Principles of Infection Control and Personal Protective Equipment

1. Principles of Infection Control and Personal Protective Equipment

2. Learning Objectives • Demonstrate knowledge of the principles of infection control • Recognize gaps in infection control infrastructure • Recognize ways to address gaps in infection control infrastructure in different situations • Demonstrate proper selection and use of personal protective equipment

3. 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

4. Routes of Disease Transmission

5. Route of transmission Port Quantity of pathogen Virulence Chain of Infection + Sensitive host

6. Routes of Transmission • Respiratory • Cough • Sneeze • Fecal-oral • Feces contaminate food, environment, or hands • Vector-borne • Transmitted by insects

7. 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

8. Routes of TransmissionDroplet Large droplets within 1 meter transmit infection via: • Coughing, sneezing, talking • Medical procedures Examples: • Diphtheria • Pertussis (Whooping Cough) • Meningococcal meningitis

9. Routes of TransmissionAirborne (droplet nuclei) Very small particles of evaporated 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)

10. Transmission of Influenza Viruses

11. Infection Control Methodsand Personal Protective Equipment

12. 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

13. 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

14. 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

15. Types of PPE • Gloves • Gowns • Masks • Boots • Eye protection

16. Types of PPE Gloves • Different kinds of gloves • Housekeeper gloves • Clean gloves • Sterile glove • Work from clean to dirty • Avoid “touch contamination” • Eyes, mouth, nose, surfaces • Change gloves between patients

17. Types of PPE Gowns • Fully cover torso • Have long sleeves • Fit snuggly at the wrist

18. Types of PPE Masks and Respirators: Barriers and Filtration • Surgical masks • Cotton, paper • Protect against body fluids and large particles • Particulate respirators (N95) • Fit testing essential • Protect against small droplets and other airborne particles • Alternative materials (barrier) • Tissues, cloth

19. Types of PPE Particulate Respirators • Three types: disposable, reusable, powered air purifying respirators • Disposable Particulate Respirators • Classified N95, N99, N100, R95, R99, R100, P95, P99, P100 • Letter indicates oil resistance: N = not resistant, R = somewhat resistant, P = strongly resistant • Number is percent of airborne particles filtered (e.g. N95 filters 95% of particles)

20. Types of PPE Boots Eye Protection • Face shields • Goggles

21. PPE Supplies • Maintain adequate, accessible supplies • Creative alternatives (not proven to be effective) • Mask: tissue, scarf • Boots: plastic bags • Gown: laboratory coat, scrubs

22. Working with Limited Resources • Avoid reuse of disposable PPE items • Consider reuse of some disposable items only as an urgent, temporary solution • Reuse only if no obvious soiling or damage • When prioritizing PPE purchase • Masks • Gloves • Eye protection

23. Infection Control Precautions

24. Precaution Levels All levels require hand hygiene • Standard Precautions Transmission based precautions: • Contact Precautions • Droplet Precautions • Airborne Precautions

25. Standard Precautions • Prevent the transmission of common infectious agents • Hand washing key • Assume infectious agent could be present in the patient’s • Blood • Body fluids, secretions, excretions • Non-intact skin • Mucous membranes

26. PPE for Standard Precautions Wear: • Gloves • Gowns • Eye Protection and / or Mask If: • Touching • Respiratory secretions • Contaminated items or surfaces • Blood & body fluids • Soiling clothes with patient body fluids, secretions • Procedures are likely to generate splashes / sprays of blood, body fluids, secretions, excretions

27. Contact Precautions Taken in addition to Standard Precautions • Limit patient movement • Isolate or cohort patients • Gown + gloves for patient / room contact • Remove immediately after contact • Do not touch eyes, nose, mouth with hands • Avoid contaminating environmental surfaces

28. Contact Precautions • Wash hands immediately after patient contact • Use dedicated equipment if possible • If not, clean and disinfect between uses • Clean, then disinfect patient room daily • Bed rails • Bedside tables • Lavatory surfaces • Blood pressure cuff, equipment surfaces

29. Cleaning and Disinfection for Contact Precautions • Detergents • Remove dirt, soiling • Mechanical force essential • Flush with clean water • Disinfectants • Kill viruses, bacteria • Decontaminate surfaces • Type depends on infectious agent • Use after detergent

30. Droplet Precautions • Prevent infection by large droplets from • Sneezing • Coughing • Talking • Examples • Neisseria meningitidis • Pertussis • Influenza • Avian influenza (probable)

31. Droplet Precautions Taken in addition to Standard Precautions • Place patients in single rooms or cohort 3 feet apart • Wear surgical mask within 3 feet of patient • Wear face shield or goggles within 3 feet of patient • Limit patient movement within facility • Patient wears mask when outside of room

32. Airborne Precautions Taken in addition to Standard Precautions • Prevent spread of infection through very small (< 5 microns) airborne particles • Examples • Tuberculosis • Measles • Varicella • Variola

33. Airborne Precautions • Use for influenza patients when: • History of travel to country with avian influenza activity within 10 days AND • Hospitalized with severe febrile respiratory illness • Or are otherwise under evaluation for avian influenza

34. Airborne Precautions • N95 respirator (or equivalent) for personnel • Check seal with each use • Patient in isolation • Negative pressure isolation room, if available • Air exhaust to outside or re-circulated with HEPA filtration • Patient to wear a surgical mask if outside of the isolation room

35. Negative Pressure Isolation Room

36. Natural Ventilation Cohorting Room 1 meter

37. Aerosol-generating Procedures (Example; Endotracheal intubation) • N95 particulate respirator • If not available, wear tight fitting surgical mask and face shield • Eye protection • Gloves and hand washing • Gown and waterproof apron • Isolation room with negative pressure, if available • Hair cover optional

38. Choosing the Appropriate PPE

39. Avian Influenza • Likely large droplet transmission • Possible airborne transmission • Recommended PPE varies depending on situation

40. Interviewing - Asymptomatic Exposed Persons and Contacts • Low-risk activity • Routine use of PPE not recommended • Maintain 3 feet distance between interviewer and interviewee • Use proper hand hygiene • May use hand sanitizer (at least 60% alcohol) if hands not visibly soiled

41. Interviewing - Symptomatic Exposed Persons • Higher risk activity • PPE recommended in community and healthcare facility • Contact precautions • Droplet precautions • N95 respirator • In healthcare facility, person should be placed in airborne isolation room

42. Specimen Collection – Exposed Persons and Birds • High-risk aerosol-generating procedure • PPE recommended • Gloves • Gown • Goggles or face-shield • N95 or better respirator

43. Avian InfluenzaInfection Control in Health Care Facilities

44. Influenza Transmission Effective Infection Control Prevents Transmission From ... • Patients to health care workers • Patients to patients • Patients to family members providing care

45. Avian Influenza Precautions Standard precautions Droplet precautions Airborne Precautions

46. 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 • Place patients in rooms alone • Alternative: cohort patients away from other patient care areas with beds > 1 meter apart

47. 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

48. Precautions for Collecting Specimens • Notify laboratory in advance • Health care worker collecting specimen should wear full barrier PPE • Place specimen in leak-proof bag • Hand deliver, if possible • Label specimen clearly as “suspected avian influenza”

49. Precautions for Suspected or Confirmed Cases Patient Infection Control Precaution Acute influenza symptom + travel to AI country in 10 days Surgical mask for patient, use respiratory hygiene Isolation room, use of PPE Apply all infection control precautions Test for influenza A/H5 Re-evaluate the precaution measures Different diagnosis Confirmed Influenza A/H5 Maintain required infection control precautions • Adults and adolescents > 12 years: Continue for 14 days after resolution of fever

50. Environmental Decontamination • Cleaning MUST precede decontamination • Disinfectant ineffective if organic matter is present • Use mechanical force • Scrubbing • Brushing • Flush with water