infection control in paramedic services teleclass slides, oct ...•published in prehospital...

Infection Control in Paramedic ServicesJennifer Amyotte, City of Sudbury Paramedic Services

Webber Training Teleclass

Hosted by Greg Bruce, County of Simcoe Paramedic Serviceswww.webbertraining.com

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Infection Control in Paramedic Services

JenniferAmyotteCommanderof CommunityParamedicine&ProfessionalStandardsCityofGreaterSudburyParamedic Services

HostedbyGregBruceCountyofSimcoeParamedicServices

www.webbertraining.com October 26, 2017

Disclosure

Idisclose,Ihavenopotentialordirectconflictofinterest.

Thispresentationcontainsmyobservations,knowledgeanddoesnotnecessarilyreflecttheopinionsofmyemployertheCityofGreaterSudburyParamedicServices.

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OverviewChallengesParamedicKnowledgeResearchPointofCareRiskAssessmentPersonalProtectiveEquipmentMovingForwardQuestionsReferences

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Challenges

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Challenges Expectedrapid“turnaroundtime”togetbackintoservicefollowingtransferofcareatED.

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Spaulding Classification System

Studieshavedeterminedbacterialpathogensinambulancesonsamplecollectionsgrewskinandenvironmentalflora.

ParamedicsandhealthcareworkersmaycarrystaphaspartofskinflorainfactastudypublishedinJEMSOctober2015determinedParamedicsare10xhigherriskofcarryingMRSAiftheydon’twashtheirhandsafterremovingtheirgloves.Thehigherrateofcolonizationthanthenormalpopulationcanleadtothebacteriabeingfoundinambulances 6




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Cleaning ProcessEstablishedprocess/policy

Checklist,cardsforreferenceProperproduct

Cleantodirty

UsePPEasrequired

Nospraybottles

Ensurewetcontacttimeasperproductrequirements

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Paramedic KnowledgeCanada:formalinCollege,InOntarioapprox.4-6hrsbriefeducationbasedonNationalOccupationalCompetencyProfile(NOCP)forParamedics

ServiceProviders:Limitedtimetoprovideongoingtraining,varieddependingontheservice,operationaldemandandcurrentfocusieEbola,H1N1,SARSOntariomandatory:“DesignatedOfficers”

IPACCANADAVeryfewserviceshave“InfectionControlPractitioners”orstaffmembersCertifiedinInfectionControl“CIC”

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Research AustralianJournalofParamedicine(2017)NigelBarr,MarkHolmes,AnneRoiko,WilliamLord

Statedrelativelylittleresearchabouttransmissionofpathogensinpre-hospitalsetting.ConcludesthatthemobileparamedicenvironmentpresentsuniquechallengestoproviderecommendedIPCpractices,andtargetedresearchintostaffcomplianceisrequiredtoidentifybarriersandenablerstoincreasetheuptakeofIPCpractices.

Reportssuggestparamedicshavelimitedunderstandingofinfectiousdiseasethatmaydemonstratepoorcompliancewithinfectionpreventionandcontrolprotocolswhencaringforpatients.

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EMS Provider Compliance with Infection Control Recommendations is Suboptimal

•StudydoneinUSA.•PublishedinPrehospitalEmergencyCare2014•ObservationalstudyinlargeED•423EMSdeliveriesobserved•899providers•Useofglovesin512(56.9%)•Handwashingobservedin250(27.8%)•Equipmentdisinfections31.6%•Mostcommonlydisinfecteditemwasthestretcher

DeterminationIPACpracticesuboptimalandstrategiesmustbedevelopedtoimprovecompliancewithestablishedrecognizedguidelines

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Aseptic procedure always possible in Paramedic Practice? Aseptic/no touchBestpracticeIVpalpatevein,HH,cleanthesite,letskindry30seconds,prepareequipment,HH,dongloves,DONOTREPALPATEVEIN,insertcannula,securewithsterileopsite,

Emergencysituationssituationrequiringmaypreventallstepsbeingtaken.

IntheUKmedicsnotifystaffsocannulacanbereplacedASAP(within24hrs)

EmergencyIntubationinthefieldwithaspirationpriororduringprocedureincreasesriskofVAP.HighestinTraumapatients.AmericanStudy2015

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Point of Care Risk AssessmentPurpose: toassessandreduceriskoftransmissionofmicroorganismsanddetermineappropriateactions/precautionspossiblePPErequirestoprovidesafeinteractionwithpatientand/orenvironment:WHATISMYPURPOSE/TASK?• Doneasapproachingpatient– lookforpossiblerisksofexposuretoblood,bodyfluids,excretions,secretions,mucousmembranes,nonintactskin.• Performhandhygienebeforetouchingpatientordonningglovesifrequired• VerbalARIrisktoolasrequired- newcough/SOB,chills/feelfeverish,travelhistory• Lookforrashes,hx diarrhea,vomiting,drainingwounds/cellulitis 12




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Point of Care Risk Assessment• Determineifrequirecontactand/ordropletprecautions- fluidsplash,respiratorysecretions• Donagownifuniformislikelytobecomecontaminatedduringdirectpatientcareorfromenvironment• Ensuretoperformhandhygiene•Ensuretopre- notifyreceivingfacilityiftransportingpatientwithsuspectedcommunicabledisease

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PPE

• Designedtogooverscrubs,canpresentachallengetomedics• Usedasabarriertoassistinpreventingexposure• Mustbereadilyaccessible• Mustbeappropriatesize• Shouldbeputonjustbeforeinteractionwithpatientbasedonpointofcareriskassessmentand/orsignageknowledge(ie.transfer)• SelectionofPPEdependsonmodeoftransmission

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PPE• Wheninteractionwithpatientisconcluded,PPEshouldberemovedanddiscardedappropriately

• ContaminatedPPEmustNEVERbewornindriver’scab

• RegulareducationandreviewofdonninganddoffingofPPEmustbeprovided

•FittestingofRespiratorsrequired,paramedicsmustbetrainedinuse

•Gowns/coveralls– considerfluidresistant•Eyeprotection- personalissueand/ordisposable

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Gloves•Paramedicsoftenwearglovesfora“wholecall”onlychangingifrippedorvisiblysoiled

•DONOTwearglovesforroutinehealthcareactivitiesinwhichcontactislimitedtointactskinofpatient

•Weargloveswhenitisanticipatedthatthehandswillbeincontactwithmucousmembranes,non-intactskin,tissue,blood,bodyfluids,secretions,excretions,orequipmentenvironmentalsurfacescontaminatedwiththeabove

GLOVESARENOTREQUIREDONEVERYCALL

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PPE Enhanced Precautions

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Moving Forward Ø CanadianParamedicServicesStandardsReport2014–IdentifiedIPACasoneofthetop5priorityareasasastrategicrecommendationforthepathforward

ØReviewyourprogramwithInfectionControlStandards–IPAChasoneforCanadaalsoanAudittoolkitforPrehospitalformembers

Ø ImmunizationProtocolsforallfirstrespondersstartingwithParamedics

Ø FurthertheeducationofparamedicsandincreasenumberofInfectionControlProfessionalsinservices

Ø IncreasenetworkofParamedicICPs,Canada,USA–potentialofPrehosptialInterestGroupgloballyØ IfyoudonothaveserviceexpertiseseekassistancefromIPACCanada,LocalHospitalICPs,PublicHealth

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References1. NationalOccupationalCompetencyProfileforParamedics

Area3:Health&Safety3.3f2 RoutinePractices&AdditionalPrecautionsinallHealthcare

SettingsPublicHealthAgencyCanada2013

3 RoutinePractices&AdditionalPracticesinallHealthcareSettingsPublicHealthOntario2012

4 AqualitativeexplorationofinfectionpreventionandcontrolguidanceforAustralianparamedicsAustralianJournalofParamedicinevolume14/Issue3/Article

5 EMSProviderCompliancewithInfectionControlRecommendationsisSuboptimalPrehospitalEmergencyCareVolume18,2014– Issue2

6 PrehospitalAspirationisAssociatedwithincreasedPulmonaryComplicationsSurgicalInfectionsApril7,2015

7 ExposureofEmergencyServiceWorkerstoInfectiousDiseasesProtocolProvinceofOntario2008

8 EnvironmentalCleaningandDisinfectionforEmergencyVehiclesIPACCanadaPracticeRecommendations– May2014 19

References9ARationalApproachtoAmbulanceCleaningandDisinfection

PracticesMaryAnnMillerJackWagnerApril2014

10. BestPracticesforEnvironmentalCleaningforPreventionandControlofInfectionsinallHealthcareSettings-2nd editionPublicHealthOntario- PIDACMay2012

11. Self-reportedbehaviorsandperceptionsofAustralianparamedicsinrelationtohandhygieneandglovingpracticesinparamedic-ledhealthcareAJICJuly2017

12. IPACCanadahttps://ipac-canada.org/about-ipac-canada.php

13. CanadianParamedicServicesStandardsReport:StrategicPlanningReportParamedicStandardsSteeringPanelMarch2014

14. InfectionPreventionandControlProgramStandardsIPACCanada

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[email protected]

Thankyou

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infection control in paramedic services teleclass slides, oct ...•published in prehospital...

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