G.8.7 Care and Transportation of Communicable Disease Cases

PURPOSE

To establish a policy directive that ensures compliance with applicable Legislation as a measure to safeguard personnel in a manner that: 

1. Ensures protection from communicable disease transmission and infection in accordance with established routine practice and enhanced utilization of PPE, and;
2. To prevent transmission of communicable disease between patients.
    

APPLICATION

• Paramedics
• Paramedic Superintendents
• Senior Managers
   

PROCEDURE

In accordance with the Patient Care and Transportation Standards, Section B, Article 1, Manitoulin-Sudbury DSB Paramedic Services has designated the Deputy Chief responsible for Professional Standards, Certification and Education as the most responsible person for management of the infection control program. 

1. Under the DC’s pervue, Paramedic Services shall ensure that:

   1. Employees are aware of current communicable disease risks, and outbreak notifications are posted for personnel to review, and
   2. Appropriate measure(s) are employed by staff to protect themselves and patients from transmission of communicable disease between employees and patients, and
   3. Each Paramedic takes appropriate infection control and occupational health measures to prevent transmission of all infectious agents to and from themselves and does not knowingly expose themselves or their patients to any communicable disease in the course of their work. Employees, who are exhibiting an acute symptomatic illness that may be infectious in origin, should not be involved in the assessment of or direct delivery of care to a patient.

2. In keeping with the principles of good patient care, each Paramedic shall utilize standard practices and additional precautions to limit the potential for disease transmission.

3. Where a Paramedic is placed in a situation of reasonable chance of being exposed to a body fluid of another person, the Paramedic shall:

   1. wear gloves that meet or exceed the requirements of the Provincial Equipment Standards for Ontario Ambulance Services, and
   2. if there is any potential splash exposure anticipated, personnel shall don issued protective eyewear. Eyewear shall meet Legislated requirements.

4. Where Paramedics may reasonably expect to be exposed to any airborne communicable disease, Paramedics will don a provided respirator that meets the regulatory requirements in the Provincial Equipment Standards.

   1. Use of respirators shall be in accordance with the manufacturer’s direction, and must comply with proper sizing as confirmed in the established fit- testing program. Additionally, a seal check must be performed following the donning of the device. Facial hair must be neat and trimmed and may not interfere with the operational function of the designated respirator. The current 3M N-95 Respirator and CSA Z-94 requires that facial hair must clean shaven (skin to mask) so as not to underlie the seal of the respirator.

5. Paramedics who are unimmunized against seasonal Influenza shall don appropriate PPE, including N95 mask, gloves, and gown on all patient contact wear risk of exposure is present. At risk patients includes but are not limited to:

   1. Patients with chronic cardiac or pulmonary disorders, diabetes, metabolic diseases, cancers, immunodeficiency/immunosuppression, renal disease, anaemia, and hemoglobinopathy
   2. Residents of Long Term/Chronic Care Facilities
   3. Elderly and young patients

6. Unimmunized personnel may be assigned to respond and transport where no immunized paramedic is immediately available for such a response into any facility with a declared influenza outbreak. Unimmunized personnel shall utilize PPE in accordance with item 6 in this directive. 
    

Paramedic/Student Immunization

Each paramedic, or paramedic student must provide to the service with  a valid Physician signed document, confirming immunization against each  disease set out in

1. Table 1 – Part A; or

2. stating that,
   1. such immunization is medically contraindicated,
   2. there is laboratory evidence of immunity (applicable only for Varicella, Measles, Mumps, Rubella and Hepatitis B, or
   3. there is a documented diagnosis/history of Varicella. 

Where a Paramedic has cause to believe a communicable disease exposure has occurred, the paramedic shall, following transfer of care: 

1. Consult with the receiving physician regarding testing, or treatment (Form 1)
2. Physician clearance to return to active duty, or quarantine.
3. Consider completing Form 2 - Applicant Report (Mandatory blood testing of respondent application) in conjunction with the Form 1 - Physician Report.
4. Report the suspected exposure and Physician direction to the Paramedic Superintendent,
5. Complete both an Occurrence Report, and an Exposure to Communicable Disease Report by the end of the shift
6. Follow up with medical care as directed by the most responsible Physician.

Manitoulin-Sudbury DSB Paramedic Services will monitor and enforce a local disinfection/deep cleaning procedure for vehicles and equipment, ensuring that processes are adhered to following any exposure, and as a process for returning to readiness.  Following the transportation of any patient with a suspected or known communicable disease, staff shall ensure:

1. Vehicles are removed from service and disinfected, and
2. Equipment involved in the care of the patient is disinfected as directed by the manufacturer.

Paramedic shall make every reasonable effort to wash their hands, immediately after contact with the patient, in accordance with the Hand Hygiene Directive.
 

REFERENCE

Emergency Health Services, Patient Care and Transportation Standards

Manitoulin-Sudbury District Services Board, Disinfecting of Vehicles and Patient Care Equipment, 2004, Directive 

Emergency Health Services Branch, 2007, Infection prevention Control, Best Practices Manual for Land Ambulance Paramedics, Ministry Of Health and Long Term Care

Emergency Health Services Branch, Influenza Educational Review, Ministry Of Health and Long Term Care

Provincial Infectious Diseases Advisory Committee, 2007, Routine Practices And Additional Precautions In All Health Care Settings, Ministry Of Health and Long Term Care