ByKatherine West, RN, BSN, MSEd and James R. Cross, JD
As most members of the emergency response community are aware, the emergency response provisions of theRyan White Comprehensive AIDs Emergency Response Actwere reinstated in 2009. This resulted from years of hard work on the part of many EMS and Fire organizations.
An exciting part of the reinstatement of the law was a Congressional directive that the CDC develop a new list of diseases covered by the law. The original list was very limited and did not even include hepatitis C. The CDC published the new list on November 2, 2011; the additional diseases added were substantial (see table below). Now included were not only Hepatitis C but many droplet diseases that are increasingly seen in greater numbers in the U.S. over the past few years.
With the reinstatement of the emergency response provisions of the Ryan White law, all seemed well again in the world of hospital notification responsibilities. However, since the publication of the new disease reporting list in November 2011, some medical facilities have “pushed back” on their responsibilities. Some facilities and one state hospital association have taken issue with several provisions in the new version of the law, such as lack of a clear definition of who is to be included in the definition of an Emergency Response Employee (ERE). Although included in the original version of the law and seemingly obvious from the title of the new legislation, not everyone sees it as obvious. Additionally, at least one state hospital association has taken issue with the fact that the body of the law does not specify “droplet” diseases. Common sense does not seem to prevail when you’re looking for a reason not to comply. Of course, this is precisely why the Ryan White Notification Law was needed in the first place.
These issues highlight the importance of having a trained designated infection control officer (DICO) to advocate for your department members. The DICO in departments that have affected such misunderstanding of the law have a responsibility to initiate change at these medical facilities. Without change in how these facilities interpret Ryan White, responders involved in exposures will not receive the source patient disease information needed for appropriate post-exposure medical follow-up. It also is critical for department administrators to be aware of these issues and be prepared to provide DICOs with assistance when their efforts do not result in changed behavior.
Medical facilities and their association representatives need to understand the following about the Ryan White law: (1) the law does not contain specific diseases covered by the law–Congress delegated the responsibility for developing a list of diseases covered by the law to the CDC; (2) the list of diseases published by the CDC on November 2, 2011 contains three categories–bloodborne, airborne, and droplet transmitted diseases. The CDC chose to include the “droplet” category to clarify the distinction between airborne and droplet transmitted diseases. If a disease is included in list of diseases in any of these categories, medical facilities must adhere to their reporting responsibilities under the law; (3) while the law does not define the term “emergency response employee,” it is clear that firefighters, paramedics, EMTs, law enforcement officers, and volunteers for emergency response employers are covered under the law. While the CDC chose not to clarify this in its November 2, 2011 publication, it did so in the prior list and guidelines it published on March 21, 1994 pursuant to the original Ryan White law passed in 1990.
瑞恩/怀特法律规定之一是CDC is responsible for identifying an “administrative contact” and process to address problems with compliance by medical facilities. The November 2, 2011 publication from the CDC announcing the new list of diseases and guidelines for compliance with the law did not identify a specific contact point or procedure to follow when seeking assistance with compliance issues. In past years, a specific contact person was extremely helpful in getting medical facilities to meet their responsibilities. Until an official contact is named by the CDC, we suggest contacting us at Infection Control/Emerging Concepts, 703-365-8388, with issues regarding medical facility compliance with the law and we will provide you with assistance. The CDC/NIOSH has been made aware of these problems is will be working on the issues identified.
最后一个注意的新疾病列表:是en established that many children are not receiving preventative vaccines for some of these diseases and that immunity for some adults has waned over the years. Many health care providers were infected with one or more of these diseases as children and have acquired immunity — believed to offer protection for life. Others received preventative vaccines as children that were thought to offer protection for life but now have been brought into question. For example, persons who received measles vaccine between 1963 and 1967 received a killed-virus vaccine and need to be revaccinated with a live virus vaccine. The killed virus vaccine has been found not to have been protective. Persons in this group need to receive two doses of live virus vaccine one month apart. Protective coverage of other vaccines is currently being evaluated. Therefore, it is important for all health care providers to have documentation of their illness and vaccination status.
Table—Disease Listing
Bloodborne DiseasesAirborne Disease
HIV Tuberculosis
HBV Measles
HCV Chickenpox
Vaccina virus
Cutaneous anthrax
Rabies
Viral Hemorrhagic fevers
Droplet Diseases
Diphtheria
新流感病毒
Meningitis
Mumps
Pertussis
Plague
Rubella (German measles)
SARS-CoV
Katherine West, BSN, MSEd, CIC is an infection control consultant actively working with Fire and EMS since 1978. She lectures nationally and internationally and has authored books, videos and articles on infection control issues. She has served as a consultant to the Centers for Disease Control, the National Institute of Occupational Safety & Health, and an education specialist for the National Institutes of Health and authored theInfectious Disease Handbook for Emergency Care Personnel,now in its third edition. Katherine is also a consultant to the US Public Health Service, Federal Occupational Health and was honored as a “Hero in Infection Control & Prevention” in 2006 for her work in the field of infection control & EMS by the Association for Professionals in Infection Control & Epidemiology (APIC).
James R. Cross, JD is an attorney and legal, regulatory, and legislative consultant and trainer. He has made presentations to the emergency response community on the legal aspects of infection control since 1992. He is the editor ofThe Source, a periodic publication for infection control officers in Fire/Rescue, EMS and Law Enforcement. James is also president of Crossroads Mediation Services in Manassas, Virginia.
