SWP - Infection Control and Post-Exposure

This procedure applies to every member on every call with patient contact, whether the department is the medical agency or arrives first at a collision, a fire or a rescue. It covers the three minutes before a patient contact, the contact itself, the cleanup, and what to do in the first hour after an exposure to blood, body fluid or a respiratory pathogen. The program behind it is Infection Control and Medical Response Safety Program.

From the hazard profile (03 Hazard Profile and Risk Register Method) and the program’s risk assessment:

• Percutaneous injury from a needle, lancet, broken glass, bone fragment or bite (hepatitis B, hepatitis C, HIV) (NFPA 1580, 2025).
• Splash of blood or body fluid to the eyes, nose, mouth or broken skin during airway work, bleeding control, childbirth or vomiting.
• Inhalation of droplets or aerosols from a coughing patient or during bag-valve-mask ventilation, suction, CPR or nebulized medication (Public Health Agency of Canada, 2017).
• Contact transfer of resistant organisms, scabies, bed bugs or lice to uniforms, apparatus and the station.
• Contaminated equipment returned to service without cleaning.
• Musculoskeletal injury from lifting and moving patients.
• Violence from a patient in crisis, withdrawal, hypoglycemia or after naloxone (SWP - Violent Scene Staging).

1. Elimination. Safety-engineered needles and lancets only; no recapping, ever (CSA Z316.6-20). Stage for violent or unknown-safety scenes until police declare them secure.
2. Substitution. Single-use items where available; powered or mechanical lifting aids in place of manual lifts where the department has them.
3. Engineering. Sharps container at the point of care and secured on the apparatus; alcohol-based hand rub in every kit; decon area and station laundry separate from living areas; surgical mask on the patient when tolerated.
4. Administrative. Point-of-care risk assessment before every contact; the PPE matrix (program toolkit T5); two-person minimum for lifts; disinfection log before the apparatus returns to service; the one-hour exposure report; fit testing annually (NFPA 1550, 2024, s. 9.14; within the two-year maximum of CSA Z94.4-18, cl. 9).
5. PPE. Gloves, eye protection, gown and fit-tested N95 as the matrix requires (Public Health Agency of Canada, 2017).

Two members minimum for any patient lift; more hands called for stairs and bariatric patients. Every member current in routine practices and PPE (annual); every member who may do airway work holds a current N95 fit test; medical first responders current in the certification their jurisdiction requires (J25 Infection Control and Medical First Response). The officer has completed the supervisor module on receiving exposure reports.

Before contact (on the way and on arrival)

1. Listen to dispatch for caution flags, respiratory symptoms and violence history. If the scene is flagged violent or unknown-safety, stage per SWP - Violent Scene Staging and do not approach until police declare it secure.
2. Ask the three questions out loud as a crew: What are we about to do? What does the patient likely have? Where are we? Set the PPE level from the answers (program toolkit T5).
3. Gloves on before leaving the apparatus. Goggles on if any airway work or splash is possible. N95 on and seal-checked if a respiratory infection is suspected, an aerosol-generating procedure is likely, or an outbreak is declared.
4. Carry the kit with the sharps container and hand rub accessible.

During contact

5. Put a surgical mask on a coughing or febrile patient who can tolerate it.
6. Look before you touch: pockets, bedding, bags, vehicle floors. If a sharp is seen, stop, use tongs, and container it before continuing.
7. For bag-valve-mask, suction or CPR: goggles and N95 on before starting; keep the number of people in the room to the task.
8. Needles and lancets: safety device activated with one hand; into the container at the point of use; never recap, never hand a used sharp to another member.
9. Lifting: two people minimum; use the stair chair, scoop or slide sheet; if the patient is bariatric or the stairs are steep, call for more hands and wait.
10. If the patient becomes aggressive: step back, speak calmly, keep the exit clear, withdraw and call police if the threat continues.

After contact

11. Doff in order: gown, gloves, hand hygiene, goggles, mask, hand hygiene. Discard single-use items in the biohazard bag.
12. Bag contaminated uniforms at the scene. Nothing contaminated goes home.
13. Clean and disinfect every item used with the DIN product for the full contact time; log it (program toolkit T4) before the apparatus is back in service.
14. Wash hands with soap and water at the station within the hour; shower if clothing was soaked.
15. Restock: gloves, goggles, N95, hand rub, sharps container level, naloxone date (program toolkit T9).

If an exposure happens (the first hour)

16. Stop the task if you can hand it off; if not, say “I have been exposed” so the crew knows.
17. First aid at once: wash skin with soap and water; flush eyes, nose or mouth with water or saline for several minutes; do not squeeze or scrub a wound.
18. Tell the officer. The officer calls the designated infection control officer on the 24/7 number within one hour of the exposure and opens Form - Body Fluid Exposure Report and Post-Exposure Checklist.
19. Go to {{Post-Exposure Clinic}} or the emergency department as directed; take the clinic card and your hepatitis B immunity status if you know it. The department covers transport and your duties.
20. The designated officer requests source patient testing through the receiving hospital or the EHS provider and tracks the clocks: HIV prophylaxis decision within two hours where indicated, and not generally after 72 hours; hepatitis B immune globulin and vaccine within seven days for the non-immune; baseline bloodwork the same day; follow-up at six weeks, three months and six months (Public Health Agency of Canada, 2024).
21. The workers’ compensation report is filed within the provincial clock (SWP - Exposure Reporting). The event is triaged for learning within 24 hours.

• Needle-stick or cut. Wash with soap and water at once; do not squeeze. Report within the hour. Keep the device in the sharps container; note whether the safety feature was activated.
• Splash to the eyes. Flush with saline or clean water for several minutes with the eye open; remove contact lenses after the first flush. Report within the hour.
• Exposure during CPR without an N95. Finish the resuscitation if no one can take over; then report as a respiratory exposure. The designated officer checks the patient’s final diagnosis through the receiving facility and arranges follow-up if an airborne or droplet infection is confirmed.
• Bite that breaks skin. Wash; report; the clinic assesses for tetanus, hepatitis B and bacterial infection.
• Member feels unwell at an overdose scene. Move to fresh air; assess as any patient; the evidence is that incidental skin contact with opioids does not cause poisoning, so treat symptoms, not fear (American College of Medical Toxicology, 2017)DOI. Report as an exposure for the record.
• Declared outbreak. The outbreak protocol escalates PPE to N95 and goggles for every contact; dispatch screens callers; crews cohort; the officer confirms the escalation at the start of every shift.
• Infestation found after contact. Bag uniforms; clean the apparatus before the next call; shower; tell the station officer so the dormitory is checked.

Disinfection log entry for every patient contact; weekly kit check; Form - Body Fluid Exposure Report and Post-Exposure Checklist for every exposure; Form - Exposure Report through SWP - Exposure Reporting for the member’s exposure history; near misses (needle found by hand, PPE breach without exposure) reported through the learning system. Exposure records are confidential, held by the designated officer, and kept for service plus 30 years.

Recruit and annual refresher on this procedure with observed donning and doffing; N95 fit test annually against the stocked model (NFPA 1550, 2024, s. 9.14; CSA Z94.4-18, cl. 9); patient handling practical annually; officer module at appointment. Sign-off recorded in the program’s toolkit T10. The Medical First Response team reviews this procedure within 12 months of adoption, after any Tier 2 event, and whenever the PPE matrix or the provincial exposure protocol changes, starting with a learning-team session with the crews who use it.

• Program: Infection Control and Medical Response Safety Program
• Policies: Policy - Occupational Medical, Fitness and Wellness; Policy - Records, Privacy and Health Information
• Procedures: SWP - Violent Scene Staging; SWP - Respirator Fit Testing; SWP - Exposure Reporting; SWP - Post-Call Station Decontamination
• Forms: Form - Body Fluid Exposure Report and Post-Exposure Checklist; Form - Exposure Report; Form - Fit Test Record
• Learning: Incident Investigation and Learning Program

This chapter relies on the following legal requirements, which differ by province and territory. Check your jurisdiction’s section on each topic page before adopting it.