Principles of infection control and personal protective equipment
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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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Principles of Infection Control and Personal Protective Equipment

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Principles of infection control and personal protective equipment

Principles of Infection Control and Personal Protective Equipment


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

    Examples:

  • 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

    may…

    • Remain in air for a long time

    • Travel farther than droplets

    • Become aerosolized during procedures

      Examples:

  • 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

    Method

    • 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

      Method

    • 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

    Gloves

    • 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

    Gowns

    • 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

    Boots

    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


    Gloves

    Gloves

    • Select correct type and size

    • Insert hands into gloves

    • Extend gloves over gown cuffs


    Principles of infection control and personal protective equipment

    Gown

    • 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 to don and doff personal protective equipment

    Sequence to Don and Doff Personal Protective Equipment


    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


    Transmission of influenza viruses

    Transmission of Influenza Viruses


    Principles of infection control and personal protective equipment

    Precautions for Suspected or Confirmed Cases

    Patient

    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


    Design of isolation room

    Design of Isolation Room


    Principles of infection control and personal protective equipment

    Toilet

    exhaust

    Toilet

    Isolation room

    Diffuser

    Anteroom

    Transfer grille

    Floor level exhaust

    Corridor


    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

    )

    (

    50,000

    - 1 = 99

    500


    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


    Application of infection control activities during an investigation

    Application of Infection Control Activities during an Investigation


    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?


    Summary

    Summary

    • 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


    Questions

    Questions?


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