Firefighter Pre-hospital Care Disease Transmission ... Pre-hospital Care Disease Transmission / Designated Officer Program. ... • most common mode for infectious ... •Chicken pox

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Captain Randy Gwyn R.N., I.C.P.Captain Randy Gwyn R.N., I.C.P.Program DeveloperProgram DeveloperCaptain Bill Sault BA, ACP Captain Bill Sault BA, ACP Program ManagerProgram ManagerFirefighter Pre-hospital Care Disease Transmission / Designated Officer ProgramRoutes of TransmissionRoutes of TransmissionThere are 4 general routes of transmission Contact (Direct) Airborne (Indirect) Vehicle (Indirect) Vector (Indirect)There are 4 general routes of transmission Contact (Direct) Airborne (Indirect) Vehicle (Indirect) Vector (Indirect)Contact TransmissionContact Transmission most common mode for infectiousdisease transmission infection may occur by Directcontact or Droplet contact most common mode for infectiousdisease transmission infection may occur by Directcontact or Droplet contact Direct TransmissionDirect Transmission contact / person to person spread there must be actual physical contact between sourceand firefighter Droplet Spread (3 feet or less) by means of talking, sneezing or coughing i.e. Cold & flu viruses some sources of infection include:soil, eating utensils, door handles contact / person to person spread there must be actual physical contact between sourceand firefighter Droplet Spread (3 feet or less) by means of talking, sneezing or coughing i.e. Cold & flu viruses some sources of infection include:soil, eating utensils, door handlesIndirect ContactIndirect Contact Airborne Transmission Similar to droplet spread lighter particles from a sneeze or coughare carried on air currents Infections such as legionnaires diseasespread through the air systems ofbuildings, airplanes, etc. Airborne Transmission Similar to droplet spread lighter particles from a sneeze or coughare carried on air currents Infections such as legionnaires diseasespread through the air systems ofbuildings, airplanes, etc. Vehicle TransmissionVehicle TransmissionInfected person Inanimate objectNon-infected personSources: Needle stick injury - HIV, Hepatitis B / C Contaminated water - Typhoid, Hep. A Contaminated food - Botulism / SalmonellaInfected person Inanimate objectNon-infected personSources: Needle stick injury - HIV, Hepatitis B / C Contaminated water - Typhoid, Hep. A Contaminated food - Botulism / SalmonellaIndirect ContactIndirect ContactIndirect TransmissionIndirect TransmissionVector Transmission Transmission by an intermediate carrierSources include: Mosquito West Nile Raccoon - Rabies Tick Lymes DiseaseVector Transmission Transmission by an intermediate carrierSources include: Mosquito West Nile Raccoon - Rabies Tick Lymes DiseaseChain of Disease TransmissionChain of Disease Transmission Infectious Agent Reservoirs Portal of Exit Mode of Transmission Portal of Entry Susceptible Host Infectious Agent Reservoirs Portal of Exit Mode of Transmission Portal of Entry Susceptible HostChain of Disease TransmissionChain of Disease Transmission Break the ChainTransmission can not occur Break the ChainTransmission can not occurCommunicable Diseases of ConcernCommunicable Diseases of ConcernHuman Immunodeficiency Virus (HIV) A severe disorder of the immune system Not highly infectious to general population Transmitted by:Direct blood / body fluid contact PEP (post exposure prophylaxis) is available for asignificant exposureHuman Immunodeficiency Virus (HIV) A severe disorder of the immune system Not highly infectious to general population Transmitted by:Direct blood / body fluid contact PEP (post exposure prophylaxis) is available for asignificant exposureCommunicable Diseases of ConcernCommunicable Diseases of ConcernHepatitis A, B, C Worldwide problem- All affect the liver but aredifferent infections/agents Hepatitis A - fecal, oral route Hepatitis B & C - blood, saliva, semen and otherbodily fluids Hepatitis B vaccine and PEP (post exposureprophylaxis) are available Hepatitis A, B, C Worldwide problem- All affect the liver but aredifferent infections/agents Hepatitis A - fecal, oral route Hepatitis B & C - blood, saliva, semen and otherbodily fluids Hepatitis B vaccine and PEP (post exposureprophylaxis) are available Communicable Diseases of ConcernCommunicable Diseases of ConcernMeningitis Inflammation of the meninges - what are they? May be viral or bacterial Primarily a disease of small children Exposure - shared saliva ( kissing contact ) Vaccine is available but is not currentlyrecommended for healthcare workers (CanadianImmunization Guide Edition 6, 2002) Meningitis Inflammation of the meninges - what are they? May be viral or bacterial Primarily a disease of small children Exposure - shared saliva ( kissing contact ) Vaccine is available but is not currentlyrecommended for healthcare workers (CanadianImmunization Guide Edition 6, 2002) Exposure DeterminationMeningitis Meningococcal DiseasehViral or Bacterial ? hNeisseria Meningitidis ( the bacteria's real name )hShared saliva ( a.k.a. kissing contact )i.e. shared utensils, cigarettes, airway managementhExposures of exposures / Are they legitimate? e.g. family of exposed firefighterCommunicable Diseases of ConcernCommunicable Diseases of ConcernTuberculosis exposure to airborne droplet when the pt. coughs or sneezes ( prevention ? ) transmission requires frequent and prolongedexposure growing problem in large urban areasTuberculosis exposure to airborne droplet when the pt. coughs or sneezes ( prevention ? ) transmission requires frequent and prolongedexposure growing problem in large urban areasCaring for Patients who May Have TBCaring for Patients who May Have TB Use a fit tested N-95 on yourself. Use a surgical maskon patient (iftolerated) Use a fit tested N-95 on yourself. Use a surgical maskon patient (iftolerated)TuberculosishAirborne / Droplet contacthDid the patient have an active and productive cough ? Fever ?hIs patient currently under treatment?hWas patient masked? Was the firefighter?hWorking environment? Small, enclosed, poor ventilation and over an extended timeperiod?Exposure DeterminationOther ExposuresAntibiotic Resistant Organisms (AROs):hMRSA, VRSA, VRE, ESBLs, C-difficilehWest Nile VirushG.A.S.All firefighters should have physicals each year.Current immunization status or results of screening testsshould be determined for the following diseases:All firefighters should have physicals each year.Current immunization status or results of screening testsshould be determined for the following diseases:MMONITORING PERSONAL HEALTHONITORING PERSONAL HEALTH Hepatitis Tetanus/diphtheria Measles Mumps Rubella Hepatitis Tetanus/diphtheria Measles Mumps Rubella Chicken pox Polio Tuberculosis (TB) Influenza immunization Flu shots offered yearly Chicken pox Polio Tuberculosis (TB) Influenza immunization Flu shots offered yearlyDesignated Officer ProgramhIdentifies police, fire and paramedics as high risk exposure grouphDeveloped to educated emergency service workershEstablish exposure protocolshProgram setup by MOH in 1994Designated Officer Program1994 Ministry of Health Guideline Establishes a means of notification of exposures. Toronto Fire Services Designated Officer (DO) is on call 24/7/365 days a year. TFS program incorporates a Occupational Health and Safety component so is identified as the SDO (Safety/Designated Officer). Should be contacted IMMEDIATELY following a suspected exposure via communications. Contact TFS communications and ask that the on-call SDO be paged. You will then be contacted by the SDO directly.Patient ConfidentialityhThe Designated Officer will be working within a mutually shared environment with other health professionals.h It is imperative that the D.O. maintains the appropriate level of patient confidentiality (both firefighters and source patients)Bill 105 Legislation enacted on Sept.1, 2003. Under specific circumstances, can legally mandate a source patient to provide a blood sample. A legal application must be made and specific process followed. Application can be denied. Process is lengthy and complicated.Bill 105 The DO should be contacted IMMEDIATELY! The DO will assist with application process. TFS staff are encouraged to utilize the TFS Chief Medical Officer (Dr. Forman). All discussions with DO and/or Chief Medical Officer are CONFIDENTIAL.DO advises firefighter to be evaluated and followed up by a doctor or other appropriate health care professional.Public Health notifies DO of possible exposure (contact tracing).Airborne Exposure ProcedureThe medical facility must notify public health within 48 hours.The medical facility diagnoses the disease in the client you treated.You treat a client who is infected with a life-threatening airborne disease, such as TB, but you are not aware that the client is infected.Bloodborne Exposure ProcedureAll results of blood work will be received by ordering physician and reported to Public Health Unit.If patient refuses to give sample, get your baselines and initiate a bill 105 application with Public health Unit (where patient resides).If possible, attend same facility as source patient, the SDO will attempt voluntary consent for source patient bloodwork via attending physician.Seek immediate medical attention, contact the SDO via communications and document the incident for workers compensation.You come into contact with blood or body fluids of a patient, and you wonder if that patient is infected with life-threatening bloodborne disease such as HIV and/or HBV and/or HCV.Self Study Suggestions hUnderstand difference between bloodborne (HIV, Hep B, Hep C etc.) vs droplet (SARS, Meningitis, influenza etc.) exposures vs airborne transmission typeshReview Antibiotic Resistant Organisms (AROs) MRSA, VRE, ESBLs, C-Difficile etc.hReview known treatments of all aforementioned diseasesSelf Study Suggestions cont...hUnderstand difference between Meningococcal Disease and other Meningitis causing organismshUnderstand difference between Active Pulmonary T.B. versus Inactive or other site T.B.hReview known treatments of all aforementioned diseasesSelf Study Suggestions cont...hReview applicable legislationhBill 105, Bill 31, DO programhReview patient confidentiality lawshBill 105 application process Exposure Risk Review Needle stick ? Needle type / function? Uncooperative pt spits in face? Blood splash in eyes? Febrile, coughing pt in close quarters? What about the driver? Families ? Normal pt care duties? To determine exposure, does pts disease status matter? How do you contact the DO??????SOBERING REALITYhPhiladelphia FD (2/3 size of TFS) have 200+ Hep.C positive firefightershMedical PPE use vs. SCBA use? Think 30 years ago (SCBA use) vs. 30 years from now (medical PPE use)?Captain Randy Gwyn R.N., I.C.P.Captain Randy Gwyn R.N., I.C.P.Program DeveloperProgram DeveloperCaptain Bill Sault BA, ACPCaptain Bill Sault BA, ACPProgram ManagerProgram ManagerQuestions ?