Education is Key to Disease 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 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.

"One needle stick costs between $3,000 to $6,000 to treat and monitor," she said, pointing out the use of non-compliant sharps is sacrificing long-term cost and the long-term health and well-being of the provider for short-term savings.

"It just doesn't make any sense," she said.

With the tight budgets and tough economic times most departments and providers are experiencing, West said it just makes sense to look for savings everywhere and in many cases, doing the right thing can be cheaper in the long run.

For instance, West said she had been advising a provider on communicable and infectious disease control and they were looking at the cost of Betadine as a topical antiseptic. They were under the belief that it was the be all and end all antiseptic for IVs and injections, but after researching, they learned that Betadine was out and Chlorhexidine was in. They learned it was more effective and cheaper, she said.

"It's a matter of using medicine-based practices," West said. "It's a matter of doing homework and reading the research to make purchasing and practice decisions."

Subscribing to the adage that an ounce of prevention is worth a pound of cure, West said there's no sense in sacrificing vaccinations and immunizations to save money.

She knows of one department that tried to save money by eliminating flu shots. That, to West, is another example of short-term savings versus long term benefits and savings.

That department, apparently, hadn't considered the cost of replacing providers with overtime employees at a greater cost, she said.

Plus, they hadn't considered the potential cost to the very people they're assigned to protect, the patient, she said, noting that an unprotected provider can easily infect patients.

"Infection control is a two-way street," she said. "...We need to look at the science and recognize that it's a patient safety issue as well."

The science also says that there's no need to take an ambulance out of service while it is "aired out," West said.

"We work in a wipe and go environment," West said, noting there are no infectious or communicable diseases that require airing. One minute contact with premixed products applied by wiping is all that is needed to put an ambulance back in service.

For those who want to save the cost of commercially available disinfecting solutions, West said bleach at a dilution ratio of a quarter cup to one gallon works great.

When it comes to protecting one's self, West said that "good old soap and water" works wonders when combined with standard universal protections.

West said she hopes that EMS providers will become more comfortable with their jobs through education and not be in fear of contracting terrible, fatal diseases from work, or be worried about brining something horrible home to their families.

That all starts with education from commanders to street level providers, she said.

"Falling into blind acceptance just doesn't cut it," West said. "You need to go out, do the research, and check things out for yourself."