Principles of Infection Control and Personal Protective Equipment

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 • Droplet

• Airborne

• Contact

• Common Vehicle transmission (Fecal-oral, blood-borne)

• Vector-borne– Transmitted by insects

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 TransmissionAirborne (droplet nuclei)

Very small particles of desiccateddroplets or dust with infectious agentmay…

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

Examples: • Tuberculosis• Measles (Rubeola)• Chicken pox

Routes of TransmissionContact

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)

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

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

• 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)

• 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

• Gloves

• Gowns

• Masks

• Boots

• Eye protection

PPE MaterialsGloves

• 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 Materials

Gowns

• Fully cover torso

• Have long sleeves

• Fit snuggly at the wrist

PPE Materials

Masks and Respirators: Barriers and Filtration

• Surgical masks

• Particulate respirators (N95)– Fit testing essential

• Alternative materials (barrier)– Tissues, cloth

PPE Materials

Boots Eye Protection– Face shields– Goggles

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

• Avoid reuse of disposable PPE items

• When prioritizing PPE purchase– Masks– Gloves – Eye protection

Gloves

• Select correct type and size

• Insert hands into gloves

• Extend gloves over gown cuffs

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

• 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

• 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

• 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

• 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

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 for Donning PPE 1. Wash hands

2. Put on boots

3. First pair of gloves

4. Gown

5. Plastic Apron

6. Second pair of gloves

7. N95 Particulate respirator

– Perform seal check

8. Hair cover

9. Goggles or face shield

Sequence for Doffing PPERemove in anteroom when possible

1. Disinfect the outer pair of gloves

2. Disinfect the apron and boots

3. Remove the outer pair of gloves

4. Remove the apron

5. Remove the gown

6. Disinfect the gloved hands

7. Remove the goggles

8. Remove the head cover

9. Remove the mask

10. Remove the boots

11. Remove the inner pair of gloves

12. Wash hands

Doffing Gloves (1)

• Grasp outside edge near wrist

• Peel away from hand, turning glove inside-out

• Hold in opposite gloved hand

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

1. Unfasten ties

2. Peel gown away from neck and shoulder

3. Turn contaminated outside toward the inside

4. Fold or roll into a bundle

5. Discard

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

• Lift the bottom elastic over your head first

• Then lift off the top elastic

• Discard

• Don’t touch front of mask

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

Seasonal Influenza in

Humans

Avian Influenza in Humans

Droplet Yes Probable

(human to human)

Airborne Likely Unknown

Contact Yes Yes

(bird to human)

Patient

Acute influenza symptom + contact with poultry

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

Infection Control Precaution

Surgical mask for patient, use tissue when coughing, sneezing

Isolation room, use of PPE

Apply all infection control precautions

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 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

Corridor

Anteroom

Isolation room

Toilet

Floor level exhaust

Diffuser

Toilet exhaust

Transfer grille

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

• 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

• 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

Desired ppm chlorine / 1,000,000( ) - 1 =

5 / 100

500 / 1,000,000( ) - 1 =

50,000

500( ) - 1 = 99

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

• 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

• Respiratory etiquette– Cover nose / mouth

when coughing or sneezing

• Hand washing!

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

• 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

• 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

Location Influences Actions

• Medical facilities

• Homes

• Farms

• Markets

• Rural versus Urban areas

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

• 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

• 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• 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?