Mercy Memorial Hospital System

INFECTION CONTROL POLICY

EMS personnel are constantly responding to calls in which they have no prior knowledge of the patient, the patient's history or diagnosis, or the potential for transmission of infection. Therefore, precautions and procedures that minimize exposure to disease-causing organisms are a critical part of EMS protocols.

Universal precautions are procedures used for all patients where there is a likelihood of exposure to blood or body fluids. The EMT cannot determine whether a patient is infectious by the patient's appearance or environment. In addition, histories are not always accurate.

Universal application of infection control barriers will protect the EMT and will prevent discrimination and inadequate patient care for those perceived to be in known risk groups.

1. EXPOSURES/NON-EXPOSURES

A. Definition of Exposure

An exposure is contact with blood or fluids that have the potential to be infectious through a puncture wound, through broken or non-intact skin, or through the mucous membranes of the nose, mouth, or eyes.

B. Not An Exposure

1. Blood on intact skin

2. Blood on clothing or equipment

3. Being present in the same room as the infected person

4. Touching the infected person

5. Talking to the infected person

C. It is important to note that infection by hepatitis B virus occurs through the same routes, non-intact skin and mucous membranes, as does the AIDS virus. The hepatitis B virus is hardier than the AIDS virus, and health care workers are at a greater risk of hepatitis B infection. However, the same infection control practices will prevent exposure to both blood-borne pathogens.

2. POLICY FOR POTENTIAL EXPOSURES

Mercy Memorial Hospital will designate an infection control coordinator to serve as liaison with EMS providers for the purpose of communicating information regarding potential exposures. Each EMS provider should appoint a supervisor to handle exposure reports, fill out exposure worksheets, and be the service's liaison with the infection control practitioner.

A. Potential Exposure -- Field-Initiated

1. Percutaneous (through the skin) - wipe off blood and apply alcohol to the wound.

2. Mucocutaneous (in eye, nose, or mouth) - flush eye thoroughly or rinse mouth with saline or water.

3. On arrival at the hospital or as soon as patient care allows, thoroughly wash hands and/or the wound; wash face and flush eyes for eye exposures. Have a physician in the emergency room assess the exposure and provide treatment.

4. Any time blood or body fluid comes in contact with skin or mucous membranes, a medical incident report will be completed and the incident reported to the designated supervisor as soon as possible.

5. The supervisor will complete the Blood/Body Fluid Exposure Worksheet (Attachment A) and determine if follow-up is needed.

6. If follow-up is needed, supervisor will contact the hospital infection control practitioner.

NOTE: If the exposure occurred while treating a patient that was transported to an Ohio hospital, it will be necessary to attach a "Request for Notification" form to the worksheet. See Attachment B. MCL 333.20191 now allows the emergency responder to require patient testing for HIV or hepatitis B virus if a percutaneous, mucous membrane or open wound exposure occurred. Patient testing must be by written request of the exposed individual on form MDCH J427. This form and instructions follow the Attachments A-D of this policy. The request must be received prior to patient discharge, and must include the exposed responder's name, address and type of exposure. An exposed EMT should contact the Emergency Department physician immediately following exposure, to explain the circumstances of the exposure and to request patient testing.

7. Hospital infection control practitioner will initiate Pre-Hospital Exposure Worksheet (Attachment C) and check patient chart. Results of these tests will be held in strictest confidence and used only for the purpose of determining appropriate plan of treatment for the pre-hospital personnel.

8. The hospital infection control practitioner will contact the exposed EMS worker and inform him/her whether follow-up testing and treatment is needed, without disclosing patient identity (Attachment D).

9. If the emergency patient is tested as part of treatment rendered at the hospital and test results are positive for an infectious agent, the health facility is required by law to notify the prehospital worker within two days of receiving test results that he or she may have been exposed to an infectious agent and the appropriate infection control precautions should be taken. If the prehospital worker wants to know if the transported patient specifically tested HIV positive, a written request must be sent to the hospital.

10. Any other EMS agencies involved in extricating, treating, or transporting a patient found positive for an infectious agent the patient will be notified to determine if exposure occurred and if follow-up is needed.

11. Follow-up care and treatment of exposed personnel shall be the responsibility of the pre-hospital provider agencies and shall be carried out without delay upon notification of exposure.

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