Infection Protection

      As predicted last spring, there is a surge of H1N1 flu cases across the country, and healthcare workers and others will soon receive vaccinations against both H1N1 and seasonal flu. But how careful are EMS employees about protecting their own health outside of potential pandemic conditions? What should they be doing now to ensure they stay healthy? EMS Magazine's Associate Editor Marie Nordberg recently spoke with expert Katherine West, BSN, MSEd, CIC, an infection control consultant with Infection Control/Emerging Concepts in Manassas, VA, about these issues and more.

   We're hearing so much about the H1N1 virus these days. What should EMS be doing to prepare for a possible pandemic?

   We haven't really seen this as a big risk for EMS providers. It's acting more like a normal seasonal flu virus. The most significant thing is that it's a totally new virus and it's hitting younger people. I do think this is a good wake-up call, because many agencies are not prepared for a pandemic, but in my opinion, it's unlikely we'll have a 1918-type event. Although this is a virus we've never seen before, within a short time, we not only identified the virus, but we have a test for it and are now ready to dispense vaccine. Putting it all in perspective, every year, more than 36,000 people die in the U.S. alone of seasonal flu, and we are at about 600 deaths in almost a year with H1N1.

   Should departments be stocking up on masks and other equipment, just in case?

   That's part of pandemic planning, so it's a necessity, but some departments are buying equipment they don't need. They have to start looking at the bottom line, doing evidence-based practice and cost-benefit analysis and take the fearmongering out of purchasing and budgets. There's no data to support a high risk for any of these diseases, but because departments don't have properly trained trainers, they're focusing on PPE because they can't answer questions on disease and risk. In 2009, people around the country still don't know how to define an exposure and don't know what body fluids pose a risk for various diseases. How can that be? Many still think if they have an exposure, they're immediately infected and can go home and give it to their families. That's not true and never was true.

   What EMS needs to do is enforce work restriction guidelines. I had a call last week from someone who said, "One of our crew members ran some calls on elderly patients with respiratory difficulties when she had a fever, and then she was diagnosed with H1N1." That's unacceptable.

   We don't hear much these days about needlestick injuries, HIV and other diseases. What's happening in those areas?

   Needlestick injuries have been reduced dramatically, and no healthcare workers have occupationally acquired HIV since 2000. The Needlestick Safety and Prevention Act was passed by Congress in 2000, and in less than two years, needlestick injuries dropped more than 50%. As for HIV, current treatments are very effective, and it's now being treated as a chronic disease. People are living with HIV 20 or 30+ years. We've had universal vaccination for hepatitis B since 1990, so virtually any young person coming into the workplace setting today has been vaccinated. Also, there is rapid testing of source patients for both HIV and hepatitis C, so we know their status in one hour. For hep C, we can do a baseline, then test for the actual virus four weeks later. An employee who is positive can be started on 24 weeks of treatment, which is allowing us to prevent chronic infection in today's world.

   What should EMS personnel be most vigilant about?

   They need to put together their immunization history, because we're seeing a comeback of measles, mumps, pertussis and chickenpox. In fact, all healthcare workers should get a one-time booster dose of TDAP--tetanus, diphtheria, acellular pertussis. Departments need to ascertain disease histories on all new hires, and, if they are not protected, vaccinate them. We just had two cases of measles in Virginia that drew the attention of CDC. There were eight EMS personnel who didn't know their measles status, so they had to be off work for 36 hours, and be blood-tested and vaccinated. It cost their department $14,000 when they could have just been vaccinated for less than $40. It's time for departments to understand that vaccination upfront is a lot less expensive than the cost of one exposure follow-up or replacing sick people.

   People misunderstand annual flu shots, and the participation rate for healthcare workers is abysmal at about 33%. Some think the shot is only good for one year, but it's only good for a year to the manufacturer. If you consistently take your flu vaccine every year, you are building up protection against more and more influenza virus strains. The question to ask is, if you're so concerned about getting diseases, why don't you use vaccination?