Communicable Disease and the Fire Service

BY DEREK WILLIAMS

Since my article on Methicillin-Resistant Staphylococcus aureaus (MRSA) was published in the December 2006 issue of Fire Engineering,¹ I have been overwhelmed with e-mails containing questions and comments not just about MRSA but about communicable diseases in general and their effects on firefighters.

Firefighters are at high risk for most communicable diseases. According to a study by the International Association of Fire Fighters (IAFF) in 2000, one out of every 50 firefighters was exposed to a communicable disease.² The reasons we are at such high risk are varied:

• When we treat patients, we almost never know their infectious disease status.
• We are commonly exposed to blood and body fluids as part of our jobs.
• We are commonly placed in hazardous conditions where cuts, abrasions, and lacerations can cause open wounds for routes of infection.
• We tend to disregard our own safety at times to “save others,” thus leaving us vulnerable to disease.
• Prolonged stress is another factor. It is a leading reason for the weakening of the immune system of normally healthy people. We typically endure high levels of stress in our daily lives.³
• Emergency responders must undergo a cultural change in their attitude about safety. Attitude is everything when it comes to our safety. The “It can’t happen to me” attitude and complacency are the biggest threats to firefighters’ health and wellness.

COMMUNICABLE DISEASES: NOT A NEW THREAT

Infectious disease is nothing new. Firefighters have been dealing with it since the very inception of the fire service. There are policies in place now to help protect us. They include the following: National Fire Protection Association (NFPA)⁴ 1500, Standard on Fire Department Occupational Safety and Health Program, 2007 ed.; 1581, Standard on Fire Department Infection Control Program, 2005 ed.; 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, 2007 ed.; 1971, Standard on Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting, 2007 ed.; and 1999, Standard on Protective Clothing for Emergency Medical Operations, 2003 ed.; and Occupational Safety and Health Administration (OSHA)⁵ 29 CFR 1910.1030, Bloodborne pathogens, and 29 CFR 1910.134, Respiratory protection (including the NIOSH standard on particulate masks).

These standards, tools for combating infectious disease, have been in place for some time. What is needed to protect us from these diseases is not a change in how we protect our members but a heightened awareness of safety!

AIRBORNE AND BLOODBORNE DISEASES

Diseases that directly affect the fire service may be airborne or bloodborne. Airborne diseases are spread when droplets of pathogens (bacteria, viruses, and fungi that cause disease) are expelled into the air from coughing, sneezing, or talking.⁶ You are considered infected when the pathogen that entered your body has resulted in disease.⁷ These expelled droplets may remain suspended in the air long after initial dispersal, depending on droplet size. The exact time a droplet can stay suspended in the air is not known and depends on a variety of factors such as ventilation, cubic air space in an enclosed room, and the force of the cough/sneeze. Airborne diseases of concern to firefighters include meningitis, tuberculosis (TB), influenza, chicken pox, pertussis, and diphtheria.

Bloodborne disease pathogens are carried in blood and other body fluids, such as amniotic fluid, semen, vaginal fluids, and cerebrospinal fluid. These pathogens can be transmitted by direct or indirect transmission. Methods for transmission of bloodborne disease include blood/body fluid entering an open wound and blood/body fluid contacting the mucus membranes (eyes, nose, and mouth) and human bites (although very low risk). Indirect transmission of a bloodborne pathogen may result from needle sticks or punctures from contaminated “sharps” and unprotected contact (of mucus membranes or open wounds) with soiled/bloody equipment. Common bloodborne diseases of which firefighters should be aware include hepatitis strains B and C as well as HIV/AIDS.

Three factors determine if an exposure will result in an infection: the dose (the amount of organisms that enter your body); the virulence (the strength of the organisms); and host resistance (your immune system’s ability to ward off infection).

You can control two of these factors—dose and host resistance. Dose can be eliminated or limited by wearing the proper personal protective equipment (PPE). Host resistance is enhanced by staying in good physical shape, lowering stress, and having routine vaccinations.⁸

CHAIN OF INFECTION

The chain of infection is the model used to understand the infection process. Each link of the chain must be present and in sequential order for an infection to occur.

1. Infectious agent, or pathogen—a microbial organism that can cause disease (as noted above).
2. Reservoir—a place within which microorganisms can thrive and reproduce, such as in a human, an animal, or inanimate objects such as in water or on a table.
3. Portal of exit—the microorganism leaving the reservoir, such as a cough or a sneeze or blood from an open wound.
4. Mode of transmission—the method by which the organism is moved/carried (airborne/bloodborne, direct or indirect). Direct transmission occurs when the pathogen travels directly from the infected individual to you. Indirect transmission occurs when an inanimate object serves as a “reservoir” for the infecting agent. Some routes of transmission for pathogens’ entering the body are inhalation (flu, TB), contact with blood/body fluids (hepatitis, HIV), ingestion, fecal-oral (C-Diff, hepatitis A), and an intermediate carrier (such as a mosquito or a tick).
5. Portal of entry—an opening through which the organism enters the host (mouth, nose, or break in the skin, for example).
6. Susceptible host—a person who cannot resist an infectious disease because he lacks the immunity or physical resistance to overcome invasion by a pathogen.

To protect yourself from communicable disease, you must break the chain of infection. This can be done only at certain “links” of the chain—the links you can control (dose and host resistance).

One way to do this is to practice medical asepsis—the practice of interventions that reduce the number of organisms in the environment and prevent their spread. Examples of medical asepsis include hand washing; wearing PPE; and separating contaminated equipment from clean equipment, disposing of expendable equipment, and decontaminating equipment that must be placed back in service. Don’t forget to decontaminate yourself and your PPE.

Another way to prevent communicable disease is to follow standard precautions (BSI/PPE) to protect yourself while on the call.

Note: The term standard precautions combines the major concepts of universal precautions and Body Substance Isolation (BSI) methods for protecting against pathogens. The terms are defined in Guidelines for isolation precautions in hospitals, Centers for Disease Control and Prevention (CDC), www.cdc.gov/ncidod/dhqp/gl_isolation_ptl.html. The terms PPE and universal precautions are being phased out. The current correct industry term is standard precautions.

You can break the chain of infection at the reservoir, portal of exit, and susceptible host links.

• Reservoir. Control sharps and other contaminated items. Always wear the proper PPE when in contact with these items.
• The portal of exit and portal of entry. Protect yourself from infection by wearing PPE, including a face mask (the most effective technique is to place a face mask on the patient; it is more effective than your wearing it) and covering all open wounds (controlling the dose).
• Mode of transmission. Use proper PPE on calls. Use medical asepsis while disposing of and decontaminating equipment.
• Susceptible host. Maintain physical fitness, lower stress, keep up to date on vaccinations (host resistance).

PROFILES OF DISEASES THAT POSE RISKS

 

Hepatitis⁹

Hepatitis, a liver disease caused by a virus, has five distinct strains: A, B, C (the greatest risk to emergency workers), D (a co-infection of hepatitis B), and E.

Hepatitis A may be transmitted person to person via fecal/oral means. It can be transmitted indirectly through objects contaminated with feces that are placed in the mouth (pens, hands). The virus can live outside the body for months.

Signs and symptoms: abrupt onset of fever, lethargy, loss of appetite, abdominal pain, and jaundice. Symptoms last from two to four months. Infected persons may not have signs/symptoms. A vaccine is available. It is not chronic.

Protection (minimum): PPE—gloves; hand washing.

What you should know: Hand washing is a must! Hepatitis A is prevalent in areas of poor sanitary conditions/poor hygiene. Once you have hepatitis A, it is extremely rare that you would get it again, and you cannot transmit the virus.

Your risk: low.

Hepatitis B is bloodborne and is transmitted when blood from an infected person enters the body. It may be directly or indirectly transmitted.

Signs and symptoms: jaundice, fatigue, abdominal and joint pain, nausea/vomiting. About 30 percent of hepatitis B-positive people have no symptoms. A vaccine is available. It can become chronic; 0.2 to 0.9 percent of the U.S. population are chronic carriers.

Protection (minimum): PPE—gloves, mask, eye protection.

What you should know: Antibody testing is now only performed when a provider has a bloodborne pathogen exposure; routine testing and booster hepatitis B vaccination are no longer done. It has a five to eight percent rate of occurrence in the U.S. population. Most chronic infection appears in neonates. Because a vaccine is available, PPE prevents its transmission.

Your risk: low, because a vaccine is available and PPE prevents its transmission.

Hepatitis C is bloodborne and occurs when blood from an infected person enters the body. It can be directly or indirectly transmitted.

Signs and symptoms: jaundice, fatigue, abdominal and joint pain, and nausea/vomiting. About 80 percent of hepatitis C-positive people have no symptoms. No vaccine is available. It is chronic in 85 percent of infected persons; 70 percent have chronic liver disease and death occurs in one to five percent.

Protection (minimum): PPE—gloves, mask, and eye protection.

What you should know: There have been known hepatitis C exposures to firefighters, including a firefighter here in the Mesa (AZ) Fire Department. The International Association of Fire Fighters (IAFF) Web site at www.iaff.org/hepc/frames/HCV.html has personal accounts from firefighters across the country who are infected with hepatitis C.

Your risk: high, based on the fact that there is no hepatitis C vaccine, its potential for chronic infection, and the known infections of fire personnel in the past.

Hepatitis D is bloodborne and needs the hepatitis B virus to exist; it cannot exist on its own. A hepatitis B vaccine is available.

What you should know: Review the hepatitis B profile.

Your risk: low, based on the fact that hepatitis D cannot exist on its own but intensifies symptoms in those infected with hepatitis B. However, those infected with hepatitis B have an increased risk (up to 20 percent higher) of liver failure, making their existing hepatitis B infection a “superinfection,” as stated by the CDC.

Hepatitis E is transmitted by eating and drinking contaminated food or water and is found in the feces of persons and animals. The highest number of those afflicted are between the ages of 15 and 40. It can be transmitted person to person, although it is less common.

Signs and symptoms: jaundice, fatigue, abdominal and joint pain, nausea/vomiting, and dark urine color. There is no vaccine available. It does not have a potential for becoming chronic.

Protection: Hand washing.

What you should know: Recent surveillance studies show that one to three percent of Americans have been infected; it is endemic in Mexico.

Your risk: not a threat for U.S. firefighters or emergency services workers. It is included in this report for informational purposes.

Note: Hepatitis strains continue to mutate (change). We must continue to be diligent in training and education to protect ourselves.

HIV/AIDS

The Human Immunodeficiency Virus is the viral agent that causes the Acquired Immunodeficiency Syndrome. The disease has spread globally (pandemic). It is bloodborne and can be transmitted directly or indirectly through unprotected sex or by infected blood entering the body. Contaminated sharps puncturing skin may also cause infection.

Signs and symptoms: rapid weight loss, night sweats, fatigue, swollen glands, open sores, and thrush. No vaccine is available. It is chronic; there are approximately 40,000 new cases each year. It is still a leading cause of death among persons 25 to 44 years of age.

Protection (minimum): PPE—gloves, mask, and eye protection.

Your risk: high, based on its high mortality rate, the lack of a vaccine, and its bloodborne transmission.¹⁰

Influenza

Pandemic. It is a seasonal respiratory illness caused by a virus. The flu season typically starts in late November and lasts through early spring. It affects 50 million Americans each year. It is airborne and can be directly or indirectly transmitted. The virus is carried in droplets expelled by sneezing or coughing. Contaminated surfaces can cause infection.

Signs and symptoms: fever, chills, sore throat, congestion, exhaustion, and muscle aches. It causes 35,000 deaths a year in the United States. A vaccine is available. It is not chronic.

Protection: PPE—gloves, mask, and eye protection. Routine hand washing throughout your shift and after each call significantly reduces the chance for infection.

What you should know: The flu virus is constantly changing; so must the vaccine. The use of a particulate mask in environments where the flu is known or suspected to reside offers significant protection. Yearly vaccinations are crucial.

Your risk: moderate, based on its mortality rate and ease of transmission.¹¹

Avian or “Bird” Flu

The avian flu, more commonly referred to as the “bird flu,” is flu strain H5N1, which primarily affects birds. On rare occasions, it has infected other species such as humans. Bird flu is not the same as seasonal flu. The current fears concerning bird flu are based on its being spread by birds across Asia and Europe and its ability to infect humans.

Protection: PPE—same as for other flu strains.

Your risk: as of 2007, not a significant threat.

Tuberculosis (TB)

Caused by Mycobacterium Tuberculosis, it affects the lungs (in 75 percent of the cases, according to most sources) most often but can affect other body systems as well (such as circulatory and lymphatic). It is airborne and is spread by droplets. Transmission is direct (person to person), especially in communal living conditions such as prisons, group homes, and fire stations.

Signs and symptoms: shortness of breath, productive/prolonged cough (including coughing up blood), fever, chills, night sweats, and loss of appetite. A vaccine is available, but it is not routinely used in industrialized countries. There is a 10 percent chance of latent (chronic) infection. Many people are asymptomatic; more than one-third of the world’s population have TB bacterium in their bodies.

Protection: PPE—NIOSH-approved particulate mask (N-95 or better). While treating patients with a productive cough, especially in an enclosed space, a NIOSH-approved (N-95 or better) particulate mask is essential.

What you should know: In recent years, neglect of TB control has led to a resurgence in TB cases. As of 2004, it is estimated that 14.6 million people worldwide have active TB. In the January 2007 issue of Fire Engineering, it was reported that hundreds of patients and hospital workers at Integris Southwest Medical Center in Oklahoma City may have been exposed to TB through contact with a health care worker. Ten people were diagnosed with the disease, and 1,650 patients—as well as 350 workers—were sent a letter concerning their possible exposure.¹²

Your risk: moderate, because its recent resurgence poses the risk that the virus can be brought home to family members and because of the ease with which the virus may be transmitted.¹³

Pertussis

More commonly known as “whooping cough,” pertussis is caused by bacteria. It is endemic (one that is constantly present in a community without external inputs). It is airborne and is directly transmitted through contact with droplets caused by sneezing, coughing, etc.

Signs and symptoms: coughing, sneezing, shortness of breath, and runny nose. The cough starts mild but rapidly becomes violent and uncontrollable. Symptoms may last two to three months. A vaccine is available. It is not chronic but may reoccur.

Protection: NIOSH-approved particulate mask (N-95 or better).

What you should know: Pertussis is highly contagious; there has been a recent increase in the incidence of infection, especially in adults. Most adults who become infected have been vaccinated in the past. In these individuals, infection may be milder, but they can still transmit the virus to others (family, children). Vaccines are effective, but they offer protection for only a few years. The Food and Drug Administration, in 2005, approved Adacel, a booster for 11- to 64-year-olds.

Your risk: moderate (because it is treatable), because of the recent resurgence and the danger of emergency responders’ bringing the virus home to their family members and the ease with which the virus may be transmitted. Pertussis is a moderate danger (only because it is treatable) to firefighters and emergency responders.¹⁴

Diphtheria

Diphtheria is an upper-respiratory-tract illness caused by Corynebacterium Diphtheriae. It is airborne and transmits directly. It is spread by contact with mucous membrane droplets.

Signs and symptoms: sore throat, low-grade fever, problems swallowing, narrowed airway/barking cough. A vaccine is available. It is not chronic.

Protection: TB mask (N-95 or better), gloves, and eye protection.

What you should know: Booster vaccinations are recommended for adults, as the benefits of the vaccine decline over time. Although only five to 10 cases are reported yearly in the United States, epidemics (localized to a geographic region) still can occur, even in developed countries. Most infected adults have been vaccinated as children.

Your risk: no significant risk; however, adults should be tested for titers and given booster vaccinations every 10 years.

SARS

Severe acute respiratory syndrome (SARS) is caused by a virus. There was an epidemic outbreak in 2002-2003. It is airborne and spread by close person-to-person contact. It is thought to be transmitted by respiratory droplets. It may be transmitted directly or indirectly through the mucous membranes.

Signs and symptoms: flu-like symptoms such as fever, lethargy, body aches, headache, and occasional shortness of breath. A vaccine is in development. It does not become chronic.

Protection: TB mask (N-95 or better), gloves, and eye protection.

What you should know: The epidemic from November 2002 through July 2003 resulted in 8,096 known cases and 774 deaths worldwide. Antibiotics are ineffective; treatment is comprised of supportive care only.

Your risk: SARS currently does not pose a threat to fire and emergency service workers; however, the Centers for Disease Control and Prevention (CDC) is preparing for future epidemics in which case the threat could be significant. Note that 25 percent of deaths from SARS worldwide were healthcare providers, largely because of unprotected exposures (failure to use PPE).

Pneumonia

An illness of the respiratory system in which alveoli become inflamed and flooded with fluid, it is caused by infection with bacteria, viruses, fungi, or parasites. It is airborne and transmitted directly, person to person, by respiratory secretions.

Signs and symptoms: cough, chest pain, fever, and shortness of breath. A vaccine is available. Although it is not a chronic condition, reinfection throughout life is common.

Protection: TB mask (N-95 or better), gloves, eye protection.

What you should know: CAP (community associated pneumonia) occurs in a person who has not recently been hospitalized and is the most common type of pneumonia (the sixth most common cause of death in the United States).

Your risk: moderate, based on morbidity, incidence of reinfection, and method of transmission. Morbidity refers to the state of being diseased and most often describes the ratio of the number of sick individuals to the total population of a community.

Meningitis

It is an infection of the brain and spinal fluid caused by bacteria, viruses, and sometimes fungus. It is airborne and is transmitted through direct contact with oral, respiratory, and throat secretions or indirectly through immediate contact with soiled objects.

Signs and symptoms: high fever, headache, and stiff neck. The viral form is usually far less severe than the bacterial form. A vaccine is available. It is not chronic.

Protection: TB mask (N-95 or better), gloves, eye protection.

What you should know: The International Association of Fire Fighters’ Department of Health, Safety, and Medicine has recently recommended vaccination of firefighters under the age of 55 with the MCV4 meningitis vaccine. Each year in the United States, about 2,400 cases of meningitis occur, with a death rate (mortality) of 10 to 14 percent.

Your risk: low to moderate, based on the fact that vaccines are available and it is treatable (especially if caught early).^15-16

Clostridium Difficile (C-Diff)

It is a spore positive-anaerobic bacillus (bacterium) that can cause antibiotic-associated diarrhea (ADD), colon perforations, toxic megacolon, sepsis, and death. It is transmitted directly or indirectly by contact with feces. Any surface/material may serve as a reservoir for C-Diff spores.

Signs and symptoms: diarrhea, fever, loss of appetite, nausea, abdominal pain. Symptoms typically last three to 10 days after treatment has begun with appropriate antibiotics. No vaccine is available. It is not chronic.

Protection: Gloves, mask, eye protection; hand washing. The best way to combat C-Diff is with adequate PPE and station hygiene/cleanliness.¹⁷ Improperly or poorly decontaminated EMS stretchers and patient care equipment such as blood pressure cuffs and stethoscopes have significant potential to transmit bacteria to susceptible patients.

What you should know: The disease can become colonized (populate groups/areas) and be transmitted person to person. However, only those individuals who are already sick or on antibiotics are likely to become ill.

Your risk: low, for the reason above.

MRSA

Methicillin-resistant Staphylococcus aureus (MRSA) is a type of staph infection that is resistant to antibiotics. VISA and VRSA staph infections are resistant to Vancomycin specifically. The information contained here applies to these strains as well.¹⁸ It is transmitted most frequently by direct skin-to-skin contact. However, it can live on surfaces for periods of time (especially warm, moist surfaces); the exact length of time is not known.

Signs and symptoms: fever, painful lesions, and wound drainage. MRSA can cause skin infections that may look like pimples or boils and are red, swollen, or painful or have pus/other drainage. More serious infections may cause pneumonia, bloodstream infections, sepsis, and death. No vaccine is available. It is not chronic.

Protection: Gloves, mask, and eye protection; hand washing.

What you should know: There are two classifications: MRSA and Community-Associated MRSA (CA-MRSA). MRSA occurs most frequently among persons in hospitals and health-care facilities (such as nursing homes) who have weakened immune systems. MRSA infections acquired by persons who have not been recently hospitalized (within the past year) or had a medical procedure (such as dialysis, surgery, catheters) are know as CA-MRSA infections and are the most prevalent in communal living areas (fire stations, locker rooms, jails, social services housing); on shared personal items (bedding, towels, bar soap); in shared personal hygiene areas (sinks, showers, and toilets); and on equipment exposed to vigorous exercise (cardio equipment, weight rooms, sports “pads”/protective equipment, firefighting turnouts, and the like).

Protection: To stop the spread of MRSA, use PPE on medical calls; practice personal hygiene after calls/decontamination; focus on station hygiene and cleanliness (spray with disinfectant and let items air dry); and pay particular attention to cleaning workout rooms, equipment, turnouts, and PPE.

Your risk: high. We contact not only patients with MRSA in medical settings such as nursing homes but also patients with CA-MRSA such as in group homes and jails. In Los Angeles, it was reported in 2006 that 20 firefighters and several police officers contracted MRSA while on duty.¹⁹

We live a “communal” lifestyle at the fire stations, sharing close quarters and personal hygiene items.

Scabies

Scabies is an infestation of the skin with the microscopic mite Sarcoptes scabei. It is transmitted directly or indirectly, mostly in crowded conditions that involve prolonged skin-to-skin contact or through contact with personal items such as towels or bedding.

Signs and symptoms: pimple-like irritations, rash, or irritation especially in webbing between toes/fingers or in areas of skin folds. There is intense itching all over the body. Open sores caused by repeated scratching is most common sign/symptom. There is no vaccine. It is not chronic.

Protection: Gloves, gowns, and long clothing.

What you should know: Away from the human body, scabies can survive for up to 72 hours. When living on a person, they can survive up to a month. Symptoms may take four to six weeks to manifest.

Your risk: moderate, based on the frequency with which we come in contact with customers living in cramped quarters who practice poor hygiene. Also, members may inadvertently bring scabies back to the station.²⁰

Lice

Body lice are parasitic insects that live on the human body and in the clothing/bedding of infected humans. They are transmitted directly or indirectly, mostly in crowded conditions in which there is prolonged skin-to-skin contact or contact with personal items such as towels or bedding.

Signs and symptoms: rash and irritation. There is intense itching all over the body; repeated scratching causes open sores, the most common sign/symptom. There is no vaccine.

Protection: Gloves, gowns, long clothing.

What you should know: It is primarily found in crowded living conditions with poor hygiene. Lice have been known to carry diseases such as Typhus and Louse-Borne Relapsing Fever. Clothing items that have contact with lice-infested persons or materials should be laundered in the machine’s hot cycle (minimum of 130°F) with a one percent pyrethrin or permthrin lice shampoo. Members should also immediately take a shower using an over-the-counter lice shampoo/body wash.

Your risk: moderate, based on the frequency with which we come in contact with customers living in cramped quarters with poor hygiene and may inadvertently bring lice back to the station.

•••

Threats to firefighter health and wellness are nothing new; neither are the measures we must take to prevent them and to protect our family, our co-workers, and ourselves. We must use PPE on every medical call; practice proper decontamination procedures for equipment, clothing, and the station; adopt exposure procedures; and have standard operating guidelines in place and follow them. We should also have a firefighter health and wellness program with a total health approach that includes medical monitoring, vaccinations with titers drawn when needed, and promotion of fitness to improve member host resistance.

Endnotes

1. “Danger in the Station: Drug-Resistant Infections,” Derek Williams, Fire Engineering, December 2006, 69-74.

2. “Infectious Diseases,” International Association of Fire Fighters. www.iaff.org/safe/content/infdis/Infections_Diseases.htm. Accessed on November 20, 2006.

3. “Stress and Disease: New Perspectives,” Harrison Wein, Ph.D. National Institutes of Health (NIH), www.nih.gov/news/Worldhealth/oct2000/story01.htm. Accessed November 29, 2006.

4. National Fire Protection Association, http://www.nfpa.org/index.asp. Accessed November 20, 2006.

5. Occupational Safety and Health Administration, www.osha.gov Accessed on November 20, 2006.

6. “The Microbial World: Airborne Microorganisms,” Jim Deacon, Institute of Cell and Molecular Biology, University of Edinburgh, www.helios.bto.ed.az.uk/bto/microbes/airborne.htm. Accessed December 10, 2006.

7. “Stress Affects Hormones, Which Affect Immune System/Physical Disease,” Medical News Today, www.medicalnewstoday.com/medicalnews.php?newsid=7398. Accessed November 29 2006.

8. “Recommendations and Reports: Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV and HIV and Recommendations for Post-Exposure Prophylaxis,” Centers for Disease Control and Prevention (CDC), pp 1- 21, www.cdc.gov/mmwr/preview/mmwrhtm/rr5011at.htm. Accessed December 10, 2006.

9. Information on the hepatitis strains is based on the respective CDC Fact Sheet for each of the strains, www.cdc.gov/hcidod/disease.

10. “A Glance at the HIV/AIDS Epidemic,” CDC fact sheet. www.cdc.gov/hiv/resources/factsheets/At-A-Glance.htm. Accessed on January 27, 2007.

11. “Influenza Pandemic. Informational Bulletin for Emergency Responders,” www.pandemicflu.gov. Accessed on February 22, 2007.

12. “Hundreds in Oklahoma Exposed to TB,” News in Brief, Fire Engineering, January 2007, 56.

13. Tuberculosis facts at www.iaff,org/safe/content/infdis/infectious_discases.htm. Accessed on January 28, 2007.

14. “Pertussis,” CDC Fact Sheet, www.cdc.gov/ncidod/dbmd/diseaseinfo/pertussis-t.htm. Accessed on December 14, 2006.

15. Meningococcal Disease Fact Sheet, CDC, www.cdc.gov/ncidod/DBMD/diseaseinfo/meningococcal_g.htm. Accessed on February 5, 2007.

16. Meningitis Facts, www.iaff.org/safe/contcnt/infdis/infectious_disease.htm. Accessed on February 2, 2007.

17. “Information for Health care Providers: C-Diff,” www.cdc.gov/ncidod/dhqp/id_CdiffFAQ_hcp.html. Accessed on November 20, 2006.

18. “About VISA/VRSA, Frequently Asked Questions,” www.cdc.gov/ncidod/dhqp/ar_visavrsa_faq.html. Accessed on December 19, 2006.

19. “The Scourge of Skid Row, Staph Infections Threaten the Lives of Cops, Firefighters, and Homeless People,” Christine Pelisek, LA Weekly Times News, www.laweekly.com/news/the-scourge-of-skid-row/1481. Accessed on January 26, 2007.

20. Scabies Fact Sheet, CDC, www.cdc.gov/ncidod/dpd/parasites/scabies/factsht_scabies.htm. Accessed on January 17, 2007.

Tips for Preventing Communicable Diseases

Post the following as a reminder for you and your department members.

1 Make it routine to wear the proper PPE on every call. When properly used, it prevents every communicable disease covered in this report.

—That includes eye protection. Presently, NIOSH and the CDC recommend it only when the potential for splash or spray exists. However, many times you can’t predict splash and spray hazards while rendering patient care.1

—Wear a mask on calls that involve known respiratory emergencies, coughing or sneezing patients, or patients with a fever. Airborne diseases are arguably more of a threat than bloodborne diseases simply because you can’t see the hazard. You can become infected with an airborne disease and not even know you were exposed. Down the road when symptoms appear, it becomes difficult to prove that it was an on-the-job injury without a source patient or call to reference. Remember also that you can bring the infection source home for your family.

2 Properly decontaminate after every call not just the medical equipment but also the boxes/bags in which the equipment was carried, uniforms/boots, and so on.

3 Implement routine station and equipment “detailing,” such as a Saturday cleaning rotation, to greatly decrease indirect infections and possible pods of MRSA, lice, and scabies. Don’t let your station become a breeding ground.

4 Report every exposure no matter how minor you think it may be. Safety officers must be on call 24/7 to lead members through the process after an exposure has occurred.

5 Stay fit to improve your host resistance to communicable diseases. Emphasize this fact when educating members about health and fitness. The moral is, if you are already healthy and fit, you are more likely to stay healthy and fit.

6 Follow recommendations for titer draws (a titer is the standard of strength per volume of a volumetric test solution) and booster shots. Initial immunizations decrease in strength over time. The chart at left is from the CDC Web site and was approved by the Advisory Committee on Immunization Practices, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, and the American College of Physicians. It is a helpful tool for recognizing the need for immunizations and designing a program or schedule for regular vaccinations and titer draws for fire department members.

7 Become knowledgeable regarding the tools available for avoiding communicable disease. Continue to investigate this topic; share the information with members of your department. Remember, these diseases continue to change; so must our body of knowledge and precautions if we are to protect ourselves.

Endnote

1. Katherine West, noted fire and EMS infection control guru, has repeatedly opposed the position that eye protection should be worn all the time. A CDC chart on recommended PPE for EMS workers supports her viewpoint (http://wonder.cdc.gov/wonder/PrevGuid/p0000114/p0000114.asp/see Table 4).

Table source: http://www.cdc.gov/vaccines/recs/schedules/downloads/adult/06-07/adult-schedule.pdf/.

DEREK WILLIAMS has been a firefighter in the state of Arizona for 15 years. For the past 11 years, he has been a member of the Mesa (AZ) Fire Department working as a captain, a firefighter/paramedic, and a member of the hazardous materials team. He is currently assigned to the Mesa Fire Department Health and Wellness Office, where he oversees health, wellness, safety, and injury prevention. He has associate’s degrees in fire science and paramedicine from Mesa Community College, where he has also been an instructor. He is a member of the Fire Department Safety Officers Association (FDSOA) and is certified by the State of Arizona, the FDSOA, and the Federal Emergency Management Agency (FEMA) as a fire department incident safety officer (ISO) and as a fire department health/wellness and safety officer (HSO).