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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

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


  • 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

    Principles of infection control and personal protective equipment

    • 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

    Principles of infection control and personal protective equipment

    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

    Principles of infection control and personal protective equipment




    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 Investigation

    • Medical facilities

    • Homes

    • Farms

    • Markets

    • Rural versus Urban areas

    Anticipate exposures
    Anticipate Exposures Investigation

    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 Investigation

    • 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 Investigation

    • 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 Investigation

    • 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? Investigation