Transcript File
Principles of Infection Control and Personal Protective Equipment May, 2007 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 Disease Transmission Chain of Infection + Quantity of pathogen Virulence Route of transmission Port Sensitive host Routes of Transmission • Respiratory – Cough – Sneeze • Fecal-oral – Feces contaminate food, environment, or hands • Vector-borne – Transmitted by insects Routes of Transmission Contact Examples: Direct Contact Indirect Contact • Host comes into contact with reservoir • Disease is carried from reservoir to host • Kissing, skin-to-skin contact, sexual intercourse • Contaminated surfaces (fomites) • Contact with soil or vegetation Routes of Transmission Droplet Large droplets within ~1 meter (3 feet) transmit infection via: – Coughing, sneezing, talking – Medical procedures Examples: • Diphtheria • Pertussis (Whooping Cough) • Meningococcal meningitis Routes of Transmission Airborne (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) Infection Control Methods and Personal Protective Equipment Hand Washing Method • Wet hands with clean (not hot) water • Apply soap • Rub hands together for about 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 Infection Control Precautions Precaution Levels All levels require hand hygiene • Standard Transmission based precautions: • Contact • Droplet • Airborne 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 PPE for Standard Precautions Wear: If: • • • • Gloves Gowns Touching – – – Respiratory secretions Contaminated items or surfaces Blood & body fluids • Soiling clothes with patient body fluids, secretions, or excretions Eye • Protection and / or Mask Procedures are likely to generate splashes / sprays of blood, body fluids, secretions, excretions 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 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 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 Droplet Precautions • Prevent infection by large droplets from – Sneezing – Coughing – Talking • Examples – Neisseria meningitidis – Pertussis – Seasonal influenza Droplet Precautions Taken in addition to Standard Precautions • Place patients in single rooms or cohort 3 feet apart • Wear surgical mask within 3 feet or 1 meter of patient • Wear face shield or goggles within 3 feet or 1 meter of patient • Limit patient movement within facility – Patient wears mask when outside of room Airborne Precautions Taken in addition to Standard Precautions • Prevent spread of infection through inhalable airborne particles • Examples – – – – Tuberculosis Measles Varicella Variola Airborne Precautions for Avian Influenza • N95 respirator (or equivalent) for personnel – Check seal with each use • Patient in isolation • Airborne 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 Negative Pressure Isolation Room Assessing Infection Control Needs During an Investigation Components of Infection Control Infrastructure • Policies • Human resources • Procedures • Financial resources • Authority • Engineering resources Assessing Infection Control Infrastructure Example: cleaning patient rooms • Policies – When to clean, what to clean • Procedures – Cleaning products, order of surfaces to clean • Authority – Enforcing policies and procedures Assessing Infection Control Infrastructure Example: Cleaning patient rooms (continued) • Human resources – Staff to clean rooms • Financial resources – Money to buy cleaning products • Engineering resources – Cleaning equipment – Hand hygiene facility (sink) How to Put on and Remove Personal Protective Equipment Sequence for Donning PPE 1. Hand hygiene 2. Gown 3. N95 Particulate respirator – Perform seal check 4. Hair cover 5. Goggles or face shield 6. Gloves 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 • Limited human to human transmission of H5N1 has occurred to date • 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 Gloves • Don gloves last • Select correct type and size • Insert hands into gloves • Extend gloves over gown cuffs 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 for Removing PPE 1. 2. 3. 4. 5. 6. 7. Remove in anteroom when possible Gloves Hand hygiene Gown (and apron, if worn) Goggles Mask Cap (if worn) Hand hygiene Removing Gloves (1) • Grasp outside edge near wrist • Peel away from hand, turning glove inside-out • Hold in opposite gloved hand Removing Gloves (2) • Slide ungloved finger under the wrist of the remaining glove • Peel off from inside, creating a bag for both gloves • Discard Removing A Gown 1. 2. Unfasten ties Peel gown away from neck and shoulder 3. 4. 5. Turn contaminated outside toward the inside Fold or roll into a bundle Discard Removing 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 Removing 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 alcoholbased hand rub 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 removed 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 Glossary Decontamination - The removal of harmful substances such as chemicals, harmful bacteria, or other organisms, from exposed individuals, rooms, and furnishings in buildings or in the outside environment. Disease transmission - The process of the spread of a disease agent through a population Infection control - Measures practiced by health care personnel in health care facilities to prevent the spread of infectious agents Personal protective equipment - Specialized clothing or equipment worn by a worker for protect from a hazard