Medic-CE

On-the-Job Infectious Disease Exposures

Introduction:

Unfortunately, each call poses the possibility of an exposure to an infectious disease. An exposure is defined as any contact with potentially infectious substances involving the mucous membranes (such as the eye and mouth), non-intact skin, or other parenteral form of entry.

Ryan White Act:

The Ryan White CARE Act, enacted in 1990, is a federal law which, among many other things, details the rights and responsibilities of emergency care personnel who may have been exposed to infectious diseases while caring for a patient. Under this Act, each agency is responsible for appointing a Designated Officer (known as a DO) to serve as a liaison between the exposed employee and healthcare facilities in the event of a potential infectious disease exposure. For example, if a healthcare facility discovers that a patient, who was transported by the EMS, has tuberculosis, then the facility must contact the Designated Officer to inform the personnel of the potential risk. In addition, if an emergency care provider believes that he or she was exposed to potentially infectious fluids, a request for the source patient’s infection status can be made by the Designated Officer, on behalf of the employee. However, the source cannot be forced to be tested.

Infectious Exposure Control Plan:

All agencies are responsible for developing an exposure control plan. The following list highlights some of the essential elements of an exposure control plan.⁶

-Steps:

1) Upon exposure, the employee should immediately notify the DO. The DO can then submit a request to the destination hospital to determine the source patient’s infection status.

2) Medical follow-up should be established with an occupational health physician.

3) The physician will then assess exposure risk. A blood test should be offered to the exposed employee. The employee can refuse to have certain tests run on the blood sample, such as HIV status, at the time of the blood draw. The blood sample will be maintained for 90 days, in case the employee should change his or her mind, or if symptoms develop.

4) Based on the risk of exposure and lab results (if available), the employee should receive counseling about the likelihood of developing disease. In addition, the employee should be counseled on the signs and symptoms that may develop, treatment options, risks of treatment, as well as ways to prevent further spread of infection. Treatment should be in line with current CDC recommendations and should only be rendered with informed consent from the employee.

5) The healthcare provider will make a written report for the Designated Officer and will identify whether a vaccination and or other post-exposure prophylaxis were recommended or received. The report should also document that the employee was informed of the results of pertinent tests and informed of medical conditions which may require further treatment.

6) A copy of the report should be supplied to both the Designated Officer and the employee. All other elements of the medical record are confidential. The report must be maintained for the duration of employment plus 30 years to comply with OSHA standards on access to employee exposure and medical records.

Specific ID Exposure Procedures:

-Tuberculosis:

If you transport a patient that you were unaware has tuberculosis and is subsequently diagnosed at the destination medical facility, the medical facility must notify your Designated Officer within 48 hours. At that time, the DO will notify you, and your employer will arrange for you to be evaluated by appropriate healthcare personnel.⁶

-AIDS and Hepatitis:

If you have come into contact with the bodily fluids of a patient that may have a life threatening bloodborne disease, seek immediate medical attention and document the incident. Ask your DO to determine if you have been exposed. If the DO determines a risk of exposure, then the medical facility, to which the patient was admitted, should be consulted. The medical facility must then gather information and report the findings to your DO within 48 hours. Your employer will arrange for you to be evaluated by appropriate healthcare personnel at that time.⁶