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September 25 Update



The Ebola outbreak provides a good opportunity to review and recommit to the basic principles of disease transmission and protection. Ebola is transmitted through the blood and body fluids of individuals who are sick with the disease.

Here are some reminders about blood and body fluid protection:
  • Disease may be transmitted by any infected body fluid including blood, feces, urine, vomitus, sputum, semen, sweat, tears, or wound drainage.
  • If a caregiver has unprotected exposure to blood or body fluids the risk of becoming infected increases when they come in contact with the caregiver’s broken skin (for example open wounds, abrasions, or needle sticks) or mucous membranes (for example mouth/gums, eyes).
  • The risk of unprotected exposure can be significantly reduced by proactive and judicious use of protective equipment including:
    • Gloves should be worn any time assessment or care activities are likely to result in contact with the patient’s body fluids or broken skin, as well as whenever performing a medical procedure that will penetrate the skin such as starting an IV. When caring for a patient with copious bleeding, vomiting or diarrhea—especially with a known history of a bloodborne infection—it may be appropriate to wear double gloves. Gloves should also be worn when handling soiled waste, linens or other materials and when decontaminating the ambulance following the call. Gloves should be donned immediately prior to interacting with the patient. Wearing them earlier increases the risk they will develop small tears that actually INCREASE the risk of exposure. Placing the gloves on in the patient’s presence also sends a professional message of mutual protection.
    • Gown is worn to cover exposed skin when caring for a patient who is experiencing severe and ongoing blood loss, vomiting, diarrhea etc. It may also be appropriate to wear a gown when treating a patient with uncontrollable coughing (to protect from sputum) or spitting. The purpose of the gown is to cover ALL exposed skin; if caregivers have exposed legs it may also be appropriate to wear protective pants and/or shoe covers. Gowns should also be worn when handling extremely soiled (dripping) waste, linens or other materials and when decontaminating the ambulance following the call. In severe cases it may be appropriate to wear two gowns.
    • Goggles/Glasses/Mask/Face shield are worn to protect the mucous membranes around the mouth and eyes. They should be utilized for any patient with uncontrollable coughing or spitting, as well as when performing procedures that are likely to cause coughing such as airway management or administration of aerosolized medications. They are also appropriate when blood/fluid loss is so severe that there is a risk of “splash”, including during ambulance decontamination. Because coughing, spitting or splashing may be hard to predict, it is important to proactively don these protections whenever there is risk they will occur.
  • The risk of becoming infected or transmitting a disease can be significantly reduced by hand washing before and after each patient encounter.

Click here to download the AMR poster that outlines the above guidelines. We request that you post it throughout your operation(s) and perhaps in the ambulance as well; place it anywhere that crews are likely to see it. We also encourage you to share freely with your first response and care partners.

Healthcare providers can dramatically reduce the risk of contamination from Ebola and other blood/body fluid transmitted diseases by following these simple guidelines. The CDC website has a useful poster that shows the proper way to put on and remove protective equipment at http://www.cdc.gov/vhf/ebola/pdf/ppe-poster.pdf.

We will continue to provide updates in the coming weeks. If you need additional information please feel free to contact Scott Bourn at Scott.Bourn@amr.net. Thank you.

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