Infectious Agents Exposure Reduction Training for First Responders

infectious agents exposure reduction
training for first responders this training was developed through the
Mel and Enid Zuckerman College of Public Health’s environment exposure science
and risk assessment Center and the western region public health training
center in partnership with the Tucson Fire Department through this video you
will be learning protocols and strategies for mitigating your exposure
to infectious agents while the content here and some of the examples will be
focused on coronavirus specifically the information can be applied to other
infectious agents as well let’s first discuss how infectious agents can be
transmitted looking at a highly infectious respiratory virus like the
corona virus responsible for COVID-19 this virus can be transmitted via
multiple pathways through contact with contaminated surfaces through inhalation
of aerosolized virus due to close proximity to infected patients and their
direct contact with infected patients in the case of corona viruses their
survival time is on the order of hours to weeks depending upon the material
type strain and temperature this survival time is common for other
pathogens as well this means that errors and
decontamination between calls could lead to the spread of infection from one
patient to another when choosing a disinfectant make sure the type of
disinfectant is appropriate for the pathogen of concern in the case of
corona virus ethanol and hydrogen peroxide can reduce concentrations by
large amounts while a 99.999 percent reduction sounds great this would mean
that if there were 10 million viruses introduced to a surface by an infected
patient that still leaves 100 viral particles for some highly infectious
viruses it may only take one viral particle to make you sick this
emphasizes the need for consistent and proper disinfection here are two
examples of disinfectants that could be used for a full list of products and
other types of disinfectants that are effective against corona virus or other
pathogens of interest check out the EPA’s registered list of
products provided on this slide is a URL for the list of products relevant for
COVID-19 while using the same rag or cloth may be convenient if your
using disinfectant from a spray bottle versus wipes this rag could become
contaminated and spread the virus between surfaces if possible use paper
towels instead when using disinfectant sprays the learning objectives for this
training are to number one identify highly infectious pathogen specific
hazards number two understand common exposure pathways for first responders
number three compare strategies for reducing exposure potentials and number
4 distinguish effective infection control protocols during outbreaks of
highly infectious diseases we should approach the uncertain situation
prepared with the right personal protective equipment or PPE and
protocols to protect ourselves and others from becoming infected tier 1 PPE
should be used for all basic medical responses this includes a surgical mask
gloves and eye protection for suspected COVID-19 cases or for invasive
procedures such as intubation additional PPE should be worn including a
disposable gown and 95 respirator and boot covers here we see a step by step
diagram of proper donning technique recommended by the CDC for tier 2 PPE
donning the gown is put on first followed by the respirator if you are
using an n95 respirator remember to be properly fit tested and to have a clean
shaven face so the mask is securely sealed the face shield or eye protection
is then donned if boot covers are worn these should
then be donned followed by the gloves when putting on gloves
note that the edge of the glove comes up over the edge of the sleeve this
protects the wrist from being exposed to air that may be contaminated and from
accidental contact with the skin let’s take a look at a donning example note here that because gloves were put
on first the edge of the gown sleeve came up over the glove this is not as
secure as the glove edge being over the gown sleeve if the patient is ambulatory
have them leave their room put on a surgical mask and move to an open-air
area when caring for a patient who may be infected limit the number of
personnel having patient contact keep a 6 to 12 foot distance if possible as
this is recommended to minimize the risk of exposure for fire department
specifically it is important to understand that for a stable patient the
entire four person crew may not be needed for patient contact equipment
should be kept as far away from the patient as possible do not bring in
unnecessary equipment as this increases the chances that the equipment becomes
contaminated keep a mental inventory of what needs to be decontaminated after
the call even surfaces such as a stethoscope need to be decontaminated
between calls notice that the gowns are untied and are dragging on the floor
this may be a challenge with gowns that have short ties however floor contact
could lead to contamination of the PPE and wherever the ties drag to next
notice also that equipment such as cords may also touch the floor decontaminating
these surfaces can limit cross contamination between calls notice that
boot covers are being worn limiting contact with the floor is one strategy
for limiting the unnecessary introduction of pathogens to other
environments such as the ambulance or the station via shoe movement when
loading the patient limit contact between the patient and surfaces a
strategy shown here is something we like to call a human burrito remember to
leave one arm out for taking vitals if possible the window between the cab and
the cabin should be shut to limit the movement of aerosolized viruses in a
study of how viruses move due to hand contact with surfaces and EMS vehicles
we found that some surfaces are more likely to be contaminated than others
while decontamination of all surfaces is important high touch
surfaces should be a priority during unloading of the patient be mindful of
contact surfaces as before here we see the CDC’s recommended order for doffing
if you’re wearing boot covers remove these first with the gloves so as to not
contaminate your hands then remove gloves being careful not to touch the
outer surfaces of the glove remove the gown rolling it outward and away from
yourself next remove the mask or respirator from the back of the head all
items should be disposed of in a biohazard bag remember when dealing with
biohazard bags later use gloves finally wash the hands or use an alcohol-based
hand sanitizer decontamination of surfaces after a call is an important
measure to not only protect future patients but also to protect yourself
from infection our exposure models predict that proper disinfection after a
call for a corona virus infected patient could reduce your infection risk by more
than 99.99% for a 15-minute call when cleaning equipment remember to be
mindful of proper contact times or the amount of time surfaces are to remain
wet with the disinfectant in order for the proper reduction to be achieved
the recommended contact time information can typically be found on the product
labeling notice here that slight contact was made with the glove during doffing
this highlights the importance of hand-washing and use of alcohol-based
hand sanitizers after the doffing process when washing your hands remember
to get spaces between the fingers on the top and bottom of the hands and
underneath the fingernails in order to not contaminate services as
they’re being decontaminated one strategy is to start with the highest
surfaces and work your way down words finishing with decontamination of the
floors remember to focus on high touch surfaces some of the most forgotten
surfaces include radios and personal items such as sunglasses glasses or
cellphones if used during the call remember to disinfect surfaces in the
cab as well such as the steering wheel and keys notice that gloves replaced
into biohazard waste as opposed to being flung or tossed this is the way to go
flinging or tossing gloves can contaminate the floors along the flight
path and other nearby surfaces a common issue at the end of decontamination is
how to doff gloves used for decontamination steps and avoid self
contamination by touching the outer handle of the ambulance doors first
clean the outer door handle next doff the gloves
dispose of the gloves and close the outer door handle that was just cleaned before going back into the station
remove boots and put on slippers this should especially be done if boot covers
were not worn on the call in order to be effective approximately 1 to 3
milliliters of hand sanitizer or enough to cover the front and back of the hands
should be used it is important to document the type of call especially
when there is a suspected highly infectious illness using Department
standard operating procedures we hope you found this information helpful for
preventing infection during highly infectious disease outbreaks thank you
for watching our training and stay safe

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