Body substance isolation

Facilitator: Becca
Time: 10 mins; 2110-2120
Actual time:
Learning Objectives:
Materials: 4x4s, water + soap, gloves for everybody, fake blood.

Intro and definitions

Q

What does "body substances" mean?

A

Anything warm and wet that came from inside the body (Blood, vomit, shit, sputum, saliva, pus).

Infections are spread through exposure to:

  • Blood -- HIV, Hepatitis C, MRSA.

  • Shit -- giardia, e. coli.

  • Saliva or sputum -- cold, flu, bronchitis, TB.

Washing hands

Set an example for everybody. Thoroughly wash hands with soap and water:1

  • Before and after providing first aid care.

  • Immediately after exposure to blood or other body fluids.

  • After shitting.

  • Before and after handling food or eating.

In urban environments, duck into a nearby bar to wash hands after providing first aid.

Hand sanitizer is alcohol in a gel carrier. It denatures some of the proteins it touches but does not remove stuff from your hands. Feel free to use it as a general preventative, as long as you know that it is not sufficient for:

  • After contact with body substances or wounds

  • Before handling food or wounds

  • After using the bathroom

Make sure hand washing options are available for protesters, especially near food.

Model field hand-washing

"Hey buddy, can you help me wash my hands?"

  • Buddy opens a 4x4 and hands it over, squirts water over washing medic's hands, squirts a little liquid soap on washing medic's hands.

  • Washing medic washes hands thoroughly for 15 seconds while lecturing about gloves.

  • Buddy hands over 4x4 for washing medic to dry hands.

Barriers

Why use barriers to prevent body substance exchange?2

  • Protect injured or ill person from your body substances.

  • Protect injured or ill person from the body substances of others you touched previously.

  • Protect you from the injured or ill person's body substances.

Gloves

Q

When wear gloves?

A

Any time you might be in contact with any body substance.

Most medics wear exam gloves all the time when rendering first aid.

  • You never know when someone might vomit or you might find hidden bleeding.

  • Best not to walk around with exam gloves on -- they get dirty and scare people.

Is anyone here allergic to latex?

  • Latex allergies range from simple skin irritation to life threatening breathing problems. Most people just get skin irritation.

  • Use nitrile or vinyl exam gloves -- never carry latex gloves.3

When to change gloves?

  • Take gloves off and throw away when you complete care of each person.

  • If gloves get too slippery with body substances or water or too contaminated with pepper spray to continue care, change gloves before you complete care.

Gloves are always trash after you take them off

never re-use (even clean gloves).

Model/practice removing gloves

Trainer: practice this ahead of time -- with the gloves you will use in the training -- or you will fuck it up.4

  • Explain principles before demonstrating (keep body substances off hands while removing gloves).

  • Model disposal (rub gloves in mock blood, ball up bloody 4x4 in first glove, take off to make biohazard bag, throw in street).

  • Hand out gloves (don't hand out earlier, 'cause folks will get distracted).

  • Students practice taking off gloves

During this training, save gloves and reuse unless they are torn or soiled. Do not do this in the street. We have no real patients here.

Pack unused gloves (and other first aid supplies) in ziploc bags to prevent contamination.

Other BSI equipment

Consider protecting any part of your body that is moist -- eyes, mouth, inside of nose. These parts absorb stuff most easily. Some options: glasses; bandanna for mouth.

If exposed to body substances

Snot, spit, shit, vomit

  • Take a deep breath or otherwise ground yourself.

  • Flush flush flush; wash with soap and water.

  • Take time off for self-care if respiratory or gastrointestinal illness presents. Tell other medics and let them help.

Blood or pus

You cannot legally or ethically force someone to reveal HIV or Hep C status.

Consider asking the person who exposed you to go get tested with you for blood-borne illness, to ensure neither of you put the other at risk. It is okay for the person to say no.

Needle sticks or bad exposures to blood can often benefit from an ER visit for antibiotics or other preventatives.

Transmission events are relatively low

in cases of a healthcare worker accidentally touching a patient's blood. Ground yourself and spread calm even when you're scared.

Lazy medics know their status

In long actions, have medic testing parties every 6 months: go together for basic healthcare worker immunizations (if desired), HIV tests, and TB tests. Support new medics so they can take care of this stuff.

  1. Trainer: see "Hand Washing" poster (PDF, 2011) at http://dft.ba/-38gC and advisory on "Hand Hygeine for First Aid Providers" (2010) available through http://dft.ba/-38ME (both commissioned by American Red Cross).↩
  2. This is a rhetorical question. Trainer answers it.↩
  3. Some non-glove medical products contain latex (especially in stretchy bandages and band-aids) -- be sure to ask about latex allergies and be sure to check for medic alert bracelets before touching with any product containing latex.↩
  4. Review how to do it by checking out the awesome illustrated "Removing Disposable Gloves" skill sheet (PDF, 2011) at http://dft.ba/-380Q (it's on the last page). Remember we're also talking about snot, spit, shit, pus, and vomit.↩