Protecting Health Care Workers: Infection Control in a Pandemic

1. Protecting Health Care Workers: Infection Control in a Pandemic Brian Schwartz MD Director, Sunnybrook Osler Centre for Prehospital Care Scientific Advisor, Emergency Management Unit MOHLTC

2. Objectives • Definitions • Infection control • Infection control in a pandemic • Personal Protective Equipment • What now?

3. 1. Definitions (CPIP): “Clinical” Influenza: • Acute onset of fever (usually >38o C) and cough • Sore throat, rhinorrhea, malaise, chills, myalgia & headache may be present • Higher predictive value when ‘flu is present in the community

4. Definitions (CPIP): “Confirmed” Influenza: • Laboratory confirmation or • Clinical case with epi link to a lab confirmed case

5. Definitions (CPIP): “Influenza-Like-Illness”: • Acute onset of respiratory illness with fever (>38 C) and cough and with one or more of: • Sore throat, arthralgia, myalgia or prostration which could be due to influenza virus (no other cause identified)

6. 2. Infection Control A mighty creature is the germ, Though smaller than the pachyderm His strange delight he often pleases By giving people strange diseases Ogden Nash

8. Influenza A virus • Transmission in droplets > 5 microns • Incubation period 1-3 days • Infectious from day before symptoms for 3-5 days after (7 in children) • Virus survives 5 minutes on hands, 12 hours on cloth, 1-2 days on surfaces

9. Infection Control • Health care settings are encouraged to implement policies to limit unprotected contact with infected patients including:

10. Infection Control • Minimizing crowding and maintaining one metre separation between patients • Accommodating patients with symptoms in a separate area away from other patients • Cohorting influenza patients in areas with other influenza patients

11. Routine &Droplet Precautions • Accessible hand hygiene stations and signage • Encouraging “cough etiquette” [cover mouth with hand (then wash)] or tissue

12. 3. Infection Control in a Pandemic • Cohorting patients will be a priority • Patients who have ILI should be segregated from others • Ideally ILI patients should be cared for by immune or prophyllaxed HCW’s • HCWs should wear PPE (unless they have seroconverted or are on prophylaxis)

13. Routine &Droplet Precautions • Hand hygiene (i.e., washing hands or using alcohol based hand rub or sanitizer: before seeing the patient, after seeing the patient and before touching the face, and after removing and disposing of personal protective equipment)

14. Personal Protective Equipment What is a person to do?

15. This?

16. This?

17. This?

18. These?

19. Or This?

20. Personal Protective Equipment Health care workers (HCWs) use routine & droplet precautions with patients presenting with FRI/ILI:

21. Droplet Precautions • A surgical mask covering the user’s nose and mouth when providing direct care • Eye protection when providing direct care

22. Droplet Precautions • Interaction with patient that minimize contact with droplets (e.g., sitting next to rather than in front of a coughing patient when taking a history or conducting an examination)

23. Routine &Droplet Precautions • Hand hygiene (i.e., washing hands or using alcohol based hand rub or sanitizer: before seeing the patient, after seeing the patient and before touching the face, and after removing and disposing of personal protective equipment)

24. Contact & Droplet Precautions • Appropriate gloves when they are likely to have contact with body fluids or to touch contaminated surfaces • Gowns during procedures when clothing might be contaminated

25. PPE Removal • Remove gloves • Remove gown (if applicable) • Hand hygiene for 15 seconds • Exit room

26. PPE Removal • Hand hygiene for 15 seconds • Remove protective eyewear • Remove mask • Hand hygiene for 15 seconds

27. Don’t Forget…. • Contact precautions (gloves, gowns if appropriate and hand hygiene) for managing/disposing of equipment and cleaning/disinfecting the environment

28. What about a mask for the patient? We may not have enough and masks for HCWs are more important if patients are cohorted

29. Key points about protecting patients: • The same precautions used to protect health care workers will also protect patients • Hand hygiene is essential in preventing the spread of influenza

30. Key points about protecting patients: • Health care workers should encourage all patients to practice hand hygiene and use a “cough etiquette”- mask or tissue to cover their mouth when coughing • If patients see health care workers using such precautions consistently, they are more likely to do the same

31. So what do we do now? • Practice excellent infection control day to day • Get your ‘flu shot • Read the relevant sections of OHPIP on the beach during your vacation

32. Questions: Thank You