Infection Prevention and Control for Epidemic- and Pandemic-Prone Acute Respiratory Diseases

1. Infection Prevention and Control for Epidemic- and Pandemic-Prone Acute Respiratory Diseases

2. Describe basic infection-control principles. Discuss core infection-control measures in health-care settings. Learning Objectives

3. Presentation Overview • Basic infection control principles • Core infection control measures used in health care settings

4. Basic Infection Control Principles

5. Basic infection control measures reduce risk of transmission of pathogens from a known or unknown source Aim of Infection Control

6. Routesof transmission Portal of entry into host Quantity of pathogen Virulence Chain of Infection + Susceptible host

7. Routes of Transmission • Contact: Infections spread by direct or indirect contact with patients or the patient-care environment(e.g., shigellosis, viral hemorrhagic fevers) • Droplet: Infections spread by large droplets generated by coughs, sneezes, etc. (e.g., Neisseria meningitidis, pertussis) • Airborne (droplet nuclei): Infections spread by particles that remain infectious while suspended in the air (TB, measles, varicella, and variola)

8. Breaking the Chain of Infection • Source control measures • -Cough etiquette, cleaning, disinfection • Modes of transmission • -Contact: hand hygiene • -Droplet: distance from source >1 m • -Airborne: ventilation • -Vector: bednets • Portal of entry into the host • -Adding barriers, e.g., PPE • Host • -Strengthen host defences, e.g., vaccination

9. Transmission of Epidemic- and Pandemic-Prone Acute Respiratory Diseases

10. Core Infection Control Measures in Health Care Settings

11. Early recognition and reporting Infection control precautions Hand hygiene: alcohol-based hand rub, hand washing PPE: gloves, gowns, masks/respirators, eye protection Core Infection Control Measures in Health Care Settings (1)

12. Patient accommodation Environmental cleaning and waste disposal Occupational health management Core Infection Control Measures in Health Care Settings (2) WHO

13. Prevention is Primary CDC

14. Early Recognition in Health Care Facilities Health care facility staff must quickly identify and separate potential sources of infection from susceptible hosts

15. Rapid identification of Patients with Epidemic- or Pandemic-Prone Acute Respiratory Diseases: Clinical indications Severe acute febrile respiratory illness (e.g., fever > 38°C, cough, shortness of breath) Exposure history consistent with ARD of potential concern Epidemiological indications History of travel to area affected by ARDs Possible occupational exposure Unprotected contact with ARDs patient(s) How to identify rapidly

16. Standard precautions Should be applied for ALL patients Transmission-based precautions* Contact Droplet Airborne Infection Control Precautions *Transmission-based precautions are often used empirically, according to the clinical syndrome and the likely etiological agent

17. Standard Precautions • Hand hygiene • Respiratory hygiene/cough etiquette • Use of personal protective equipment (PPE) • Prevention of needle sticks/sharps injuries • Cleaning and disinfection of the environment • and equipment

18. Protection against respiratory pathogens transmitted by large droplets In addition to Standard Precautions: Use a medical mask when < 1 m of patient Maintain a distance ≥ 1 meter between infectious patient and others Place patient in a single room or cohort with similar patients Limit patient movement Droplet Precautions

19. Protection against contact with large droplets In addition to Standard Precautions: Use non-sterile, clean, disposable gloves, gown, apron (only if gown is not impermeable) Use disposable or dedicated reusable equipment (which must be cleaned and disinfected before use on other patients) Limit patient contact with non-infected persons Place patient in a single room or cohort with similar patients Contact Precautions

20. Protection against inhalation of tiny infectious droplet nuclei In addition to Standard Precautions: Use particulate respirator Place the patient in adequately ventilated room (≥ 12 air changes per hour) Limit patient movement Use airborne precautions for performance of any aerosol-generating procedures associated with pathogen transmission Airborne Precautions

21. Hand Hygiene • Hand hygiene should be performed: • before and after any direct contact with a patient • after contact with blood, body fluids, secretions and excretions • after contact with items contaminated with blood, body fluids, secretions and excretions, including respiratory secretions • Use alcohol-based hand rub or wash hands with soap and water • Wash hands if visibly soiled

22. Part of standard precautions Education of health care workers, patients and visitors Source control measures (e.g., cover cough to prevent dissemination of infectious droplets) Hand hygiene Spatial separation (> 1 meter) of persons with acute febrile respiratory symptoms Respiratory Hygiene and Cough Etiquette

23. Personal Protective Equipment Courtesy of K. Harriman

24. Types of PPE Used in Healthcare Settings • Gloves – protect hands • Gowns/aprons – protect skin and/or clothing • Masks and respirators– protect mouth/nose • Respirators – protect respiratory tract from airborne infectious agents • Goggles – protect eyes • Face shields – protect face, mouth, nose, and eyes

25. IF direct contact with blood & body fluids, secretions, excretions, mucous membranes, non-intact skin Gloves Gown IF there is the risk of spills onto the body and/or face Gloves Gown Face protection (mask plus eye protection goggle or visor; face shield) PPE for Standard Precautions: Based on Risk Assessment

26. Used in addition to Standard Precautions Contact Precautions Gloves Gown Droplet Precautions Medical mask Airborne Precautions Particulate respirator PPE for Transmission-Based Precautions +

27. Masks and Respirators: Barriers and Filtration • Surgical masks • Protect against body fluids and large particles • Particulate respirators (e.g., N95) • Protect against small particles and other airborne particles • Alternative materials (barriers) • Tissues, cloth

28. PPE for Persons Providing Care for Patients with Acute Febrile Respiratory Illness, Including Patients with Suspected or Confirmed AI Infection

29. Asymptomatic exposed persons and contacts (low-risk) Routine use of PPE not recommended Maintain 1 meter distance between interviewer and interviewee Use proper hand hygiene Symptomatic exposed persons (higher-risk) PPE recommended in community and health care facility: Contact and Droplet Precautions In health care facility, person should be placed in adequately ventilated room (≥ 12 air changes per hour), if possible Maintain a distance of > 1 meter, if possible PPE for Interviewing Exposed Persons and Contacts of ARDs Patients

30. Collecting respiratory specimens is a high-risk, aerosol-generating procedure PPE recommended Gloves Gown Goggles or face shield N95 or higher level respirator PPE for Specimen Collection – Exposed Persons CDC

31. Patient Accommodation • Isolate patients with droplet or airborne spread diseases from other patients • Separate wards, areas, or establish rooms for infectious patients where isolation facilities do not exist • Only those patients with epidemiological and clinical information suggestive of a similar diagnosis should share rooms • Separate patients by at least 1 meter

32. Patient accommodation: Natural Ventilation Room 1 meter

33. Adults and adolescents > 12 years of age – from time of admission until 7 days after symptoms resolved Infants and children ≤ 12 years of age – from time of admission until 21 days after symptoms resolved For immunocompromised patients, pathogen shedding may be protracted Duration of IC measures for Avian and Pandemic Influenza

34. Environmental Cleaning and Waste Disposal • Environmental cleaning: • Use appropriate procedures for the routine cleaning and disinfection of environmental and other frequently touched surfaces • Waste disposal: • Treat waste contaminated with blood, bodily fluids, secretions and excretions as clinical waste, in accordance with local regulations WHO

35. Use Standard Precautions Gloves and hand washing Gown + Eye protection Avoid aerosolization Prevent spills and leaks Double bag if outside of bag is contaminated Incineration is usually the preferred method Waste Disposal

36. Autopsy Precautions for Influenza A (H5N1) • Follow standard PPE procedures for autopsies • Anyone handling a corpse should follow standard precautions for blood and body fluids

37. Monitor staff who work with patients with an infectious disease of potential concern for symptoms Screen for symptoms of influenza-like illness among staff reporting for duty (fever, cough) Occupational Health Management During an Outbreak WHO

38. Early recognition and reporting Infection control precautions Hand hygiene PPE: gloves, gowns, masks/respirators, eye protection Patient accommodation Environmental cleaning and waste disposal Occupational health management Implementation of Core Infection Control Measures During Rapid Containment

39. Apply standard precautions routinely in all health-care settings Place all patients (suspected or confirmed with an infectious ARD) in a room or area separate from other patients Practice both standard and droplet precautions when caring for patients with infectious ARD Hospital Preparedness: Key Points

40. Important Components for HC Facility Infection Prevention and Control Program • Available supplies and equipment (PPE, disinfectants) • Policies and guidelines for procedures • Ongoing educational programs for healthcare facility staff • Process for monitoring staff health to identify and to prevent staff-to-patient and patient-to-staff spread of infection Jamaica IC Guidelines

41. Infection Control for ARD in Heath Care Settings Infection control precautions Patient Standard and droplet precautions Symptoms acute ILI + Risk Factor Single room adequately ventilated, if possible Investigation for ARD of potential concern Report to Public Health Authorities Reassess precautions Different diagnosis Confirmed ARD of potential concern Single room adequately ventilated (≥ 12 air changes per hour), if possible WHO

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

43. Household bleach (diluted) Quaternary ammonia compounds Chlorine compounds (Chloramin B, Presept) Alcohol Isopropyl 70% or ethyl alcohol 60% Peroxygen compounds Phenolic disinfectants Germicides with a tuberculocidal claim on label Others Environmental Decontamination: Disinfecting

44. First clean organic material from surfaces or items Wipe nonporous surfaces with sponge or wet cloth Allow to dry Use fresh diluted bleach daily! Using Bleach Solutions