INTRODUCTION

In recognition of the increased awareness, and presence of, infectious diseases among the general public which Gila Regional EMS System serves, every effort will be made by all pre-hospital personnel to prevent the transmission of disease to employees or between patients. The procedures outlined in this document are mandated for all personnel while performing their regular duties as patient care providers. The Occupational Safety and Health Administration (OSHA) require certain procedures and tasks. The employer may be fined for failure to assure compliance with these procedures.

1. Personnel who are at risk of exposure to blood borne pathogens:
   1. Emergency Medical Technicians
   2. Intermediate Emergency Medical Technicians
   3. Paramedics
   4. First Responders
   5. Fire Department Personnel
   6. Law Enforcement Personnel

2. Personal Protective Equipment - The following equipment should be immediately available to all personnel whenever providing patient care:
   1. Disposable latex gloves, for direct patient contact.
   2. Mask/Shiled devices for protection of the eyes, mouth, and nose.
   3. Impervious membrane suits.
   4. Bag-Valve Mask Device.
   5. Hep-filter mask (for protection from airborne pathogens such as TB.

3. Pre-hospital personnel will be responsible for using appropriate protective equipment while performing specific skills. The following list of skills and required protective equipment shall be used:
   1. Patient Assessment-Gloves do not have to be worn unless body fluids are present, although it is recommended to don gloves prior to arriving at the patients side. Gloves should be directly available at all times.

   2. Venipuncture-Gloves shall be worn on both hands while performing any venipuncture, including IV starts and "blood draws". Heaby latex gloves will be used for this purpose. A sharps container shall be immediately present for the EMT's use when performing the venipuncture.

   3. Suctioning-Gloves shall be worn on both hands during all suctioning procedures. A A face shild/mask combination will be worn during the entire suctioning procedure. Regular eyeglasses are not sufficient to protect against exposures.

   4. Combi-Tube-Use the same precautions as for suctioning (item 3).

   5. Major Bleeding-Gloves, mask/shield, and an impervious membrane suit/gown shall be worn to prevent contamination of clothing (use a suit/gown when appropriate).

   6. Coughing/Spitting by Patient-Masks may be placed on the patient if it will not interfere with the airway or other patient care procedures. The EMT should wear gloves, mask/shield, and suit (use a suit when appropriate and will not not interfere with patient care).

   7. Contact With Any Body Fluids-Gloves must be worn when any contact with body fluids exists regardless of type or cause. Gloves should be worn if mechanisms or probability exists for fluids to be present.

   8. Contact With Saliva-Although saliva has not been implicated in blood borne pathogen transmissions, it is a mode of transmission for other illness. Equipment will be utilized to prevent contact during resuscitation efforts. A pocket mask should be immediately available to all personnel. A disposable BVM will also be available in an immediately accessible location and should be used in all resuscitative efforts.

4. Engeneering and Work Practice Controls
   1. Hand Washing-All personnel who perform a task where there is a risk of exposure to blood or body fluids shall wash their hands as soon as feasible, after removing Personal Protective Equipment (gloves, mask/shield, etc.). When it is not feasible to wash hands, personnel are to use antiseptic hand cleaner. Hands should be washed with warm water and soap at the earliest convenience.

   2. Eating/Grooming-Personnel shall not eat, drink, smoke, apply cosmetics or lip balm, or handle contact lenses until hands are washed. Even though hands are washed following patient contact, personnel shall also wash their hands following cleaning of the emergency vehicle and its equipment.

   3. Sharps Handling-Needles or any other types of sharps shall not be bent, sheared, or recapped. All sharps shall be placed in the appropriate sharps container provided in the work area. The containers shall be kept in all patient care areas, or in "kits" that carry portable equipment that is intended to provide this procedure at the location of the patient. Sharps shall be disposed of according to the GRMC's procedures.

   4. Restricted Activity in the Work Area-No eating, drinking, smoking, applying cosmetics, or handling of contact lenses will be permitted in ambulances or designated dirty utility areas.

   5. Transport of Contaminates-All blood samples, avulsed, amputated or expelled tissue removed and transported to a hospital will be placed in a container and appropriately labeled. The container must be leak-proof, puncture-resistant, and sealed to prevent spillage.

1. When cleaning equipment or unit, use a bleach water mixture (or equivalent) with at least 1:10 concentration (bleach:water). For cleansing of suspected TB infected equipment, one should use a 1:1 mixture.

2. If you believe you've been exposed ('exposure') to a patient;
   1. Immediately stop exposure, protect yourself.
   2. Cleanse the exposure site ASAP with disenfectant soap and water.
   3. Report the incident to your Immediate Supervisor, the House Supervisor, and or Medical Control for guidance.
   4. Document the incident on an incident form.