HIV attacks the body’s immune system, making the body vulnerable to opportunistic diseases.
While HIV is fatal, infected persons usually die from the opportunistic diseases that overwhelm the body. Pneumonia Pneumonia Tuberculosis (TB) Tuberculosis (TB) Toxoplasmosis (protozoan infection) Toxoplasmosis (protozoan infection) Some Cancers Some Cancers Diarrheal Disease Diarrheal Disease
Homosexual Males Users of Injectable Drugs Sexually Promiscuous Babies born of HIV mother HIGH- RISK HIV PATIENTS
AIDS Late stage HIV disease, when opportunistic diseases develop Late stage HIV disease, when opportunistic diseases develop May take years to develop
ROUTE OF INFECTION HIV is a blood borne disease and: Semen, Cervicovaginal Fluid, Breast Milk Saliva has not been discounted or proven, but the HIV virus is found in it, although in small amounts. HIV infected blood has approximately 1 thousand viral particles per milliliter (ml.).
INCUBATION PERIOD Disease may develop in a matter of months or take several years. Antibodies usually detected by a blood test 2 weeks to 3 months after infection. May develop later in a small percentage of persons
Illness, disability, and except in rare instances, DEATH! HIV/AIDS has become more manageable. It is a chronic disease for many people, but still has no definite cure or vaccine
Highly contagiousHighly contagious Usually transmitted via the fecal - oral routeUsually transmitted via the fecal - oral route Outbreaks of type A hepatitis often occur after people have eaten seafood that came from contaminated water.Outbreaks of type A hepatitis often occur after people have eaten seafood that came from contaminated water. Common exposures occur in care facilities such as convalescent / nursing homes, mental institutions, day care centers and schoolsCommon exposures occur in care facilities such as convalescent / nursing homes, mental institutions, day care centers and schools
15 to 50 days, depending on dose15 to 50 days, depending on dose Average of 28 to 30 daysAverage of 28 to 30 days Incubation
In most patients with HAV, liver cells eventually regenerate with little or no residual damage. Patients usually recover readily, with a life-long immunity to hepatitis type A, but not type B or type C Old age & serious medical conditions (CHF, severe anemia, diabetes) make complications more likely. PROGNOSIS
Description: A generalized inflammation of the liver caused by HBV that attacks and destroys liver cells.
HIGH-RISK PATIENTS Homosexual Males Users of Injectable Drugs Sexually Promiscuous (Multiple Partners) Prostitutes (sex for money or drugs) –(homosexual and/or heterosexual) Babies born/breast feeding HBV mother NOTE: Some blood bank statistics report as many as 80% of homosexual males have been exposed to HBV
Route of Infection: Classified as a blood borne disease, considered to be spread by contact with body fluids such as: Blood Saliva Semen Vaginal Fluid Note: HBV has approximately 1 billion viral particles per milliliter of blood, making HBV much more infectious than HIV and more difficult to kill on surfaces
RECOMBIVAX VACCINE Available to all Montgomery County Fire & Rescue personnel, career and volunteer, through Fire Rescue Occupational Medical Services (FROMS) at no charge.
INCUBATION PERIOD : 45 - 180 days [6-weeks to 6-months] with the average being 60-90 days.
PROGNOSIS: If detected early, prognosis is good. Although not usually fatal, it causes many liver diseases, such as cirrhosis and causes up to 80% of all liver cancer. If detected early, prognosis is good. Although not usually fatal, it causes many liver diseases, such as cirrhosis and causes up to 80% of all liver cancer. Despite the fact that Hepatitis B is curable, it still causes about 200 deaths to HEALTHCARE WORKERS each year. Despite the fact that Hepatitis B is curable, it still causes about 200 deaths to HEALTHCARE WORKERS each year.
Thought to be leading cause of hepatitis resulting from blood transfusions. vNOT transmitted efficiently by sexual contact vPrimarily a BLOODBORNE disease: vSingle needle stick can contaminate Greater likelihood of becoming a chronic carrier of HCV after infection. No current vaccine Immune globulin (IG) following exposure to HCV provides temporary, passive immunity.
A bacterial infection that infects via the respiratory system Usually settles in the lower 2/3 of the lungs, where ventilation (exchange) is minimal. May spread to lymph nodes and other areas: brain, meninges, kidneys, adrenal glands, stomach, intestines, peritoneum and bones.
High-Risk Persons Recent Immigrants Persons living in overcrowded / poverty conditions (homeless). Persons with low immunity HIV, Cancer, Long term steroid use, Elderly Alcohol/Drug abusers
HIV Infected persons Correctional Inmates Long-term care facility residents Close contact of TB patients Substance Abusers
Foreign-born individuals from countries with high incidence of TB Health-care workers providing care to high-risk groups Persons with previous Hx of TB People in Poverty: Crowded conditions, poor sanitation, poor nutrition
Multi-Drug Resistant TB Usually found only in high- density population areas Common in DC, New York
PROGNOSIS: After several weeks, otherwise healthy patients may develop a specific immunity, encapsulating the TB bacteria in granular tumors. These granulomas usually remain dormant for life, but are capable of producing the disease again at any time. If untreated, 8-20% of TB patients will develop serious diseases.
Route of Infection: Droplet infection, transmitted by inhaling droplets from infected carrier by coughing, sneezing, or talking
EMERGENCY CARE: A-B-C, O 2 as needed NIOSH approved face masks for all EMS personnel Disposable surgical masks on: Patient, unless on O 2 Family members riding in the ambulance Notify hospital of potential TB patient so they may prepare respiratory isolation. Ventilate back of ambulance by opening windows TB Bacillus is very sensitive to light and air.
DESCRIPTION: Inflammation of the membranes of the brain and spinal cord (meninges). Meningitis may be caused by –Bacteria –Virus –Other organism that reaches the meninges by: Bloodstream Lymphatic System Trauma (open wounds) From adjacent sinuses
Patients at High-Risk Persons in overcrowded / poor living conditions Homeless Schools & Colleges Institutions Military Barracks Persons with low immunity HIV, Cancer, Long term use of steroids
Petechiae (small, purple, spider-like hemorrhage spots on skin) Signs of Infection Chills Low Or Dropping B/P Rapid, Shallow Respirations Rapid Pulse Purpura - purple spots that don’t turn white when pressed VERY SERIOUS IF:
Route of Infection DROPLET DROPLET Transmitted by inhaling droplets from coughing, sneezing or talking by the infected carrier Saliva Exchange
Prognosis: Favorable with PROMPT diagnosis & treatment May leave long term neurological disorders if diagnosis and/or treatment are delayed. Potentially fatal Most serious in Children (especially neonates) Elderly
EMERGENCY CARE: A-B-C, O 2 as needed NIOSH approved face masks for all F/R personnel Disposable surgical masks on: Patient, unless on O 2 Family members riding in the ambulance Notify hospital of potential meningitis patient so they may prepare respiratory isolation. Ventilate back of ambulance by opening windows
Body Substance Isolation Eliminates the Means of Entry Infectious Agent Reservoir Means of Exit Mode of Transmission Means of Entry Susceptible Host
Body Substance Isolation Consider ANY patient’s blood or body fluid to be infectious GLOVES : All fire/Rescue personnel MUST don appropriate protective gloves PRIOR to arrival at the scene of any EMS incident Anytime you could possibly contact body fluids During extrications, wear under heavy gloves While decontaminating &/or disinfecting
MASKS Wear in any situation in which blood or body fluids could be splashed in your face, or droplet infection is suspected. With a potential or known TB or meningitis patient, put a surgical mask on the patient. Mouth-to-mouth ventilations should not be performed, rescuer should use a pocket mask with a one-way valve
EYE PROTECTION Wear any time blood or body fluids could be splashed in your eyes, such as active bleeding, vomiting or mentally disturbed patients (spit)
GOWNS Indicated for situations such as childbirth or uncontrolled bleeding Blood-soiled gowns and/or other contaminated clothing is considered infectious.
PROTECT BROKEN SKIN Cuts, abrasions, insect bites, etc. should be protected with a Band-Aid or a dressing.
SHARPS IV needles, etc. are to be placed in a sharpe- safe container as soon as possible IV needles, etc. are to be placed in a sharpe- safe container as soon as possible NEVER leave on seat, litter or squad bench NEVER leave on seat, litter or squad bench NEVER leave ANY contaminated materials or sharps at the scene or patient's residence NEVER leave ANY contaminated materials or sharps at the scene or patient's residence NEVER recap a used needle: put it in a sharps container. NEVER recap a used needle: put it in a sharps container.
WASH YOUR HANDS !!! With disinfectant or anti-bacterial soap as soon as possible after every call.With disinfectant or anti-bacterial soap as soon as possible after every call. At the hospitalAt the hospital After handling items soiled with blood or body fluidsAfter handling items soiled with blood or body fluids Wash your hands when you take the gloves offWash your hands when you take the gloves off
Cleaning/Decontamination Procedures All non-disposable equipment used in patient care should be cleaned after each use Any equipment in contact with body fluids needs to be cleaned and disinfected Wear gloves and other protective devices as needed Clean with detergent, etc. To remove dirt, blood, etc. You cannot disinfect a surface that is dirty
After cleaning, DISINFECT the equipment by using one or more of the following agents: A freshly mixed solution of 1 part bleach to 9 parts of water oFor non-metallic surfaces oEspecially effective on fresh (non-dry) blood spills oContact time: 20-30 minutes for high level disinfection, followed by clear water rinse & air dry
Disinfectant Soaps: May be used on most equipment where a high level disinfection is not necessary 70 % Isopropyl alcohol: Contact time : 5-30 minutes Is NOT EFFECTIVE in presence of blood or dirt Good for use on skin, metals, and electrical equipment 3 % Hydrogen Peroxide Not recommended for high-level disinfection Good for removing blood on fabrics
DISPOSABLE ITEMS All sharps MUST BE transported and disposed of in a approved Sharps container………ONLY!
DISPOSABLE ITEMS Items such as blood soaked sheets should be placed in a red BIOHAZARD impervious plastic bag & transported to the hospital with the patient. DO NOT throw the sheets in the hamper Each station must have an approved bio-hazard waste container. They are disposed of by an approved bio-hazard contractor
WHAT IS NOT A PERCUTANEOUS EXPOSURE ? Blood or body fluids on equipment Blood or body fluids on clothing with intact skin underneath Blood or body fluids on intact skin unless it is a LARGE quantity of blood & a prolonged exposure (i.e. greater than 20 mins) BLOODBORNE diseases CANNOT be transmitted by talking to or touching an infected person
EXPOSURE PROCEDURE Immediate Self-Care: Percutaneous Wipe off excess blood from skin and scrub area with soap & water or antiseptic hand cleaner for 5-10 minutes. If the wound is bleeding, allow it to bleed to remove any contaminants. If soap & water are not immediately available apply your issued Antiseptic Handwash from your fanny pack until proper disinfecting measures can be taken.
EXPOSURE PROCEDURE Immediate Self-Care: Mucocutaneous Flush eye(s) thoroughly for 15 minutes and/or rinse mouth with saline or water. As soon as patient care allows, or upon arrival at the hospital, wash your hands and the wound thoroughly. Wash face as necessary. Have emergency department physician assess and provide treatment for wound as needed.
EXPOSURE PROCEDURE Immediate Self-Care Access the DRFS-STP Infectious Disease web site and click on “Exposure” for the current, complete exposure procedure. http://www.montgomerycountymd.gov/content/firerescue/ psta/stp/infectiousdisease04/ExposeF.asp
FOLLOW UP PROCEDURE Notify your Supervisor immediately Document the circumstances concerning the exposure. Career personnel must follow Policy & Procedure #807. If you were not on the transporting unit, regardless of the type of exposure, report to the hospital ED for the appropriate treatment.
For both Career and Volunteer personnel: notify Fire & Rescue Occupational Medical Section (FROMS) at 240-777-5185 as soon as possible following an exposure. If it is determined that a patient that was treated has a communicable disease, the EMS section of the DFRS will notify the individuals departments. FOLLOW UP PROCEDURE
It is extremely important that the run sheets be left for all transported patients with the Emergency Department as well as properly listing all personnel that were involved with the incident on the MAIS report & FIREHOUSE!!!!
QUESTIONS Contact the On-Duty EMS captain. Reference the Website on QuicklinksReference the Website on Quicklinks