Transcript SARS - European Food Safety

Infection
Control
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MasterMeasures
title style
to Prevent Hospital
• Click to edit Master text styles
Transmission
• Second level
• Third level
Severe
Acute
Respiratory
• Fourth level
Syndrome (SARS)
• Fifth level
WHO Western Pacific Regional Office
14 October
1
Overview
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••
••
•
•
••
•
Epidemiology
andtext
Clinical
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styles Management
Infection
Control Precautions
Second level
Laboratory
Third
level Safety
Fourth
level Safety
Mortuary
Fifth
level
Linen,
Laundry, Waste Management
Environmental Cleaning
2
Background
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• Approximately
8098 cases
in 29 countries
• Click to edit Master
text styles
as
of
31
July
2003
• Second level
• Third level
• At
least
774
deaths
• Fourth level
• Fifth level
• 1707 Cases (21%) have been health care workers
3
Chronology
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• •SARS,
Click to
anedit
atypical
Master
pneumonia
text styles of unknown
was recognized at the end of
•etiology,
Second level
February
2003
• Third level
• Fourth level
• •The
World
Health
Organization
(WHO)
coFifth level
ordinated the international responses to
provide epidemiological, clinical and
logistical support as required
4
Chronology
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11 February
• Chinese
Click to health
edit Master
textreported
styles
officials
“atypical
• pneumonia”
Second levelin Guangdong Province,
China; 305 cases/5 deaths (Nov 02–Feb 03)
• Third level
• Fourth level
19
February
• Fifth
level
Hong Kong confirms human infection of
Influenza H5N1
5
Chronology
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5 March
in Hanoi
recognized
• Outbreak
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text styles
11
• March
Second level
Hong Kong reports SARS outbreak
• Third level
• March
Fourth level
13
• Singapore
Fifth level
reports 3 SARS cases
15 March
The disease spread to outside Asia (Canada,
Germany)
6
Chronology
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WHO initiates :
• Global Alert (12 March)
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• • Travel
Advisory
Second
level (15 March; 2, 23 & 29 April)
Third level
• • Enhanced
global surveillance
• Fourth level
• Global Outbreak Alert and Response Network
• Fifth level
• Specific Global Networks (Lab, Case
Management, Epidemiology)
7
Chronology
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Forward planning of Activities since then :
• Infection
Guidelines
– bi-regional
• Click toControl
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text styles
guidelines
will
now
cover
all
issues
for
• Second level
Infection Control practice in a Health Care
• Third level
Facility
– due out soon
• Fourth level
• Infection
Control Programme – will support
member
states in how to set up an IC
• Fifth level
programme
• IC Audit tool – for self evaluation of HCF
8
Click toEpidemiology
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• Cause : SARS CoV
• Click to edit Master text styles
• Highly infectious
• Second level
• Mainly affects adults
• Third level
• Superspreading events important in
•transmission
Fourth level process
•
Fifth
level
• No reports of transmission occurring before
onset of symptoms
9
Click toEpidemiology
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• •Means
of edit
transmission
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Master text styles
• Second level
Evidence of person to person transmission
• Third level
• Close
Fourthcontact
level with body fluids (especially
respiratory
• Fifth
level droplets )
Contaminated hands, clothes, equipment;
environment may also be important
10
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• •Risk
factors
transmission
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to editfor
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• Second level
• •High
medical procedures:
Thirdrisk
level
• Intubation
• Fourth level
• Bronchoscopy
• Fifth level
• Cough-inducing procedures (sputum induction,
administration of nebulised medications,
suctioning)
11
Click toEpidemiology
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• •Incubation
period
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– 2 –10 days and up to 13 days in exceptional
• Second
cases level
Onsetlevel
and duration of infectivity unknown
• –Third
• Fourth level
• Fifth level
• Organism survival in environment
– Duration unknown
– Data has shown SARS CoV may survive for 2-3
days
12
Case Definitions
Developed
forto
public
health
purposes
in the
interClick
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outbreak period
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to edit
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A •person
a history
of:text styles
• Second
•Fever
(> 38oC)level
•AND
one orlevel
more of the symptoms of lower respiratory tract
• Third
illness (cough, difficulty breathing, shortness of breath)
• Fourth level
•AND Radiographic evidence of lung infiltrates consistent with
• Fifth or
level
pneumonia
RDS or autopsy finding consistent with the
pathology of pneumonia or RDS without an identifiable cause
•AND No alternative diagnosis can fully explain the illness
13
Case Definitions
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to definition
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Laboratory
of SARStitle style
•A person with symptoms and signs that are clinically
• ClickoftoSARS
editAND
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styles
suggestive
with text
positive
laboratory findings for
SARS-CoV based on one or more of the following diagnostic
• Second level
criteria:
• Third level
a) PCR for SARS-CoV – using a validated method from:
•
Fourth
level
•At least 2 different clinical specimens (eg nasopharyngeal or
stool)
OR level
• Fifth
•The same clinical specimen collected on 2 or more occasions
during the course of the illness
•Two different assays or repeat PCR using a new RNA extract
from the original clinical sample on each occasion of testing14
Case Definitions
b) Seroconversion
by ELISA
or IFAtitle style
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• Negative antibody test on acute serum followed by positive
antibody
testto
onedit
convalescent
• Click
Masterphase
text serum
stylestested in parallel OR
• Fourfold
or greater
• Second
level rise in antibody titre between acute and
convalescent phase sera tested in parallel
• Third level
c) Virus Isolation
• Fourth level
•Isolation in cell culture of SARS-CoV from any specimen AND
• Fifth
level using a validated method
PCR
confirmation
•Testing should only be undertaken in a national or regional
reference laboratory as per WHO guidelines.
15
Contacts
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Definition
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Close
contact level
: having cared for, lived with, or had
• Second
direct contact with the respiratory secretions or body
• Third
fluids
of alevel
suspect or probable case of SARS.
• Fourth level
Contacts
persons under investigation for SARS
• Fifthoflevel
should be traced and quarantined until SARS has
been ruled out as the cause of the illness
16
Clinical picture in SARS patients
Exposure to SARS Fever, myalgia, dry non-productive cough
cough, headache shortness of breath
Incubation period
~2 to 10 days
up to 13 days
reported
Prodrome
~ 1- to 2 days
Lower respiratory
phase
From day 4 onwards
Infectivity
None /very low
Low
Recovery
approx
90%
Very high
Acute
respiratory
distress
syndrome
approx 10%
Clinical Picture
Onset
/ Presentation
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to edit
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• •Sudden
of high
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edit Master
textfever
styles with
chills, rigors and a non•myalgia,
Second level
•productive
Third level cough
• Fourth level
• •Most
Fifth cases
level have bilateral pneumonia
• ~ 90% begin to recover from
day 6 or 7
18
Clinical Picture
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to edit
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/ Presentation
• Rapid deterioration in 10% (+/-) of cases
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• Second
level
 Acute
RDS
• Third level

Require
ICU
admission
&
• Fourth level
mechanical ventilation
• Fifth level
• Case fatality rate: ~ 6%
• No specific treatment available
19
Clinical Picture – Management
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to
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style
SUPPORTIVE TREATMENT
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• Antibiotic Therapy:
•toSecond
level
cover causative
organisms
• Third level
• •Prophylactic
Fourth level Antibiotic Therapy:
prevent
• toFifth
level secondary bacterial infection
• Maintain oxygenation:
 intubate and ventilate as necessary
20
Clinical Picture – Management
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SUPPORTIVE TREATMENT
•
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to
edit
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text
styles
Avoid interventions which may cause
• Second level
aerosolisation
of respiratory secretions:
• Third level
 Bronchoscopy
•Fourth
levelbronchodilators
Nebulised
Chest
physiotherapy
•Fifth
level
 Gastroscopy
 Any procedure / intervention that may
release respiratory secretions
21
Clinical
– Management
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title style
• Click
SUPPORTIVE
to edit MasterTREATMENT
text styles
• Second level
• Third level
In severe cases corticosteroids and ribavirin
• Fourth
level
have been used, however there
• is
Fifth
level
no evidence
to support their general
or routine use at this stage.
22
Summary – SARS
• Multi
- Country
Outbreak
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to edit
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title style
• New Pathogen:
• Click
to
edit
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text
styles
CoronaVirus family – SARS CoV
• Second level
• • Clinical
Picture:
Third level
 Fever and respiratory symptoms
• Fourth level
 ~ case fatality rate currently 4%
• Fifth level
• Transmission:
 Close contact with symptomatic case(s)
 Contaminated hands and objects
23
Summary – SARS
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• Prevention
Control:
 Identification
Isolation
suspect
and
probable cases
•Click
to editofMaster
text
styles
Tracing
& quarantine of close contacts
•Second
level
 Infection control precautions for all
• Third level
suspect and probable cases
•Fourth
Publiclevel
Education
• Fifth level
• Health care workers are currently at
greatest risk therefore:
 Infection control precautions are
24
essential
Infection Control Precautions
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Infection Control precautions (previously
Barrier
nursing
techniques) are
• known
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Master
text styles
to prevent infection from the patient
• designed
Second level
to the staff/visitor or the staff/visitors to other
• Third level
patients.
• Fourth level
• Fifth level
Strict precautions must be used
for all
SARS patients.
25
Patient Management
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 SARS : Infection Control Goals
• Click to edit Master text styles
• SARS
SecondAdmissions
level

- Triage
• Third level
• Components
Fourth level of SARS Isolation

• Fifth level
 SARS : Infection Control Practices
26
SARS : Infection Control Goals
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In addition to providing the best possible
• clinical
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edit Master text styles
• Second level
•
Third
level
Detect early any suspect cases.
•
Fourth
level
Implement appropriate isolation measures.
•
Fifth
level
Protect health care personnel.
Protect other patients.
Protect family and community members.
27
Triage for SARS Admissions
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to edit
title
style
If possible,
shouldMaster
be separate
wards/areas
for each of the following categories :
• Click to edit Master text styles
• Patients
Secondwith
levelcolds, sniffles and runny noses
should be isolated in a single room / area
Third level
• Suspect
cases
• -Fourth
Place inlevel
a single room
• Probable
cases
Fifth level
- If cohort nursing, keep probable and suspect cases
apart
- May share room with other probable cases; where
possible use a single room for all patients
28
Components of SARS Isolation
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•• Facility
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•• Administrative
Controls
Second level
Third level
•• Clinical
Surveillance of Staff
Fourth level
•• Organization
of Isolation Area
Fifth level Equipment
•• Protective
• Standard Precautions
29
Facility
Clickfrom
toother
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Master
style
Isolated
/ stafftitle
movement
•
• Good ventilation
• –Click
to edit Master
styles
Air movement:
corridor text
to room
to outdoors
Turn off level
central air-conditioning systems unless the
• –Second
room can be isolated from the system.
• Third level
• Sinks and running water
Fourth level
• •Adequate
bathroom facilities
Fifth level
• •Capacity
to handle waste and laundry
• Sufficient rooms for expected number of patients
• Contingency plans for converting other areas to
isolation facilities
30
ISOLATION
WASH/TOILET
General Principles of isolation unit
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to
edit
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title
style
A
F
• ISOLATION
Click to ROOM
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styles
CHANGE
Negative pressure/
ROOM
(e.g.
blow
air
out
of
• Second level
E window with fan)
D
• Third level
A D
B C
• Fourth
level
E
A
•A. Fifth
level
Disinfection
station
GENERAL
ACCESS AREA
B. Container for disinfection of reusable items e.g. goggles
C. Biohazard bag for used (personal protective equipment)
disposal
D. Wall-mounted alcohol handwash dispensers
E. External windows only. Keep clear of public.
F. Storage for general ward clothes, new PPE
31
ISOLATION
WASH/TOILET
General Principles of Isolation Unit
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A
F
ISOLATION ROOM
Negative pressure/
ROOM
•(e.g.Click
Master CHANGE
text styles
blow airto
outedit
of window
E
with fan)
D
• Second level
A D
• Third level
B
E
A
B
• Fourth level
A. Disinfection station
Fifth level
B.• Container
for disinfection of reusable items
C.
D.
E.
F.
GENERAL
ACCESS AREA
C
e.g. goggles.
Biohazard bag for used (personal protective equipment) disposal
Wall-mounted alcohol hand wash dispensers
External windows only. Keep clear of public.
Storage for general ward clothes, new PPE
32
Facility
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Isolation Area – Full IC Precautions required
Colour codes
•
Click
to
edit
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text
styles
• Green
• Second
level[reduced] staff movement
(GO)
: General
• Third level
•• Yellow
Fourth level
(CAUTION)
• Fifth level: Limited staff movement
• Red
(RESTRICTED) : Assigned staff only
33
Administrative Controls
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• Limit and control points of entry to SARS
ward(s)
• Click to edit Master text styles
•
•
•
•
Second level
– One entrance
Third
level
– “Guard” to control entrance
–Fourth
Log oflevel
permitted visitors (staff & visitors)
levelmust be restricted or preferably
–Fifth
Visitors
forbidden with NO EXCEPTIONS
– Limit patient travel/transport outside unit
– Minimize the number of staff exposure to cases
34
Administrative
Controls
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• Assignment of responsibility
• Click to edit Master text styles
• Second level
– Determining patient placement
• –Third
level implementation and enforcement
Overseeing
of infection
• Fourth
level control measures
Enforcing
• –Fifth
level access restrictions
–
Supply acquisition and distribution
– Surveillance of Health Care Workers (HCWs)
35
Clinical Surveillance of Staff
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• Maintain list of all staff who worked with SARS
patients or on the SARS ward;
• –Click
to
edit
Master
text
styles
Systematically monitor for fever; and
• –Second
level
Twice daily
temperature for staff working in the
area (baseline Chest X-Ray may be needed )
• Third
level
• Screen for symptoms of SARS-like illness among
•staff
Fourth
level for duty.
reporting
• •List
contact
Fifth
levelinformation for:
–
–
Persons visiting or caring for SARS patients; and
Contacts of HCWs in close contact with SARS
patients.
36
Organization of SARS Isolation Area
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• Put Up Signs: eg. SARS Isolation Area
• Designated
for cleantext
protective
• Click to area
edit Master
styles equipment
–
Instructions for using protective equipment
• Second level
– Accessible to personnel
•– Third
level
Sufficient
inventory to meet daily needs
• Separation
of clean and dirty supplies including an
• Fourth level
area
for level
containment of waste and soiled linen
• Fifth
–
–
Color-coded bags and containers for contaminated waste
and laundry
Containers for laundry and all waste should have footoperated lids
37
ISOLATION
WASH/TOILET
General Principles of Isolation Unit
Click to edit Master title style
A
F
ISOLATION ROOM
Negative pressure/
ROOM
•(e.g.Click
Master CHANGE
text styles
blow airto
outedit
of window
E
with fan)
D
• Second level
A D
• Third level
B
E
A
B
• Fourth level
A. Disinfection station
Fifth level
B.• Container
for disinfection of reusable items
C.
D.
E.
F.
GENERAL
ACCESS AREA
C
e.g. goggles.
Biohazard bag for used (personal protective equipment) disposal
Wall-mounted alcohol hand wash dispensers
External windows only. Keep clear of public.
Storage for general ward clothes, new PPE
38
Infection Control
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•
•
•
•
•
“Youtocan
Click
edit minimize
Master textYOUR
styles risk of
catching
Second level
Third level
SARS
Fourth level
Fifth level by following
Infection Control Precautions.”
39
Infection Control Precautions
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forMaster
SARS title style
•
•
•
•
•
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Standard
Precautions
Second
level
+
Third level
Fourth
level
Respiratory
Precautions
Fifth level
+
Contact Precaution
40
Exposure Risks
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• Patient:
• Health Care Staff:
Respiratory
– Respiratory
secretions
• –Click
to edit Master text
styles
secretions
– Blood
• Second level
– Blood
– Body fluids including
• Third level
– Body fluids
excreta
• Fourth
level
including
excreta
– Mucous membranes
• –Fifth
Skin level
lesions
– Skin lesions
–
Staff
– Visitors
–
Sharps
– Visitors
41
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Hand Washing
• Click to edit Master text styles
• Second level
• Third level
An essential Infection Control
• Fourth level
precaution
to
prevent
the
• Fifth level
transmission of SARS
42
Principles of Hand Washing
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Hand Washing :
• •IsClick
the single
important
and effective
to editmost
Master
text styles
component for preventing the transmission of
•infection.
Second level
levelto remove transient
• •IsThird
designed
that may have been picked
•microorganisms
Fourth level
from
the environment.
•up
Fifth
level
• Prevents the transfer of these microorganisms
to other patients, staff and equipment.
• Is best performed using soap (preferably
liquid) and warm running water.
43
Handwashing – When?
– After removing gloves
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to
edit
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title
style
– Before and after patient
contact
–• After
with
blood ortext
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to edit
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body fluids from any
• patient
Second level
– After taking blood
• pressure
Third level
or vital signs from
patient
• any
Fourth
level
styles
Other times:
•– After
Fifthusing
levelbathroom
– After blowing or wiping
nose
– Before eating
– Before preparing food
44
Handwashing – How?
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Handwashing procedure :
• Click to edit Master text styles
• Second
level
Running
water
• Third level
Soap (preferably
liquid)
• Fourth
level
• Fifth level
 Friction
Or use Alcohol-based hand
rub
45
Handwashing Steps
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Step
1
• Click to edit Master text styles
• Second
Wet
hands level
and wrists.
• Third level
Apply
soaplevel
• Fourth
• Fifth level
46
Handwashing Steps
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Step 2
• Click to edit Master text styles
• Second
Right
palmlevel
over left.
• Third level
• Fourth
level
Left
over right.
• Fifth level
47
Handwashing Steps
Click to edit Master title style
• Click
Step
3 to edit Master text styles
• Second level
Palm to palm
• Third level
• Fourth
level
with
fingers
• Fifth level
interlaced.
48
Handwashing Steps
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Step
4
• Click to edit Master text styles
Back
of thelevel
• Second
fingers
the
• Thirdtolevel
opposing
fingers
• Fourth level
and interlocked.
• Fifth level
49
Handwashing Steps
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Step
5
• Click to edit Master text styles
Rotational rubbing of
• Second level
• Third
the
right level
thumb by
• Fourth level
clasping it in the left
• Fifth level
palm.
And vice versa.
50
Handwashing Steps
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Step 6
• Click to edit Master text styles
Rotational rubbing
• Second level
backwards
and
forwards
with tops of
• Third level
fingers
and
thumb
of
• Fourth level
right hand in left.
• Fifth level
And vice versa.
51
Drying Your Hands
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Master
title style
It is important
dry your
hands thoroughly
after
washing them because :
• Click to edit Master text styles
• Damp hands collect microorganisms
• Second level
• Damp hands spread potentially infectious
•microorgansims
Third level
• •Damp
hands
Fourth
levelmay become colonised with
potentially infectious microorganisms
• Fifth level
Therefore it is important to “pat dry” your hands
thoroughly.
“Pat drying” also helps to prevent damage to skin.
52
Handwashing
Tips
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Remember:
• Click to edit Master text styles
• Second level
Wash hands for a minimum of 15 to 20
• Third level
seconds.
• Fourth level
•Ensure
you have washed all areas properly.
Fifth level
Dry hands thoroughly.
53
Handwashing
Tips
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Alcohol based hand gels/ lotions
• Click to edit Master text styles
 Use on clean (unsoiled) hands
• Second level
Use enough of the product to cover hands
Third levelrub hands using the same steps as
•Vigorously
• Fourth
Step
1 – 6 level
(do not wet hands prior to applying
the
solution/gel)
• Fifth
level
54
Handwashing in Difficult Situations
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If running water is not immediately available,
• Click
to edit
what
should
youMaster
do? text styles
• Second level
Use
a basin
• Third
levelof clean water and wash hands.
Use
a clean
basin each time.
• Fourth
level
Use
fresh
water each time.
• Fifth
level
DO NOT contaminate sources of fresh / clean
water by handling ladles or dippers.
55
Handwashing in Difficult Situations
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to
edit
Master
title
style
If water is not immediately available, what
should you do?
• Click
to edit
Master–text
styles
Use
an 70%
alcohol
based
hand rub solution.
• Second
levelamount to completely cover
Use
sufficient
your
hands.
• Third
level
Wash
your
hands using running water
• Fourth
level
and
soaplevel
as soon as they become soiled
• Fifth
NB: Alcohol is very effective when hands are clean
(i.e.. not soiled with blood, body fluids etc)
56
Infection Control Precautions
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Precautions
Other Infection Control
• Click to edit Master text styles Factors
• Standard Precautions
• Second level
• Respiratory
• Precautions
Third level
Fourth Precautions
level
• • Contact
• • Hand
FifthWashing
level
• PPE
• Exposure Risks
• Patient transport
• Patient and family
education
• Laboratories / Specimens
• Mortuary Care
• Waste and Linen
Handling
• Cleaning & Disinfection
57
Personal Protective Equipment (PPE)
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• N-95 Respirator Mask must be worn
•
••
•
••
•
Click to edit Master text styles
Goggles
(protective glasses)
Second level
Third level
Disposable
Fourth levelor Reusable Gowns
Fifth level
• Disposable Gloves
• Cap and shoe covers are optional
58
Personal Protective Equipment for SARS
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•
•
•
•
•
Click to edit Master text styles
Second level
Third level
Fourth level
Fifth level
59
Personal Protective Equipment
Click to edit(PPE)
Master title style
•
•
•
•
•
N-95 Respirator Mask
Click to edit Master text styles
Gloves
Second level
Gown
Third level
Goggles
Fourth level
Fifth level
Optional
Cap
Shoe covers
60
Principles for Using PPE
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to
edit
Master
title
style
Personal Protective Equipment (PPE) is used
to• protect
care workers
Click tohealth
edit Master
text stylesby preventing
potentially
infectious
microorganisms
from:
• Second level
• Third level
•• Contaminating
their
hands,
eyes
and
Fourth level
clothing;
• Fifth level
and
• Being transmitted to other patients and
staff.
61
Principles for Using PPE
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• PPE reduces but does not completely
•eliminate
Click to edit
Master
text
styles
the possibility of infection.
• Second level
•
Third
level
• PPE is only effective if used correctly.
• Fourth level
•
Fifth
level
• The use of PPE does not replace basic
hygiene measures such as hand washing –
hand washing is still essential to prevent
transmission of infection.
62
N-95
Click
to Respirator
edit Master Masks
title style
•
•
•
•
•
Click to edit Master text
styles types of
Different
Second level
N-95 Respirator
Masks
Third level
Fourth level
Fifth level
63
Principles for Using the
N-95
Respirator
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to edit
Master Mask
title style
• Click
edit Master
styles
The
N-95 to
respirator
masktext
is used
to protect health
care
workers,
other patients, staff or visitors by
• Second
level
preventing
potentially infectious microorganisms
• Third level
such as respiratory secretions from:
• Fourth level
Fifth level their face including the nose and
• • Contaminating
mouth.
• Being inhaled or ingested.
64
N-95
Respirator
Mask
Click
to edit
Master title
style
• Click to edit Master text styles
For respiratory
• Second level
protection wear
• Third level
an N-95
• Fourth level
respirator mask
• Fifth level
during all
patient contact
65
Proper use of N-95 Respirator
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Mask
•• DO
Click
NOT
to edit
touch
Master
the front
text styles
of the mask once
masklevel
has been fitted
• the
Second
• Third level
•• Wear
one N-95 mask – no need for
Fourthonly
level
additional
respiratory
protection
• Fifth level
• REMOVE the N-95 respirator mask before
leaving the isolation unit / area
66
WHY
antoN-95
Respirator
Mask?
Click
edit Master
title style
•
•
•
•
•
Click to edit Master text styles
N-95
masks offer a
Second respirator
level
higher
Third
level level of filtration for
Fourth
level
respiratory
secretions than a
Fifth level surgical mask
67
HOW to use an N-95 Respirator
Click to editMask
Master title style
• Use for single shift unless excess moisture
•necessitates
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Master text
styles
replacement
during
each shift or it has
by touching or soiling
•become
Secondcontaminated
level
Label with
• –Third
levelthe wearer’s name
• Fourth level
• Dispose of with medical waste
• Fifth level
NB: You must fit the mask securely over both your
nose and mouth
68
HOW to use an N-95 Respirator
Click to editMask
Master title style
•• Always
correct
Click touse
editthe
Master
textsized
stylesmask.
• Second level
•• The
Thirdincorrect
level size will not fit properly and
will fail the ‘fit test’.
• Fourth level
• Fifth level
NB: You must fit the mask securely over both
your nose and mouth so size is important.
69
N-95
Respirator
Mask
Click
to edit
Master title
style
• This
only
oneMaster text styles
Clickis to
edit
example (brand) of an
• Second level
N95 respirator mask.
•
••
•
Third level
Fourth
level
Other types
of N95
masks
must be fitted
Fifth level
according to the
manufacturers
instructions
70
N-95 Respirator Masks
Click- Fitting
to edit Master
title style
Instructions
Step 1
• Click to edit Master text styles
Cup the respirator
Second
level
in• your
hand
with
the
nosepiece
• Third
level at
your
fingertips
• Fourth level
allowing the
• Fifth levelto hang
headbands
freely below your
hand.
71
N-95 Respirator Masks
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- Fitting Instructions
• Click
Step
2 to edit Master text styles
• Second level
Position the
• Third level
respirator
under
your
chinlevel
with the
• Fourth
nosepiece up.
• Fifth level
72
N-95 Respirator Masks
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to edit Master
title style
Instructions
Step 3
Pull
the top
strap
• Click
to edit
Master text styles
over
your
head
• Second level
resting it high at the
• Third
top
backlevel
of your
head.
Pulllevel
the
• Fourth
bottom
strap
over
• Fifth level
your head and
position it around
the neck below the
ears.
73
N-95 Respirator Masks
Fitting
Instructions
Click
to
edit
Master
title
style
Step 4
Place the fingertips of both
hands
at the
the
• Click
totop
editofMaster
text styles
metal nosepiece. Mould the
• Second
level
nosepiece
to the
shape of
your
nose by
pushing
•
Third
level
inward while moving your
fingertips
• Fourthdown
levelboth sides
of the
•
Fifth
level
nosepiece.
Pinching the nosepiece
using one hand may result
in less effective respirator
performance.
74
N-95 Respirator Masks
- Fitting
Instructions
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to edit Master
title style
Step 5.1
The seal of the respirator
• the
Click
edit Master
on
facetoshould
be fit- text styles
• Second
level
checked
prior
to wearing
in• the
work
area.
Third
level
• Fourth level
Cover the front of the
•
Fifth
level
respirator with both
hands, being careful not
to disturb the position of
respirator.
75
N-95 Respirator Masks
- Fitting
Instructions
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to edit Master
title style
Step 5.2
Positive Fit Test
Exhale
sharply.
positive
• Click
to editA Master
pressure should be felt
• Second level
inside the respirator. If
• Third
level
any
leakage
is detected,
adjust
the position
• Fourth
level of the
respirator and/or tension
•
Fifth
level
of straps. Retest the seal.
Repeat the steps until
the respirator is sealed
properly.
text styles
76
N-95 Respirator Masks
Click- to
edit Master
title style
Fitting
Instructions
Step 5.3 Negative Fit Test
• Click
to edit
Inhale
deeply.
If Master
there is text styles
no
negative
• leakage,
Second the
level
pressure
make the
• Thirdwill
level
mask cling to your face.
• Fourth level
A poor seal will result in
• Fifthloss
level
prompt
of negative
pressure in the mask due to
air entering through gaps in
the seal.
77
When to change your N-95
ClickRespirator
to edit Master
title style
Mask?

If you
the front
of the mask
• Click
to touch
edit Master
text styles
• Second level
• Third

If it islevel
grossly contaminated
• Fourth level
• Fifth level
If it becomes wet
78
Principles for Using Goggles, Gowns,
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to edit
title style
Gloves,
CapsMaster
and Overshoes
• Click to edit Master text styles
Goggles, gowns, gloves, caps and overshoes are
• Second level
used to protect health care workers, by preventing
• Third level
potentially infectious microorganisms from :
• Fourth level
Fifth level their eyes, clothing, hands, hair and
• • Contaminating
shoes and
• Being transmitted to other patients and staff.
79
Goggles
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• Assign one pair to each worker at the
• beginning
Click to edit
of aMaster
shift text styles
• Second level
Third goggles
level in room with SARS patients
•• Wear
• Fourth level
•• Fifth
Leavelevel
in the container in the anteroom at
the end of the shift to be cleaned and
disinfected
80
Goggles
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Master title style
• Click to edit Master text styles
• Second
level
You
should
use
• Third level
goggles to cover
• Fourth level
all
of
the
eye
area.
• Fifth level
81
Gowns
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• Long sleeved gowns must
be worn when in direct
•contact
Clickwith
to edit
the Master
patient text styles
Second
• •Wear
gownlevel
at all times in
patient’s
room
•the
Third
level
• Gowns must be removed
• Fourth level
before leaving the patient’s
•room
Fifthorlevel
dedicated anteroom
• Remove used gowns as
soon as possible particularly
when grossly contaminated
82
Gowns
AClick
new Gown
be worn fortitle
everystyle
patient
to should
edit Master
contact
• Click to edit MasterReusable
text styles
Gowns
Disposable Gowns
If necessary, gowns may be
• Second level
reused during one shift for
• Third
level for
Use
a new gown
the same patient, e.g. when
each
patientlevel
contact.
short of supplies.
• Fourth
Discard immediately if
• Fifth level
Visibly contaminated.
Discard immediately if
visibly contaminated.
Hang gown with outside
facing in when not in use.
Discard at the end of the
shift.
83
Gloves
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• Before all patient
• contact
Click to edit Master text styles
•
••
•
••
Second level
Third level
Before
all cleaning
Fourth level
Before
handling
Fifth level
soiled linen &
waste
84
•
Gloves
Clickaftertocontact
edit with
Master title style
Remove
patients or lab specimens
• Click to edit Master text styles
• • Do
not wear
gloves outside
Second
level
of the patient’s room /
• anteroom
Third level
• Fourth level
• • Do
not re-use
Fifth
level gloves
• Wash hands after removing
your gloves
85
Plastic Disposable Aprons
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• Plastic disposable aprons must be worn
is atext
likelihood
• whenever
Click to editthere
Master
styles of other PPE
such as gowns becoming wet.
• Second level
• Third level
• They are worn to reduce the risk of
• Fourth level
breakthrough and contamination of clothing
• worn
Fifth underneath
level
the PPE.
• They must be disposed of after use.
86
Plastic Disposable Aprons
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to
edit
Master
title
style
Aprons must be worn when :
• Performing patient care activities where
• soiling
Click to
edit
Master
text
styles
or increased moisture is likely;
Second level
•• Cleaning
and disinfecting the patient
• environment.
Third level
•• Cleaning
and disinfecting medical; other
Fourth level
patient care equipment.
• Fifth level
• Laundering used linen.
• Cleaning and disinfecting the cleaning
equipment.
87
Caps
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Caps are optional and
worn
to protect
hair text styles
• Click
to editthe
Master
from aerosols that may
• Second level
occur from high risk
• Third level
procedures
such as
intubation
• Fourth or
level
bronchoscopy
• Fifth level
88
Overshoes
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Overshoes are
•optional
Click toand
editworn
Master
to text styles
• Second
level
protect
the
health
care
worker’s
• Third
level shoes
and
feet
from
being
• Fourth level
splashed by spills
• Fifth level
such as blood or
other body fluids or
aerosols
89
•
Key Points
Click
edit Master
titledisposable
style
Wear
N-95 to
respirator
mask, goggles,
gowns, gloves (and hats, overshoes – optional in
high risk situations) for all patient contact &
•aprons
Click when
to edit
Master text styles
necessary
• Second level
• •Wash
Thirdhands
levelusing soap (preferably liquid) and
water when leaving the anteroom
• Fourth level
Fifth
levelalcohol-based hand rub solution after
• •Use
an 70%
hand washing
• Wash hands when leaving the unit
90
Personal Protective Equipment for SARS
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•
•
•
•
•
Click to edit Master text styles
Second level
Third level
Fourth level
Fifth level
91
Patient Transport
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It is essential to avoid all unnecessary
• Click to edit Master text styles
transport of isolated SARS patients to
•control
Secondand
level
prevent the potential spread of
•SARS
Thirdinfection.
level
• Fourth level
• Fifth level
92
Patient Transport
If the patient needs to be out of their room for an
Click
to
edit
Master
title
style
essential procedure, e.g. X-Ray
•
•
•
•
•
Transport
route
must avoid
Click
to edit
Master
textpopulated
styles areas.
levelwear an N-95 respirator mask (standard
–Second
Patient must
surgical masks can be used by patients if N-95
Third
levelmasks are not tolerated or are in insufficient
respirator
supply)level
and an isolation gown.
Fourth
–Fifth
Accompanying
level staff must wear :
–
•
N-95 respirator mask
• Gloves
• Gown
• Goggles
93
•
Patient Transport
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to edit Master title style
Transport
–
No dedicated ambulance needed
edit (N-95
Master
text styles
–Click
Maskto
patient
respirator
mask)
– Transporters wear personal protective equipment
Second level
•
•
 N-95 respirator mask, disposable gown, goggles, gloves
Thirdand
level
• • Clean
disinfect ambulance after transport
• –Fourth
level
Standard
cleaning and disinfecting
or
• Fifth level
1:100 dilution of bleach; after 10 minute contact time,
clean and disinfect using standard procedures.
DO NOT use spray cleaners
94
Patient, Family & Community
Click to edit
Master title style
Education
• •Education
forMaster
the patient,
their family and
Click to edit
text styles
community
•the
Second
level is essential in the control and
prevention of the SARS Virus.
• Third level
• Fourth level
• It is particularly essential for those persons
• Fifth level
requiring hospital or home isolation to
understand the necessary restrictions.
95
Patient, Family & Community
Click to edit
Master title style
Education
Explain:
• Click to edit Master text styles
• What SARS is (to date)
•
•
•
•
•
•
Second level
Third level
Why isolation is required.
Fourth level
Fifth level
Precautions required including PPE
• Hand washing procedures
96
Patient and Family Education
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• Teach the patient and family members:
• Click to edit Master text styles
– about the SARS illness
• Second level
and
the reason
• –Third
levelfor the precautions being used
• Fourth level
• Teach the patient and visiting family members:
• Fifth level
–
–
how to perform hand hygiene
how to wear an N-95 respirator mask, gown, gloves and
goggles (if available)
97
Patient and Family Education
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Explain to the patient and family why
• Click to edit Master text styles
disposable equipment is being used
• Second level
such as:
• Third level
• Fourth level
• Eating utensils
• Fifth level
• Medical equipment
• Patient gowns
98
Laboratories
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• Laboratory staff must ensure that their
• practices
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Master
text
styles
are meticulous.
• Second level
• Third level
• Fourth level
• Fifth level
99
Click to edit Master title style
Laboratories
• Click to edit Master text styles
• Second level
• •Advance
Third levelplanning in each
• designated
Fourth levellaboratory is essential to
ensure that specimen handling,
• Fifth level
transportation and storage is
managed according to the guidelines.
100
Bio Safety for SARS in
Click toLaboratories
edit Master title style
The following activities may be performed in biosafety
•level
Click
to edit facilities
Master text
2 (BSL-2)
withstyles
appropriate work
•practices
Second level
• •Routine
tests
Third diagnostic
level
• •Manipulations
Fourth level involving known inactivated viru
and/or incomplete, non-infectious portions of the
• Fifth level
viral genome
• Routine examination of mycotic and bacterial
cultures
• Final packing of specimens for transport
101
Bio Safety for SARS in
Click toLaboratories
edit Master title style
Precautions for BSL-2 labs
• Click
edit Master
text styles
biological
safetyto
cabinet
for any procedure
that may generate
aerosols
• Second level
• PPE•toThird
be worn:
level
•disposable gloves
• Fourth level
• solid-front or wrap-around gowns with cuffed sleeves
• Fifth
level
• eye
protection
• surgical mask, or full-face shield, according to the risk of
aerosols and exposure
• When working at a biological safety cabinet, a full face
shield is not necessary.
102
Bio Safety for SARS in
Click toLaboratories
edit Master title style
Precautions for BSL-2 labs
• Click to edit Master text styles
•Use sealed centrifuge cups – unload in a safety cabinet
• Secondwork
level
•Decontaminate
surfaces and equipment
• Third
level
•Biological
waste
should be treated as outlined in the WHO
Laboratory Biosafety Manual – 2nd Edition (Revised), 2003
• Fourth level
• Fifth level
103
Bio Safety for SARS in
Click toLaboratories
edit Master title style
BSL-3 facilities & BSL-3 work practices are required
• Click to edit Master text styles
for:
••Viral
Second
level
cell culture of the etiologic agent
••Manipulations
Third level involving growth or concentration of the
•etiologic
Fourthagent.
level
When
a procedure
• Fifth
level or process cannot be conducted within a
biological safety cabinet, then appropriate combinations of
personal protective equipment (e.g., respirators, face shields) and
physical containment devices (e.g., centrifuge safety cups or sealed
rotors) must be used.
104
Specimen Collection
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•
•
•
•
••
••
••
•
Wear full PPE
Click to edit Master text styles
Write clinical details on the request form
Second level
Samples
should be collected by clinical staff
Third level
Label
clinical samples clearly
Fourththe
level
Change
PPE between patients
Fifth level
Discard all disposable materials in a
biohazard bag
105
Storage of Specimens
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•
•
•
•
•
•
•
Respiratory samples and frozen tissues:
Click to edit Master
text styles
o
– store at –70 C
Second level
Third
level
Serum:
Fourth
level o
– store at 4 - 8 C for 24-48 hours
Fifth level
or
–
at -20oC for longer periods
106
Patient Specimens
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• Treat all
•
•patient
Click to edit Master text styles
specimens as
• Second level
highly
•infectious
Third level
•
• Fourth level
Fifth
• •Use
leaklevel
proof
containers for
collection
Do not
contaminate
outside of
container
Transport
specimens in
leak-proof
outer
containers e.g.
a sealed
plastic bag
107
Mortuary Precautions
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Health care workers must wear full PPE:
(N-95
respirator
mask,
Goggles,
Gown, Gloves)
• Click
to edit
Master
text styles
• Second
level
Health
Care
Workers must:
level
• Third
Prepare
the body
level
• Fourth
Place in
a body-bag or leak-resistant bag
• Fifth level or
 Place in plastic sheeting, wrap the body and
tape/seal with waterproof adhesive tape
108
Mortuary Precautions
tobeedit
Master
title (3°C
style:
The Click
body must
placed
in cold storage
+/- 2°C ) as soon as possible after the body is
• Click and
to edit
Masterintext
styles
prepared
wrapped
a bag
or plastic sheeting.
• Second level
The
need for
a post mortem must be discussed
• Third
level
with
the designated
• Fourth
level national laboratory as there
are potential infection risks for personnel during a
• Fifth level
post mortem.
Post mortems must be performed wearing full PPE
109
Mortuary Care
Click
to deference
edit Master
titletostyle
Although
all due
must be given
local
cultural and religious customs associated with the
death
of ato
member
of the community,
• Click
edit Master
text stylesthe following
must
be considered
• Second
level to minimize the potential risk of
spread of the SARS Virus.
• Third level
• The body must not be embalmed, to reduce
• Fourth
level
exposure
risk.
•• Fifth
The need
levelfor cremation with minimal delay.
• The delaying of a ‘wake’ to celebrate the life of the
individual until all close contacts and possible
secondary contacts are cleared.
110
Linen & Laundry
ClickWaste
to editManagement
Master title style
• Health care and laundry workers must understand
importance
of handling
correctly to
• the
Click
to edit Master
textlinen
styles
prevent the spread of potentially infectious
• microorganisms
Second level
•
••
•
Third level
Linen
canlevel
be washed using routine laundry
Fourth
practices.
Fifth level
• The health care facility should follow routine
waste management practices but all waste must be
incinerated.
111
Linen
Click to edit Master title style
All contaminated or
soiled linen is potentially
• Click to edit Master
infectious therefore:
text styles
• Second level
• • Wear
fulllevel
PPE when handling
Third
linen.
• Fourth level
Fifth level
• • Separate
grossly contaminated
linen from non- contaminated
linen in the patient’s room for
ease of handling in the laundry.
112
•
Laundry
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to
edit
Master
title
style
Place in color-coded bags and double bag for
transport.
Click
to edit
text styles
• •Do
not sort
linenMaster
in the laundry
to avoid the
aerosols.
•creation
Secondoflevel
• •Staff
handling
Third
level linen should wear full PPE as per
standard procedures for SARS.
• Fourth level
• Use routine detergents.
• Fifth level
Bleach may be added if desired, and
compatible with the detergent being used.
113
Waste
Click to edit Master title style
•
•
•
•
•
•
•
Wear full PPE when handling waste.
Click to edit Master text styles
Second level
Clinical waste: all items from treatment
Third level
areas
Fourth
level
– Soiled surgical dressings
Fifth
level
– Swabs
–
Masks
– Gowns
– Other contaminated waste
114
•
Waste
Sharps
ClickContainers.
to edit Master title style
Click towaste
edit Master
text styles
•• Collect
in designated
color-coded
• plastic
Secondbags
levelfor incineration.
• Third level
Fourth level
•• Double
bag for transport.
• Fifth level
• Contact the local authorities for assistance
if the health care facility does not have
incineration facilities.
115
Sharps Disposal
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Disposal containers should be puncture-resistant
and leak- proof.
•
•
•
•
•
•
••
Click to edit Master text styles
Second level
Do not overfill container
Third
level
Do not reach into
Fourth level
container
Dispose
of used sharps
Fifth level
into the sharps container
116
Cleaning & Disinfecting the Hospital
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to edit Master
title style
Environment
and Equipment
• Cleaning is usually sufficient for prevention and
• control
Click to
Master
styles infection the use
of edit
infection,
buttext
for SARS
a disinfectant
• ofSecond
level following cleaning is
recommended
level to clean thoroughly before
• • ItThird
is essential
the environment or equipment.
• disinfecting
Fourth level
• Cleaning and disinfection must be carried out at
• least
Fifthdaily
level
and particularly when gross
contamination occurs.
• In some instances it may be necessary to disinfect
to render the item safe to handle.
117
Cleaning & Disinfecting the Hospital
Click
to edit Master
title style
Environment
and Equipment
•
•
•
•
•
Click to edit Master text styles
Cleaning and disinfecting patient
Second level
rooms and equipment is one of the best ways
Third level
to reduce transmission of infection
Fourth level
Fifth level
Wear full PPE when cleaning and
disinfecting
118
Cleaning & Disinfecting the Hospital
Click
to edit Master
title style
Environment
and Equipment
• To communicate infection
risk, use signs.
• Click to edit Master text styles
eg. SARS Isolation
• Second level
Third patients
level & staff by:
• •Protect
• Fourth level
and disinfecting
•- Cleaning
Fifth level
equipment.
- Cleaning and disinfecting
the room and anteroom.
119
Cleaning & Disinfecting the Hospital
Environment
and Equipment
Click
to edit Master
title style
Click
to edit Master
text styles
•• The
immediate
area around
patients
must be
heavily contaminated.
• considered
Second level
• Third level
• Bedside table, bed stand, and accessible areas of
• bed
Fourth
level must be cleaned with detergent
and floors
warm
• and
Fifth
levelwater at least daily (preferably twice a
day).
•
In addition, disinfect all surfaces after cleaning.
120
Cleaning & Disinfecting the Hospital
Environment
and Equipment
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to edit Master
title style
• Contain and dispose of infectious materials in
:
• waste
Clickcontainers
to edit Master
text styles
– Put waste containers near entrance / exit to
• Second
patientlevel
room.
• Third level
• • Provide
patient equipment when
Fourth dedicated
level
possible.
• Fifth level
• Clean and disinfect patient care equipment
immediately after use depending on the type of
equipment.
121
Cleaning & Disinfecting the Hospital
Click
to edit Master
title style
Environment
and Equipment
Use
standard
procedures
and agents
• Click
to edit
Master text
styles for cleaning
And disinfecting environmental surfaces and
• Second level
patient care equipment.
• Third level
Fourth
level and warm water, rinse in hot
• • Use
detergent
• water
Fifthand
level
dry.
• Use disinfectant afterwards.
122
Cleaning & Disinfecting the Hospital
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to edit Master
title style
Environment
and Equipment
• When areas and inanimate objects are
• grossly
Click tocontaminated
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styles
use:
• –Second
level hypochlorite (bleach) solution
1:100 sodium
to disinfect
• Third
level (before cleaning)
– it will reduce the viral load and the potential
• Fourth
level to spread.
for infection
• Fifth level
• Then use the standard cleaning and
disinfecting procedures mentioned
previously.
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Cleaning & Disinfecting the Hospital
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title style
Environment
and Equipment
•
All reusable patient items such as basins and
• bedpans
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be: text styles
•
•
•
•
Second level

Cleaned
and disinfected before being used on another
Third
level
patient
Fourth level

Taken
to the dirty utility room for cleaning
Fifth
level
Staff should wear full PPE when handling
contaminated equipment.
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Cleaning & Disinfecting the Hospital
Environment
and Equipment
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to edit Master
title style
•
DO NOT spray clean the room / area.
• Click to edit Master text styles
Why?
• Second level
Because it:
• Third level
– Spreads droplets
• Fourth level
• –Fifth
level aerosols
Spreads
–
Is not effective as a surface disinfectant
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