Integrating infection control into the patient treatment process
Don’t be complacent when it comes to infection control – stay current in the treatment process by being proactive before, during and after
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By Rachel Lesczynski, EMS1 BrandFocus Staff
Over the course of the pandemic, infection control has taken the front seat. In a September presentation on EMS1, three expert panelists weighed in on current best practices for infection control through three common but different scenarios. How can you apply these steps to protect yourself, your coworkers and your patients, as well as your family when you return home?
SCENARIO 1: NAUSEA, VOMITING, DIARRHEA
The first scenario is a patient who calls in for abdominal pain, including nausea, vomiting and diarrhea. Immediately, you know what the environment could look like before arriving on scene. What conditions could lead to these symptoms?
These symptoms could arise from a host of different things, from food poisoning to flu to appendicitis or diverticulitis, says Brittney Prater, lead EMS faculty member at Calhoun Community College in Alabama. These symptoms are less often associated with COVID-19, but that’s also a significant possibility.
“COVID presents with nausea, vomiting and diarrhea in a lot of our patients, which is not something we really think about a lot of times,” said Prater.
With a wide range of potential causes, what is the best way to prepare?
At minimum, gloves and a mask are mandatory, but there are additional items to have on hand to prepare yourself for what you might walk into during this call, such as goggles and gowns.
“We don’t think about eye protection a lot of times, but anytime there’s a chance of splatter, have a gown available,” said Prater. “Maybe I don’t want to put it on to start with, but who knows what’s going to be on the patient and around the patient?”
Should you need to move the patient to an area where you are easily able to assess and treat them, that is when a gown will protect you from what fluids could be on the patient.
A call like this might require IV treatment due to fluid loss and dehydration. Disposal of sharps, patient protection and decontamination – and your own protection from potential blood – all come into play if this type of treatment is necessary.
Be aware that the highly infectious C. diff, which will not be diagnosed from your time at the scene or transport, may be present in this scenario. Therefore, it is critical that you are properly removing and disposing of your PPE, because this bacteria in its spore form can exist on surfaces for up to six months.
Proper decontamination of the ambulance, patient care equipment and yourself is what kills or eliminates the bacteria and prevents it from being transferred to any new host. One of the most critical steps: Wash your hands. Alcohol-based sanitizer alone will not kill the bacteria, so wash your hands thoroughly using soap and water.
SCENARIO 2: FEVER AND SEPSIS
This second scenario is a call for a patient at a skilled nursing facility who exhibits an altered mental status, fever and weakness. As in the first scenario, there is a wide net of possibilities, including any type of infection to cause the fever, such as pneumonia, UTI or general sepsis. How is this patient to be assessed, treated and transported using the best infection control practices?
First, protect yourself. Fever most likely means infection, meaning an N95 mask should be worn. If the patient needs volume replacement, it’s best to give them a mask as well. Patient irritability and mental state play a factor in this step, but this adds a layer of protection for you and other individuals at the scene. If any intervention with the airway is necessary, or if the patient is in respiratory distress, this step might not be logical.
“We can’t depend on masking our patients,” said Prater, “but if it’s logistically possible, we absolutely should.”
Again, decontamination of the ambulance and its contents play a big factor in infection control, as bacteria and viruses that may be infecting the patient have a potential of living on surfaces long after the call.
“Those bacteria and possibly viruses that the patient is infected with might be multi-drug resistant organisms and resistant to antibiotics,” said Caryn Humphrey Arnold, a Medline medical science liaison.
Be sure to read the label of whatever disinfecting/cleaning agents you use to be sure they are EPA registered to kill many different pathogens quickly.
Also make sure you know and allow the required contact time, which is the amount of time that the disinfectant should remain wet on the surface to effectively kill pathogens. Wiping anything off too soon will reduce the effectiveness of your decontamination efforts, warns Nikki Cracknell, another Medline medical science liaison.
SCENARIO 3: ASTHMA
The third scenario involves an 8-year-old child having an asthma attack at home. What seems to be an asthma attack could be caused by something else contagious, including RSV, the flu or COVID-19. Start with an N95 and eye protection against aerosols.
The first line of treatment in this scenario is typically nebulized medication: Albuterol, DuoNeb or Xopenex. Nebulizers produce a high amount of respiratory particles that can transmit up to a 33-foot radius, so it would be beneficial if you are able to move the patient to a well-ventilated area or keep the ambulance doors open. Some providers have been transitioning from nebulized medication to a metered-dose inhaler (or MDI) instead to reduce the amount of aerosols, says Prater.
“If at all possible, try to avoid the use of the nebulizers and go to that MDI with a spacer and a mouthpiece,” said Cracknell, “or at least a well-fitted face mask to really help to reduce the amount of those respiratory particles being transmitted into the air.”
STAY CURRENT IN YOUR RESEARCH
Guidelines for infection control from the CDC and other governing boards are constantly changing, and staying up to date can be a daunting task. Reading through CDC guidelines and those of other trusted sources is one way to stay current in these topics. The CDC and Agency for Healthcare Research and Quality also provides a subscription sent to your email with notifications of new guidelines and updates.
Information or guidance from colleagues, mentors and patient care partners can also be a benefit.
“If you have the ability to ask when you’re going into the hospitals, ask what information they are getting from some of their infection preventionists or directors of quality that might be able to give you some information to help you out in the field,” said Cracknell.
Don’t skimp on continuing education, adds Prater. Not only is this a means to stay on top of current guidelines and practices, but it sets a good example for those starting in EMS. Finding a good source of information and knowledge is critical to staying on top of your practice, and we should be encouraging each other to do so as well.
PPE goes well beyond gloves and the N95. Hand washing and decontamination -- always being conscientious of contact time – are key to stopping the spread of pathogens. No one will care about your personal safety more than you do, so own your safety by being vigilant and taking the correct precautions.