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Principles of Infection Control and Personal Protective Equipment. Session Overview. Disease transmission Introduction to personal protective equipment (PPE) How to use PPE Demonstration Infection control precautions In health care facilities In the community. Routes of Transmission.

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Presentation Transcript
session overview
Session Overview
  • Disease transmission
  • Introduction to personal protective equipment (PPE)
    • How to use PPE
    • Demonstration
  • Infection control precautions
    • In health care facilities
    • In the community
routes of transmission
Routes of Transmission
  • Droplet
  • Airborne
  • Contact
  • Common Vehicle transmission (Fecal-oral, blood-borne)
  • Vector-borne
    • Transmitted by insects
routes of transmission droplet
Routes of TransmissionDroplet

Large droplets within 1 meter transmit

infection via:

    • Coughing, sneezing, talking
    • Medical procedures


  • Diphtheria
  • Pertussis
  • Smallpox
  • Meningitis caused by N. meningitidis, H. influenzae
routes of transmission airborne droplet nuclei
Routes of TransmissionAirborne (droplet nuclei)

Very small particles of desiccated

droplets or dust with infectious agent


    • Remain in air for a long time
    • Travel farther than droplets
    • Become aerosolized during procedures


  • Tuberculosis
  • Measles (Rubeola)
  • Chicken pox
routes of transmission contact
Direct Contact

Host comes into contact with reservoir

Kissing, skin-to-skin contact, sexual intercourse

Contact with soil or vegetation

Indirect Contact

Disease is carried from reservoir to host

Contaminated surfaces (fomites)

Routes of TransmissionContact
standard precautions
Standard Precautions
  • Prevent the transmission of common infectious agents
  • Assume infectious agent could be present in the patient’s
    • Blood
    • Body fluids, secretions, excretions
    • Non-intact skin
    • Mucous membranes
  • Hand and PPE are critical
hand washing
Hand Washing


  • Wet hands with clean (not hot) water
  • Apply soap
  • Rub hands together for at least 20 seconds
  • Rinse with clean water
  • Dry with disposable towel or air dry
  • Use towel to turn off faucet
alcohol based hand rubs
Alcohol-based Hand Rubs
  • Effective if hands not visibly soiled
  • More costly than soap & water


  • Apply appropriate (3ml) amount to palms
  • Rub hands together, covering all surfaces until dry
personal protective equipment ppe
Personal Protective Equipment (PPE)
  • When used properly can protect you from exposure to infectious agents
  • Know what type of PPE is necessary for the duties you perform and use it correctly
personal protective equipment
Personal Protective Equipment
  • Gloves
  • Gowns
  • Masks
  • Boots
  • Eye protection
ppe m aterials
PPE Materials


  • Different kinds of gloves
    • Heavy duty gloves
    • Clean gloves
    • Sterile glove
  • Work from clean to dirty
  • Avoid “touch contamination”
    • Eyes, mouth, nose, surfaces
  • Change gloves between patients
ppe m aterials1
PPE Materials


  • Fully cover torso
  • Have long sleeves
  • Fit snuggly at the wrist
ppe m aterials2
PPE Materials

Masks and Respirators: Barriers and Filtration

  • Surgical masks
  • Particulate respirators (N95)
    • Fit testing essential
  • Alternative materials (barrier)
    • Tissues, cloth
ppe materials
PPE Materials


Eye Protection

  • Face shields
  • Goggles
ppe supplies
PPE Supplies
  • Maintain adequate, accessible supplies
  • Use locally produced PPE when possible
  • Creative alternatives are not recommended
    • Mask: tissue, scarf
    • Boots: plastic bags
    • Gown: laboratory coat, scrubs
working with limited resources
Working with Limited Resources
  • Avoid reuse of disposable PPE items
  • When prioritizing PPE purchase
    • Masks
    • Gloves
    • Eye protection
  • Select correct type and size
  • Insert hands into gloves
  • Extend gloves over gown cuffs
  • Select appropriate type and size
  • Opening may be in back or front
  • Secure at neck and waist
  • If too small, use two gowns
    • Gown #1 ties in front
    • Gown #2 ties in back
surgical mask
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
n95 particulate respirator
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

eye and face protection
Eye and Face Protection
  • Position goggles over eyes and secure to the head using the ear pieces or headband
  • Position face shield over face and secure on brow with headband
  • Adjust to fit comfortably
key infection control points
Key Infection Control Points
  • Minimize exposures
    • Plan before entering room
  • Avoid adjusting PPE after patient contact
    • Do not touch eyes, nose or mouth!
  • Avoid spreading infection
    • Limit surfaces and items touched
  • Change torn gloves
    • Wash hands before donning new gloves
duration of ppe use
Duration of PPE Use

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
sequence for donning ppe
Sequence for Donning PPE
  • Wash hands
  • Put on boots
  • First pair of gloves
  • Gown
  • Plastic Apron
  • Second pair of gloves
  • N95 Particulate respirator
    • Perform seal check
  • Hair cover
  • Goggles or face shield
sequence for doffing ppe
Sequence for Doffing PPE

Remove in anteroom when possible

  • Disinfect the outer pair of gloves
  • Disinfect the apron and boots
  • Remove the outer pair of gloves
  • Remove the apron
  • Remove the gown
  • Disinfect the gloved hands
  • Remove the goggles
  • Remove the head cover
  • Remove the mask
  • Remove the boots
  • Remove the inner pair of gloves
  • Wash hands
doffing gloves 1
Doffing Gloves (1)
  • Grasp outside edge near wrist
  • Peel away from hand, turning glove inside-out
  • Hold in opposite gloved hand
doffing gloves 2
Doffing Gloves (2)
  • Slide ungloved finger under the wrist of the remaining glove
  • Peel off from inside, creating a bag for both gloves
  • Discard
doffing a gown
Doffing A Gown
  • Unfasten ties
  • Peel gown away from neck and shoulder
  • Turn contaminated outside toward the inside
  • Fold or roll into a bundle
  • Discard
doffing goggles or a face shield
Doffing Goggles or A Face Shield
  • Grasp ear or head pieces with ungloved hands
  • Lift away from face
  • Place in designated receptacle for disinfecting or disposal
doffing a mask
Doffing a Mask
  • Lift the bottom elastic over your head first
  • Then lift off the top elastic
  • Discard
  • Don’t touch front of mask
hand washing1
Hand Washing
  • Between PPE item removal if hands become visibly contaminated
  • Immediately after removing all PPE
  • Use soap and water or an alcohol-based hand rub

Precautions for Suspected or Confirmed Cases


Infection Control Precaution

Acute influenza symptom + contact with poultry

Surgical mask for patient, use tissue when coughing, sneezing

Isolation room, use of PPE

Apply all infection control precautions

Test for influenza A/H5

If Confirmed Influenza A/H5

Maintain required infection control precautions

  • Adults and adolescents > 12 years: Continue for 7 days after resolution of fever
  • Infants and children < 12 years Continue for 21 days after symptom onset
precautions for suspected or confirmed cases
Precautions for Suspected or 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 areas but 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 confirmed cases1
Precautions for Suspected or 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




Isolation room



Transfer grille

Floor level exhaust


using bleach solution
Using Bleach Solution
  • First clean organic material from surfaces or items
  • Clean using warm water and detergent
  • Wipe surfaces with sponge or wet cloth
    • Allow to dry
  • Make fresh diluted bleach daily!
  • NB: Chlorine CORROSIVE to stainless steel
household bleach safety
Household Bleach Safety
  • Use mask, goggles, rubber gloves, waterproof apron
  • Mix in well-ventilated area
  • Do not use or mix with other detergents
  • Use cold or room temperature water to mix
preparing 1 liter of bleach solution
Preparing 1 liter of Bleach Solution
  • With bleach containing 5% sodium hypochlorite

10 ml bleach + 990 ml cold tap water

  • With bleach containing 2.5% sodium hypochlorite

20 ml bleach + 980 ml cold tap water

preparation of chlorine solutions



% chlorine in liquid bleach / 100

- 1 =

Desired ppm chlorine / 1,000,000



5 / 100

- 1 =

500 / 1,000,000

Preparation of chlorine solutions




- 1 = 99


waste disposal
Waste Disposal
  • Use Standard Precautions
    • Gloves and hand washing
    • Gown + Eye protection
  • Avoid aerosolization – DO NOT SHAKE
  • Prevent spills and leaks
    • Double bag if outside of bag is contaminated
  • Incineration is usually the preferred method
managing linens and laundry
Managing Linens and Laundry
  • Use Standard Precautions
    • Gloves and hand hygiene
    • Gown
    • Mask
  • Avoid aerosolization – DO NOT SHAKE
  • Fold or roll heavily soiled laundry
    • Remove large amounts of solid waste first
  • Place soiled laundry into bag in patient room
preventing transmission in the community
Preventing Transmission in the Community
  • Respiratory etiquette
    • Cover nose / mouth when coughing or sneezing
  • Hand washing!
avian influenza and food
Avian Influenza and Food
  • Heat to > 70°C to kill the avian influenza virus
  • Consumption of any raw / undercooked poultry 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
Patients Cared for at Home
  • Potential for transmission!
  • Must educate family caregivers
  • Fever / symptom monitoring
  • Infection control measures
    • Hand washing
    • Use of available material as PPE
precautions for handling corpses
Precautions for Handling Corpses
  • Mortuary staff should use Full Barrier PPE
  • Anyone handling a corpse infected with avian influenza should be informed
location influences actions
Location Influences Actions
  • Medical facilities
  • Homes
  • Farms
  • Markets
  • Rural versus Urban areas
anticipate exposures
Anticipate Exposures

Contact with. . .

  • Infected individuals
  • Individuals suspected to be infected
  • Potentially contaminated substances
  • Potentially contaminated surfaces / items
  • High-risk procedures
  • Corpses
  • Animals
practical questions
Practical questions
  • What type of PPE would you use for a patient with febrile respiratory illness but no risk factors for avian influenza when

1. Giving a bath?

2. Transporting a patient in a wheelchair?

3. Responding to an emergency where blood is spurting?

more practical questions
More practical questions
  • What type of PPE would you use for a patient with febrile respiratory illness but no risk factors for avian influenza when. .

4. Drawing blood from a vein?

5. Cleaning an incontinent patient with diarrhea?

6 Taking vital signs?

  • Influenza transmission occurs mainly through respiratory droplets
    • Contact can be prevented using PPE
    • Virus can be inactivated with infection control procedures
    • Hand washing is key
  • PPE must be donned and doffed appropriately to prevent contamination of wearers and environments
  • Guidelines for using PPE and infection control measures for avian influenza in humans should be practiced until they are routine