Public health, occupational safety and the use of PPE

PUBLIC HEALTH, OCCUPATIONAL SAFETY AND PUBLIC HEALTH, OCCUPATIONAL SAFETY AND PERSONAL PROTECTIVE EQUIPMENTPERSONAL PROTECTIVE EQUIPMENT

Harm Kiezebrink

MODULE OBJECTIVESMODULE OBJECTIVES

At the conclusion of this module, participants will be able to:

• Practice basic infection prevention principles;

• Describe the procedures for taking rest breaks, water and food when at an infected site without compromising safety;

• Explain safe procedures for putting on and taking off PPE.

What We Will Do in This ModuleWhat We Will Do in This Module• Talk about personal protective equipment (PPE)

• Put on PPE

• Talk about protecting people from HPAI

• Take a break wearing PPE, as we should in an outbreak response

• Remove PPE in a safe manner so we don’t infect ourselves or carry disease home or to another location

Personal Protective Equipment Personal Protective Equipment (PPE)(PPE)

• Coveralls• Shoe Covers• N-95 Respirator• Goggles• Plastic Apron• Gloves• Germicidal Wipes• Alcohol Wipes• Infectious Waste Bag

Why Use PPEs?Why Use PPEs?

• You can be infected by HPAI through your eyes, nose or mouth

Why Use PPEs?Why Use PPEs?• Virus can be carried to farms

• Virus can survive in the environment

• You may not be aware that it is there

What is the difference What is the difference between a SURGICAL MASK and a between a SURGICAL MASK and a

RESPIRATOR? RESPIRATOR?

Surgical mask Respirator

Particulate RespiratorsParticulate Respirators• N-95, N-99 or N-100, dependent on particle size allowed

through the mesh• Filter out most infectious agents transmissible by air• Not appropriate for persons with beards

Air-Purifying RespiratorsAir-Purifying Respirators• Half- or full-face• “Gas Mask”• Replaceable HEPA filters for different hazards • Not appropriate for persons with facial hair

““PoweredPowered”” Air-Supplied Respirators (PAPR) Air-Supplied Respirators (PAPR)• Air circulates, helps keep worker cool• Replaceable HEPA filters• Does not require fit testing• Can be used by a person with facial hair

Air-Purifying RespiratorsAir-Purifying Respirators

Coverall: Big is good, coveralls should be Coverall: Big is good, coveralls should be 2 sizes larger than you normally wear2 sizes larger than you normally wear

Before You Put on the PPEBefore You Put on the PPE

• Remove your watch and any jewelry

• Remove extra clothing

• Remove all tobacco products (cigarettes, snuff, etc.)

• It is recommended to leave cell phones behind.

Before You Put on the PPE: Before You Put on the PPE: Wash Your Hands!Wash Your Hands!

• Wet hands with soap and water• Rub all surfaces• Rub for 20 seconds• Rinse well• Wash forearms and face• Towel or air dry

Donning the PPE properlySEQUENCE• Coveralls• Shoe covers• Respirator• Goggles• Pull hood over head • Apron• 2 pairs of gloves

Take off what you donTake off what you don’’t need t need (jewelry, extra clothing, cell phones)(jewelry, extra clothing, cell phones)

Put On CoverallsPut On Coveralls

Put on Shoe CoversPut on Shoe Covers

Put On Your RespiratorPut On Your Respirator

Put on Goggles and Pull Up HoodPut on Goggles and Pull Up Hood

You may want to remove vent covers so that goggles don’t steam up. Don’t cover vents with hood.

Put On ApronPut On Apron

Put on Inner and Outer Gloves

You May Also Want To:

• Tape on a sample bag to carry back samples

Ready to Go!

Leave your biohazard bag at the intersection of the clean and dirty area

Protecting Poultry Workers and Farm FamiliesProtecting Poultry Workers and Farm Families

• Education

• Personal hygiene

• Prevention

Poultry Farm Worker: EducationPoultry Farm Worker: Education• If workers notice severely depressed birds or high mortality:

– Immediately leave the poultry house to prevent exposure– Contact a supervisor to investigate

• From outside the house if possible

• Determine if problem is mechanical

• Anyone entering the house should :– Wear full PPE

– Limit exposure time

– Limit contact with dead or dying birds

– Limit contact with potentially infective manure

Poultry Farm Worker Protection: HygienePoultry Farm Worker Protection: Hygiene

• Practicing careful personal hygiene when working with poultry can greatly minimize workers’ risk of disease.

• Hand-washing– One of the simplest and most effective– Hands should be lathered with soap

for at least 20 seconds– An alcohol-based hand rub can be used

Poultry Farm Worker Protection: HygienePoultry Farm Worker Protection: Hygiene• Clothing

– Wear clean clothes to the farm– Change into dedicated work clothing, which

never leave the farm• Coveralls, head cover, and boots.

– Farm should have a changing area

• Decontamination– Best practice: Shower at the end of the day,

wear personal clothes home– Good practice: Change out of work clothes

and shower when arrive home.

Poultry Farm Worker Protection: PreventionPoultry Farm Worker Protection: Prevention

• Vaccinations– Workers should have seasonal influenza vaccinations.

– Vaccination does not protect against H5N1 HPAI.

– Vaccination does help prevent dual infection with AI and seasonal flu.

Backyard / Smallholder Poultry Owners: EducationBackyard / Smallholder Poultry Owners: Education

Protecting Children– Many HPAI H5N1 cases in children – Require supervision around poultry– Restrict access to reduce exposure

Education is the key to protecting farm families

Backyard / Smallholder Poultry Owners: HygieneBackyard / Smallholder Poultry Owners: Hygiene

• Personal hygiene to decrease their risk of infection– Hand washing– Keep poultry outside family living space

Backyard / Smallholder Poultry Owners: PreventionBackyard / Smallholder Poultry Owners: Prevention

• Biosecurity to protect their birds– Covered, screened buildings– Don’t mix species in a pen– Separate shoes worn in poultry area, so manure is

not carried into the house

• Birds that die in the markets are potential sources of infection.

• If a worker finds a dead bird it should be:– Removed from the cage– Placed into a closed container– Not be eaten– If possible, the bird should be submitted to authorities for

testing

• After the bird has been handled, the worker should thoroughly wash hands with soap and water.

Live Bird Market Worker Protection: PreventionLive Bird Market Worker Protection: Prevention

• Large Numbers of Dead Birds:

– Limit exposure by leaving the market – Secure the market areas so others can not enter– Contact their supervisor, the market owner, or

designated first responder– Monitor their own health– Consider quarantine or culling all exposed birds

Live Bird Market Worker Protection: PreventionLive Bird Market Worker Protection: Prevention

When You Take a Break:When You Take a Break:

– Remove all PPE– Or remove only

• Gloves (both pairs)• Boot covers• Respirator• Apron• And then get assistance

Taking a Break in PPETaking a Break in PPE• Moving from Red Zone (infected area)

to Orange Zone (transit area)– Clean gloves with a germicidal wipe– Remove apron– Remove outer boot covers, touch only

outside, so you don’t dirty the coveralls– Remove outer gloves, touch only outside of

first glove, inside of second glove

Taking a Break in PPETaking a Break in PPE• At interface of Orange Zone and Green Zone

(clean area)– NEVER TOUCH YOUR DIRTY PPE– Assistant in Green Zone removes hood and

respirator– Assistant gives you drink with a straw– Assistant replaces your respirator, goggles and

hood– Assistant gives you new apron, gloves and boot

cover– Return to Red Zone (your seat)

Case Definition for Suspect Human HPAICase Definition for Suspect Human HPAI

Any individual presenting with an unexplained lower respiratory tract infection with:

• Fever (temperature > 38 C)

• Shortness of breath or

• Difficulty breathing

AND…..

And one or more of the following exposures in the 7 days prior to symptom onset:

• Exposure to poultry or wild birds or their remains or to an environment contaminated with their feces in an area where H5N1 infections in animals or humans have been suspected or confirmed in the last month

• Close contact with a suspect, probable or confirmed human or animal case

• Consumption of raw or undercooked poultry products in an area where H5N1 infections in animals or humans have been suspected or confirmed in the last month

• Handling animal / human samples suspected of containing H5N1

Case Definition for Suspect Human HPAICase Definition for Suspect Human HPAI

Surveillance of Animal Control Workers and Surveillance of Animal Control Workers and Family Members of HPAI Affected HouseholdsFamily Members of HPAI Affected Households

• Daily symptom check of all control workers

• Symptom check of all family members

• Confirm temperatures of any with suspect symptoms

• Referral for evaluation of any suspected cases of human HPAI

• Prompt isolation for anyone exhibiting symptoms

Accidental Exposure of Workers Accidental Exposure of Workers to HPAIto HPAI

• Active daily surveillance for symptoms and fever.

• Consider initiating prophylaxis;– Oseltamivir 75 mg once a day for 10 days

• Refer for further evaluation and treatment if patient meets case definition of suspect human HPAI.

• Consider quarantine.

Management of Suspect Human HPAI CaseManagement of Suspect Human HPAI Case

• Initiate prompt infection control activities with standard and airborne precautions for all personnel in contact with suspect patient.

• Refer to nearest health facility capable of evaluation of patient.• Maintain strict isolation of patient, either in health facility or in

home:– 7 days for adults– 21 days for children

• If suspect human case meets case definition, start Oseltamavir 75 mg twice a day immediately pending confirmation of positive or negative Influenza A H5 test.

Proper Order for Doffing the PPEProper Order for Doffing the PPE• Wipe off gloves with germicidal wipes• Remove:

– Apron– Shoe covers– Outer gloves– Coveralls– Goggles– Respirator– Inner gloves

• Tie off biohazard bag• Wash hands with soap and water

Removing PPE:Removing PPE: Biohazard Bag Should Be

Opened at The End Of The Donning Process in

Preparation For Doffing: Clean Gloves

Remove ApronRemove Apron

Remove Shoe CoversRemove Shoe Covers

Remove Outer GlovesRemove Outer GlovesFirst hand touches only outside of first glove, second hand touches only inside of second glove

Roll down Roll down coveralls coveralls without without

touching touching outsideoutside

Remove Remove goggles by goggles by the strap the strap that was that was covered by covered by hood, not by hood, not by the front the front piece!piece!

Remove Respirator: Remove Respirator: Bottom Strap first!Bottom Strap first!

Remove gloves, tie bag, sanitize hands Remove gloves, tie bag, sanitize hands with alcohol wipe and wash handswith alcohol wipe and wash hands

Clean Hands, Arms and Face with Clean Hands, Arms and Face with Alcohol Wipes and Wash With Soap Alcohol Wipes and Wash With Soap

and Water, if Possibleand Water, if Possible

• Wet hands with soap and water

• Rub all surfaces• Rub for 20 seconds• Rinse well• Wash forearms and face• Towel or air dry

Do Not Reuse PPEDo Not Reuse PPE

• PPE kit contents are designed for single use only

• Do not wash and reuse

• Reuse could result in:– Self-contamination– Contaminating someone else– Contaminating a new location

Discard PPE:Discard PPE:• Immediately if it is torn, heavily soiled or wet

• Immediately after use

• Change respirator if:–Dirty–Damaged–Difficult to breath through

Discard PPE After Use!Discard PPE After Use!

• Use plastic bags provided– Be sure to seal the bag and disinfect the

surface of the bag– Dispose of the bag appropriately by burial– Burning is not a preferred method of

disposal due to the environmental implications associated with burning plastic

– Proper disposal is important to prevent further disease spread and contamination

PPE CASE STUDYPPE CASE STUDY

•Read the case study assigned to your table and discuss what you would say in response to the concerns raised in the cases.

•Choose someone to take notes and someone to report your thinking to the larger group.

Case Study #1• You have been called to a site to help with the de-population of a

sick flock. When you arrive and go to the designated place to get your PPE Kit, many other workers are already there putting on their PPE. As you start to put your equipment on, you hear a worker say:

• “I cannot believe all of this stuff! It is so wasteful to use it once and

then throw it away. I think when I’m finished today I’m going to keep some of the equipment. After all, I am probably going to need it again.”

• You notice that a couple of other workers are nodding in agreement. You know that it is important to dispose of equipment after it has been used once and want to say something, but you are not sure how to approach the worker. After all, you do not know him and you are not from his village (neighborhood).

Case Study #2• A worker reports for duty, helping to clean up a chicken yard

where an outbreak of highly pathogenic avian influenza is suspected, but has not yet been confirmed. He has been trained on the use of PPE, but this is his first time to put on the equipment. He opens his PPE Kit from USAID and cannot believe how many things are in it. But instead of being pleased with the PPE, he sees it as exaggerating the danger of the situation. You walk up to him and ask him if he needs help getting into his gear and he tells you,

• “There is no way I am putting on all of this to clean up a chicken yard! We do not need all of this. I have on my own boots. I can cover my face with a scarf or cloth. Let’s get the job done, and get out of here. All this stuff is just a waste of time. Why is everyone being so dramatic?”

Questions?