Severe Acute Respiratory Syndrome (SARS)

1. Severe Acute Respiratory Syndrome (SARS) Personal Protective Equipment (PPE) WHO Western Pacific Regional Office April 17, 2003

2. Infection Control Practice “You can minimise YOUR risk of catching SARS by following infection control procedures including the use of Personal Protective Equipment (PPE).”

3. Standard Precautions(Respiratory Precautions) Designed to reduce the risk for occupational exposure to SARS infection from both recognizedand unrecognized sources of infection

4. Patient: Respiratory Secretions Blood Body fluids including excreta Skin lesions Staff Visitors Health Care Staff: Respiratory secretions Blood Body fluids including excreta Mucous membranes Skin lesions Sharps Visitors Exposure Risks

5. Principles for Using PPE Personal Protective Equipment (PPE) is used to protect health care workers by preventing potentially infectious microorganisms from : • Contaminating their hands, eyes and clothing and • Being transmitted to other patients and staff.

6. 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 hygiene measures such as hand washing – hand washing is still essential to prevent transmission of infection.

7. Personal Protective Equipment for SARS

9. Personal Protective Equipment (PPE) Cap Gown N-95 Respirator Mask Gloves Goggles Shoe covers

10. N-95 Respirator Masks N-95 Respirator Mask

11. Principles for Using the N-95 Respirator Mask The N-95 respirator mask is used to protect health care workers, other patients, staff or visitors by preventing potentially infectious microorganisms such as respiratory secretions from : • Contaminating their face including the nose and mouth. • Being inhaled or ingested.

12. N-95 Respirator Mask For respiratory protection wear an N-95 respirator mask during all patient contact

13. Proper use of N-95 Respirator Mask • DO NOT touch the front of the mask • Wear only one N-95 mask – no need for additional respiratory protection • REMOVE the N-95 mask before leaving the isolation unit / area

14. WHY an N-95 Respirator Mask? N-95 respirator masks offer a higher level of filtration for respiratory secretions than a surgical mask

15. HOW to use an N-95 Respirator Mask • Use for single shift unless excess moisture necessitates replacement during each shift • Label with the wearer’s name • Dispose of with medical waste NB: You must fit the mask securely over both your nose and mouth

16. HOW to use an N-95 Respirator Mask • Always use the correct sized mask. • The incorrect size will not fit properly and will fail the ‘fit test’. NB: You must fit the mask securely over both your nose and mouth so size is important.

17. N-95 Respirator Masks - Fitting Instructions Step 1 Cup the respirator in your hand with the nosepiece at your fingertips allowing the headbands to hang freely below your hand.

18. N-95 Respirator Masks - Fitting Instructions Step 2 Position the respirator under your chin with the nosepiece up.

19. N-95 Respirator Masks - Fitting Instructions Step 3 Pull the top strap over your head resting it high at the top back of your head. Pull the bottom strap over your head and position it around the neck below the ears.

20. N-95 Respirator Masks - Fitting Instructions Step 4 Place the fingertips of both hands at the top of the metal nosepiece. Mould the nosepiece to the shape of your nose by pushing inward while moving your fingertips down both sides of the nosepiece. Pinching the nosepiece using one hand may result in less effective respirator performance.

21. N-95 Respirator Masks - Fitting Instructions Step 5.1 The seal of the respirator on the face should be fit- checked prior to wearing in the work area. Cover the front of the respirator with both hands, being careful not to disturb the position of respirator.

22. N-95 Respirator Masks - Fitting Instructions Step 5.2 Positive Fit Test Exhale sharply. A positive pressure should be felt inside the respirator. If any leakage is detected, adjust the position of the respirator and/or tension of the straps. Retest the seal. Repeat the steps until the respirator is sealed properly.

23. N-95 Respirator Masks- Fitting Instructions Step 5.3 Negative Fit Test Inhale deeply. If there is no leakage, the negative pressure will make the mask cling to your face. A poor seal will result in prompt loss of negative pressure in the mask due to air entering through gaps in the seal.

24. When to change your N-95 Respirator Mask? • If you touch it • If it is grossly contaminated But not necessarily between isolated patients

25. Principles for Using Goggles, Gowns, Gloves, Caps and Overshoes Goggles, gowns, gloves, caps and overshoes are used to protect health care workers, by preventing potentially infectious microorganisms from : • Contaminating their eyes, clothing, hands, hair and shoes and • Being transmitted to other patients and staff.

26. Goggles • Assign one pair to each worker at the beginning of a shift • Wear goggles in room with SARS patients • Leave in the container in the anteroom at the end of the shift to be cleaned and disinfected

27. Goggles You should use goggles to cover all of the eye area.

28. Gowns • Long sleeved gowns must be worn when in direct contact with the patient • Wear gown at all times in the patient’s room • Gowns must be removed before leaving the patient’s room or dedicated anteroom • Remove used gowns as soon as possible particularly when grossly contaminated

29. Disposable Gowns Use a new gown for each patient contact. Discard immediately if visibly contaminated. Reusable Gowns If necessary, gowns may be reused during one shift for the same patient, e.g. when short of supplies. Discard immediately if visibly contaminated. Hang gown with outside facing in when not in use. Discard at the end of the shift. Gowns Gowns should be worn for every patient contact and ideally a new gown worn for each patient contact

30. Before all patient contact Before all cleaning Before handling soiled linen & waste Gloves

31. Gloves • Remove after contact with patients or lab specimens • Do not wear gloves outside of the patient’s room / anteroom • Do not re-use gloves • Wash hands after removing your gloves

32. Plastic Disposable Aprons • Plastic disposable aprons must be worn whenever there is a likelihood of other PPE such as gowns becoming wet. • They are worn to reduce the risk of breakthrough and contamination of clothing worn underneath the PPE. • They must be disposed of after use.

33. Plastic Disposable Aprons Aprons must be worn when : • Performing patient care activities where soiling or increased moisture is likely • Cleaning & disinfecting the patient environment • Cleaning & disinfecting medical; other patient care equipment • Laundering used linen • Cleaning and disinfecting the cleaning equipment

34. Caps Caps are worn to protect the hair from aerosols that may otherwise lodge on the hair and be transferred to other parts of the health care worker such as the face or clothing by the hands or onto inanimate objects.

35. Overshoes Overshoes are worn to protect the health care worker’s shoes and feet from being splashed by spills such as blood or other body fluids or aerosols

36. Key Points • The use of goggles, disposable gowns, gloves, caps and overshoes for all patient contact is designed to protect both the health care worker and the patient. • It also protects other patients, staff and visitors from potentially infectious microorganisms.

37. Key Points • Wear N-95 respirator mask, goggles, disposable gowns, gloves, cap and overshoes for all patient contact • Wash hands using soap (preferably liquid) and water when leaving the anteroom • Use an 70% alcohol-based hand rub solution after hand washing • Wash hands when leaving the unit

38. Personal Protective Equipment for SARS

39. Can You Now Answer These Questions? • Why is personal protective equipment (PPE) used? • When should it be used? • Who should use PPE? • What PPE should be worn for SARS patients? • Which mask is recommended for use with SARS patients? Why? • For how long can this mask be worn before being changed?

40. Can You Now Answer These Questions? • What is the sequence for putting on, and taking off, PPE? Why? • If the recommended mask is in short supply or not available, what type of mask should you (and the patient) wear? • What should you do with PPE that you remove? Why? • How can health care workers protect themselves when nursing SARS patients?

41. Take Home Messages • Personal Protective Equipment (PPE) is essential for all contact with SARS patients. • Ensure N-95 respirator masks fit properly. • Ensure goggles cover the entire eye area. • Have sufficient PPE supplies available. • All visitors must wear full PPE. • Dispose of all PPE in the appropriate container for disposal or cleaning and disinfecting.

42. Personal Protective Equipment(PPE) We hope YOU have learnt something about the use of personal protective equipment (PPE), its use in caring for SARS patients and its role in the prevention of transmission and infection control of SARS. Thank you for listening.