Designated Officer Training - PowerPoint Presentation

1. Designated Officer Training

2. History of Designated Officer’s (DO) Program1988 - CDC issues document updating Universal Precautions and prevention of transmission of HIV, HBV, and other blood borne infections. -First relating to PPE -Laboratory Centre for Disease Control endorses recommendations1990 - USA – Ryan White Comprehensive AIDS Resources Emergency Act (CARE)1991 - MOHLTC taskforce recommends use of Universal Precautions be adopted and used in all health care settings and all procedures where risk of exposure exists1994 - MOHLTC release of Notification of Emergency Service Workers Protocol2008 - MOHLTC Exposures of Emergency Service Workers to Infectious Disease Protocol

3. Purpose of Designated Officers ProgramThis program will provide participants with information about the legislation and guidelines that apply, and how to recognize, assess and control common communicable diseases in the emergency services. Emergency Services Workers may come in contact with:- Bloodborne disease e.g. Hepatitis B, Hepatitis C and HIV- Respiratory diseases e.g. TB, Meningococcal disease and invasive Group A Strep. - Emerging drug resistant organisms eg. MRSA

4. “If you think that you have been exposed to an infectious disease while attending a victim of an emergency, you should notify your designated officer.”

5. ESW (Emergency Service Worker) Designated Officers Public Health

6. Role of the Employer• Set standards of practice – SOP• Provide personal protective equipment (PPE) • Appoint designated officer (DO)• Train employees to reduce exposure to blood and other body fluids

7. Role of the Emergency Service Worker (ESW)Be aware of the risks of exposure to infectious diseases and understand how to prevent or minimize the risk of exposure.Prevent exposures by using routine practices, appropriate procedures and/or personal protective equipment (PPE)Comply with workplace Health and Safety policiesReport possible exposures to DO

8. Role of the Designated Officer (DO)Receive reports from ESWAssess whether a significant exposure has occurredConsult with the local Medical Officer of Health (MOH) or appointed health unit staff for support and recommended actionFollow-up with ESWs with recommendations Important: consultation with MOH does not replace urgent medical assessment and/or the role of the family physicianCompletion of forms – WSIB etc.

9. Legal role of the Middlesex-London Health UnitTo Support DO’s and ESWs, the public health unit is required to:Assist the DO in determining the significance of the exposuresHave available to DO’s and EMS staff, a MOH or designate to receive and respond to calls.Have an on-call system for receiving and responding to reports of infectious diseases of public health importance 24/7Contact – M-F 8:30am-4:30pm 519-663-5317 ext. 2330 After hours 519–675-7523

10. Role of the Middlesex-London Health UnitActively seek out contacts of cases with infectious disease of public health importanceInform the DO that an EMS staff may have been exposed to an infectious disease of public health importance.Inform DO regarding any specific actions to be taken based on information provided.Comply with all existing regulations in the protection of personal information and ensure that confidentiality is respected.

11. Supporting Designated Officers LocalSupport Designated Officer (DO) in their training of staffCreate a List Serve for DO (updates, notices, information via email)Liaise with local services (individual detachments and organizations)DO training daysMLHU Health Connection Line (services to various programs) 519-850-2280ProvinciallyLocal IPAC Canada chapter (IPAC-SWO)Provincial Designated Officers Group – membership

12. Supporting Designated OfficersProvinciallyPublic Health Ontario or Provincial Infectious Diseases Advisory Committee (PIDAC)Other local public health units (36)Professional groups (Police, Fire, Ambulance)NationalInfection Prevention and Control Canada (IPAC) formerly CHICA Pre-hospital Care interest groupsInternational International Federation of Infection Control

13. Through inhalationThrough mucous membranesThrough non-intact and/or broken skinEyesNoseMouthOnly 3 Ways for Infectious Diseases to get into the Body:

14. AirborneDropletContactOnly 3 Ways Infectious Diseases are Transmitted

15. What’s the concern?Blood-borne pathogensHepatitis B, Hepatitis C, HIVRespiratory InfectionsTB, Influenza, MeningococcalOther infectionsMRSA, VRE, C. diff, Norovirus, etc.

16. Prevention is the best protection for the Emergency Worker

17. HCW ImmunizationUp to date immunization is in the best interest of your clients and other employeesTetanus and Diptheria – every 10 yearsPolioPertussis – Adacel (Tdap) once in adulthoodMeasles, Mumps, and RubellaHepatitis BInfluenzaTB skin test - 1-step or 2-step

18. Routine PracticesAll Clients …All The TimeHand HygienePersonal Protective Equipment (PPE)Sharps HandlingEquipment Disinfection

19. Hand HygieneThe single most effective measure to prevent the spread of diseaseBefore and after client contactAfter removal of glovesIf hands are visibly soiledBefore touching face

20. Hand HygieneSoap and WaterIf hands are visibly soiledAlcohol- based hand rubMinimum 60% alcoholIf hands are visibly clean

21. Personal Protective Equipment (PPE)GlovesFace protectionGowns/Overalls/ Bunker gear

22. PPEGlovesShould be worn to prevent exposure to organismsShould be worn throughout the procedure and changed for each clientThings to think about:Keep gloved hands away from faceAvoid touching or adjusting other PPERemove gloves if they become torn; perform hand hygiene put on new glovesLimit surfaces and items touched

23. PPEFace ProtectionGoggles or face shields should be worn to protect from splashes or spraysMasks should be worn to protect from splashes, spraysThings to think about:Eyeglasses do not provide appropriate protectionNot all masks are the same – N95 respirator

24. PPEGownShould be worn to protect from splashes, sprays of blood or body fluidsThings to think aboutHow much contact will there be with infectious material?

25. Sharps DisposalDiscard at point of use in designated sharps container

26. Bloodborne DiseasesHepatitis BHepatitis CHIVNeed direct route into body

27. Hepatitis Hepatitis BVirus attacks the liverCan cause permanent damage or cancer of the liverHalf of infected people have no symptoms and can pass the virus without knowing it1 in 10 adults become carriersTreatment is available but does not cure infectionHepatitis CVirus that attacks the liver25% develop symptoms20% of people can clear infection on their ownChronic carrier can pass infection and develop complications decades laterChronic carriage can lead to development of liver scarring and liver cancerTreatment available but does not work for everybody

28. HIVTransmitted by blood and body fluidsAlters the bodies ability to fight off infectionCarried without symptoms for a long timeTreatment available to alleviate symptoms and prolong lifeEventually body can not fight off infections leading to the development of AIDS

29. BitesExposure to saliva - only a risk for hepatitis B, and only if breaks skinIf bitten person is exposed to saliva only, follow-up for hepatitis B biter source; bitten person exposedIf blood in mouth of biter and bite breaks skin, risk to both bitten person and biter as both exposed to other persons bloodIf blood from bitten person gets into mouth of biter, biter is exposed to bitten persons blood, bitten person exposed to biters saliva

30. Risks of InfectionAfter puncture wound from a known infected source:Risk of HIV - .3% (1 / 300)Risk of hepatitis B - 2- 40%Risk of hepatitis C - 0-10% average 1.8%After a mucous membrane exposure, risk is lower:Risk of HIV <.1% (1 / 1,000)

31. Factors that Increase RiskThe virus (HBV > HCV > HIV)Type of exposure (deep injury more likely to cause transmission than splash)Amount of bloodAmount of virus in source person’s bloodSusceptibility of exposed

32. Managing a potential Bloodborne exposureESW - Immediatelyif appropriate, bleed the wound and wash thoroughly with soap and waterif mucous membrane was exposed, flush area with water for 10 minutesif chapped or non-intact skin was exposed, wash thoroughly with soap and waterGet as much information from source personREPORT to Designated Officer and seek Medical Advice

33. Designated Officer:• assess the situation• complete the incident form • consult the Communicable Disease (CD) staff of the Middlesex London Health Unit if a significant exposure has occurred Managing a potential exposure

34. Is it a significant exposure or not?Considered an exposure:Cut or poke with blood containing objectBlood on skin with cut, rash, open soreBlood in eyes, mouth or noseBite that breaks the skinNot considered an exposure:Blood on intact, normal skin

35. Health Unit:Determine if an exposure has occurredProvide appropriate counselling - Suggest medical follow-up Attempt to follow-up on the source patientEvaluating an Exposure

36. Post-Exposure Follow-up by CD staffGather information on exposed employee:Hep B vaccine statusHep B, C and HIV baseline Tetanus and other vaccinesCounsel re: precautions to reduce transmission during testing periodCommunicate with exposed employees physician

37. Post Exposure Follow-up by CD StaffHealth Unit will contact source patient if possible to determine:if known to have blood borne infectionif has risk factors for blood borne infectionif willing to be tested for blood borne infectionif willing to have results released to exposed person

38. Health UnitDepending on results of information and/or tests from source patient, Health Unit will:provide more specific advice about testing, treatment and precautions that Emergency Service Worker should take

39. Post Exposure Prophylaxis (PEP)Hepatitis BHBIG within 48 hours (up to 7 days)Hepatitis B vaccine asapHepatitis CNo PEP, no vaccine availableHIV- 2 or 3 drug regimen for 4 weeks- 80-90% effective if started within 2 hours- has many side effects

40. What if source will not consent to blood testing?EMS workers are eligible to make an application under the Mandatory Blood Testing Act (2006):Correctional employeesPolice officers and civilian employees of a police service, First Nations constables and auxiliary membersFirefighters (fulltime & volunteer)Paramedics and emergency medical attendantsParamedic students in field trainingMembers of the College of Nurses of Ontario Testing is restricted to Hepatitis B, C and HIV

41. Mandatory Blood Testing ActCan apply for order to take blood from another person if there is contact with body fluids of another personAs a result of being a victim of crimeWhile providing emergency servicesIn the course of his or her duties

42. You must submit:Applicant reportPhysician reportApplicant must submit to examination and counselingMandatory Blood Testing Act

43. Mandatory Blood Testing ActMOH will:Review applicationsSeek voluntary compliance from respondentForward application to Consent and Capacity Board

44. Consent and Capacity BoardCommence and conclude hearing within 7 daysBoard decision is final

45. Respiratory DiseasesTuberculosisMeningococcal MeningitisInfluenza

46. TuberculosisA bacterial infectionCan have latent infection or active diseaseTransmitted by coughing, sneezing, talking or spittingTuberculin Skin Test (TST)- after exposure and then 8-10 weeks laterTreatment for latent infection- izoniazid for 9 months

47. Meningococcal MeningitisBacterial infection of spinal fluid that surrounds the brainHighest incidence in children and adolescentsTransmitted by: direct contact, contact with respiratory secretions PEP: ciprofloxacin, rifampin, or ceftriaxone

48. Influenza (Flu)Influenza season: October to AprilRespiratory illness with fever, cough, chills, sore throat, malaise, body aches, tiredness and headacheSpread through coughing and sneezing and by touching contaminated surfaces and objectsPrevention:Yearly immunization Good hand hygiene, mask and eye protection with couching client FYI:Influenza is not “Stomach Flu” (vomiting and diarrhea)

49. MRSA(Methicillin Resistant Staphylococcus aureus)A common bacteria that has become resistant to certain antibioticsStaphylococcus aureus lives on the skin and mucous membranes of healthy peopleCommon cause of skin and soft tissue infections Most skin infections are minor (pimples and boils) but can be more serious (wound infections, blood infections and pneumonia)Colonization vs. Infection

50. Cleaning and Disinfection- Airway Roll- Blood Pressure Cuff- Bunker Gear- Cardiac Monitor & Leads- End Tidal CO2- Glucometer- GPS Unit- Handcuffs- Hatch Gloves- Laryngoscope Handle- Mobile Data Units- Non-Disposable Cervical Collars- Oxygen Regulator- Oxygen Tank- Pen- Pen-Light- Portable Radio- Portable Suction Unit- Protective Eyewear - Pulse Oximetre- Radio- Scissors- Scoop Stretcher / Spinal Board- Stair Chair- Stethoscope- Stretcher & Stretcher Straps- Unit Suction- Vehicle Surfaces (Handles, Switches, Steering Wheel)There are many medical devices and equipment used in the pre-hospital environment. The following is a partial list of equipment that may need cleaning and disinfection after a call:

51. DisinfectionUse hospital-grade disinfectant on items that are non-critical items. Hospital-grade disinfectants must have a Drug Identification Number (DIN) from Health Canada

52. AnthraxMeningitis, acute: bacterial, viral and other causesBotulismMeningococcal disease, invasiveBrucellosis MumpsCholeraParalytic Shellfish Poisoning (PSP)Paratyphoid FeverClostridium difficile associated disease (CDAD) outbreaks in public hospitalsPertussis DiphtheriaPlagueFood poisoning all causesPoliomyelitis, acuteGastroenteritis, institutional outbreaksPsittacosis/OrnithosisGroup A Streptococcal Disease, invasiveRabiesHaemophilus influenzae b disease, invasiveRespiratory infection outbreaks in institutionsHantavirus pulmonary syndromeRubella and Congenital Rubella SyndromeHemorrhagic fevers, including Ebola and Marburg & other viral causesSARS (Severe Acute Respiratory Syndrome)Hepatitis AShigellosisInfluenza (health care facility cases)SmallpoxInfluenza (Novel, not seasonal)Tuberculosis Lassa FeverTularemiaLegionellosisTyphoid FeverMeaslesVerotoxigenic-producing E. coli infection indicator conditions, including hemolytic uremic syndrome (HUS)IMMEDIATE REPORTING REQUIRED (Confirmed and Suspect Cases)Immediate reporting is required for the following diseases due to the need for public health follow-up. Immediate reporting is also required: a) For clusters of any reportable diseases and b) When the Health Unit issues an alert requesting immediate reporting.Reportable Diseases

53. Acute Flaccid Paralysis (AFP) in children <15 yearsInfluenza (Community cases)Acquired Immunodeficiency Syndrome (AIDS)LeprosyAmebiasisListeriosisCampylobacter enteritisLyme DiseaseChancroidMalariaChickenpox, varicellaOphthalmia neonatorumChlamydia trachomatis infectionsPneumococcal disease (Streptococcus pneumoniae), invasiveCryptosporidiosisQ feverCyclosporiasisSalmonellosis SyphilisEncephalitis primary viral, post-infectious, vaccine-related, subacute sclerosing panencephalitis and unspecifiedTetanusGiardiasis Transmissible Spongiform Encephalopathy (eg. CJD)GonorrhoeaTrichinosisGroup B Streptococcal disease, neonatalWest Nile Virus Hepatitis BYellow Fever Hepatitis CYersiniosis  REPORT AS SOON AS POSSIBLE, AND BY NEXT WORKING DAY (Confirmed and Suspect Cases)Reportable Diseases

54. Clean your handsWear the right PPE at the right timeMake sure your immunizations are up to dateDecontaminate and disinfect your equipmentConclusion

55. ‘Life-Threatening Illness’ doesn’t mean immediately life threateningYou’ve been vaccinated or have antibodies:MMR, DTPP, HBV, Varicella, influenza, HiB, MeningitisPEP is available: HIV, Meningococcal, iGAS, iStaphThe disease is actually hard to catch:TB, HIV, HCV Your immune system is pretty darn good:Influenza, iGAS, TB, MeningococcalFinal Note:

56. Monday to Friday 8:30 to 4:30519-663-5317 Ext. 2330After 4:30 and weekends and holidays519-675-7523