Drill of the Month Developed by Gloria Bizjak Why We Use Body Substance Isolation Precautions.

Drill of the MonthDrill of the MonthDeveloped by Gloria BizjakDeveloped by Gloria Bizjak

Why We Use Body Why We Use Body Substance Isolation Substance Isolation

PrecautionsPrecautions

Drill of the MonthDrill of the Month 22


PrecautionsPrecautionsStudent Performance Objective: Given

information, resources, and opportunity for discussion and practice:

– List and describe types of protective precautions.– Define BSI precautions and explain their purpose,

importance, and requirements.– List personal protective equipment and describe

its purpose.– Demonstrate techniques for donning, doffing, and

disposing of PPE based on scenarios.

EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency Medical Providers.



PrecautionsPrecautionsOverview: Types of Protective Precautions BSI Precautions Personal Protective Equipment Donning, Doffing, and Disposing of

PPE


Types of Protective Types of Protective PrecautionsPrecautions

Isolation precautions– In-hospital isolation infection control,

1975– Disease specific precautions to prevent

spread of infection In-hospital precautions: patient in private

room Provider precautions:

– Protective barriers: masks, gowns gloves– Wash hands– Special disposal/handling of contaminated articles



Isolation precautions– Includes other precautions (discussed

later) Standard precautions Transmission-based precautions



Universal precautions (UP)– CDC 1987 (replaced CDC 1983

Guidelines for Isolation Precautions)– In-hospital practices to prevent

transmission of bloodborne diseases– Emphasized that visible blood

required barrier protection– Does not address disease-specific

isolation precautions for nonbloodborne infections (in-hospital)



Universal precautions (UP)– Precautions: Gloves, gowns, masks,

protective eyewear when contact with blood or body secretions containing blood is anticipated (not all the time as with BSI) Applies to blood, body fluids containing

visible blood, semen, vaginal secretions Applies to tissues and specific body

fluids: cerebrospinal, synovial, pleural, peritoneal, pericardial, amniotic



Universal precautions (UP) continued…– Precautions: Gloves, gowns, etc. as

with previous slide, when contact with blood or body secretions containing blood is anticipated Does not apply to feces, nasal secretions,

sputum, sweat, tears, urine, vomit unless they contain visible blood

Does not apply to saliva except when visibly contaminated with blood or in the dental setting where blood-contaminated saliva is predictable



Body Substance Isolation (BSI)– Developed by nurses, colleagues

working in large hospital epidemiology departments

– Assumed all moist body substances were potentially infectious Not just blood as in UP Wear gloves for anticipated contact



Body Substance Isolation (BSI)– Purpose: Reduce transmission of

infectious material from any moist body substance regardless of presumed infection status Blood: HIV, HBV Feces: shigella, salmonella, escherichia-coli Urine: e-coli



Body Substance Isolation (BSI) continued…

– Purpose: Reduce transmission of infectious material from any moist body substance regardless of presumed infection status Sputum: tuberculosis, resistant

staphylococcus areus Saliva: small and large droplets Wound seepages/excretions Other body fluids



Body Substance Isolation (BSI)– Precautions

Gloves when anticipating contact with moist body substances while caring for all patients

Immunization against infectious diseases transmitted by airborne or droplet (discussed later)– Measles– Mumps– Rubella– Varicella (chickenpox)

Other appropriate barriers: gowns, masks, eye protection



Standard precautions– CDC 1996 for in-hospital health care

providers– Major features of UP and BSI

UP: gloves, gowns, masks, protective eyewear to reduce risk of transmission of bloodborne pathogens

BSI: gloves, immunization to reduce risk of pathogens from moist body substances



Standard precautions– Applied to all patients regardless of

diagnosis or presumed infection status Blood, all body fluids, secretions and

excretions except sweat, regardless of whether or not they contain blood

Nonintact skin Mucous membranes



Standard precautions– Precautions

Consider every person infectious Wash hands and wear gloves Wear other body protection: masks, goggles, face

masks, gowns Handle soiled linen with gloves; dispose of in biohazard

waste container/bags Handle patient care equipment with gloves; clean

reusable equipment Clean and disinfect equipment Dispose of sharps in containers Use face/mouthpieces, bag-valve-mask for resuscitation



Transmission-based precautions (also include BSI)

– Airborne transmission Small particle evaporated droplets or dust

containing droplets– Remain suspended for a long time– Dispersed by air currents

Inhaled by or deposited on susceptible host Included measles, varicella, Legionella,

tuberculosis




– Airborne transmission precautions Respiratory protection: High efficiency filter

mask Patient transport: Place a mask on the

patient Environmental control: Equipment cleaning,

disinfection, sterilization




– Droplet transmission Large droplet contact with conjunctiva or

oral/nasal mucosa Droplets generated during coughing,

sneezing, talking Requires close contact

– Large droplets do not stay suspended for long– Large droplets travel short distance (possibly 3

feet)




– Droplet transmission Precautions

– Respiratory protection: Wear a mask when within 3 feet of patient

– Protective eyewear: With possibility of splashing, talking, sneezing within 3 feet

– Patient transport: Place a mask on the patient– Environmental control: Equipment cleaning,

disinfection, sterilization




– Contact transmission Direct contact

– Skin-to-skin contact and physical transfer– Touching hands, face, other body parts

Provider-to-patient contact Patient-to-patient or patient-to-other

person contact




– Contact transmission Indirect contact: Skin-to-object contact

– Patient’s contaminated hand touches object

– Provider touches contaminated object




– Contact transmission Precautions

– Wash hands; use gloves– Wear a gown– Clean and disinfect care/contact items

After patient use/touch Before using on or with another patient, or

use disposable items– Dispose of all patient contact items

Red medical waste/biohazard containers/bags

Sharps containers


BSI PrecautionsBSI Precautions Definition

– A method of infection control– Equipment, procedures to protect

providers and patients from blood and body fluids, including airborne droplets

Purpose– Protects patients and providers

Impossible to identify that either has an infectious disease just by looking at them

– Prevents exposure to blood, body fluid, and respiratory pathogens


BSI PrecautionsBSI Precautions Need/Importance

– Patient’s full medical history is not always available or forthcoming

– Protects providers from patients and patients from providers

– Expands principles of UP beyond bloodborne disease to include all moist body substances

– Presumes all body substances carry infectious agents

– Protects providers from both bloodborne and airborne pathogens


BSI PrecautionsBSI Precautions Requirements

– Must meet Occupational Safety and Health Administration (OSHA) guidelines

– Employer responsibilities Must develop written exposure control plan Must provide training, immunizations, and

personal protective equipment (PPE) Must have policy for exposure to infectious

substances – Baseline testing and periodic follow-up– Federal legislation allows provider notification of

patient infection


BSI PrecautionsBSI Precautions Requirements

– Employee responsibilities Participate in training Follow exposure control plan


Personal Protective Equipment Personal Protective Equipment (PPE)(PPE)

Purpose– Match to exposure hazard for proper

protection– Protect emergency services personnel

From sharp, pointed, jagged objects From objects that may fall on your head or feet From body substances and includes BSI

precautions– Gloves– Other appropriate barriers: gowns, masks, eye protection– Immunization



Hand washing: After patient contact Hand washing: After patient contact when gloves are removedwhen gloves are removed– Soap and warm waterSoap and warm water

Lather; scrub vigorously for 20 seconds (CDC Lather; scrub vigorously for 20 seconds (CDC guidelines)guidelines)

– Alcohol-based hand sanitizersAlcohol-based hand sanitizers Apply to palms; rub hands together until dry Apply to palms; rub hands together until dry

(CDC guidelines)(CDC guidelines) Cover all surfaces of hands and fingers (CDC)Cover all surfaces of hands and fingers (CDC) Not effective if hands are visibly soiledNot effective if hands are visibly soiled



Gloves– Medical grade vinyl, rubber latex, or

synthetic latex nitrile gloves– Change if torn or damaged; wash hands;

reglove– Use new gloves for each patient– Dispose of gloves in biohazard waste

container/bag



Protective eyewear– Protects from splashing, splattering,

spraying fluids/droplets– Types: should cover front and sides of

face Goggles: acceptable, but tend to fog Safety glasses with side shields Combo face shield and mask



Face mask or particulate respirator– Surgical mask: Protects from blood or

fluid splatter (intubation, suctioning)– N-95 or high efficiency particulate air

(HEPA) mask: Protects from small particle droplets, e.g., tuberculosis



Fluid resistant gown– Protects clothing or bare skin from

splatter Childbirth Arterial bleeding Multi-trauma

Pocket face mask, bag-valve-mask– Prevents mouth-to-mouth contact


Donning, Doffing, Disposing of Donning, Doffing, Disposing of PPEPPE

Demonstrate and practice the following using scenarios that follow

– Wash or sanitize hands– Don PPE in proper order—why in this

order? Gown Mask or respirator Goggles or face shield Gloves




– Doff PPE in proper order—why in this order? Gloves Goggles of face shield Gown Mask or respirator




– Dispose of PPE equipment Sharps container Biohazard containers/bags


PPE ScenariosPPE Scenarios The patient:

– A bed-ridden 72-year-old woman– Coughing up bloody sputum for the past hour– The room has an odor of feces– Her daughter tells you the woman has been

incontinent diarrhea for three days, her urine is brown

– The daughter has been caring for and cleaning her mother, but there are no indications she used gloves or masks

– She called 9-1-1 because the patient became unresponsive.

PPE: __ Gloves __ Mask __ Protective eyewear __ Gown __ Pocket face mask/BVM



– A 21-year-old female auto crash victim – Thrown through the windshield because

she was not wearing her seatbelt– Multiple lacerations on her face, hands,

arms, torso, and thighs– You also suspect intoxication because of

the odor of alcohol on her breath– She says she has to throw up




– A child who jumped from a tree pretending to be a super hero who could fly

– He appears to have a fractured right forearm and fractured right ankle

– No apparent external bleeding except from is gums where he knocked out two front teeth




– A 16-year-old teenager who cut his hand while trying to slice a bagel while staying with his grandparents

– The grandparents don’t have a car to drive him to the hospital

– They immediately put wads of paper towels on the wound and had him hold pressure and elevate it until you arrived




– A5-year-old boy bitten in the face by a neighbor’s dog

– The dog is under the control of the owner; Animal Control has been contacted

– The mother is hysterical and is cradling her son in her arms and has blood all over her

– She has tried to clean and control the bleeding with a cold, wet washcloth

– The boy’s wounds are bleeding mildly– The child is calm but cowering in his mother’s arms




PrecautionsPrecautionsStudent Performance Objective: Given

information, resources, and opportunity for discussion and practice:

– List and describe types of protective

precautions.– Define BSI precautions and explain their

purpose, importance, and requirements.– List personal protective equipment and

describe its purpose.– Demonstrate techniques for donning, doffing,

and disposing of PPE based on scenarios.

EMTs will follow acceptable Maryland medical practice and Maryland Medical Protocols for Emergency Medical Providers.


Why We Use Body Substance Why We Use Body Substance Isolation PrecautionsIsolation Precautions

Review: List the types of protective precautions

– Isolation precautions– Universal precautions– BSI– Standard– Transmission

Why do you think it is necessary to know history of protective precautions?



PrecautionsPrecautionsReview: Review: Why do you think you need to know in-hospital Why do you think you need to know in-hospital

precautions when you usually just drop patients at precautions when you usually just drop patients at the ED?the ED?

What are the types of transmission precautionsWhat are the types of transmission precautions– AirborneAirborne– DropletDroplet– ContactContact



PrecautionsPrecautionsReview: Review: Describe the difference between airborne Describe the difference between airborne

transmission and droplet transmissionstransmission and droplet transmissions– Describe the respiratory protection for eachDescribe the respiratory protection for each

BSI precautionsBSI precautions– DefineDefine– What is its significant purpose?What is its significant purpose?– What is the need and importance?What is the need and importance?– What are the requirements of a BSI What are the requirements of a BSI

plan/program?plan/program?



PrecautionsPrecautionsReview: Review: Personal Protective EquipmentPersonal Protective Equipment

– List PPE commonly used in BSIList PPE commonly used in BSI– Describe the purpose or each piece of PPEDescribe the purpose or each piece of PPE

Donning, Doffing, Disposing of PPEDonning, Doffing, Disposing of PPE– List PPE used for each scenarioList PPE used for each scenario– Explain why it was used (what protection it Explain why it was used (what protection it

provided)provided)


Why We Use Body Substance Why We Use Body Substance Isolation PrecautionsIsolation Precautions

Review:Review: BSI PrecautionsBSI Precautions Personal Protective EquipmentPersonal Protective Equipment Donning, Doffing, and Disposing of Donning, Doffing, and Disposing of

PPEPPE

Drill of the Month Developed by Gloria Bizjak Why We Use Body Substance Isolation Precautions.

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