infection prevention & control...racf covid-19-ppe train the trainer package author: clinical...

Residential Aged Care Facility (RACF) Train the Trainer Package Version 1.0

October 2020

Table of Contents Train the Trainer Program for RACF Providers Overview & Agenda ........................................... 3-4

Train theTrainer Package for PPE and Infection Prevention and Control for NSW RACF –

COVID-19 guidance document ................................................................................................ 5-31

Personal Protective Equipment (PPE) RACF Train the Trainer Powerpoint Presentation ...... 32-120

Scenarios for Train the Trainer RACF Program ................................................................... 121-125

Personal Protective Equipment (PPE) RACF Train the Trainer Powerpoint Handouts ......... 126-156

Train the Trainer for RACF Evaluation Form ........................................................................ 157-158

COVID-19 Infection Prevention and Control Agenda for the Train the Trainer Program for RACFs

Page 1 of 2

COVID-19 Infection Prevention and Control Train the Trainer for Residential Aged Care Facilities

Thank you for agreeing to participate in the Clinical Excellence Commission infection prevention and control ‘train the trainer’ program.

Overview of the program • NSW Health and the Commonwealth Department of Health have formalised the coordination of

government support to residential aged care providers in their management of a COVID-19 outbreak. The protocol incorporates feedback received during consultation sessions with aged care peak bodies and providers.

• The roles and responsibilities of all relevant parties, governance structures and escalation procedures are outlined with the intention that the protocol facilitates fast mobilisation of required government support to an aged care provider in the event of a COVID-19 outbreak.

• The primary objectives of the protocol are to optimise care for all residents in impacted RACFs (regardless of their COVID-19 status) and to contain and control an outbreak to bring it to an end as quickly and safely as possible.

• Staff within RACFs will be required to understand when an outbreak for COVID-19 is declared, that they feel confident of their ability to understand the PPE requirements, when to wear PPE, when to change PPE elements and how to remove PPE safely.

What to bring to the training session? 2 sets of your typical PPE

1. Gown 2. Gloves 3. Surgical mask 4. P2/N95 respirator/mask 5. Protective eyewear - face shield or goggles

The training program Learning Objective

• CEC Staff will explain why PPE is necessary in reducing the risk of transmission of COVID-19 • Staff will be able to identify correct PPE required in the residential aged care setting • Aged care participants will be able to demonstrate the correct donning and removal of PPE to

enable training of staff

Learning Outcomes

• Identify the PPE available for staff within residential aged care facilities • Understand the importance of PPE • Have an understanding of previous infectious disease outbreaks and relate that to the importance

of correct PPE use

https://www.health.nsw.gov.au/Infectious/covid-19/Pages/racf-outbreak-management.aspx

COVID-19 Infection Prevention and Control Agenda for the Train the Trainer Program for RACFs

Page 2 of 2

COVID-19 Infection Prevention and Control Train the Trainer for Residential Aged Care Facilities

• Identify the PPE required for: o Standard precautions o Transmission-Based Precautions

Contact precautions Droplet precautions Airborne Precautions Combined Precautions: Contact and Droplet Combined Precautions: Contact, Airborne and Droplet

Assessment criteria

• Staff will demonstrate correct technique for donning and removing PPE

Training Program Agenda Date: Venue: Time: Special Instructions:

TOPICS TO BE COVERED TIME FRAME

Introduction

Overview of the session 15 minutes

Present PowerPoint presentation (PPE) 60 minutes

Donning and removing PPE competency tool

P2 N95 competency- fit check

Trainer to demonstrate sequence to staff

30min

Discussion and questions 45 minutes

How to use the training package provided – scenarios/workshops and videos

Support materials available e.g. posters

When is PPE required within RACFs

The correct PPE to be used

60-90 minutes

Name of Document Version

Page 1 of 27

Train the Trainer Package for Personal Protective Equipment (PPE) and Infection Prevention and Control for NSW RACF – COVID-19 Version 1 October 2020

Train the Trainer – Residential Aged Care Version 1.0, October 2020

UNCONTROLLED WHEN PRINTED Page 2 of 27

Contents Introduction .............................................................................................................................................. 3

Infection Prevention and Control .............................................................................................................. 3

Key Infection Prevention and Control Resources and Guidance .......................................................... 4

Escalation and Response – geographical areas................................................................................... 4

Education and Training Infection Prevention and Control ........................................................................ 5

Train the Trainer Model ........................................................................................................................ 5

1. Clinical Excellence Commission PPE Training Session Plan for Aged CareTrainers ................. 5

2. PPE Training Session Plan for Aged Care Trainers ................................................................... 6

Training Resources ................................................................................................................................. 8

Online Infection control training and education for RACF staff ............................................................. 8

Infection Prevention and Control Precautions .......................................................................................... 8

Training: Standard Precautions ............................................................................................................ 8

Training: Transmission Based Precautions .........................................................................................13

Contact precautions .........................................................................................................................13

Droplet precautions .........................................................................................................................15

Airborne precautions – rarely used in RACF ....................................................................................16

Video: Combined contact and droplet precautions ..............................................................................19

Video: Combined contact, droplet and airborne precautions ...............................................................19

Appendix A - Support Material ................................................................................................................21

Appendix B - Session Plan: PPE sizing, donning and doffing demonstration and practice ......................27

Train the Trainer – Residential Aged Care Version 1.0, September 2020


Introduction Residential aged care (RAC) is an essential service for older people, some younger people with complex health conditions and people with disabilities who can no longer live at home and who need help with everyday tasks or health care.

Residential Aged Care Facilities (RACFs) are at risk of outbreaks due to the complexity of the residents, shared spaces/activities and limited access to infection prevention and control education. A solid and practical infection prevention and control program, with a focused understanding of personal protective equipment (PPE) and its application is particularly important for the management and control of COVID-19 outbreaks.

The following resource provides a train the trainer package to be implemented to NSW RACFs to facilitate their understanding in infection prevention and control and PPE as it applies to COVID-19.

This resource does not replace the requirements for RACF to meet the national standards as set out by the Aged Care Quality and Safety Commission and should be used to support and enhance existing programs and strategies.

NSW Health and the Commonwealth Department of Health have formalised the coordination of government support to residential aged care providers in their management of a COVID-19 outbreak. The protocol incorporates feedback received during consultation sessions with aged care peak bodies and providers.

The roles and responsibilities of all relevant parties, governance structures and escalation procedures are outlined with the intention that the protocol facilitates fast mobilisation of required government support to an aged care provider in the event of a COVID-19 outbreak.

The primary objectives of the protocol are to optimise care for all residents in impacted RACFs (regardless of their COVID-19 status) and to contain and control an outbreak to bring it to an end as quickly and safely as possible.

Governance and escalation are a critical component to manage the identification, management, education and communication, of potential and confirmed, COVID-19 outbreaks in RACFs.

Infection Prevention and Control Infection Prevention and Control (IP&C) refers to evidence-based practices and procedures that, when applied consistently in healthcare settings, can prevent or reduce the risk of transmission of communicable diseases and transmissible infections to aged care providers, staff, residents and visitors.

Staff within RACFs will be required to understand when an outbreak for COVID-19 is declared, that they feel confident of their ability to understand the PPE requirements, when to wear PPE, when to change PPE elements and how to remove PPE safely.

All Personal Protection Equipment (PPE) should be used in line with the principles in the Australian Guidelines for the Prevention and Control of Infection in Healthcare (2019), whilst acknowledging the unique circumstance of COVID-19.

https://www.agedcarequality.gov.au/providers/standardshttps://www.health.nsw.gov.au/Infectious/covid-19/Pages/racf-outbreak-management.aspxhttps://www.health.nsw.gov.au/Infectious/covid-19/Documents/racf-outbreak-roles.pdfhttps://www.nhmrc.gov.au/about-us/publications/australian-guidelines-prevention-and-control-infection-healthcare-2019https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-prevention-and-control-infection-healthcare-2019



Key Infection Prevention and Control Resources and Guidance Australian Guidelines for the Prevention and Control of Infection in Healthcare (2019)

CEC Infection Control Policy and Guidelines

CEC COVID-19 infection prevention and control guidance

Coronavirus (COVID-19) guidelines for infection prevention and control in residential care facilities. National Guidelines

Australian Health Protection Principle Committee (AHPPC) update to residential Aged Care facilities about minimising the impact of COVID-19, RACF Visitor guidelines

Coronavirus (COVID-19) Environmental cleaning and disinfection principles for health and residential care facilities

CEC Respiratory Protection in Healthcare (PDF)

CEC Application of PPE in Response to COVID-19 Pandemic V2.3 (PDF)

Escalation and Response – geographical areas In geographical areas with significant community transmission of COVID-19 (as defined by jurisdictional public health units), in specified aged care settings, and aged care staff1 may need to take extra precautions. This may include precautions above those usually indicated for standard and transmission-based precautions. See ICEG guidelines on PPE in areas with significant community transmission for more in depth information.

Within NSW, during situations of increased risk, it is important to be able to escalate the infection prevention and control precautions to align with the risk of community transmission and onward spread. Risk may change based on numbers and geographical locations of spread. Changes to risk of COVID-19 will be based on NSW Health changing the response and escalation levels for NSW. This should be checked before any changes are made to PPE use outside of standard and transmission based precautions.

Within RACFs, decisions to change existing COVID-19 prevention strategies will be directed from NSW Health, Commonwealth Department of Health or RACF owner/operators.

1 Includes aged care staff, personal care workers and support staff who have direct contact with residents or residents in health and residential care facilities, where the risk of COVID-19 transmission is judged to be significant.

Personal Protective Equipment (PPE) RACF Train the Trainer PowerPoint Presentation

https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-prevention-and-control-infection-healthcare-2019http://www.cec.health.nsw.gov.au/keep-patients-safe/infection-prevention-and-control/infection-prevention-and-control-precautionshttp://www.cec.health.nsw.gov.au/keep-patients-safe/COVID-19/core-guidancehttp://internal.cec.health.nsw.gov.au/__data/assets/word_doc/0019/1250191/Coronavirus%20(COVID-19)%20guidelines%20for%20infection%20prevention%20and%20control%20in%20residential%20care%20facilitieshttps://www.health.gov.au/news/australian-health-protection-principal-committee-ahppc-update-to-residential-aged-care-facilities-about-minimising-the-impact-of-covid-19https://www.health.gov.au/resources/publications/coronavirus-covid-19-environmental-cleaning-and-disinfection-principles-for-health-and-residential-care-facilitieshttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0006/597687/Respiratory-Protection-in-Healthcare.pdfhttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0006/590307/Application-of-PPE-in-COVID-19.pdfhttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0006/590307/Application-of-PPE-in-COVID-19.pdfhttps://www.health.gov.au/resources/publications/iceg-guidance-ppe-health-workers-community-transmissionhttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0008/595754/COVID-19-Infection-Prevention-and-Control-Response-and-Escalation-Framework.pdf?fbclid=IwAR2-V_Tlk7e2yEW1p6pJmT8QOFYYhG0bOJnwVtR4q2AlJysiI_E-6B-rJO8https://www.cec.health.nsw.gov.au/__data/assets/powerpoint_doc/0019/611425/PPE-RACF-Train-the-Trainer-Presentation.pptx



Education and Training Infection Prevention and Control Train the Trainer Model

1. Clinical Excellence Commission PPE Training Session Plan for Aged CareTrainers

Learning Objective

• CEC Staff will explain why PPE is necessary in reducing the risk of transmission of COVID-19 • Staff will be able to identify correct PPE required in the residential aged care setting • Aged care participants will be able to demonstrate the correct donning and removal of PPE to

enable training of staff

Learning Outcomes

• Identify the PPE available for staff within residential aged care facilities • Understand the importance of PPE • Have an understanding of previous infectious disease outbreaks and relate that to the

importance of correct PPE use • Identify the PPE required for

o Standard precautions o Transmission-Based Precautions

Contact precautions Droplet precautions Airborne Precautions Combined Precautions: Contact and Droplet Combined Precautions: Contact, Airborne and Droplet

Assessment criteria

• Staff will demonstrate correct technique for donning and removing PPE

Resources and training aids required

• PowerPoint presentation- use note section on presentation to guide you • PPE competencies (donning and removing) • Hand hygiene product • Detergent wipes for reusable protective eyewear • Waste receptacle/bags • P2/N95 respirator competency- fit check • PPE for each staff member

⋅ Gloves ⋅ Impervious gown or apron ⋅ Fluid repellent surgical mask ⋅ P2 N95 mask ⋅ Protective eyewear



Session plan

Outcome of training session

Staff will be able to demonstrate the correct sequence in donning and removal of PPE and have an understanding of importance of PPE in the health care setting to prevent transmission of organism.

Staff will be able to demonstrate an ability to train others in safe donning and doffing of PPE

Record of training: Record ALL staff completing this education/competency session

2. PPE Training Session Plan for Aged Care Trainers Training of staff within each RACF will vary, depending on previous infection prevention and control training and education. The sessions can range from presentations, scenario workshops, watching videos and practising donning/doffing PPE.

Suggested presentations and practice sessions:

Overview of coronavirus, SARS-CoV-2 and COVID-10 How is COVID-19 transmitted How droplets and aerosols spread How do we transmit COVID-19 How do we break the chain of infection

30 minutes

What are standard precautions 30 minutes What are transmission based precautions Combining precautions - videos

45 minutes

Respiratory protection: P2/N95 respirators Fit checking - videos

20-30 minutes

Practicing donning/doffing PPE 60 minutes Practicing donning/fit checking/doffing P2/N95 respirators 45 minutes

TOPICS TO BE COVERED TIME FRAME FOR 5 STAFF MEMBERS

Introduction Overview of the session 15 minutes

Present PowerPoint presentation (PPE) 90 minutes

Donning and removing PPE competency tool P2 N95 competency- fit check Trainer to demonstrate sequence to staff

2 hours

Discussion and questions 90 minutes

How to use the training package provided – scenarios/workshops and videos Support materials available eg posters When is PPE required within RACFs

The correct PPE to be used

60 minutes



Competency Assessment for donning/doffing PPE

See Session Plan: PPE sizing, donning and doffing demonstration and practice

Suggestions for short in-service sessions: Key practice points for standard precautions: Suggested topic Suggested session timeframe

Hand Hygiene Respiratory Hygiene (Cough Etiquette) Personal Protective Equipment (PPE) Aseptic Technique Needle-stick and Sharps Injury Prevention Cleaning and Disinfection Waste Disposal Linen management

30 minutes 30 minutes 30 – 45 minutes 30 – 45 minutes 20 minutes 30 – 45 minutes 20 minutes 20 minutes

Session Plan Break into smaller groups of 2-3 staff members Write down responses to the questions All groups present their discussion responses Discuss other options or practices that need to be considered

Key practice points for contact precautions: Suggested topic Suggested session timeframe

As per scenario 30 – 45 minutes Include watching the video


Key practice points for droplet precautions: Suggested topic Suggested session timeframe



Key practice points for airborne precautions: Suggested topic Suggested session timeframe





Training Resources Online Infection control training and education for RACF staff

1. Autralian Commission Quality and Safety In healthcare elearning modules Infection Prevention and Control

o National Hand Hygiene Initiative, also includes infection prevention and control education (free)

2. ACIPC – Basic Infection Prevention and Control (cost to complete course) 3. ACIPC - Aged Care: Online short course in Infection Prevention and Controlin Aged Care

Settings (cost to complete course) 4. NSW Health managed aged care facilities - Aged care staff are encouraged to complete three

My Health Learning modules related to COVID-19, in addition to the new module titled "Personal protective equipment for combined transmission-based precautions".

o Infection Prevention and Control Practices (Course code: 46777047) (free) o Infection Prevention – Transmission Based Precautions (Course code: 253093581) (free) o Infection Prevention – Enhanced Precautions for Pandemic Flu (Course code:

289888589) (free) 5. Clinical Excellence Commission - free education videos are available to view on the YouTube

channel. or they can be accessed on: o Combined contact, droplet and airborne precautions (COVID-19) o Transmission Based Precautions

Contact Precautions + Standard Precautions – donning PPE, interacting with patients and doffing PPE

Droplet Precautions + Standard Precautions – donning PPE, interacting with patients and doffing PPE

Airborne Precautions + Standard Precautions – donning PPE, interacting with patients and doffing PPE

Donning and fit checking P2 or N95 respirators (various brands)

Trainers and education providers from RACFs should use these resources to continue training and assessment of the aged care workforce.

Infection Prevention and Control Precautions Key training practice point: It is important that staff understand that there are several infection prevention and control strategies to prevent and control the transmission of COVID-19 and other communicable diseases within RACFs. The focus on COVID-19 specific PPE is required as it is unlike other PPE worn for RACF previously experienced communicable disease outbreaks eg influenza, gastroenteritis. Existing evidence indicates and reports from Victoria indicate that COVID-19 can be transmitted to aged care staff if PPE is not worn, removed or disposed of correctly.

Training: Standard Precautions Standard Precautions represent the minimum infection prevention measures that apply to all resident’s care, regardless of suspected or confirmed infection status of the residents, in any setting where healthcare is delivered. These evidence-based practices are designed to both protect and prevent spread of infection among residents and healthcare personnel.

https://nhhi.southrock.com/cgi-bin-secure/Home.cgi?msecs=a90cf0ad06431bd7522707f4fd937c9e&https://www.covid-19training.gov.au/loginhttps://www.acipc.org.au/https://www.acipc.org.au/online-short-course-in-ipc-in-aged-care-settings/https://www.acipc.org.au/online-short-course-in-ipc-in-aged-care-settings/https://www.youtube.com/channel/UCasUkYzW1sK897aDvtXuHbwhttps://www.youtube.com/channel/UCasUkYzW1sK897aDvtXuHbwhttp://www.cec.health.nsw.gov.au/keep-patients-safe/COVID-19/personal-protective-equipment/ppe-training-videoshttp://www.cec.health.nsw.gov.au/keep-patients-safe/COVID-19/personal-protective-equipment/ppe-training-videoshttp://www.cec.health.nsw.gov.au/keep-patients-safe/COVID-19/personal-protective-equipment/ppe-training-videos



Standard Precautions comprise the following measures:

• Hand Hygiene • Respiratory Hygiene (Cough Etiquette) • Personal Protective Equipment (PPE) • Aseptic Technique • Needle-stick and Sharps Injury Prevention • Cleaning and Disinfection • Waste Disposal • Linen management

Key practice points for standard precautions:

Suggested inclusion in an education program

For information: see Infection Prevention and Control Handbook

Suggested scenario or workshop

Hand Hygiene (HH) – include these points into the training scenario

• Why is HH important to protect staff, residents and the environment/equipment

• Why is it important to use HH rather than gloves

• Staff - when to perform hand hygiene when not in contact with residents e.g. going to the bathroom, eating, arrival to work, cleaning equipment

• Staff - when to perform hand hygiene when in contact with residents e.g. 5 Moments of hand hygiene

• Resident hand hygiene e.g. before eating, before activities, before going outside, before physiotherapy or activities

• Visitor hand hygiene e.g. before entering, before and after touching the resident

• Include duration of HH

• Products to use for HH, including any particular hand wipes for residents

• Location of HH products

• What to do if HH products are empty

• What to do if you have a reaction to a HH product

• Why should staff be bare below the elbow?

A new resident is admitted, and they require an orientation to the RACF.

They require a daily dressing to an arm wound, sustained in a fall.

Family members are anxious to visit

The resident is very outgoing and wants to participate in ‘all activities’

Workshop: what education will be required for staff, the resident and family members on HH?

Handbook Reference: 4.1 Hand hygiene

Respiratory Hygiene (Cough Etiquette) – include these points into the training scenario

• How to teach residents to cover their nose and mouth when coughing and sneezing

Workshop:

1. what would you provide to a resident who has common cold symptoms? How would

http://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0010/383239/IPC-Practice-Handbook-2020.PDFhttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0010/383239/IPC-Practice-Handbook-2020.PDF







• Disposing of tissues immediately after use

• Performing HH after touching nose/mouth

• Staff who have acute respiratory illness symptoms – why they are unable to come to work

• What will happen to staff who become unwell during work hours

• Why visitors with acute respiratory symptoms should not enter a RACF unless they have been reviewed by the in-charge, determined to be COVID-19 negative and a mask is to be worn (special circumstances such as end of life)

you provide reminders to the resident?

2. how would you know if it was a common cold or COVID-19?

3. Who would this be reported to? How quickly should you report it?

Handbook Reference: 4.2 Respiratory Hygiene and cough etiquette

Personal Protective Equipment (PPE) – include these points into the training scenario

• PPE is required to protect staff from contact with blood or body fluids.

• Performing a risk assessment to determine what PPE is required when performing care or a procedure on a resident

Workshop: A resident who has Alzheimer’s, is aggressive at times (unpredictable) and is incontinent. The resident becomes very frightened if staff wear a yellow gown. What PPE would be required when showering the resident?

Handbook Reference: 4, 4.3 PPE

Aseptic Technique – include these points into the training scenario

• What is aseptic technique?

• When would aseptic technique be used

• How would a procedure be performed using aseptic technique?

Workshop: A resident requires a daily wound dressing. How will this be performed using an aseptic technique?

Handbook Reference: 4.4 Aseptic technique

Needle-stick and Sharps Injury Prevention – include these points into the training scenario

• What is a sharps injury?

• What is a blood or body fluid splash

• What first aid should be performed?

• What are the risks of a bloodborne virus transmission?

• How should these be prevented?

Workshop: staff member jabs their finger with an insulin needle. What do they need to do immediately? Who should they report to? What follow up do they require?

Handbook Reference: 4.5 Needlestick and sharps injury prevention








Cleaning and Disinfection – include these points into the training scenario

• Why is cleaning the environment important

• How does it prevent transmission of COVID-19?

• What should you use to clean?

• Why is important to clean any shared equipment or shared activity equipment?

• What is the difference between a detergent and a disinfectant?

• When do you use a detergent?

• When is a disinfectant required?

• What is a frequent high touch point e.g. door handles, light switches, TV remote?

• How do we identify frequent high touch points for residents, staff and visitors?

Workshop:

1. Residents come together come together on a daily basis for activities. They handle various shared equipment and items. Choose 3 common items that residents share and determine how they should be cleaned and stored after use

2. list 5 high touch points that could be classified as potentially contaminated in a resident's room

Handbook Reference: 4.6 Cleaning and disinfection, 4.8 Environmental cleaning

Waste Disposal – include these points into the training scenario

• Why is it important to dispose of waste correctly?

• What types of waste within the RACF?

• Handling of waste safely

Workshop: ideas for a recycling program

Handbook Reference: 4.9 waste management

Linen Management – include these points into the training scenario

• Why is it important not to mix clean and dirty linen storage?

• How should line be stored?

• How should dirty linen be handled and carried by staff

• When should linen be placed in a fluid resistant bag?

Workshop: how should be handle linen if there is an outbreak?

Handbook Reference: 4.7 Clean Linen




Key practice points: Respiratory Hygiene (Cough Etiquette) for staff

During a pandemic, people with any acute respiratory symptoms must not enter a RACF.

To minimise the risk of transmission of infection to others, everyone entering, visiting or working within a RACF presenting with the signs and symptoms of respiratory infection should practise respiratory hygiene and cough etiquette. A RACF should encourage and enable residents, visitors and staff to perform respiratory hygiene and cough etiquette and provide appropriate resources to support these behaviours.

The following measures to contain respiratory secretions are recommended for all individuals;

• Cover your mouth and nose with a tissue when coughing or sneezing;

• If you don't have a tissue, cough or sneeze into your elbow;

• Use the nearest waste receptacle to dispose of the tissue after use;

• Perform hand hygiene (e.g. hand washing with soap and water, alcohol-based hand rub, or antiseptic hand wash) after having contact with respiratory secretions and contaminated objects/materials.

Healthcare facilities should ensure the availability of materials for adhering to Respiratory Hygiene/Cough Etiquette in waiting areas for residents and visitors.

• Provide tissues and no-touch receptacles for used tissue disposal.

• Provide conveniently located dispensers of alcohol-based hand rub; where sinks are available, ensure that supplies for hand washing (i.e. soap, disposable towels) are consistently available.

Handbook References: http://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0010/383239/IPC-Practice-Handbook-2020.PDF

1. Handbook Reference: 4.2 Respiratory Hygiene and cough etiquette

Key practice points: Personal Protective Equipment (PPE) – risk assessment for standard precautions

Appropriate PPE should be selected to prevent contamination of skin and/or clothing. Selections should be guided by the anticipated type and amount of exposure to blood and body substances and the likely transmission route of microorganisms. Further information is available at ACSQHC.

When you are selecting PPE, consider three key things;

• First is the type of anticipated exposure. This is determined by the type of activity, such as touch, splashes or sprays, or large volumes of blood or body substance that might penetrate the clothing.

• Second is the strength and suitability of the PPE for the task. This will affect, for example, whether a gown or apron is selected for PPE, or, if a gown is selected, whether it needs to be fluid resistant, fluid proof, or neither.

• Third is fit. PPE must fit the individual user, and it is up to the employer to ensure that all PPE are available in sizes appropriate for the workforce that must be protected.

Handbook References: http://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0010/383239/IPC-Practice-Handbook-2020.PDF

2. 4.3 Personal Protective Equipment

3. 5.5 Personal Protective Equipment Requirements

http://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0010/383239/IPC-Practice-Handbook-2020.PDFhttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0010/383239/IPC-Practice-Handbook-2020.PDFhttps://www.nhmrc.gov.au/about-us/publications/australian-guidelines-prevention-and-control-infection-healthcare-2019http://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0010/383239/IPC-Practice-Handbook-2020.PDFhttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0010/383239/IPC-Practice-Handbook-2020.PDF



Training: Transmission Based Precautions Transmission-Based Precautions should be used when standard precautions alone are not enough to stop the transmission of a communicable disease or a transmissible infection.

It is also known how the communicable disease, or a transmissible infection is transmitted and what PPE is required to stop the spread to staff, the environment and to the resident.

Transmission-Based Precautions are to be applied in addition to standard precautions. There are three basic types of Transmission-Based Precautions, tailored to the different types of transmission;

Contact precautions Contact precautions, when used with standard precautions, are designed to reduce the risk of transmission of microorganisms by direct and/or indirect contact.

Perform a risk assessment based on residents' communicability or risk of transmitting infection to others, the RACF environment and to staff. This will guide decisions regarding what contact precautions PPE is required, when is HH performed, when gloves should be worn and when PPE is removed.

Contact precautions should be considered for residents colonised or infected with a multi-resistant organism (MRO) where there is significant resident and/or environmental contact.

Assessment of the resident’s risk factors that potentially contribute to the spread of organisms in addition to local epidemiology will guide clinicians to whether resident require contact precautions with isolation, cohorting or management using standard precautions.

Contact precautions consist of:

Before entering residents’ zone

• Perform hand hygiene • Preform a risk assessment on the need for apron/gown i.e. type of resident contact (contact with

blood or a body substance), type of MRO (how and where it is transmitted from on the resident), residents’ status (wet or dry)

After entering residents’ zone

• Perform hand hygiene • Perform a risk assessment on the need for gloves and what you will be in contact with when

providing care, assistance or a procedure on the resident • Change or remove glove (if worn) and perform hand hygiene in between dirty and clean tasks.

Also change gloves and perform hand hygiene between different procedures on the resident eg changing a dressing and an incontinence pad.

On leaving residents zone

• Remove and dispose gloves (if worn) • Perform hand hygiene • Dispose apron/gown (if worn) • Perform hand hygiene • Clean shared equipment (if used) and perform hand hygiene • Dispose of all waste and perform hand hygiene

When transporting residents outside of the room, remove PPE and perform hand hygiene after placing residents on trolley/stretcher/wheelchair.

Use residents-dedicated or single-use non-critical residents-care equipment.

https://www.heti.nsw.gov.au/education-and-training/my-health-learning



Ensure consistent cleaning and disinfection of surfaces in close proximity to the residents and those likely to be touched by the residents and staff.

Clinical Excellence Commission Infection Prevention and Control Handbook Reference: 5.1 Contact Precautions

Contact Precautions

Key practice points for contact precautions:




Contact Precautions – include these points into the training scenario

• Why is it important to only wear gloves when in contact with blood and body fluid?

• How do you decide if you need to wear an apron or a gown?

o Patient factors: Mrs Smith no longer has symptoms of COVID-19 and has been compliant with respiratory and hand hygiene.

o Time: Let’s think how much time you are going to spend within 1.5 metres of Mrs Smith. Checking ID for medication safety, handing her the medication and taking observations will take approximately 3 minutes.

o Activities: you will be giving Mrs Smith oral medications, checking her blood pressure, heart rate, respiratory rate and temperature. You can stand or sit 1.5 metres away to speak to her.

o The risk of you coming into contact with significant blood or body fluid or respiratory droplets is extremely low or nil.

Workshop: Mrs Smith is a 65 year old person with suspected COVID-19 and isolated in her room. She has been isolated for 2 days and is now feeling better and no longer has any respiratory symptoms. Her COVID-19 results are expected back this afternoon.

You have cared for Mrs Smith before and know she is very compliant with respiratory and hand hygiene.

She requires some oral medication and her observations completed.

Will you wear an apron or a gown?

https://www.safetyandquality.gov.au/publications-and-resources/resource-library/approach-2-contact-standard-precautions-iconhttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0010/383239/IPC-Practice-Handbook-2020.PDF



Droplet precautions Droplet precautions should be employed in addition to standard precautions when caring for any residents known to be or suspected of being infected with a microorganism that can be transmitted by the respiratory droplet transmission route.

Specific requirements for droplet precautions are:

• Preferentially, the residents should be placed in a single room with an ensuite bathroom. If not possible, the resident should be cohorted with residents infected or colonised with the same confirmed communicable disease or transmissible infection and have access to a designated bathroom. Maintain a physical separation of greater than 2.4 m between mid-points of the beds in cohorted residents or draw bed curtains between residents to impede the direct spread of droplets and space beds at least 2.4m apart.

• Staff are to wear a disposable fluid repellent surgical mask. Masks should be removed and disposed of on leaving the residents zone (e.g. at the door, curtain or the anteroom) and perform hand hygiene

• Protective eyewear (goggles or face shield) is to be worn as part of standard precautions. Prescription glasses not regarded as ‘protective eye wear.’

If a resident who is being cared for under droplet precautions requires an aerosol generating procedure (AGP), this procedure should be undertaken in a dedicated treatment room away from other residents. If aerosol generating-procedures are anticipated, a P2/N95 mask should be worn by attending staff. AGPs may include the resident using a continuous positive airway pressure ventilation CPAP machine and open suctioning of the airway.

Protective eyewear should be worn as part of standard precautions. The following should be adhered to when managing residents on droplet precautions;

• Symptomatic residents should be transported on their own or with residents infected or colonised with same microorganism.

• If clinically able, residents should wear surgical mask when outside of the usual resident’s zone. • Depending on the microorganism, disinfection may be required in addition to cleaning. • Visitors are recommended to wear a surgical mask if within 1m of residents and practice hand

hygiene. • Use droplet precautions signage at entrance of resident’s zone.

Given that droplets do not remain suspended in the air, a negative pressure room is not required under droplet precautions. The resident’s door to their room is not required to be closed at all times unless the resident is unable to understand that they must stay in their room.

The resident’s room is their zone. If a room is shared, each resident has their own zoned area.

Droplet precautions consist of:


• Perform hand hygiene • Put in a surgical mask – ensure it fits comfortably • Put on protective eyewear



providing care, assistance or a procedure on the resident

http://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0006/596301/AGPs-in-relation-to-COVID-19.pdf



• Change or remove glove (if worn) and perform hand hygiene in between dirty and clean tasks. Also change gloves and perform hand hygiene between different procedures on the resident eg changing a dressing and an incontinence pad.

• Remove gloves before leaving the room


• Perform hand hygiene • Remove surgical mask and dispose in general waste bin • Remove protective eyewear. Clean thoroughly with a detergent wipe, if reusable. • Perform hand hygiene • Clean shared equipment (if used) and perform hand hygiene • Store protective eyewear dry • Dispose of all waste and perform hand hygiene

Droplet Precautions

Key practice points for droplet precautions:




Droplet Precautions – include these points into the training scenario

• It is important that surgical masks are worn correctly

o How will you wear your mask?

o What parts of the mask can you touch?

o How will you prevent residents from touching the front of the mask?

o What type of protective eyewear will you wear?

o Why are you not able to use your prescription glasses as protective eyewear?

• Should the residents door be closed all the time?

Workshop:

1. 2 residents share a bathroom. 1 resident has acute respiratory symptoms and is undergoing testing for COVID-19. How will you decide who uses the bathroom? What will you do to stop the other resident entering the bathroom?

2. Where will you place the PPE and the waste bin for the used PPE?

Airborne precautions – rarely used in RACF Airborne precautions are designed to interrupt the airborne transmission route. Airborne precautions should be employed in addition to standard precautions when caring for residents who are known or suspected to be infected with a communicable disease or a transmissible infection that can be transmitted by the airborne route.

https://www.safetyandquality.gov.au/publications-and-resources/resource-library/approach-1-droplet-standard-precautions-photohttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0010/383239/IPC-Practice-Handbook-2020.PDF



Specific requirements for airborne precautions are:

• The residents should be placed in a negatively pressurised single room with ensuite bathroom. If not possible, place the residents in a single room with door should be closed at all times. In this second instance, the residents should have access to an ensuite or designated bathroom. Staff are to wear a P2/N95 respirator on entering the resident's zone. P2/N95 respirators require a proper seal to the face and all staff are to be instructed on fit check of a P2/N95 respirator. Respirators should be removed and disposed in an anteroom or outside the resident's room.

• Visitors are recommended to wear a surgical mask and maintain a physical distance. P2/N95 respirators may be an alternative but must be accompanied with training and fit checking. P2/N95 mask requires a proper seal to the face and instruction should be given on how to perform a fit check. This should include a demonstration of donning, removing and disposing of respirator in addition to hand hygiene.

• Residents in airborne precautions are to be transported or transferred on their own. • If the residents can tolerate wearing a surgical mask, this should be worn when outside of the

isolation zone or their room. • Residents are never to wear a P2/N95 mask. • Protective eyewear should be worn as part of standard precautions • Depending on the communicable disease, disinfection may be required in addition to cleaning of

the room and any shared equipment. • Adequate time must be allowed after resident’s discharge or transfer for removal of at least 99%

of airborne contaminants. This time period will vary; depending on the amount of air exhausted from the room, room air mixing, and the size of the room

• P2/N95 respirators should be worn by all staff entering these rooms until terminal cleaning is completed and the time period has elapsed.

For further information visit ACSQHC - 6.4 Type and duration of precautions for specific infections and conditions. Please see the Resources page for signs and posters.

Airborne precautions consist of:


• Perform hand hygiene • Put in a P2/N95 respirator – ensure it seals completely by performing a fit check • Put on protective eyewear



providing care, assistance or a procedure on the resident • Change or remove glove (if worn) and perform hand hygiene in between dirty and clean tasks.

Also change gloves and perform hand hygiene between different procedures on the resident eg changing a dressing and an incontinence pad.

• Remove gloves before leaving the room


• Perform hand hygiene • Remove P2/N95 respirator and dispose in general waste bin • Perform hand hygiene • Remove protective eyewear. Clean thoroughly with a detergent wipe, if reusable. • Perform hand hygiene • Clean shared equipment (if used) and perform hand hygiene

https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-prevention-and-control-infection-healthcare-2019http://www.cec.health.nsw.gov.au/keep-patients-safe/infection-prevention-and-control/healthcare-associated-infections/resources



• Store protective eyewear dry • Dispose of all waste and perform hand hygiene

Airborne Precautions

Key practice points for airborne precautions:




Airborne Precautions – include these points into the training scenario

• It is important that staff understand that they must fit check the P2/N95 respirator every time they use it

• How will they ensure that they can fit check their P2/N95 respirator every time

Workshop:

1. A resident is suspected of having Tuberculosis (TB) and is undergoing an investigation. They will be in a single room with their own bathroom.

2. Where will you place the PPE and the waste bin for the used PPE?

3. How will you ensure that the number of times you need to enter the resident’s room is maximised? Not going in 3 times in quick succession when everything could be done during one visit?

Health workers must have an understanding of the basic principles of Contact, Droplet and Airborne precautions as they are applied individually. Combined precautions are required for COVID-19 in clinical practice.

The correct donning (putting on PPE) and doffing (removing PPE) should be done in a methodical way every time.

WATCH VIDEOS FOR TRANSMISSION BASED PRECAUTIONS Contact, Droplet and Airborne Precautions

http://www.cec.health.nsw.gov.au/keep-patients-safe/COVID-19/personal-protective-equipmenthttp://www.cec.health.nsw.gov.au/keep-patients-safe/COVID-19/personal-protective-equipmenthttp://www.cec.health.nsw.gov.au/keep-patients-safe/COVID-19/personal-protective-equipmenthttps://www.safetyandquality.gov.au/publications-and-resources/resource-library/approach-1-airborne-standard-precautions-photohttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0010/383239/IPC-Practice-Handbook-2020.PDFhttp://www.cec.health.nsw.gov.au/keep-patients-safe/COVID-19/personal-protective-equipmenthttp://www.cec.health.nsw.gov.au/keep-patients-safe/COVID-19/personal-protective-equipmenthttp://www.cec.health.nsw.gov.au/keep-patients-safe/COVID-19/personal-protective-equipment/ppe-training-videos



The proper removal (doffing) and disposal of contaminated PPE is the most important step in preventing inadvertent exposure to pathogens such as COVID-19.

There are a variety of ways to safely remove PPE without contaminating your clothing, skin, or mucous membranes with potentially infectious materials. See three examples below.

NB: Facilities can adopt other safe ways of PPE removal according to local guidelines and procedures.

Hand Hygiene should be performed between steps and at any point where contamination occurs.

Video: Combined contact and droplet precautions For residents with infections such as COVID-19, you will need to use contact and droplet precautions combined to provide the protection required for health workers.

Video: Combined contact, droplet and airborne precautions Some procedures are believed to generate aerosols beyond normal droplet dispersion as a source of respiratory pathogens. These procedures include using a CPAP machine, open suction and using a nebuliser. Standard precautions apply at all times.

For residents with infections such as COVID-19 and aerosol generating procedures, you will need to use contact, droplet and airborne precautions combined to provide the protection required for health workers. Some critically ill residents requiring extended length of care may also require addition of airborne precautions.



This video briefly outlines the principles and steps for putting on and taking off PPE when applying contact, droplet and airborne precautions in addition to standard precautions, when aerosol generating procedures are conducted on residents with COVID-19.

Key Practice Point: List of Video’s to be completed by each staff member Droplet Precautions

Contact Precautions

Airborne Precautions

Airborne Precautions- Donning and Fit checking of Respirator

Combined Contact and Droplet Precautions

Combined Contact, Droplet and Airborne Precautions

WATCH VIDEO’S FOR COMBINED PRECAUTIONS Contact and Droplet Precautions

Contact, Droplet and Airborne Precautions

http://www.cec.health.nsw.gov.au/keep-patients-safe/COVID-19/personal-protective-equipmenthttp://www.cec.health.nsw.gov.au/keep-patients-safe/COVID-19/personal-protective-equipmenthttp://www.cec.health.nsw.gov.au/keep-patients-safe/COVID-19/personal-protective-equipmenthttp://www.cec.health.nsw.gov.au/keep-patients-safe/COVID-19/personal-protective-equipmenthttp://www.cec.health.nsw.gov.au/keep-patients-safe/COVID-19/personal-protective-equipmenthttp://www.cec.health.nsw.gov.au/keep-patients-safe/COVID-19/personal-protective-equipment



Appendix A - Support Material Clinical Excellence Commission:

http://www.cec.health.nsw.gov.au/keep-patients-safe/COVID-19/personal-protective-equipment Commonwealth Department of Health:

https://www.health.gov.au/resources/collections/coronavirus-covid-19-campaign-resources

NSW Health:

https://www.health.nsw.gov.au/Infectious/covid-19/Pages/resources.aspx#stop

http://www.cec.health.nsw.gov.au/keep-patients-safe/COVID-19/personal-protective-equipmenthttps://www.health.gov.au/resources/collections/coronavirus-covid-19-campaign-resourceshttps://www.health.nsw.gov.au/Infectious/covid-19/Pages/resources.aspx#stophttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0011/577442/Contact-and-droplet-precaution-poster-portrait-v.4.pdfhttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0009/577530/Contact-and-droplet-precaution-poster-gloves-and-gown-portrait-v.4.pdfhttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0003/579522/Contact-and-droplet-precaution-and-airborne-poster-portrait-gown-and-gloves-separately-V.4.pdfhttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0011/579521/Contact-and-droplet-precaution-and-airborne-poster-gown-and-gloves-together-portrait-v.6.pdf



http://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0007/580219/Special-Precautions-for-COVID-19-Designated-Zones.PDFhttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0006/580218/Infection-Prevention-and-Control-COVID-19-Personal-Protective-Equipment.pdfhttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0007/571309/Respiratory-Hygiene-A3-Poster.pdfhttps://www.health.nsw.gov.au/Infectious/diseases/Documents/stop-the-spread.pdf



NSW HEALTH

COVID-19: Advice for aged care services

Residential aged care facility outbreak management

Protocol to support joint management of a COVID-19 outbreak in a residential aged care facility (RACF) in NSW 23 June 2020

Outbreak management: Governance structure for outbreaks in residential aged care facilities

Incident Action Plan for a public health response to a confirmed case of COVID-19 in an Aged Care Facility

https://www.health.nsw.gov.au/Infectious/covid-19/Pages/aged-care.aspxhttps://www.health.nsw.gov.au/Infectious/covid-19/Pages/racf-outbreak-management.aspxhttps://www.health.nsw.gov.au/Infectious/covid-19/Documents/racf-outbreak-protocol.pdfhttps://www.health.nsw.gov.au/Infectious/covid-19/Documents/racf-outbreak-protocol.pdfhttps://www.health.nsw.gov.au/Infectious/covid-19/Documents/racf-outbreak-roles.pdfhttps://www.health.nsw.gov.au/Infectious/covid-19/Documents/racf-outbreak-roles.pdfhttps://www.health.nsw.gov.au/Infectious/covid-19/Documents/iap-aged-care-facilities.pdfhttps://www.health.nsw.gov.au/Infectious/covid-19/Documents/iap-aged-care-facilities.pdf



NSW – CLINICAL EXCELLENCE COMMISSION

Infection Prevention and Control COVID-19 (SARS-CoV-2) – Residential & Aged Care Facilities

COVID-19 Outbreak Preparedness Assessment for Residential Aged Care Facilities

Aged Care Facilities COVID-19 Outbreak Management Checklist

http://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0005/603761/COVID-19-IPC-Health-worker-information-in-CEC-policies,-guidelines-and-resources.pdf

http://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0010/566776/CEC-Principles-of-Fit-checking-chart-2020.pdf

AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH

Coronavirus (COVID-19) resources for health professionals, including aged care providers, pathology providers and health care managers.

http://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0007/571543/RACF-Infection-prevention-and-control-COVID-19-Interim-guidance-March-2020.pdfhttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0007/571543/RACF-Infection-prevention-and-control-COVID-19-Interim-guidance-March-2020.pdfhttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0005/596588/COVID-19-Outbreak-Management-Preparedness-Assessment-for-Residential-Aged-Care-Facilities.pdfhttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0005/596588/COVID-19-Outbreak-Management-Preparedness-Assessment-for-Residential-Aged-Care-Facilities.pdfhttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0012/596586/COVID-19-Outbreak-Management-Checklist-for-Residential-Aged-Care-Facilities.pdfhttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0012/596586/COVID-19-Outbreak-Management-Checklist-for-Residential-Aged-Care-Facilities.pdfhttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0005/603761/COVID-19-IPC-Health-worker-information-in-CEC-policies,-guidelines-and-resources.pdfhttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0005/603761/COVID-19-IPC-Health-worker-information-in-CEC-policies,-guidelines-and-resources.pdfhttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0005/603761/COVID-19-IPC-Health-worker-information-in-CEC-policies,-guidelines-and-resources.pdfhttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0010/566776/CEC-Principles-of-Fit-checking-chart-2020.pdfhttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0010/566776/CEC-Principles-of-Fit-checking-chart-2020.pdfhttps://www.health.gov.au/resources/collections/coronavirus-covid-19-resources-for-health-professionals-including-aged-care-providers-pathology-providers-and-health-care-managers#aged-care-serviceshttps://www.health.gov.au/resources/collections/coronavirus-covid-19-resources-for-health-professionals-including-aged-care-providers-pathology-providers-and-health-care-managers#aged-care-serviceshttps://www.health.gov.au/resources/collections/coronavirus-covid-19-resources-for-health-professionals-including-aged-care-providers-pathology-providers-and-health-care-managers#aged-care-services



Coronavirus Disease 2019 (COVID-19) Outbreaks in Residential Care Facilities CDNA National Guidelines for the Prevention, Control and Public Health Management of COVID-19 Outbreaks in Residential Care Facilities in Australia

OUTBREAK MANAGEMENT IN RESIDENTIAL AGED CARE

Coronavirus (COVID-19) guidelines for infection prevention and control in residential care facilities

Governance and escalation For outbreaks of COVID-19 in RACF

AUSTRALIAN GOVERNMENT AGED CARE QUALITY AND SAFETY COMMISSION AND AUSTRALIAN COMMISSION ON QUALITY AND SAFETY IN HEALTHCARE

https://www.agedcarequality.gov.au/covid-19-coronavirus-information

https://www.health.gov.au/resources/publications/cdna-national-guidelines-for-the-prevention-control-and-public-health-management-of-covid-19-outbreaks-in-residential-care-facilities-in-australiahttps://www.health.gov.au/resources/publications/cdna-national-guidelines-for-the-prevention-control-and-public-health-management-of-covid-19-outbreaks-in-residential-care-facilities-in-australiahttps://www.health.gov.au/resources/publications/coronavirus-covid-19-outbreak-management-in-residential-care-facilitieshttps://www.health.gov.au/resources/publications/coronavirus-covid-19-guidelines-for-infection-prevention-and-control-in-residential-care-facilitieshttps://www.health.gov.au/resources/publications/coronavirus-covid-19-guidelines-for-infection-prevention-and-control-in-residential-care-facilitieshttps://www.health.nsw.gov.au/Infectious/covid-19/Documents/racf-outbreak-roles.pdfhttps://www.agedcarequality.gov.au/covid-19-coronavirus-informationhttps://www.agedcarequality.gov.au/covid-19-coronavirus-informationhttps://www.health.nsw.gov.au/Infectious/covid-19/Documents/racf-outbreak-roles.pdf



COVID-19: Aged care staff infection prevention and control precautions – Poster

https://www.safetyandquality.gov.au/publications-and-resources/resource-library/covid-19-aged-care-staff-infection-prevention-and-control-precautions-posterhttps://www.safetyandquality.gov.au/publications-and-resources/resource-library/covid-19-aged-care-staff-infection-prevention-and-control-precautions-poster



Appendix B - Session Plan: PPE sizing, donning and doffing demonstration and practice

Session Aim: To equip participants with the ability to understand and demonstrate safe donning and doffing of combined transmission precaution PPE Session Learning Outcomes By the end of the session the participant will be able to; 1. Understand the types, purpose and features of PPE necessary for contact, droplet and airborne precautions

and combined precautions for COVID-19

2. Understand which PPE is used at this RACF 3. Identify correct size of PPE for personal use 4. Demonstrate how to properly don, doff, adjust, and wear PPE safely 5. Describe and demonstrate the role of the trained observer (buddy) for ensuring that PPE is applied

and removed correctly Competencies: TBA Target group: Aged care staff Duration: 20 mins/staff member Mode/s of delivery • Face to face classroom based • Demonstration • Practical session

Equipment & teaching resources: Prior to session: • Donning/doffing checklists/competency assessment printed for trained observer role (buddy) • Set up, with all PPE/accessories, for facilitators to deliver PPE don/doff demonstration • Individual stations, for all participants, set up in simulation room for practical simulation session

o Participants will bring own PPE from PPE sizing session o Bin/plastic bag (one per participant) o Alcohol based hand rub (one per participant) o Donning/doffing checklists/competency assessment for trained observer role (one per participant) o Extra gloves, masks, detergent wipes (or other), hair ties/clips

Session Facilitators: • 2 facilitators (minimum) Prerequisites: • Completion of presentation • Watching videos for transmission-based precautions • Attendance at practice session for PPE donning and doffing • To familiarise themselves with the PPE used in their organisation

Evaluation/Assessment: • Participants will be assessed for PPE competency • Participant session evaluation • Course session evaluation

Infection Prevention & Control:

Personal Protective Equipment (PPE)RACF TRAIN THE TRAINER

Acknowledgement of Country and Elders

Before we begin,

I would like to acknowledge the traditional owners of the land where we meet today.

I pay my respects to their Elders past and present.

It is upon their lands that we meet.

Clinical Excellence Commission 2

Introduction


Using this resource• Designed as an introductory guide to infection prevention and control standard and transmission-based

precautions and for Train the Trainer for Residential Aged Care facilities to implement training on the use of PPE

• Intended for train the trainers identified by RACF

• Can be self directed or used for group training

• Can be viewed in one (1) session as a whole or divided into smaller sessions

Heading/title slide introduces a new learning session and can be used to divide the sessions

• There are links to further information throughout the presentation – provides a more thorough understanding of the topic


Learning outcomes

• Understand the role infection prevention and control within the national aged care standards

• Provide an understanding on how COVID-19 is transmitted

• Summarise the purpose of personal protective equipment (PPE)

• Describe differences between standard precautions and transmission-based precautions

• Identify the steps for donning (putting on) PPE for combined transmission-based precautions

• Identify the steps for doffing (removing) PPE for combined transmission-based precautions


https://www.agedcarequality.gov.au/sites/default/files/media/Guidance_%26_Resource_V11.pdf

What is a Coronavirus?


• Coronaviruses are a large family of viruses, that can cause illness in humans, and in animals, such as bats, camels, and civet cats.

• Human coronaviruses typically cause mild illness, such as the common cold

• Human coronaviruses were first identified in the mid-1960s

• This new strain of coronavirus is called: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

What is COVID-19?• COVID-19 is the disease caused by the SARS-CoV-2 virus

• It appears to have first emerged in Wuhan, China, in late 2019.

• By the end of January 2020, the World Health Organisation (WHO) alerted the world regarding this new virus

• Australia declared it a pandemic at the end of February and WHO declared it as an international pandemic mid March 2020


How does it become a pandemic?

8

? Human – eating something infected

BatsCoronavirus

? Another animal -unknown

HumanHuman to human transmission

Pandemic

Unknown

COVID-19 transmission• Generally, it is spread by larger respiratory

droplets caused by coughing, sneezing, singing.

• The droplets go about a metre and then fall on surfaces/floors (e.g. furniture, counters) relatively quickly

• Smaller aerosol droplets travel over longer distances on air currents – usually occurs in hospitals when the person is undergoing a special procedure of their airways egputting a tube in a persons throat to help them breathe in ICU

• We have learnt more about the symptoms, how it is transmitted and how quickly it can spread

Most common symptoms include a fever, dry cough and tiredness, and in mild cases people may get just a runny nose or a sore/scratchy throat.

Older people can experience more subtle signs of COVID-19 such as not wanting to eat, feeling very tired, looking pale

In severe cases, people can experience difficulty breathing, leading to hospitalisation and sometimes in an intensive care unit (ICU).

Some may die


How do droplets and aerosols spread?

10

https://www.cidrap.umn.edu/news-perspective/2020/03/commentary-covid-19-transmission-messages-should-hinge-science

https://www.cidrap.umn.edu/news-perspective/2020/03/commentary-covid-19-transmission-messages-should-hinge-science

Australian National Response The Australian Government’s health response to the COVID-19 outbreak has focused on:

• minimising the number of people becoming infected or sick with COVID-19

• ensuring adequate hospital beds for those who need them or care for them in the community

• manage the demand on the health and aged care system

• help people manage their own risk and the risk to their family and the broader community


NSW Health Response to COVID-19• Mandatory quarantine for overseas travellers for 14 days – from 29 March 2020

• Widespread availability of testing in COVID-19 clinics – ongoing pop up clinics in areas of risk

• Developing diagnostic tests through laboratories to rapidly diagnose cases

• Ensuring adequate supply of PPE

• Managing cases with appropriate infection prevention and control

• Providing regular updates to the community, through media briefings, media releases and social media including in community languages

• Public health messages: hand hygiene, physical distancing, don't go to work sick, get tested if symptomatic, mask if unable to physical distance + lots of others

• Community strategies/Public Health Orders e.g., limiting number of people gathering – this will be decided by number of people in the community with COVID-19


How do we transmit COVID-19?

A person with COVID-19

Some who is susceptible and not wearing PPE

Through droplets• Coughing, sneezing,

singing, yelling/screamingThrough contact• Contaminated hands• Contaminated surfacesThrough the air• Special procedures on the respiratory

tract/lungs performed on patients in hospitals – may not an issue in RACF

Breaking the chain of infection – how do we stop COVID-19 from spreading from one person to another person?

• Prevent people coming to work with acute respiratory symptoms• Screening and temperature checks – stop staff and visitors coming into the facility• Hand hygiene – frequently and correctly• Physical distancing• Personal hygiene• Respiratory hygiene and cough etiquette• Correct use of PPE – putting it on, knowing when to change and removing it• Cleaning high touch points frequently eg door handles, light switches, keyboards,

phones• Preventing contamination eg putting waste bag on top of clean linen• Using the correct cleaning chemicals – detergent and disinfectants• Keeping cleaning equipment clean, dry and stored correctly• Having PPE free areas – stop the spread to other people and to surfaces• Having a high standard of cleaning that is consistently performed by all staff• Separating clean and dirty linen safely• Managing waste safely• Limiting number of people being close together in a room

It is important that you understand that it takes a number of infection prevention and control practices to break the chain and prevent and control the spread of COVID-19

Public health messages

• Physical distancing

• Hand hygiene

• Cough etiquette

• Surgical mask

• Do not touch your face


Why focus on precautions and PPE?The focus on PPE is required as:

1. Staff have not previously worn all this PPE previously

2. Staff have not had to wear this type of PPE for long periods of time

3. Understanding that if the incorrect PPE is worn, it may not stop the spread of COVID-19

4. The PPE becomes contaminated when worn and looking after a person with COVID-19

5. People can unknowingly contaminate themselves or surfaces with the PPE if not removed correctly

6. Understanding that some PPE will require changing when performing different procedures or care on residents eg gloves

7. Some PPE can be worn as a ‘session’ and can be worn when caring for multiple residents eg masks and protective eyewear

8. Some PPE cannot be worn when caring for multiple residents eg gown and gloves

9. Understanding that gloves are not a substitute for hand hygiene – gloves have the potential to spread the virus to multiple surfaces and equipment


Using Standard and Transmission Based Precautions to prevent the spread


Standard and Transmission based precautions protects you, equipment and surfaces


Potentially infected people

Health workers

Environment –surfaces and equipment

We know that an infected person can 1. Transmit COVID-19 to the person

caring for them in an aged care facility

2. Can also contaminate surfaces and equipment in their room

3. A person can pick up the virus from the contaminated surfaces and equipment

Australian guidelines Infection Prevention and Control

Indirect

• Everyone is treated the same – accept that anyone is infected with something that can be passed on to another person Resident Visitor Aged care staff Health workers

• Standard precautions protect the worker, the resident and the aged care facility environment and equipment – prevent spreading any potential infection

• If followed correctly, minimise the risk of contact with blood and other body substances.

Clinical Excellence Commission19Infection Prevention and Control Practice Handbook

Standard Precautions(all day, everyday, every potentially infected person)

http://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0010/383239/IPC-Practice-Handbook-2020.PDF

What are standard precautions?


Environmental cleaning

Cleaning shared equipment and items shared in activities

Handling linen –separating clean and dirty linen. Keeping clean linen free of contamination

Managing waste and sharps – preventing sharps injuries

Using aseptic technique when doing dressing to prevent residents getting an infection

Hand hygiene

PPE

Scenarios to help understand standard precautions

10 residents are doing an activity together. They will be using small pool noodles –each will have their own.

1. When should staff do hand hygiene?

2. When should the residents do hand hygiene?

3. When should the pool noodles be cleaned?

4. How will they be cleaned?

5. How do you make sure they are stored dry?

A resident has been incontinent of urine and faeces in the shower. They threw their towel and PJs over the floor and now covered in faeces.

1. What PPE would you wear?

2. What will you do with the resident?

3. What will you do with the residents PJs and the towel?

4. How will you make sure that the bathroom is cleaned properly?

5. When will you do hand hygiene?

A resident bumped their leg wound on the chair and it is now bleeding on the floor and their bed.

1. What PPE would you wear?

2. What will you do with the resident?

3. When will you do hand hygiene?

4. How will you make sure that the dressing is done using an aseptic technique?

5. How will you make sure that the floor is cleaned properly?


Scenario 1 Scenario 2 Scenario 3

Transmission-based precautions – COVID-19• Used when standard precautions alone, are not enough to stop the spread of COVID-19 • Used with standard precautions as transmission based precautions are only specific types of

PPE• There are three types of transmission-based precautions, depending on how the spread occurs

o Contact precautions – when having direct contact with a resident or the environment that they are in e.g., their room

o Droplet precautions – use when caring for any resident who is coughing, sneezing, spitting, yelling, singing, touching mouth/nose and talking. Because they are large and heavy, droplets will travel up to 1 metre in distance. We stay 1.5 meters away to make use safer!

o Airborne precautions – used when caring for residents who may require a procedure that produces aerosols e.g., resuscitation

Clinical Excellence Commission 22Infection Prevention and Control Practice Handbook

http://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0010/383239/IPC-Practice-Handbook-2020.PDF

COVID-19 Requires Combined Precautions• Standard precautions, including hand hygiene for all patients. Patients and

health workers should observe respiratory hygiene and cough etiquette.

• Transmission-based precautions for patients with suspected, probable or confirmed COVID-19:

- Contact and droplet precautions for routine contact.

- Contact, droplet and airborne precautions for respiratory aerosol generating procedures (AGPs) e.g. intubation during resuscitation.


PPE


Infection Prevention -Hierarchy of Controls


Example: air handling systems – negative pressure room

Example: Isolation of a patient with a communicable disease

Example: Vaccination

Example: substitution of detergent to disinfectant to kill environmental contamination

PPE is• A variety of barriers used alone or in combination to protect mucous membranes, eyes, skin,

and clothing from contact with infectious agents and blood/body substances• Includes equipment such as gloves, apron or gowns, eye protection (safety glasses, goggles,

face shield) and masks • PPE needs to be:

o suitable for the nature of the worko a proper size and fit for the persono properly stored and maintainedo If reusable – cleaned and/or disinfected after use and according to the manufacturer’s instructionso Used according to the manufacturer’s instructions

• PPE must meet Australian Standards and where applicable Therapeutic Goods Administration (TGA) requirements


Personal protective equipment (PPE) SafeWork NSW

https://www.standards.org.au/https://www.tga.gov.au/https://www.safework.nsw.gov.au/safety-starts-here/physical-safety-at-work-the-basics/personal-protective-equipment-ppe

PPE for infection preventionPPE is worn for standard and/or transmission based precautions:

o When there is risk of exposure to blood and body substances

o When caring for patients, or in a healthcare environment where there is a risk of transmission of pathogenic microorganism or communicable disease

• Hand hygiene is an integral part of standard precautions. It is not PPE but must be performed in the steps for donning, doffing and changing PPE. It prevents contamination of the PPE and contamination of person when removing PPE


PPE for Contact Precautions


Close contactApron + Gloves

The minimum requirement when

providing care (close contact)

Gown + GlovesA gown may be

required if expected to provide close and

prolonged care

or

All gowns are different

Thumbs up


• Eye protection• Surgical Mask

If prescription glasses are worn, eye protection must fit over glasses

Note: prescription glasses are not designed to protect the wearer from exposure to splash and fluid from blood and body substances.

PPE for Droplet Precautionsbased on Risk Assessment choose either


Standard Contact Droplet AirborneBlood or body substance contact anticipated Symptoms such as skin infections, MRO colonisation, diarrhoea,

Respiratory symptoms such as cough, coryza, SOB +/- fever.Suspected or confirmed influenza or COVID-19 mild/moderate symptoms and there is no Aerosol Generating Procedure (AGP)

Suspected or confirmed Tuberculosis, measles, varicella, or suspected or confirmed COVID-19 with significant symptoms, or when AGPs done

A combination of these different levels of precautions will be applied in certain situations depending of the mode of transmission of the pathogen.

For example COVID-19 patient and AGPs requires Contact + Droplet + Airborne

National Health and Medical Research CouncilInfection Prevention and Control Practice HandbookNational Standard 3

PPE and risk assessment

https://www.nhmrc.gov.au/health-advice/public-health/preventing-infectionhttp://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0010/383239/IPC-Practice-Handbook-2020.PDFhttps://www.safetyandquality.gov.au/standards/nsqhs-standards/preventing-and-controlling-healthcare-associated-infection-standard/infection-prevention-and-control-systems

Note: Combining transmission based precautions, like contact and droplet precautions is needed for some infectious diseases such as COVID-19.

Where respiratory aerosol generating procedures (AGP) are performed on COVID-19 case, combined contact, droplet and airborne precautions are needed; refer to the CEC YouTube channel.

Donning PPEfor combined contact and droplet precautions in addition to standard precautions


https://www.youtube.com/watch?v=tfITL694UAQ&feature=youtu.be

Sequence for donning PPE


1. Perform hand hygiene2. Put on gown/apron3. Put on mask4. Put on eye protection5. Perform hand hygiene6. Put on gloves

Remove items before hand hygiene


Remove rings, watches, etc. that will interfere with effective hand hygiene, and roll up your sleeves

NSW Health Infection Prevention and Control Policy

Note: Nail polish, artificial and false nails must not be worn in clinical environments.Artificial or false nails continue to demonstrate increased opportunity for transmitting pathogenic microorganisms.

https://www1.health.nsw.gov.au/pds/Pages/doc.aspx?dn=PD2017_013

Perform hand hygiene


Clean hands with:• alcohol based hand rub (ABHR) in

either liquid, foam or gel form; or• antiseptic liquid hand wash and

running water; or • (plain) liquid soap and running water

and dry with single use towels

National Hand Hygiene InitiativeInfection Prevention and Control Practice Handbook

Note: manufacturers of ABHR solutions state the amount of solution delivered per pump dispenser action and how much solution is required per hand hygiene moment.


Sequence for donning PPE


1. Perform hand hygiene2. Put on gown/apron3. Put on mask4. Put on eye protection5. Perform hand hygiene6. Put on gloves

Put on Gown or Apron

Clinical Excellence Commi