Principles of Infection Control and Personal Protective Equipment

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

41. 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

42. 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

43. 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

44. ) ( % 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

45. 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

46. 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

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

48. 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

49. 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

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