PRINTER'S NO. 1436
No. 1164 Session of 1989
INTRODUCED BY PETERSON, WILLIAMS, GREENWOOD, AFFLERBACH, HOPPER,
O'PAKE, SHUMAKER, REIBMAN, PUNT, STEWART, STOUT, DAWIDA,
BRIGHTBILL, SALVATORE, FUMO, CORMAN, REGOLI, MADIGAN, JONES,
WILT, GREENLEAF, LYNCH, HELFRICK, ROCKS, BAKER, FATTAH,
PECORA, MELLOW AND LOEPER, JULY 7, 1989
REFERRED TO PUBLIC HEALTH AND WELFARE, JULY 7, 1989
AN ACT
1 Amending the act of July 3, 1985 (P.L.164, No.45), entitled "An
2 act relating to the prevention and reduction of premature
3 death and disability in this Commonwealth; providing for
4 assistance, coordination and support of the development and
5 maintenance of a comprehensive emergency medical services
6 system and for qualifications, eligibility and certification
7 of emergency medical services personnel and licensing
8 ambulance services; imposing powers and duties on the
9 Department of Health; and making repeals," providing for the
10 prevention of infectious diseases.
11 The General Assembly of the Commonwealth of Pennsylvania
12 hereby enacts as follows:
13 Section 1. Section 12 of the act of July 3, 1985 (P.L.164,
14 No.45), known as the Emergency Medical Services Act, is amended
15 by adding a subsection to read:
16 Section 12. Minimum standards for ambulance service.
17 * * *
18 (u) Prevention of transmission of infectious diseases.--
19 Appropriate protective equipment shall be made available
20 routinely for use by all emergency medical personnel who may be
1 exposed to blood and other body fluids. The secretary shall
2 establish procedures to be followed when emergency medical
3 personnel are exposed to blood or body fluids when fluid contact
4 has been made with the worker's eyes, mouth or broken skin due
5 to a cut, puncture wound or rash. The following guidelines are
6 intended to assist emergency medical personnel in making
7 decisions concerning use of personal protective equipment and
8 resuscitation equipment, as well as for decontamination,
9 disinfection and disposal procedures:
10 (1) Disposable gloves should be a standard component of
11 emergency response equipment, and should be donned by all
12 personnel prior to initiating any emergency patient care
13 tasks involving exposure to blood or other body fluids to
14 which universal precautions apply. Extra pairs of disposable
15 gloves should always be available. Considerations in the
16 choice of disposable gloves should include dexterity,
17 durability, fit, and the task being performed. There is no
18 single type or thickness of glove appropriate for protection
19 in all situations. For situations where large amounts of
20 blood are likely to be encountered, it is important that
21 gloves fit tightly at the wrist to prevent blood
22 contamination of hands around the cuff. For multiple trauma
23 victims, gloves should be changed between patient contacts,
24 if the emergency situation allows. While wearing gloves,
25 emergency medical personnel should avoid handling personal
26 items, such as combs and pens, that could become soiled or
27 contaminated. Gloves that have become contaminated with blood
28 or other body fluids to which universal precautions apply
29 should be removed as soon as possible, taking care to avoid
30 skin contact with the exterior surface. Contaminated gloves
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1 should be placed and transported in bags that prevent leakage
2 and should be disposed of, or, in the case of reusable
3 gloves, cleaned and disinfected properly.
4 (2) Mouth-to-mouth resuscitation masks designed to
5 isolate emergency response personnel (i.e., double lumen
6 systems) from contact with victims' blood and blood-
7 contaminated saliva, respiratory secretions and vomitus
8 should be provided to all personnel who provide or
9 potentially provide emergency treatment. Disposable
10 resuscitation equipment and devices should be used once and
11 disposed of, or, if reusable, thoroughly cleaned and
12 disinfected after each use according to the manufacturer's
13 recommendations.
14 (3) Masks, eyewear and gowns should be present on all
15 emergency vehicles that respond or potentially respond to
16 medical emergencies or victim rescues. These protective
17 barriers should be used in accordance with the level of
18 exposure encountered. Minor lacerations or small amounts of
19 blood do not merit the same extent of barrier use as required
20 for exsanguinating victims or massive arterial bleeding.
21 Management of the patient who is not bleeding, and who has no
22 bloody body fluids present, should not routinely require use
23 of barrier precautions. Masks and eyewear (i.e., safety
24 glasses) should be worn together, or a faceshield should be
25 used by all personnel prior to any situation where splashes
26 of blood or other body fluids to which universal precautions
27 apply are likely to occur. Gowns or aprons should be worn to
28 protect clothing from splashes of blood. If large splashes or
29 quantities of blood are present or anticipated, impervious
30 gowns or aprons should be worn. An extra change of work
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1 clothing should be available at all times. Clothing contacted
2 by blood or body fluids should be commercially dry cleaned or
3 machine laundered in hot water with household bleach and
4 machine dried at high temperature.
5 (4) All workers should take precautions to prevent
6 injuries caused by needles, scalpel blades and other sharp
7 instruments or devices during procedures; when cleaning used
8 instruments; during disposal of used needles; and when
9 handling sharp instruments after procedures. To prevent
10 needle-stick injuries, needles should not be recapped,
11 purposely bent or broken by hand, removed from disposable
12 syringes or otherwise manipulated by hand. After they are
13 used, disposable syringes and needles, scalpel blades and
14 other sharp items should be placed in puncture-resistant
15 containers for disposal. The puncture-resistant containers
16 should be located as close as practical to the use area in
17 the ambulance or, if sharps are carried to the scene of
18 victim assistance from the ambulance, a small puncture-
19 resistant container should be carried to the scene as well.
20 Reusable needles should be left on the syringe body and
21 should be placed in a puncture-resistant container for
22 transport to the reprocessing area.
23 (5) Hands and other skin surfaces should be washed
24 immediately and thoroughly if contaminated with blood, other
25 body fluids to which universal precautions apply or
26 potentially contaminated articles. Hands should always be
27 washed after gloves are removed, even if the gloves appear to
28 be intact. Hand washing should be completed using the
29 appropriate facilities, such as utility or restroom sinks.
30 Waterless antiseptic hand cleanser should be provided on
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1 responding units to use when hand-washing facilities are not
2 available. When hand-washing facilities are available,
3 emergency medical personnel should wash hands with warm water
4 and soap. When hand-washing facilities are not available,
5 emergency medical personnel should use a waterless antiseptic
6 hand cleanser. The manufacturer's recommendations for the
7 product should be followed.
8 (6) All spills of blood and blood-contaminated fluids
9 should be promptly cleaned up, using an Environmental
10 Protection Agency-approved germicide or a 1:100 solution of
11 household bleach in the following manner while wearing
12 gloves:
13 (i) Visible material should first be removed with
14 disposable towels or other appropriate means that will
15 ensure against direct contact with blood.
16 (ii) If splashing is anticipated, protective eyewear
17 should be worn, along with an impervious gown or apron
18 which provides an effective barrier to splashes.
19 (iii) The area should be decontaminated with an
20 appropriate germicide.
21 (iv) Hands should be washed following removal of
22 gloves.
23 (v) Soiled cleaning equipment should be cleaned and
24 decontaminated or placed in an appropriate container and
25 disposed of according to departmental policy.
26 Plastic bags should be available for removal of contaminated
27 items from the site of the spill. Shoes and boots can become
28 contaminated with blood in certain instances. Where there is
29 massive blood contamination on floors, the use of disposable
30 impervious shoe coverings should be considered. Protective
19890S1164B1436 - 5 -
1 gloves should be worn to remove contaminated shoe coverings.
2 The coverings and gloves should be disposed of in plastic
3 bags. A plastic bag should be included in a crime scene kit
4 or the car which is to be used for the disposal of
5 contaminated items. Extra plastic bags should be stored in
6 the emergency vehicle.
7 Section 2. Section 14(d) of the act, amended October 21,
8 1988 (P.L.1055, No.121), is amended to read:
9 Section 14. Support of emergency medical services.
10 * * *
11 (d) Purpose of fund.--All money from the Emergency Medical
12 Services Operating Fund shall be disbursed by the department to
13 eligible providers of emergency medical services, as determined
14 by the department by regulation, and to regional emergency
15 medical services councils for the initiation, expansion,
16 maintenance and improvement of emergency medical services,
17 including ambulance and communications equipment, infectious
18 disease prevention equipment and immunization, and for training,
19 education and ambulance licensure purposes. These funds shall
20 not be used for any other purposes, nor shall these funds be
21 utilized by the department to fund departmental or regional
22 administration of this act.
23 * * *
24 Section 3. This act shall take effect immediately.
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