As EMS and healthcare providers, we face certain risks unique to our profession. One of those is possible exposure to infectious diseases.
To control the transmission of microorganisms and best protect our patients, coworkers, families, and friends, we must first understand the basics about bloodborne diseases, airborne diseases, bloodborne pathogens, airborne pathogens, and uncommon diseases as well as how these germs are acquired, transmitted, and how they behave outside the body.
|Anthrax||Diphtheria||Hepatitis A – G|
|HIV/AIDS||Influenza (all strains)||Measles|
|Varicella Disease||Viral Hemorrhagic Fevers|
The diseases listed above can be categorized via their routes of transmission. Droplet transmission is how diphtheria, meningococcal disease, influenzas, mumps, pertussis, SARS, and the pneumonic plague are transmitted from person to person.
Airborne diseases are those that are aerosolized and include: tuberculosis, measles, and varicella disease.
Those infections passed through bodily fluid contact are HIV/AIDS, hepatitis, and rabies. Bodily fluids that can carry these microorganisms include: semen, vaginal secretions, blood, any fluids/feces/sputum containing blood, amniotic fluid, peritoneal fluid, pleural, synovial, and pericardial.
Feces, nasal secretions, sputum, saliva, tears, sweat, urine, and vomit are not considered potentially infectious bodily fluids.
It is important to understand the symptoms associated with each disease so that you can better protect yourself and your partner from contracting any of the following diseases. If you are ever in doubt, err on the side of caution and get the mask, gloves, gown, and goggles donned and take precautions to avoid safety hazards in the workplace. Only testing can rule out the presence of these diseases, and it is always better to be cautious to help with incident prevention.
Presently, there are outbreaks of HEP A in California, New York, and South Carolina. The age groups most vulnerable are those that were not vaccinated as children. Today, children receive the HEP A vaccine in the first 2 years of life. Those who have not been vaccinated would be those in the 30-years-of-age group and older and those who have not been vaccinated at all. This outbreak is gaining traction due to increases in the homeless population and poor sanitation in their tent cities. In the past, most of the outbreaks were due to contaminated food sources. Hepatitis A is transmitted through contaminated food and oral-fecal contamination: in other words, not washing your hands properly after using the bathroom. Often times, these outbreaks surround a specific restaurant or food source and are also common in prison and jail facilities.
Occupationally acquiring hepatitis B has a very low occurrence today. In the 1910-1030 guideline, OSHA mandated that the vaccine be offered to any employee who could be exposed to the disease. Once you have received the vaccination series, you should have a titer drawn to ensure immunity coverage. There are instances where a person may be refractory to the vaccine and need a second series of the vaccine. For those who needed a second series, as many as 50% of them were then immune and the vaccine took hold.
Exposure to contaminated blood or bodily fluids, whether you have been vaccinated or not, requires reporting to your dedicated infection control officer (DICO) and protocols must still be followed to ensure that you are receiving adequate care to maintain your health and well-being, both physical and psychological. This is where bloodborne pathogen training becomes critical.
Hepatitis C is rarely contracted occupationally. This is in part due to the use of needless systems and the fact that, while the virus is found in blood, it is rarely transmitted through semen or other bodily fluids. You contract hepatitis C from sharing intravenous drug paraphernalia, unprotected sex with a person who has hepatitis C, needlestick injury, mother-to-baby transmission, and coming in contact with an infected person’s blood. There is a cure for hepatitis C, but it does not work for everyone; it is also expensive.
You can only contract HEP D if you already are infected with HEP B. Hepatitis E is transmitted through fecally contaminated water or through uncooked or undercooked meat. Hepatitis G is usually seen in individuals with co-infections like HIV and is rare in the United States.
Measles has seen a worldwide resurgence due to low vaccination rates, and there are outbreaks all over the world. There were close to 10 million cases of measles in 2018. Of those cases, 140,000 people perished. The best protection against this disease is vaccination. When identifying hazards in the workplace, it’s important to recognize that those infected with measles virus do not begin to have symptoms until 7 to 14 days after contact with the virus. These symptoms include high fever, cough, runny nose, watery eyes, malaise, diarrhea, headache, photosensitivity, sore throat, anorexia, fatigue, and swollen lymph nodes. The typical measles rash appears within 3 to 5 days after the eruption of symptoms. Small raised bumps may appear on top of the flat red sores when the rash is fulminant, and fevers could be as high as 104° F (40° C). Tiny white spots known as Koplik spots could appear inside the mouth within 2 to 3 days of symptom eruption.
Pertussis, also known as whooping cough, caused by the Bordetella pertussis, has also reared its ugly head and begun infecting children who are unvaccinated. There are 3 stages to the disease; they are known as the catarrhal, paroxysmal, and convalescent stages. The initial stage, the catarrhal stage, has symptoms that are mild and often go unnoticed by the infected. The paroxysmal stage is when the classic “whooping” cough erupts during inspiration. This sound is what gives it the name whooping cough. In the convalescent stage, the coughing episodes are reduced, and the patient begins to improve. Pertussis is a highly contagious disease that can last for as long as 10 weeks. Due to the smaller diameter of a newborn’s airway, the symptoms are more severe in newborns and they are more susceptible than older infants and toddlers, especially so because these youngsters have not been vaccinated against the disease. Newborns are held close and it is easy to pass on the microorganism to them. Often newborns are infected by unsuspecting adults who have not reached the paroxysmal stage yet and have no idea that they are contagious with the bacteria. This disease can be prevented with the DTaP vaccination.
Diphtheria, much like Rubella, is rare and there are less than 20,000 cases in the United States each year. Symptoms begin 2 to 5 days after a person is exposed and becomes infected. Those symptoms are a thick, grey membrane covering your throat and tonsils, sore throat and hoarseness, swollen lymph glands in the neck, difficulty breathing and tachypnea, nasal discharge, fever, chills, and malaise. Some individuals only have a mild illness or virtually no visible signs and symptoms. These individuals are known as carriers, and they easily spread the illness because they aren’t aware that they need to quarantine themselves. This disease can be prevented by the DTaP vaccination.
Tetanus is caused by the bacteria Clostridium. This bacteria lives in soil, saliva, dust, and manure. The bacteria gains entry into your body through a deep cut that you might get from stepping on a sharp object or even a burn. This serious bacterial infection will cause painful muscle spasms that could lead to death. The average incubation period is 7 to 10 days, but the signs and symptoms can appear from a few days to several weeks after the tetanus bacteria enters your body through a break in the skin. The symptoms include trismus (spasms and stiffness in the jaw muscles), stiffness in neck muscles, difficulty swallowing, stiffness of abdominal muscles, fever, sweating, elevated blood pressure, tachypnea, and painful body spasms that can last for several minutes. These spasms are triggered by minor irritations, like drafts, loud noises, physical touch, or light. Tetanus can be prevented by the DTaP vaccination and boosters every 10 years. If contracted, treatment includes antibiotics, antitoxin, vaccines, sedatives, and pain medication.
Mumps is a viral infection that affects the salivary glands. This can be prevented by being vaccinated with the MMR vaccination. Symptoms of mumps include salivary gland and parotid gland discomfort; difficulty chewing; fever; headache; muscle aches; fatigue; pain and tenderness in the testicles; pain in the abdomen, muscles, neck, and pelvis; chills; anorexia; malaise; swollen lymph nodes; and swollen salivary glands. These signs and symptoms appear about 2 to 3 weeks after exposure to the virus.
Mumps is often seen in schools or college campuses or other close-contact settings. You can contract it by also sharing utensils with someone who is infected. More often than not it is spread through droplet transmission when the infected sneezes or coughs. There are complications of mumps, including hearing loss. There is no treatment for mumps, so prevention is the best course of action.
Rubella is usually contracted through droplet transmission from an infected person’s cough or sneeze. This disease is preventable by receiving the MMR vaccination. There are usually less than 20,000 cases per year in the United States. Symptoms will erupt within 2 to 3 weeks after exposure and include a mild fever, headache, malaise, enlarged lymph nodes, runny nose, and a red rash.
Polio is a virus that destroys nerve cells in the spinal column, which can cause muscle wasting and paralysis. This virus is extremely rare, with fewer than 1,000 cases a year in the United States. The polio vaccine is the best preventive against the poliovirus. Some individuals who are infected do not have any symptoms and do not become sick. Those individuals who do become sick can develop paralysis, which could become fatal for some. The symptoms include vomiting, headache, sore throat, fatigue, fever, back pain or stiffness, neck pain or stiffness, pain or stiffness in the arms or legs, muscle weakness or tenderness, loss of reflexes, severe muscle aches and weakness, flaccid paralysis, muscle wasting, sleep-related breathing disorders, decreased tolerance of cold temperatures, and breathing and/or swallowing problems.
There are cases of the plague each year as well, about 100 per year in the United States. These cases are usually in the Midwest and are caused by the fleas on prairie dogs and other rodents. The plague is caused by Yersinia pestis, and, contrary to popular belief, it has not been eradicated through the use of vaccines. It is alive and well throughout the world. As we encroach on areas where infected rodents live, we continue to see an uptick in the number of cases of human-acquired plague. If caught early enough, antibiotics are all that is needed to clear the patient of the bacteria. Some of the symptoms of the plague include abdominal pain, diarrhea, nausea, vomiting, fever, chills, extreme weakness, bleeding, shock, skin turning black, cough with blood-tinged sputum, malaise, swollen lymph nodes, muscle aches, headache, and shortness of breath. There is no vaccine for the plague.
Influenza A, B, and C are still serious threats. There is a vaccine each year, and while it may not always be as effective as healthcare providers would like, it is still your best bet to combating the spread of the virus. Those infected are contagious for 24 hours prior to onset of symptoms and that continues unabated for up to 5 to 10 days after onset. Those symptoms include fever, chills, cough, sore throat, runny or stuffy nose, muscle and body aches, headache, fatigue, and children could have vomiting and diarrhea. This is not as common in adults.
With a better understanding of the disease process of each virus or bacteria, it allows the healthcare provider to be able to make critical decisions on where patients will be transported and how to care for them.
Your dedicated infection control officer (DICO) is the person tasked with educating all of the providers in your organization and keeping records of those education programs. They are the contact person who will have the most up-to-date information on emerging trends of infectious agents and their potential threat level to healthcare providers. They will handle the annual bloodborne pathogens training (BBP) and part of that curriculum will include the donning and doffing of PPE, the importance of PPE in reducing transmission of infectious agents, and when to deploy which PPE. Your DICO is the go-to person when you have suspected exposures. They will document the circumstances and refer you to the proper resources to provide you with the healthcare and support you will need post-exposure.
Symptomology of communicable diseases. Centers for Disease Control and Prevention. https://www.cdc.gov/.
Novel Coronavirus2019. World Health Organization. https://www.who.int/emergencies/diseases/novel-coronavirus-2019.
Bloodborne pathogen training and guidelines. Occupational Safety and Health Administration. https://www.osha.gov/SLTC/bloodbornepathogens/index.html.
Anne Margaret Perry—NRP, CET, CPT, LPN—is the clinical program director for CareerCert and has worked in the medical field for over 25 years. Anne began her career in medicine in 1992 in New York state as a basic EMT. She gained her paramedic license in 1998 and nursing license in 2005. She recently moved to South Carolina, where she acquired her National Registry Paramedic and is working on her master’s in nursing education.