rapid response module 6 ic

7/28/2019 Rapid Response Module 6 IC

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Hospital Infection Control and

Personal Protective Equipment


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Learning Objectives

Demonstrate knowledge of the principles of

infection control

Recognize gaps in infection control infrastructure

Recognize ways to address gaps in infectioncontrol infrastructure in different situations

Demonstrate proper selection and use of personalprotective equipment


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Session Overview

Introduction to personal protective equipment (PPE)

How to use PPE Demonstration

Infection control precautions In health care facilities


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Transmission of Influenza Viruses

Yes

(bird to human)

YesContact

UnknownLikelyAirborne

Probable

(human to human)

YesDroplet

Avian Influenza in

Humans

Seasonal Influenza

in Humans


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Infection Control Methods

andPersonal Protective Equipment


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Hand Washing

Method

Wet hands with clean water

Apply soap

Rub hands together for at least 20seconds

Rinse with clean water

Dry with disposable towel or air dry Use towel to turn off faucet


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Alcohol-based Hand Rubs

Effective if hands not visibly soiled

More costly than soap & water

Method

Apply coin-sized amount to palms

Rub hands together, covering all surfaces until dry


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Personal Protective Equipment (PPE)

When used properly canprotect you from

exposure to infectious

agents

Know what type of PPE is

necessary for the dutiesyou perform and use it

correctly


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Gloves

Gowns

Masks

Boots & Shoe covers

Eye protection


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PPE Materials

Gloves

Different kinds of gloves Housekeeper gloves Clean gloves

Sterile glove

Work from clean to dirty

Avoid touch contamination Eyes, mouth, nose, surfaces

Change gloves between patients


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PPE Materials

Gowns

Fully cover torso

Have long sleeves

Fit snuggly at the wrist


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PPE Materials

Masks and Respirators: Barriers andFiltration

Surgical masks

Cotton, paper

Particulate respirators (N95)

Fit testing essential

Alternative materials (barrier)

Tissues, cloth


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PPE Materials

Boots Eye Protection

Face shields Goggles


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PPE Supplies

Maintain adequate, accessible supplies

Use locally produced PPE when possible

Creative alternatives

Mask: tissue, scarf

Boots: plastic bags

Gown: laboratory coat, scrubs


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Working with Limited Resources

Avoid reuse of disposable PPE items

Consider reuse of some disposable items only as anurgent, temporarysolution

Reuse only if no obvious soiling or damage

When prioritizing PPE purchase Masks

Gloves

Eye protection


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Infection Control Precautions


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Precaution Levels

All levels require hand hygiene

Standard Precautions

Transmission based precautions:

Contact Precautions

Droplet Precautions

Airborne Precautions


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Standard Precautions

Prevent the transmission of

common infectious agents

Hand washing key

Assume infectious agent could bepresent in the patients

Blood

Body fluids, secretions,excretions

Non-intact skin

Mucous membranes


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PPE for Standard Precautions

1. Gloves

2. Gowns3. Eye Protection

When touching: Blood & body fluids

Secretions, excretions

Contaminated items Mucous membranes

Non-intact skin


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Contact Precautions

Prevent infection through direct or

indirect contact with patients or patientcare environment

Examples Avian influenza Ebola hemorrhagic fever Methicillin Resistant S. Aureus

Shigellosis


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Contact Precautions

Taken in addition to Standard Precautions

Limit patient movement

Isolate or cohort patients

Gown + gloves for patient / room contact Remove immediately after contact

Do not touch eyes, nose, mouth with hands

Avoid contaminating environmental surfaces


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Contact Precautions

Wash hands immediately after patient contact

Use dedicated equipment if possible If not, clean and disinfect between uses

Clean, then disinfect patient room daily Bed rails Bedside tables Lavatory surfaces Blood pressure cuff, equipment surfaces


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Cleaning and Disinfection for

Contact Precautions Detergents

Remove dirt, soiling Mechanical force essential

Flush with clean water

Disinfectants

Kill viruses, bacteria

Decontaminate surfaces

Type depends on infectious agent

Use afterdetergent


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Droplet Precautions

Prevent infection by largedroplets from

Sneezing

Coughing

Talking

Examples

Neisseria meningitidis

Pertussis

Influenza

Avian influenza (probable)


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Droplet PrecautionsTaken in addition to Standard Precautions

Wear surgical mask within 1 meter of patient

Wear face shield or goggles within 1 meter of patient

Place patients in single rooms or cohort 1 meter apart

Limit patient movement within facility Patient wears mask when outside of room


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Airborne Precautions

Taken in addition to Standard Precautions

Prevent spread of infection through very small (< 5microns) airborne particles

Examples

Tuberculosis

Measles

Varicella

Variola


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Negative Pressure Isolation Room


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Natural Ventilation

Cohorting Room

1 meter


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Aerosol-generating Procedures

(Example; Endotracheal intubation)

N95 particulate respirator

If not available, wear tight fitting surgical mask andface shield

Eye protection

Gloves and hand washing

Gown and waterproof apron

Isolation room with negative pressure

Hair cover optional


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How to Put on and Remove



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Personal Protective

Equipment (PPE)Recommended

Mask: N-95/FFP2 respiratorOR surgical mask

Gloves

Disposable long sleeved

cuffed gown Protective eyewear: goggles,

faceshield

Optional Cap

Plastic apron (splashing ofblood, secretions, excretions)


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Principles for Using PPEPersonal Protective Equipment (PPE) is used

to protect personnel byPreventing potentially infectiousmicroorganisms from:

Contaminating their hands, eyes andclothing;

and

Being transmitted to other people.


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Principles for Using PPE PPE reduces but does not completely eliminate

the possibility of infection. PPE is only effective if used correctly.

The use of PPE does not replace basic hygienemeasures such as hand washing - hand

washing is still essential to prevent

transmission of infection.


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Gown

A new gown should be worn for every patient contact.Discard immediately if visibly contaminated.

Purpose

protect skin and/or clothing

Material Natural or man-made

Reusable or disposable

Resistance to fluid penetration

Clean


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A new gown should be worn for every patient contact.

Discard immediately if visibly contaminated.

Gown


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Gown

Disposable Gowns

Use a new gown for

each patient contact.

Discard immediately if

visibly contaminated.

Dispose as per policy

for waste disposal

Reusable Gowns

If necessary, gowns may be

reused during one shift forthe same patient, e.g. whenshort of supplies.

Discard immediately if

visibly contaminated.

Discard at the end of the

shift.


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Removing Gown

Unfasten ties

Peel gown away from neck and shoulder

Turn contaminated outside toward the inside

Fold or roll into a bundle Discard


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Surgical Mask

Place over nose, mouth and chin

Fit flexible nose piece over nose bridge

Secure on head with ties or elastic

Adjust to fit


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Prevent

Inhalation / ingestion of infected particles (< 5 m) Contamination of the face, including the nose and mouth

Wear only one N-95/FFP2 respirator no need for additional

respiratory protection

DO NOT touch the front of the respirator once the it has been

fitted

Use correct size, fit over nose and mouth, perform seal check

Dispose of with medical waste

N-95 / FFP2 Particulate Respirators


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N95 Particulate Respirator

Pay attention to size (S, M, L)

Place over nose, mouth and chin

Fit flexible nose piece over nose bridge

Secure on head with elastic

Adjust to fit and check for fit:

Inhale respirator should collapse

Exhale check for leakage around face

W i M k


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Wearing a Mask


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Respirator Fit testing


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Respirator Fit-testing

Four qualitative methods and three

quantitative your choice.

Quantitative methods are more

accurate but more expensive.

Both methods require specific

training, are time-consuming, and

imply costs.

Checking fit of respirator on individual employees

qualitative

quantitative


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Removing a Particulate Respirator or a


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Removing a Particulate Respirator or a

Surgical Mask

Lift the bottom elastic over your head first

Then lift off the top elastic

Discard


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Eye and Face Protection

Remove Goggle or Face Shield


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Remove Goggle or Face Shield

Grasp ear or head pieces

Lift away from face

Place in designated receptacle for reprocessing

or disposal

Gloves


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Purpose:- protect hands- patient care, environmental services,

other

9 Before all patient contact

9 Before all cleaning

9Before handling soiled linen & waste

9 Remove after contact with patients or labspecimens

9 Do not wear gloves outside of the patients

room / anteroom9 Do not re-use gloves

9 Hand hygiene after removing gloves


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Gloves

Don gloves last

Select correct type and size

Insert hands into gloves

Extend gloves over gown cuffs

Dos and Donts of Glove Use


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Do s and Don ts of Glove Use

Protect yourself, others, and the environment

Limit opportunities for touch contamination

Avoid touching:

your face or adjusting PPE with contaminated gloves

environmental surfaces except as necessary during patient care

Removing Gloves


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Removing Gloves

Grasp outside edge near wrist

Peel away from hand, turning glove inside-out

Hold in opposite gloved hand

Slide ungloved finger under the wrist of the remaining glove

Peel off from inside, creating a bag for both gloves

Discard

How to put on PPE


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Hand hygiene

Long sleeved, cuffed disposable gown

Apron is optional, if splashes are expected (e.g., cleaning)

Caps are optional to protect hair from aerosols that may

occur from high risk procedures (e.g., intubation)

Particulate respirators: completely seal mouth and nose,

perform seal check

Protective eyewear: goggles (upper edge of mask under

goggles), faceshield

Gloves, with gown sleeve tucked into gloves

Put onPutting on personal protective equipment (PPE)


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trousers

Put on boots

Put on shoe

covers

Put on gown

and apron

Put on hood or

head cover

Tie sleeves at wrist

Put on mask and

goggle or face shield

Tuck in sleeve inside

gloves

Put on gloves

*Tuck in trouser cuffs

inside the boots

Tie shoe covering over

trouser leg

Hood or hair cover mustcompletely cover the

hair


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Before remove your PPE remember !


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Contaminated Area

outside front

contact with

body sites,

materials,

environment

al surfaces

Clean area

Inside

outside back

ties on head

and back

y

Who should wear PPE?


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Anyone who enters the isolation area:

All health care workers

Radiographers

Physiotherapists, etc.

Laboratory staff handling HPAI

All support staff

Family members and visitors

How to reprocess the goggle?


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p g gg

1. Cleaning: water + plain liquid soap. Protect yourself!

2. Disinfect.

Duration of PPE Use


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Surgical Masks (if N95 not available)

Wear once and discard

Discard if moist

N95 Particulate Respirators

May use just one with cohorted patients

Eye Protection

May wash, disinfect, reuse

Instructor Demonstration


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Instructor Demonstration

Put on and Remove PPE


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PPE Practice


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PPE Practice

Put on, remove, and dispose of PPE

1. Practice once alone

2. Pair up with someone and critique:

Sequence

Technique / contamination prevention


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Hand Hygiene

The Role of Hand Hygiene and

Standard Precautions in Avian

Influenza (AI) Preparedness


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It is the single most important and effectivecomponent for preventing the transmission of

infection It is designed to remove transient

microorganisms that may have been picked up

from the environment Prevent the transfer of these microorganisms toself and other patients, staff and equipment.

It is best performed using soap (preferably liquid)and warm running water.

Infection Control for Human cases of

Influenza A (H5N1) in Health Care


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Standard precautions

plus

Contact precautions

plus

Droplet precautions*

or

Airborne precautions*

*depends on resource/procedure

= Hand Hygiene + PPE accordingto risk assessment

= glove + gown

= surgical mask + googles/faceshield + (single room)

= particulate masks (N95/FFP2) +goggles/face shield + negativepressure room

Influenza A (H5N1) in Health Care

Settings


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Attitude and habit


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Hand hygiene is an element of

process qualityNot to do hand hygiene at the

defined moments using a

standardized quality (technique)

represents a medical error.


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1. Before patient

contact

2. Before aseptic

task3. After body fluid

exposure task

4. After patient

contact

5. After contact

with patient

surroundings


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What to use?


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Hand rub (alcohol)

Hand wash (soap)

Alcohol based hand rubs are the gold

standard for hand hygiene in health care(unless hands are visibly soiled)

?

Hand rubbing blocks spread of AI


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Host defenses

Transmissible

microbe

contact


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Alcohol based hand


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Rub hands for hand

hygiene.Wash hands only

when visibly soiled.

A good technique is

important

20-30 seconds and

hands are safe

(WHO training

materials, 2006)

rub


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Tool to instruct onlocal production of

alcohol hand rub

Tool to estimate

local cost and usage

of alcohol

Hand washing blocks spread of AI


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Host defenses

Transmissible

microbe

contact

Soap and water


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Wash hands only

when visibly soiled.Rub hands for hand

hygiene.

A good technique is

important

40-60 seconds and

hands are safe

(WHO training

materials, 2006)


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A i I f ti C t l N d D i


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Avian Influenza

Infection Control in

Health Care Facilities

Assessing Infection Control Needs During anInvestigation

Influenza Transmission


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Effective Infection Control PreventsTransmission From. . .

Patients to health care workers

Patients to patients

Patients to family membersproviding care

Precautions for Suspected or

C fi d C


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Confirmed Cases

Duration

Adults and adolescents > 12 years

Continue for 7 days after resolution of fever

Infants and children


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Confirmed Cases

Place patient in a negative air pressure room

To create a negative air pressure room: Install exhaust fan and direct air from inside to an

outside area with no person movement

If no air conditioning, open windows in isolation areasbut keep doors closed

Place patients in rooms alone Alternative: cohort patients away from other patient

care areas with beds > 1 meter apart

Precautions for Suspected or

C fi d C


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Confirmed Cases

Limit number of health care workers, family members

and visitors

Designate experienced staff to provide care

Limit designated staff to avian influenza patient care

Teach family and visitors to use PPE

Precautions for Collecting

Specimens


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Specimens Notify laboratory in advance

Health care worker collecting specimen should wear fullbarrier PPE

Place specimen in leak-proof bag

Hand deliver, if possible

Label specimen clearly as suspected avian influenza


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Environmental Decontamination


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Cleaning MUST precede decontamination

Disinfectant ineffective if organic matter is present

Use mechanical force

Scrubbing

Brushing

Flush with water


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Household Bleach Safety


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Use mask, goggles, rubber gloves,waterproof apron

Mix in well-ventilated area

Do not use or mix with other detergents

Using Bleach Solutions


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First clean organic material from surfaces or items

Wipe nonporous surfaces with sponge or wet cloth Allow to dry

Immerse items for 30 minutes

Make fresh diluted bleach daily!

Waste Disposal


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Use Standard Precautions

Gloves and hand washing

Gown + Eye protection

Avoid aerosolization

Prevent spills and leaks

Double bag if outside of bag is contaminated

Incineration is usually the preferred method


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ADDITIONAL PRECAUTIONS for handling dead bodies

with infectious diseases, cat,2&3


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Identify the body and attach to the body the appropriate

identity label. The body should be placed in a robust,

plastic bag of not less than 150 mm thick, which shouldbe zippered or closed tightly with tapes and bandage

strips.

The outside of the plastic bag should be wiped with 0.1%household bleach ( 1:50 dilution ) if soiled.

The body is then wrapped with mortuary sheet, placed

on mortuary trolley and transported to the mortuary.


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Use minimal amount of equipment

Avoid using instruments with pointed ends


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g p use disposable instruments and equipment

staff -- minimum

Cleaning ---thoroughly , followed by disinfection

pour1% sodium hypochlorite first.,leave for 10-15min.

followed by cleaning and usual disinfection-

0.1% hypochlorite


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Avian Influenza Infection Control

in the Community

Preventing Transmission

in the Community


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Respiratoryetiquette Cover nose / mouth

when coughing orsneezing

Hand washing!

Avian Influenza and Food

H t t > 70C t kill th i i fl i


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Heat to > 70C to kill the avian influenza virus

Consumption of any raw / undercookedpoultry ingredients is risky Runny eggs Meat with red juice

Separate raw meat from cooked or ready-to-eat foods to avoid cross-contamination

Wash hands before and after preparing food

Patients Cared for at Home


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Potential for transmission!

Must educate family caregivers

Fever / symptom monitoring

Infection control measures

Hand washing

Use of available material as PPE


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Application of Infection Control

Activities during anInvestigation

Location Influences Actions


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Medical facilities

Homes

Farms

Markets

Rural versus Urban areas


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Assess Existing Infection

Control Infrastructure


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Policies and procedures

Authority

Human resources

Financial resources

Engineering resources


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Summary

Influenza transmission occurs mainly through respiratorydroplets


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droplets

Contact can be prevented using PPE

Virus can be inactivated with infection controlprocedures

Hand washing is key

PPE must be donned and removed appropriately toprevent contamination of wearers and environments

Guidelines for using PPE and infection control measuresfor avian influenza in humans should be practiced untilthey are routine


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Questions?

Glossary

Decontamination - The removal of harmful substancessuch as chemicals harmful bacteria or other organisms


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such as chemicals, harmful bacteria, or other organisms,from exposed individuals, rooms, and furnishings in

buildings or in the outside environment.

Disease transmission - The process of the spread of adisease agent through a population

Infection control - Measures practiced by health carepersonnel in health care facilities to prevent the spreadof infectious agents

Personal protective equipment - Specialized clothing orequipment worn by a worker for protect from a hazard


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rapid response module 6 ic

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