2. How can you, as an EMS
provider and a citizen,
recognize infectious disease,
prevent the spread of blood
borne pathogens, treat your
patients properly, and most of
all, keep yourself safe and
protected?
3. Objectives
Identify the types of PPE
and how and when they
should be applied
Identify the characteristics
of infectious diseases that
are a threat to EMS
providers (HEPC, HBV)
Identify appropriate
measures for protecting
yourself against infectious
disease obtaining 3 of 3
test items correct
Identify the appropriate
actions to take for
exposure to an infectious
disease
Distinguish between the
infectious diseases EMS
providers can encounter
4. Terms to know
Antibodies – proteins made by the immune system that have a
memory for an invading virus and help recognize and destroy future
invasions by that virus
Antibiotic – medicine or drug that is effective in killing bacteria or
inhibiting their growth
Bacteria – a single-celled, microscopic organism that can cause
damage to the body’s cells. They multiply very quickly by dividing
Body Substance Isolation (BSI) – an infection control practice that
assumes all body substances including blood, urine, saliva, feces,
tears, etc., are potentially infectious.
Epidemic – an outbreak of a contagious disease that spreads among
many individuals in an area or a population at the same time.
Methicillin-Resistant Staphylococcus Aureus (MRSA) – a type of
staphylococcus or “staph” bacteria that are resistant to many
antibiotics.
5. Terms to know (continued)
Pandemic – an outbreak of a contagious disease that affects an entire
population over a wide geographical area. A pandemic affects a far higher
number of people and a much larger region than an epidemic.
Parasite – an organism that grows, feeds, and is sheltered on or in a different
organism which contributing nothing to the survival of its host.
Pathogen – an agent that causes disease such as a bacterium, virus or fungus
Personal Protective Equipment (PPE) – Specialized clothing or equipment
Universal Precautions – include personal protective equipment and body
substance isolation – should be used observed on every incident.
Vaccine – a preparation of a weakened or disabled virus that stimulates
antibody production and provides immunity when injected into the body.
Virus – a very small agent made of genetic information (RNA or DNA)
surrounded by a protein coat. It cannot reproduce on its own, but must
take over a living cell to multiply.
6. Personal Protective Equipment
• Treat every scene that has a potentially
infectious patient as a biological hazmat.
• Avoid infection from fluids and airborne
particles.
• Decontaminate equipment and surfaces after
use and wash your hands frequently.
• Universal precautions should be universal –
they should be observed on EVERY incident.
7. Types of PPE
• Fit-tested masks (N95 and N100 masks)
• Eye protection (glasses, face shields, or goggles
• Gowns
• Gloves
N95 mask
You must wear full PPE with
any patient who is
potentially infectious
especially those with a
history of a fever and cough.
8. Putting on your PPE
Use the sequence – MEGG
1. Mask
2. Eye Protection
3. Gown
4. Gloves
Taking off your PPE
Reverse the order you put it on
1. Gloves
2. Gown
3. Eye Protection
4. Mask
Always be careful as to
not contaminate yourself
and remember to
WASH YOUR HANDS
9. Hand Washing is Vital
WHAT?
• Single most effective way to prevent the
spread of disease
HOW?
• Soap and water for at least 20 seconds or with
waterless alcohol
WHEN?
• After all patient contact,
even if you wore gloves
10. Equipment Decontamination
After completing a response to an infectious
patient, you must decontaminate all
equipment that was exposed or cross-
contaminated (everything touched) including:
12. Exposures (cont.)
If you are stuck by a needle
Wash area well with soap and water
Do NOT use bleach or other harsh chemicals as these may
damage the skin, making it easier for virus to enter the body
If you are exposed by non-intact skin (abrasions and cuts)
Wash area well with soap and water
Blood on intact skin is not considered a significant exposure
If you are exposed by contact to your mucus membranes
Flush liberally with water
If you are exposed to an airborne disease
The hospital may notify exposed responders if patient is
diagnosed with airborne disease
Some diseases may require automatic and immediate PEPs,
others may require PEPs only if you become positive
13. Types of Infectious Diseases
• Hepatitis C
• MRSA
• HIV
• Hepatitis B
• Tuberculosis
• Influenza
• Norovirus
• West Nile Virus
14. Hepatitis C
• Four million persons infected
with Hepatitis C in US
• Caused by virus found in blood
of persons who have disease
• Spread by contact with blood
of infected person
• Most common chronic blood
borne viral infection in US
• Can cause cirrhosis of liver and
liver cancer
Cirrhosis of the liver and liver cancer
15. Hepatitis C (cont.)
Transmission
• Blood and other bodily
fluids
• Sharing needles with
infected person
• Sex with infected person
• From a woman to her baby
during birth
Prehospital Presentation
• There are generally no signs
or symptoms during early
stages; maybe none for
years.
• If symptoms occur –
– Fatigue
– Nausea
– Vomiting
– Poor appetite
– Muscle and joint pain
– Low-grade fever
17. MRSA (cont.)
• Type of staph bacteria
resistant to common
antibiotics.
• Traditionally associated with
hospitals, but now there is
an epidemic of community-
acquired MRSA.
• Multiplies rapidly causing
many types of infections
ranging from skin infections
to septicemia and toxic shock
syndrome.
Cutaneous abscess caused by MRSA
18. • The best defense against
MRSA is to wash your hands
frequently, especially after
contact with other people.
• Thorough washing with soap
and water or alcohol hand
disinfecting gels is effective
against MRSA. (Hand
disinfectant gels are only a
short term solution until
proper hand washing can be
performed.)
Advanced MRSA
MRSA (cont.)
19. Transmission
• Found commonly on
human skin, in the
nose, in the throat, in
the colon and in the
urine (less common).
• Can infect other tissues
when skin or mucosal
lining have been
breached.
Occupational Exposure
Can be spread by –
- Contact with pus from
infected wound
- Skin-to-skin contact
with infected person
- Contact with objects
such as towels, sheets,
or clothing used by
infected person
MRSA (cont.)
20. MRSA (cont.)
Prehospital Presentation
• Staph infections, including
MRSA, generally start as small
red bumps that resemble
pimples, boils or spider bites.
• Can quickly turn into deep,
painful abscesses.
• Can also penetrate deep into
body causing potentially life-
threatening infections in
bones, joints, surgical wounds,
the bloodstream, heart valves,
and lungs.
21. MRSA (cont.)
Prevention
• Best defense against MRSA – washing hands
often, especially after contact with other people.
• Wear a gown when caring for patients with a
known or suspected MRSA infection of the skin.
• In some cases, MRSA is a respiratory infection –
wear a fitted mask. Place a NRB mask on the
patient to help reduce exposure.
22. Human Immunodeficiency Virus (HIV)
• AIDS caused by HIV
• HIV attacks cells of
immune system
• Immune system fails
and patient becomes
susceptible to
“opportunistic”
diseases and infections Chest x-ray of HIV-infected
man with pulmonary Kaposi
sarcoma
Kaposi’s sarcoma of
the skin on an AIDS
patient
23. Transmission
• Unprotected sex with an
infected partner
• Infected blood given
during a transfusion
(extremely rare)
• Sharing of needles by IV
drug users
• Infected mother to her
baby
• Occupational
transmission usually by a
needle stick of infected
blood
Occupational Exposure
Can be spread by –
- needle stick of infected
blood
HIV(cont.)
24. HIV (cont.)
Prehospital Presentation
• Dehydration and
hypotension secondary to
diarrheal diseases.
• Seizures or altered
mental status secondary to
nervous system infection.
• Dyspnea secondary to
respiratory infection
(pneumonia, tuberculosis,
etc.)
•Medication reactions.
•End of life issues.
Prevention
• Prevention should focus
on preventing significant
blood exposures (needle
sticks).
• Post-exposure
prophylaxis (PEP) if
exposed.
25. PEP for HIV
• Any possible exposure to a
blood borne disease must be
reported immediately to your
Operational Supervisor
• Post-exposure prophylaxis
reduces the already very low
risk of acquiring the disease
• Medications taken for PEP are
TOXIC
• Once the patient is determined
to be HIV-negative, PEP
medications can be stopped
26. Hepatitis B
• Caused by virus (HBV),
which damages liver
• Vaccination against
HBV has been available
since 1982
• Spread by contact with
blood of infected
person with the disease
or by sexual contact
Hepatitis B Virus
27. Transmission
• Unprotected sex with
an infected partner
• Blood and other bodily
fluids
• Sharing of needles with
infected person
• Infected mother to her
baby
Occupational Risk
Risk for acquiring HBV
for an unvaccinated
person is significant.
The risk for a
vaccinated person is
VERY LOW.
Hepatitis B(cont.)
28. Prehospital Presentation
• Most signs and symptoms
of Hep B are mild.
• It is unlikely you will be
called to respond to acute
illness caused by this
virus.
• You may on occasion see
a patient with end stage
liver cancer or other
complications from the
disease.
Prevention
In addition to taking care
to protect yourself
from blood exposure,
the best way to
prevent occupational
exposure to HBV is to
be vaccinated against
the disease.
Hepatitis B (cont.)
29. Tuberculosis (TB)
• Caused by small bacteria that travels from small
airways to cells of lungs.
• Less than 10% of people infected with TB develop the
disease.
• The bacteria hides until the patient becomes immuno-
compromised or otherwise debilitated
30. Transmission
• Via small airborne
particles expelled by
cough, sneezing, or
speaking.
• Particles are inhaled
into small airways.
• Prolonged exposure in
confined space confers
highest risk.
Occupational Risk
Risk for acquiring TB is
low, but difficult to
quantify.
TB (cont.)
31. Prehospital Presentation
• Cough, often productive
of blood-tinged sputum
• Fatigue and weakness
• Night sweats
• Low-grade fever
• Loss of appetite and
weight loss
Prevention
• Maintain high index of
suspicion among patients
who are at risk of having
TB.
• Take precautions if patient
presents with suspicious
signs and symptoms.
TB (cont.)
32. Influenza (flu)
• Caused by the influenza virus
which attacks the respiratory
system.
• Occurs seasonally from
November to April in the
northern hemisphere.
• The structure of the virus
changes slightly, but frequently
over time; this accounts for the
appearance of different strains
each year.
Best flu prevention is the flu
vaccine
33. Transmission
• Coughed droplets
• Touching contaminated
surfaces (less
commons)
Occupational Risk
Varies depending on
the strain
Flu (cont.)
34. Prehospital Presentation
Sudden onset of:
• High fever
• Malaise
• Headache
• Dry cough
• Body aches
Prevention
• Hand washing and
cleaning surfaces
• Placing masks on patient
or asking patient to cover
mouth when coughing.
• Best prevention is the flu
vaccine which must be
taken yearly
Flu (cont.)
35. Norovirus
• Highly contagious virus responsible for outbreaks of
gastrointestinal disease on cruise ships.
• Norovirus is the general name given to a virus of this
type.
• Responsible for many cases of severe, but short-lived
illnesses causing vomiting, diarrhea, and stomach
cramps.
• “Stomach flu” and “food poisoning” are typical
infections of a norovirus
36. Transmission
• Occurs via fecal-oral
route
For example, a food handler does not
wash his hands after using the
bathroom, then you ingest food that
has been contaminated with small
amounts of fecal matter
Occupational Risk
• Community-acquired,
usually situations where
large numbers share same
food or living space
(cruise ships, schools,
nursing homes, etc.).
• Several outbreaks of
noroviruses among staff
at hospitals and nursing
homes.
Norovirus (cont.)
A person with norovirus is considered
contagious from the time he or she starts
feeling ill to as long as two weeks after
recovery.
37. Prehospital Presentation
• Nausea, vomiting and
diarrhea
• Stomach cramps
• Low-grade, transient fever
• General feeling of malaise,
headache, body aches
Prevention
• Wear gloves
• Wash your hands
thoroughly
• Consider use of protective
eyewear and mask
• Surfaces contacted by the
patient must be thoroughly
disinfected
Norovirus (cont.)
Symptoms begin suddenly, may last
one to three days, and usually resolve
on their own.
If you become sick, wait two days after
the last of your symptoms subside
before returning to work.
38. West Nile Virus
• First identified in Africa
• The virus causing the disease, West Nile
Virus (WNV), infects certain types of birds
(ravens, crows and jays), mosquitoes,
horses, and other animals.
• Humans are an incidental, rather than
primary host.
39. Transmission
• WNV is transmitted
through the bite of an
infected mosquito.
• WNV is NOT
transmitted person-to-
person except in rare
case of blood
transfusion from an
infected person.
Occupational Risk
None
West Nile Virus(cont.)
40. Prehospital Presentation
• Fever
• Headache
• Fatigue
• A rash and swollen
lymph nodes (rarely)
Prevention
• Not transmitted person-
to-person so no specific
disease prevention
precautions are necessary
at work
• Usage of repellant when
in environment
susceptible for
mosquitoes.
West Nile Virus (cont.)
Less than 1% of the people infected with
WNV will develop severe illness. These
people may present with high fever,
headache or altered LOC.
41. Pandemic Flu
• Outbreak of contagious disease that affects entire
population over a wide geographical area.
• Caused by influenza virus to which humans have little
or no natural resistance.
• Such an outbreak has potential to cause many deaths
and illnesses.
• Past pandemic flu viruses known for virulence causing
rapid death, especially in young people.
• It is difficult to accurately predict which strain of
influenza may be responsible for the next pandemic.
42. Pandemic VS Seasonal Flu
• Pandemic outbreaks
different from seasonal
outbreaks of influenza.
• Seasonal outbreaks
caused by subtypes of
influenza viruses that
already circulate among
humans.
• Pandemic outbreaks
caused by new subtypes –
subtypes never circulated among
people or subtypes not circulated
among people for a long time
43. Conclusion
• Hand washing is the most effective method of
preventing infection disease.
• Wear gloves when disinfecting equipment.
• Cleanse visible contamination first, then
disinfect surface.
• Occupational risk of acquiring AIDS in VERY
LOW.
