RISK OF
VIRAL INFECTION
GENERAL
1. Since the 1980’s, there has been a heightened interest in, and concern
about, the threat posed by viral infections such as Acquired Immune Deficiency Syndrome
(AIDS) and Hepatitis B. Questions have been raised about the risks posed to Brigade
members during the provision of patient care procedures, and the steps that may be taken
to limit this risk.
RISK
2. The provision of patient care by a member of the St. John Ambulance Brigade may
pose a risk of disease transmission to the caregiver or the patient. It is important that
the caregiver be aware of and minimize the risk of infectious disease transmission.
3. The viruses responsible for the transmission of AIDS and Hepatitis B are found in
body fluids and the risk to the caregiver is directly related to the exposure to these
contaminated fluids. Blood, blood products, semen, breast milk, sputum, saliva, tears and
urine are potential sources of contamination for the AIDS (HIV) and the Hepatitis B (HBV)
virus. It is therefore mandatory that all members of the Brigade, who by the nature of
their service, be trained in the appropriate methods of reducing exposure to potential
contamination.
ACTIONS TO LIMIT RISK
4. There is a low risk of infectious disease transmission when providing care. This
risk can be further reduced by:
a. good personal hygiene (e.g. handwashing);
b. the use of appropriate barrier devices as warranted;
c. prompt decontamination following possible exposure; and
d. immunization (for Hepatitis B).
5. Refer to the Reference Text for the Brigade Training System for the details of these
actions.
RISK ASSESSMENT
6. Patient care providers must be prepared to assess the risk of infectious disease
transmission as a direct consequence of treating an injured or ill person. The following
factors must be considered in determining the procedures and specific actions to be taken
in limiting the risk of exposure:
a. Are body fluids present, and are they likely to be a source of contamination? If so,
take specific precautions as listed below.
b. To what degree will introduction of appropriate barriers increase the risk to the
ill or injured person? The caregiver must immediately assess the increased risk to the
injured or ill person that may result from the use of appropriate barrier devices and any
delay in instituting appropriate care. The insertion of barriers between the caregiver and
the casualty may decrease the effectiveness of first aid procedures, and will be a
function of:
i. the time taken to apply a barrier; and
ii. the degree to which a barrier reduces the Brigade member’s ability to provide
effective care, ie. impairment of sense of touch, and the use of resuscitation devices
during artificial respiration.
The severity of the injury and the consequences of delay, judged against the risk to
the patient care provider not using mechanical aids, will determine whether or not the use
of mechanical barriers is warranted.
PRECAUTIONS
7. It is important for the caregiver to limit the potential for contamination. The
two principle methods are:
a. the introduction of appropriate barrier devices between the caregiver and the
potential contaminant; and
b. the use of hygienic procedures.
BARRIER DEVICES
8. As disease transmission results from the transfer of infected body fluids it
follows that the introduction of an appropriate barrier device that reduces or inhibits
the transfer of fluids will reduce the risk to the caregiver. Barrier devices that have
proven to be effective in limiting exposure to body fluids are:
a. disposable latex or vinyl gloves; and
b. faceshields and masks with one-way valves.
9. Patient care providers must have access to, and training in the use of these
appropriate barrier devices. The use of barrier devices will be the member’s
responsibility and should be consistent with their assessment of the degree of risk posed
to them by the patient.
HYGIENE
10. Good personal hygiene following exposure to body fluids by a caregiver will
significantly reduce the risk of disease transmission. Skin that has been exposed to
potentially contaminated body fluids must be thoroughly washed (but not scrubbed with a
stiff brush) at the earliest practical opportunity following exposure. Abrasions and
breaks in the skin should be thoroughly and carefully washed preferably with soap and
water, any cuts or lacerations being allowed to bleed freely for a few moments first. Note
that it is the mechanical action of washing properly that is more important than the type
of soap or disinfectant which is used.
11. Clothing and other non-disposable items that may have been contaminated with body
fluids should be decontaminated. At the earliest opportunity following exposure, use a
disinfectant such as a 1:10 solution of sodium hypochlorite in water. This is made by
diluting one part of a 5-6% solution of sodium hypochlorite (household bleach) with ten
parts of water. The item may then be washed in the normal manner.
12. Disposable items such as soiled gloves, bandages, dressings, tissues, etc. should
be placed in a sturdy plastic bag, sealed and then bagged again in a second plastic bag
and sealed before disposal. Where available, use biohazard disposal.
13. Following the handling of potentially contaminated clothing or equipment, and after
the removal of disposable gloves, hands and exposed parts of the body should be carefully
washed. If a Brigade member is splashed in the eyes with blood, the eyes and face should
be rinsed immediately with running water.
IMMUNIZATION
14. Hepatitis B is a relatively common disease which can have serious consequences.
It is strongly recommended that members eliminate this danger by taking advantage of the
three-stage immunization procedure as soon as possible. To assist in this, National
Headquarters has facilitated an immunization program. Details of the Hepatitis B
Immunization Program are available in the manual prepared for this purpose, which is
available from each Provincial/Territorial Council.
