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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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    1. Principles of Infection Control and Personal Protective Equipment

    2. 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

    3. Routes of Transmission • Droplet • Airborne • Contact • Common Vehicle transmission (Fecal-oral, blood-borne) • Vector-borne • Transmitted by insects

    4. 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

    5. 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

    6. 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

    7. 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

    8. 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

    9. 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

    10. 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

    11. Personal Protective Equipment • Gloves • Gowns • Masks • Boots • Eye protection

    12. 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

    13. PPE Materials Gowns • Fully cover torso • Have long sleeves • Fit snuggly at the wrist

    14. PPE Materials Masks and Respirators: Barriers and Filtration • Surgical masks • Particulate respirators (N95) • Fit testing essential • Alternative materials (barrier) • Tissues, cloth

    15. PPE Materials Boots Eye Protection • Face shields • Goggles

    16. 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

    17. Working with Limited Resources • Avoid reuse of disposable PPE items • When prioritizing PPE purchase • Masks • Gloves • Eye protection

    18. Gloves • Select correct type and size • Insert hands into gloves • Extend gloves over gown cuffs

    19. 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

    20. 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

    21. 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

    22. 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

    23. 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

    24. 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

    25. Sequence to Don and Doff Personal Protective Equipment

    26. 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

    27. 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

    28. Doffing Gloves (1) • Grasp outside edge near wrist • Peel away from hand, turning glove inside-out • Hold in opposite gloved hand

    29. Doffing Gloves (2) • Slide ungloved finger under the wrist of the remaining glove • Peel off from inside, creating a bag for both gloves • Discard

    30. 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

    31. 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

    32. Doffing a Mask • Lift the bottom elastic over your head first • Then lift off the top elastic • Discard • Don’t touch front of mask

    33. 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

    34. Transmission of Influenza Viruses

    35. 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

    36. 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

    37. 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

    38. Design of Isolation Room

    39. Toilet exhaust Toilet Isolation room Diffuser Anteroom Transfer grille Floor level exhaust Corridor

    40. 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

    41. 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

    42. 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

    43. ) ( % 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

    44. 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

    45. 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

    46. Preventing Transmission in the Community • Respiratory etiquette • Cover nose / mouth when coughing or sneezing • Hand washing!

    47. 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

    48. 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

    49. Precautions for Handling Corpses • Mortuary staff should use Full Barrier PPE • Anyone handling a corpse infected with avian influenza should be informed