FA-112 / January 2002 Guide To Managing An Emergency Service Infection Control Program United States Fire Administration 2002 GUIDE TO MANAGING AN EMERGENCY SERVICE INFECTION CONTROL PROGRAM 2002 UNITED STATES FIRE ADMINISTRATION As an entity of the Federal Emergency Management Agency, the mission of the U.S. Fire Administration is to reduce life and economic losses due to fire and related emergencies through leadership, advocacy, coordination, and support. We serve the Nation independently, in coordination with other Federal agencies and in partnership with fire protection and emergency service communities. With a commitment to excellence, we provide public education, training, technology, and data initiatives. PREFACE In 1992, the United States Fire Administration (USFA) developed the Guide to Developing an Emergency Service Infection Control Program in conjunction with the National Fire Academy (NFA) field course, Infection Control for Emergency Response Personnel: The Supervisor’s Role. These two major Federal initiatives were designed to provide accurate information and guidance to the emergency services regarding communicable disease infection control. Both were developed with the support and assistance of the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA), to coincide with the promulgation of 29 CFR Part 1910.1030, Occupational Exposure to Bloodborne Pathogens, Final Rule. Since the original publication, many advances have occurred in the field of infection control, and all emergency services should have some form of infection control program. The initial guide focused on the development of an infection control program. The new Guide to Managing an Emergency Service Infection Control Program updates relevant information from the original 1992 guide and focuses on the management of an infection control program. The guide is designed to meet or exceed all applicable Federal/national laws, regulations, standards, and guidelines in effect at the time of publication. Many of these are included in their entirety in Appendix B of the guide. The guide also contains Internet Web addresses for accessing those guidelines not included in their entirety. The principal development team for the guide included: Judy Janing, Ph.D., R.N., EMT- P, Emergency Program Specialist, IOCAD Emergency Services Group, Omaha, NE; Murrey Loflin, M.S., EMT-B, Battalion Chief, Virginia Beach Fire Department, Virginia Beach, VA.; Gordon Sachs, MPA, Director, IOCAD Emergency Services Group; Mike Grill, Captain, Sierra Vista Fire Department, Sierra Vista, AZ; David Barillo, M.D., Associate Professor of Surgery, Medical University of South Carolina, Charleston, SC. Sandy Bodgucki, M.D., Ph.D., Assistant Professor, Yale University School of Medicine, Department of Surgery, Section of Emergency Medicine, New Haven, CT. Members of the Technical Review Panel for the development of this guide were: Jonathan M. Lieske, M.D., M.P.H., International Association of Fire Fighters (IAFF); Richard Knopf, International Association of Fire Chiefs (IAFC), Health and Safety Committee; Philip Stittleburg, National Volunteer Fire Council; Decker Williams, Phoenix Fire Department; Richard Patrick, VFIS, Inc.; Scott Deitchman, M.D., Centers for Disease Control and Prevention (CDC); Ron Thackery, American Ambulance Association; and Susan McHenry, National Highway Transportation and Safety Administration (NHTSA). 3 TABLE OF CONTENTS Preface..................................................................................................................................3 Table of Contents.................................................................................................................5 INTRODUCTION..............................................................................................................7 SECTION 1: OVERVIEW OF INFECTION CONTROL ..........................................11 Chapter One: Technical Background.....................................................................13 Introduction to Infection Control...............................................................15 Basic Concepts...........................................................................................16 Assessing Risk Potential............................................................................17 Bloodborne Diseases..................................................................................18 Airborne Diseases ......................................................................................21 Infection Control Techniques ....................................................................22 Summary....................................................................................................23 Chapter Two: Laws, Regulations, and Standards ..................................................29 Public Law .................................................................................................32 OSHA Regulations.....................................................................................34 National Fire Protection Association (NFPA) ...........................................37 Centers for Disease Control and Prevention..............................................40 Summary....................................................................................................46 SECTION 2: COMPONENTS OF AN INFECTION CONTROL PROGRAM .......47 Risk Management ..................................................................................................49 Risk Management Model.......................................................................................50 Training and Education..........................................................................................53 Members ................................................................................................................54 Health Maintenance ...............................................................................................55 Roles and Responsibilities .....................................................................................56 Policies and Procedures .........................................................................................62 Exposure Control Plan ...........................................................................................64 Standard Operating Procedures..............................................................................65 Interactions with Other Departments.....................................................................65 SECTION 3: VEHICLES, EQUIPMENT, AND SUPPLY CONSIDERATIONS 69 Vehicles..................................................................................................................71 Personal Protective Equipment..............................................................................76 Equipment and Supplies ........................................................................................81 Equipment Advances .............................................................................................82 5 Other Considerations .............................................................................................85 Summary................................................................................................................87 SECTION 4: FACILITIES CONSIDERATIONS........................................................89 The Need for Facility Safety..................................................................................91 Facility Issues.........................................................................................................93 Summary................................................................................................................98 SECTION 5: ASSESSING EFFECTIVENESS: THE EVALUATION PROCESS..99 Overview..............................................................................................................101 Assessing Effectiveness.......................................................................................102 Information Management.....................................................................................104 Program Revision.................................................................................................113 Action Plan...........................................................................................................114 Summary..............................................................................................................115 SECTION 6: SPECIAL SITUATIONS .......................................................................117 Overview..............................................................................................................119 The Training Environment...................................................................................119 Protecting the Patient ...........................................................................................121 Summary..............................................................................................................122 BIBLIOGRAPHY..........................................................................................................123 APPENDICES................................................................................................................129 Appendix A: Glossary of Common Terms ......................................................131 Appendix B: Laws, Regulations, and Standards.............................................143