order)

• infectious agents

• reservoirs

• portals of exit

• modes of transmission

• portals of entry

• susceptible host

how to remove PPE before cleaning ambulance

• remove linen and push stretcher into hallway

• remove gloves

• wash hands

• remove gown

• wash hands

• leave room

• wash hands

• put on new gloves

how to clean ambulance after a call

• open back and side doors

• idle wit fan on in front and controls set to vent

• allow 15 minute settle time and air exchange

• clean wearing gloves

aerosol generating medical procedure AGMP

• any medical procedure that causes a virus to become aerosolized

• use airborne PPE (n95), goggles and face shield, gown

• anything that can pressurize or aerosolize droplets

• 50m per minute is the amount of pressure before considered AGMP