Education is Key to Infection Control

For more than 35 years, Katherine West has been involved with infection control and was a pioneer in education for emergency medical service personnel.After all those years involved with educating providers West said it's "abundantly clear that...

For more than 35 years, Katherine West has been involved with infection control and was a pioneer in education for emergency medical service personnel.

After all those years involved with educating providers West said it's "abundantly clear that providers are not being educated properly" when it comes to communicable and infectious disease control.

"It's so frustrating," said West, who has a Bachelor of Science degree in nursing, a Master of Science degree in education and is certified in infection control. "There is so much fear mongering and such a lack of training. ... I'm so sick of it, I could just scream."

West is an infection control consultant with Infection Control/Emerging Concepts, Manassas, Va. and a member of the editorial board of Cygnus' EMS Magazine.

It's West's mission to educate providers that, despite the draconian warnings and fear instilled in providers, the risks aren't as bad as some might think.

"EMS providers have jobs to do and they need to go out there and do them," West said.

That's not to say that providers shouldn't use universal precautions and common sense. It's just that they shouldn't be paralyzed by the thought they're going to become infected with some horrible disease, even treating the most risky and questionable patients.

Perhaps the biggest fear that any provider has is contracting HIV from patient contact. West said fear of that happening is dwarfed by the reality of it actually happening.

In the most risky situation, treating an HIV positive patient, who is not being treated and being stuck with a large bore infected needle, the chance of contracting the disease is 0.3 percent, or less than one half a percent, according to West.

"This is the kind of information that just isn't getting out there," she said, noting the information has been available for years, but is not being taught.

Even if the provider is exposed, it doesn't mean they'll contract the disease, she said, noting there are treatments and procedures to follow, which means providers have an almost zero percent change they'll get the disease.

In another scenario, blood spatter to the eyes from a patient with HIV means the provider has a .09 percent chance (less than one tenth of a percent) of contracting the disease, she said.

For Hepatitis C, a high-risk needle stick means there's a 1.5 percent chance of the provider contracting the disease, West said.

Exposure to Hepatitis B is not a problem because virtually all providers have been vaccinated before touching a single patient, she said.

West points out that before any treatments are provided to the provider, the patient must be tested and be found positive. When it comes to knowing whether a patient is infected and should be tested, it's a matter of a right to know under the terms of the Ryan White Law. White said it's one of the "greatest" pieces of legislation ever written for EMS providers.

While the risk of contamination and exposure to communicable disease is negligible, West said there's no reason to take risks when it comes to needle sticks, which is by far the most serious means of exposure.

Occupational Safety and Health Administration regulations require EMS providers to use needle and sharps safe devices, West said. Compliant devices have retractable needles which make needle sticks virtually impossible.

The safe needles seem to be working too. While there are no statistics for needle sticks just for EMS providers, there are statistics available for health care providers in general. Before the safe needle requirement, which went into effect in October 2001, there were between 600,000 and 800,000 needle sticks annually, according to information provided by West and OSHA.

Since the requirements, needle sticks have dropped to half or less with 250,000 to 300,000 sticks recorded annually, West said.

"There is no excuse not to use safe needles," she said, noting that it's actually an OSHA requirement. However, non-compliant needles are still widely used, largely because they cost less than safe needles, but that argument doesn't wash with West, she said.

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