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Chapter 22 Standard Precautions in the Prehospital Setting

Chapter 22 Standard Precautions in the Prehospital Setting. Standard Precautions in the Prehospital Setting. Overview. Bloodborne viral illnesses Most common for EMS exposure Signs and symptoms of tuberculosis Protective measures Potentially infectious materials precautions

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Chapter 22 Standard Precautions in the Prehospital Setting

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  1. Chapter 22 Standard Precautions in the Prehospital Setting

  2. Standard Precautionsin the Prehospital Setting

  3. Overview Bloodborne viral illnesses • Most common for EMS exposure Signs and symptoms of tuberculosis • Protective measures Potentially infectious materials precautions Appropriate personal protective equipment use Accidental exposure procedures Standard Precautions -

  4. Standard Precautions Exposure does not mean infection. Exposure can be treated. Standard Precautions -

  5. 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) Standard Precautions -

  6. Potentially Infectious • CSF • Synovial fluid • Amniotic fluid • Pericardial fluid • Other potentially infectious materials: • Plural fluid • Body fluid with gross visible blood Standard Precautions -

  7. Potentially Infectious • Tears • Sweat • Saliva • Urine • Only with gross visible blood • Stool • Vomitus • Nasal secretions • Sputum Standard Precautions -

  8. 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! Standard Precautions -

  9. 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 Standard Precautions -

  10. Hepatitis B (HBV) • Immigrants from HBV prevalent • Incarcerated • Institutionalized • IV drug users • High-risk groups • Male homosexuals • Hemophiliacs • Household contacts • Hemodialysis Standard Precautions -

  11. Hepatitis B (HBV) Clinical manifestation • Acute hepatitis • Chronic hepatitis • Cirrhosis • Liver cancer Chronic carrier risk: 5–10% Standard Precautions -

  12. Hepatitis B (HBV) Health care protection • Hepatitis B vaccines • Does not contain antibodies • Life-long protection • Effective immunity in 90% • Hepatitis B immunoglobulin • Contains antibodies • Passive protection for 6 months • Effective immunity in 70% Standard Precautions -

  13. 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: 1.8% Standard Precautions -

  14. 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 Standard Precautions -

  15. 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 Standard Precautions -

  16. 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 High-risk groups: • Male homosexuals • Bisexuals • IV drug users • Transfused • Blood, pooled-plasma • HIV sexual contact Standard Precautions -

  17. 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 Standard Precautions -

  18. 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 Standard Precautions -

  19. 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 Standard Precautions -

  20. 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 Standard Precautions -

  21. 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 Standard Precautions -

  22. Tuberculosis Health care protection • TB infection (no active disease) • Isoniazid (INH) or rifampin for 6–9 months • TB disease • Antibiotic agents Standard Precautions -

  23. Precautions for Prevention Be knowledgeable Bandage lesions Routine handwashing Immunizations Report exposures Standard Precautions -

  24. If exposed,wash exposed area immediately. Standard Precautions -

  25. 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. Standard Precautions -

  26. 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 reduces risk of infection. Standard Precautions -

  27. Discussion Standard Precautions -

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