1 / 129

A 3 Prong Infection Control Strategy for Public Buildings

This research project aims to facilitate infection control in public buildings by minimizing the use of toxic cleaning products and antimicrobial pesticides. It provides strategies, policies, procedures, products, and training to protect workers and occupants from hazardous disinfectants.

knop
Télécharger la présentation

A 3 Prong Infection Control Strategy for Public Buildings

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. A 3 Prong Infection Control Strategy for Public Buildings Based on the School Disinfection Workgroup National Conference Call Research and Document Collaboration 2009 Project Coordinated by: Lynn Rose Training and Documents Written by: Lynn Rose and Carol Westinghouse, Informed Green Solutions, Inc. Funded by: the Massachusetts Toxics Use Reduction Institute, University of Massachusetts, Lowell 1

  2. Workgroup Members National: Centers for Disease Control and Prevention and Environmental Protection Agency Massachusetts: Division of Occupational Safety, Dept Public Health, MA Nurses Association, MassCOSH, TURI Surface Solutions Lab California: Dept of Public Health, California Childcare Health Program, UCSF Connecticut: University of Connecticut Health Center New England: Informed Green Solutions, Inc. 2

  3. Objectives http://www.vancouverdad.com/photos/germs1.jpg 3 Facilitate adequate infection control while minimizing the use of toxic cleaning products and antimicrobial pesticides. Protect workers and building occupants from exposure to hazardous disinfectants. Clarify the differences between cleaning and disinfecting products and processes, and when each is appropriate.

  4. Presentation Overview 4 • Why be concerned? • How is disease transmitted? • How can Facility Managers safely reduce disease transmission in their buildings? • Strategies and planning • Policies and procedures • Products and equipment • Training and resources

  5. Why reduce use of disinfectants? Chemical Hazards • Disinfectants are actually antimicrobial pesticides, designed to kill microbes. • Disinfectants do not clean, and cleaners to do not disinfect. • The active ingredients of common disinfectants are among the most toxic chemicals used in custodial work. cide = kill

  6. Why reduce use of disinfectants?Chemical Exposure Risks A single janitorial worker uses, on average, 194 lbs. of chemicals annually, approximately 25% of which are hazardous substances Environmental Working Group tested 21 common cleaning products used in California schools. They found 457 chemicals were emitted into the air: 6 known asthmagens 11 known, probable or possible cancer-causing agents Others - health effects are unknown

  7. Why reduce use of disinfectants?Chemical Exposure Risks Children are at greater risk than adults when exposed to toxins because: They are exposed at higher levels as they eat more food, breathe more air, drink more water They metabolize and eliminate toxins more slowly Their rapidly developing systems are more sensitive Play closer to the ground Have significant hand-to-mouth activity

  8. Why reduce use of disinfectants?Occupational Hazards • If not handled properly, some disinfectants can cause serious injuries: • Eye damage • Chemical burns • Severe skin irritation • Out of 100 janitors injured each year: • 20% are serious burns to the eyes or skin • 12% are a result of chemical vapors

  9. Why reduce use of disinfectants?Occupational Asthma Note: 12% of all Work Related Asthma cases in 4 states were associated with cleaning and disinfectant products. CA, MA, MI, NJ 1993-1997Rosenman et al 2003 JOEM 45(5):556-63

  10. Why reduce use of disinfectants?Children’s Asthma Massachusetts Department of Public Health Data on Student Asthma Rates

  11. Myth Buster: Question Do you always need to use disinfect to control infection?

  12. Myth Buster: Answer • No, some alternatives include: • An all purpose cleaner and microfiber • Equipment without chemicals such as a steam cleaning machine

  13. 3 Levels of Microbe Control: Sanitizing Killing Bacteria 99.9 to 99.999% Disinfecting Killing Microbes 99.99% Cleaning Removing Microbes 99%

  14. Breaking the Chain of Infection: “3 Prong Approach ” • 1. Personal Strategies Example: Influenza • 2. Cleaning for Health • 3. Targeted Sanitization and Disinfection • a. Hand Hygiene • b. Respiratory Hygiene • d. Social Distancing and Isolation • c. Cough Etiquette

  15. UnderstandingtheChain of InfectionA series of events that need to occur before a person develops an infectious disease.

  16. What are Microbes?Dispelling the “Fear Factor” • Microbes are everywhere in the environment – in the air, water, soil, plants and animals. • We can’t live without them. • Some are good for you, and other pathogenic” microbes cause infections and disease, commonly referred to as “germs”. 16

  17. What are Microbes? • * Spores produced by some types of bacteria and fungi can live in the environment for months or years. 17 Bacteria* – have their own cell walls, and can live independently. Fungi* – grow on dead and decaying matter. Common forms are yeast and molds. Viruses – live and multiply inside of cells of a living host, and cannot live independently.

  18. How Are Microbes Transmitted? Infectious Microbes Bacteria, Virus, Fungi Susceptible Host Microbes make host sick Reservoir Microbes adapt and multiply (on animate & inanimate objects) Chain of Transmission Portal of Entry: Microbes enter new location (e.g. mucous membranes) Portal of Exit Microbes leave (e.g. sneeze or cough) Modes of Transmission: Microbes are transported to new location (by animate or inanimate objects) Where people come in contact with them Contact Contact Respiratory

  19. Reservoir • Microbes live and multiply in a reservoir. • Microbes prefer: • Warm, dark environment • Moisture • Source of food

  20. Droplet Transmission • Large droplets containing microbes are: • propelled short distances (3-6 feet) through the air from sneezing, talking, and coughing. • deposited on a host’s mucous membranes - eyes, nose or mouth • Examples: • flu, cold, strep 20 Photo: 2009 Camfil Farr , http://www.camfilfarr.com/cou_us/industries/care/infection_transfer.cfm

  21. Airborne Transmission Photo: 2009 Camfil Farr , http://www.camfilfarr.com/cou_us/industries/care/infection_transfer.cfm • Microbes in airborne droplets: • Survive from evaporated droplets, and • Remain in the air for long periods (hours to days). • Examples: • measles, TB, chickenpox 21

  22. Contact Transmission: Indirect Contact • Transfer of microbes from object to person • Examples such as MRSA or Norovirus- transmitted by: • Touching environmental surfaces contaminated with infectious blood or body fluids, and • Then touching mucous membranes (eyes, nose, mouth) or touching an area with broken skin. 22

  23. Contact Transmission: Direct Contact • Transfer of microbes from person to person. • Examples such as MRSA or Norovirus-transmitted by: • Touching infected area or infectious body fluid on a person, and • Then touching mucous membranes or touching an area with broken skin. 23

  24. Means of Entry • Breaks in the skin • Respiratory tract • Digestive tract • Circulatory system

  25. Susceptible Host • Weakened Immune System - body not able to fight off infection!

  26. What Influences the Survival of MicrobesOutside of the Body? Properties of the Object Porous or nonporous, How clean, How much moisture Conditions of Surrounding Environment Humidity, pH, temperature, microbes present, ultraviolet light exposure Microbe Properties Type of microbe and type of medium it is suspended in Adds up to microbe survival on object

  27. BreakingtheChain of Infection Breaking any of the links of the chain can interrupt the transmission of disease. Example: Influenza

  28. The Three Prong Approach Personal Strategies and Responsibilities Prevent transmission Cleaning for Health Removereservoir Prevent transmission Targeted Sanitizing/Disinfection Remove reservoir Preventtransmission

  29. Personal Strategies:Will Respiratory Hygiene and Cough Etiquette Reduce Flu Transmission? Yes. The CDC recommends: • Covering the nose/mouth when coughing or sneezing, and washing hands after. • Coughing into the elbow when tissues are not available. • Using & disposing of tissues. • Leaving a 3-6 foot buffer between yourself and others when coughing or sneezing.  CDC Influenza Fact Sheet, http://www.cdc.gov/flu/professionals/pdf/resphygiene.pdf.

  30. Personal Strategies: Will Self-Isolation and Social Distancing Help Reduce Flu Transmission? Yes, and guidelines for sick people from the CDC include: • Staying home and away from people until at least 24 hours after they are free of fever (100° F), or signs of a fever without the use of fever-reducing medications. • Limiting contact with others and maintaining a distance of at least 6 feet from people. • Wearing a surgical or N95 mask around other people. 30

  31. Personal Strategies: Will Hand Hygiene Help Reduce Flu Transmission? • Yes, depending on the product and process used. • Hand washing with soap and water can reduce infections by more than 50 % in some cases!

  32. Hand Hygiene: Product Types • Anti-bacterialproducts kill bacteria and some, but not all viruses. • Anti-microbialproducts can kill or suppress growth of bacteria, viruses or fungi. 32 Soap will remove, not kill microbes.

  33. Hand Hygiene Products: Hand Soap 33 • Soap is available in liquid, bar (not recommended) and hand wipe forms. • Soap and warm water remove microbes by breaking down the oil and dirt that harbors them, and washing them away. • The CDC guidelines call for washing hands with warm water and soap for 15 to 20 seconds to effectively prevent infection.

  34. Hand Hygiene Products: Anti-bacterial Hand Soap • Kills bacteria and some, but not all viruses such as the common cold, flu, stomach flu and blood borne pathogens such as HIV and Hepatitis B and C. • A Federal Drug Advisory Panel concluded in 2005 that, for general use, antibacterial soaps are no more effective than regular plain soap at removing germs. • Reference: http://www.cdc.gov/Features/HandWashing , August 28, 2008

  35. Hand Hygiene Products: Anti-bacterial Hand Soap Can be absorbed through skin, linked to liver damage. Detected in breast milk, urine and blood. Linked to hormone disruption. • The most common ingredients are triclosan and triclocarban. Triclosan health issues include:

  36. Hand Hygiene Products: Anti-Microbial Hand Sanitizer • Product that can kill or suppress growth of viruses, bacteria or fungi. • Available in foam, gel or hand wipes. • Most common ingredient is alcohol, which comes in 2 forms and different strengths. Note: Always replace product in dispenser, never top off to prevent microbial growth in dispenser. 36 36

  37. Hand Hygiene Products: Alcohol Based Sanitizers - Concentrations Concentration Required to Kill Specific Viruses Note: 70% Ethyl Alcohol would be better than 62%, but its hard to find.

  38. Hand Hygiene Products: Alcohol Based Sanitizers - Dangers • Routes of Exposure for Children • absorb it through skin • lick it off their hands • squirt it into their mouths

  39. Hand Hygiene Products: Alcohol Based Sanitizers - Dangers • Risks • 3 squirts* can raise blood alcohol level in a toddler to be legally intoxicated .10, which is comparable to someone that size to drinking 120 proof alcohol. • “Ingesting as little as an ounce or two of this product could be fatal to a toddler,” says Heidi Kuhl, health educator, Central NY Poison Control Center. * Purell and Germ-X contain 62% Ethyl Alcohol Reference: http://www.snopes.com/medical/toxins/sanitizer.asp

  40. Hand Hygiene: Alcohol Based Sanitizers - Dangers • Class 1 - Flammable Liquid • Follow 527 CMR storage guidelines • State Fire Marshal reissued an Advisory for Alcohol Based Hand Sanitizers containing 60% - 95% ethanol or isopropanol. • Posted: SFO website  Fire Prevention  SFO Advisory

  41. Hand Hygiene: Product Limits 41 Dirt: antimicrobial and alcohol basedproducts don’t necessarily remove dirt on hands, which compromises their ability to kill microbes. Proteins: soap is more effective at removing proteins from hands than alcohol sanitizers.

  42. Do Hand SanitizersReplace Hand Washing? No, hand-washing is the first and most important step, especially if hands are visibly soiled. CDC Recommendations: When hand washing is not an option (e.g. school bus or field trip), “alcohol-based hand cleaners are also effective.” Sources: 1) City of Ottawa FAQs about Alcohol-Based Hand Sanitizers and 2) Hygiene of the Skin: When Is Clean Too Clean? CDC Emerging Infectious Diseases, by Dr. Elaine Larson, prof pharmaceutical & therapeutic research, & prof of epidemiology, Columbia Univ School of Nursing

  43. Infection Control Strategy as part of A Cleaning for Health Program

  44. Cleaning for Health Program A comprehensive program to: prevent proliferation of dirt and microbes use safe cleaning products and work practices Sample strategies include: More frequent cleaning of high-touch surfaces Cleaning with color coded microfiber mops/cloths Using floor/vacuuming equipment with HEPA filters Cleaning that protects public health, without adversely affecting the staff, building occupants and the environment.

  45. Three Levels of Microbe Control 1. Cleaning Microbes 99% 2. Sanitizing Bacteria 99.9 – 99.999% 3. Disinfecting Microbes 99.99% Level 1: General Surface Cleaning 45 • Physically remove viruses, fungi and bacteria and the conditions they need to survive (e.g. organic matter). • Accomplished with water, detergent, and abrasion of the surface. • Microfiber can enhance this process by removing up to 99% of microbes.

  46. Three Levels of Microbe Control 1. Cleaning Microbes 99% 2. Sanitizing Bacteria 99.9 – 99.999% 3. Disinfecting Microbes 99.99% Level 2. Sanitizing 46 Reduces (kills) 99.9% to 99.999% of tested bacteria to levels considered safe for public health. May not have claims for killing viruses or fungi. Some products can be both a sanitizer and a disinfectant, depending on specified concentration. References: Infection Control for Dummies, J. Darrel Hicks, REH, http://www.epa.gov/iaq/glossary.html#S, http://www.epa.gov/iaq/glossary.html#D, and Source: Cleaning for Health, Inform, Inc, and presentation by Marcie Tidd on Disinfectants, Sanitizers, and Product Labeling, Overview of EPA’s Antimicrobial Registration Process, Women's Voices for the Earth Conference Call, February 4th, 2009

  47. Three Levels of Microbe Control Level 2. Sanitizing 47 • Registered by EPA for use on porous and nonporous surfaces: • Food contact surfaces: sanitizing rinses for surfaces such as dishes and cooking utensils. • Non-food contact surfaces: carpet, laundry, toilet bowl, etc. References: Infection Control for Dummies, J. Darrel Hicks, REH, http://www.epa.gov/iaq/glossary.html#S, http://www.epa.gov/iaq/glossary.html#D, and Source: Cleaning for Health, Inform, Inc

  48. Three Levels of Microbe Control 3. Disinfecting Microbes 99.99% 1. Cleaning Microbes 99% 2. Sanitizing Bacteria 99.9 – 99.999% Level 3. Disinfecting 48 Destroys 99.99% of all forms of microbial life, but not necessarily their spores. Use on hard nonporous surfaces, which have higher transmission rates.

  49. Disinfectants: Claims • All disinfectants do not kill all types of microbes. • EPA categorizes & registers products by their Disinfectant Claims based on what they kill: Limited Broad Spectrum, General Hospital, Medical Use

  50. Disinfectants: Claims 50 • Hospital / Medical Use Disinfectant: • meets the requirements for a general disinfectant • also effective against the Pseudomonas aeruginosa • does not necessarily kill TB or HIV

More Related