Guide to Infection Prevention in Emergency Medical Services

APIC Implementation Guide

Guide to Infection Prevention in Emergency Medical Services

About APIC APIC's mission is to create a safer world through prevention of infection. The association's more than 14,000 members direct infection prevention programs that save lives and improve the bottom line for hospitals and other healthcare facilities. APIC advances its mission through patient safety, implementation science, competencies and certification, advocacy, and data standardization.

About the Implementation Guide series

APIC Implementation Guides help infection preventionists apply current scientific knowledge and best practices to achieve targeted outcomes and enhance patient safety. This series reflects APIC's commitment to implementation science and focus on the utilization of infection prevention research. Topic-specific information is presented in an easy-tounderstand-and-use format that includes numerous examples and tools.

Visit implementationguides to learn more and to access all of the titles in the Implementation Guide series.

Copyright ? 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC)

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopied, recorded, or otherwise, without prior written permission of the publisher.

Printed in the United States of America First edition, January 2013 ISBN: 1-933013-54-0

All inquiries about this guide or other APIC products and services may be directed addressed to:

APIC 1275 K Street NW, Suite 1000 Washington, DC 20005 Phone: 202-789-1890 Fax: 202-789-1899 Email: info@ Web: Email: info@ Web:

Disclaimer APIC provides information and services as a benefit to both APIC members and the general public. The material presented in this guide has been prepared in accordance with generally recognized infection prevention principles and practices and is for general information only. It is not intended to provide, or act as a substitute for, medical advice, and the user should consult a health care professional for matters regarding health and/or symptoms that may require medical attention. The guide and the information and materials contained therein are provided "AS IS", and APIC makes no representation or warranty of any kind, whether express or implied, including but not limited to, warranties of merchantability, noninfringement, or fitness, or concerning the accuracy, completeness, suitability, or utility of any information, apparatus, product, or process discussed in this resource, and assumes no liability therefore.

Guide to Infection Prevention in Emergency Medical Services

Table of Contents

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Declarations of Conflicts of Interest and Disclaimer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Section 1: Guide Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Section 2: Epidemiology and Pathogenesis: Infectious Diseases in EMS. . . . . . . . . . . . . . . . . . . . . . . . . 12 Section 3: Risk Factors/Risk Assessment in EMS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Section 4: Surveillance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Section 5: Engineering and Work Practice Controls and Personal Protective Equipment . . . . . . . . . . . . 32 Section 6: Occupational Exposure Health Issues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Section 7: Bioterrorism and Infectious Disease Emergency Preparedness . . . . . . . . . . . . . . . . . . . . . . . . 65 Section 8: Education, Training, Compliance Monitoring, and Summary. . . . . . . . . . . . . . . . . . . . . . . . 71 Appendix A: Sample Ambulance Cleaning Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Appendix B: Sample Exposure Control Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Appendix C: Definition of Terms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Appendix D: Acronyms and Abbreviations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

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Guide to Infection Prevention in Emergency Medical Services

Acknowledgments

Lead Author Janet Woodside, RN, MSN, COHN-S EMS Program Manager, Portland Fire and Rescue, Portland, OR

Authors Terri Rebmann, PhD, RN, CIC Associate Professor, Institute for Biosecurity, Saint Louis University, School of Public Health,

Saint Louis, MO

Carolyn Williams, RN, BSN Occupational Health/Infectious Disease Program Manager, City of Portland, Portland, OR

Jeff Woodin, NREMT-P, FAHA Tualatin Valley Fire and Rescue, Tigard, OR

Research Assistant Martin B. Schopp EMS Intern, Portland Fire and Rescue, Student Nurse, Concordia University, Portland, OR

Reviewers Linda Bell, MSN, ARNP, EMT-P Programs Coordinator, Consultant Services, Middleburg, FL

Greg Bruce A-EMCA CHICA-Canada, Platoon Supervisor/Infection Control Officer, County of Simcoe Paramedic Services,

Ontario, Canada

William E. Coll, BA, MPUB AFF, LP, REHS Clinical Commander/ICO, Austin/Travis County EMS, Austin, TX

Jeffrey D. Ferguson, MD, FACEP, MS-HES, NREMT-P Assistant Professor of Emergency Medicine, Medical Director, Vidant Medical Transport, Assistant EMS

Director, Pitt County, NC; Brody School of Medicine, East Carolina University, Greenville, NC

Louis Gonzales, BS, LP System Coordinator ? Performance Improvement and Research, Senior Science Editor, American Heart

Association, Office of the Medical Director, Austin/Travis County EMS system, Austin, TX

4 Association for Professionals in Infection Control and Epidemiology

Guide to Infection Prevention in Emergency Medical Services

Arthur Mata Medical Coordinator, Training Division, City of Flint, Michigan Fire Department (Retired), National

Fire Academy Instructor ? EMS Katherine H. West, BSN, MSEd, CIC Infection Control/Emerging Concepts, Manassas, VA

Production Team

Managing Editor Thomas Weaver, DMD Director, Professional Practice Association for Professionals in Infection Control and Epidemiology, Inc. Project Management and Production Oversight Anna Conger Sr. Manager, Practice Resources Association for Professionals in Infection Control and Epidemiology, Inc. Layout Meredith Bechtle Maryland Composition Cover Design Sarah Vickers Art Director Association for Professionals in Infection Control and Epidemiology, Inc.

Association for Professionals in Infection Control and Epidemiology 5

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