Principles of Infection Control and Personal Protective Equipment

1. Principles of Infection Control and Personal Protective Equipment

2. Learning Objectives • Learn principles of infection control: how to protect yourself and others • Spot problems with infection control procedures • Recognize ways to deal with such problems in different situations • Learn to select and use appropriate personal protective equipment (PPE)

3. Session Overview • Routes of disease transmission • Infection control methods and personal protective equipment (PPE) • Infection control precautions • How to put on and remove PPE

4. Remember… Your first obligation is to protect yourself! If you have any doubt about your safety in any situation, avoid that situation!

5. Glossary Decontamination (“decon”)- 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

6. Glossary (cont’d) Infection control - Measures practiced by health care personnel in health care facilities to prevent the spread of infectious agents Personal protective equipment (PPE)- Specialized clothing or equipment worn by a worker for protect from a hazard

7. Routes of Disease Transmission

8. Route of transmission Port Quantity of pathogen Virulence Chain of Infection + Sensitive host

9. Routes of Transmission • Respiratory • Cough • Sneeze • Fecal-oral • Feces contaminate food, environment, or hands • Vector-borne • Transmitted by insects or other animals

10. Direct Contact Host comes into contact with reservoir Kissing, skin-to-skin contact, sexual intercourse Contact with animal, soil, or vegetation Indirect Contact Disease is carried from reservoir to host Contaminated surfaces (fomites) Routes of TransmissionContact Examples:

11. Routes of TransmissionDroplet Large droplets within ~1 meter (3 feet) transmit infection via: • Coughing, sneezing, talking • Medical procedures Examples: • Diphtheria • Pertussis (Whooping Cough) • Meningococcal meningitis

12. Routes of TransmissionAirborne (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)

13. Transmission of Influenza Viruses

14. Video clip from The Great Fever

16. Infection Control Methodsand Personal Protective Equipment(PPE)

17. 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

18. 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

19. Personal Protective Equipment (PPE) • When used properly can protect you from exposure to infectious agents • Know what type of PPE is necessary for the duties you perform and use it correctly

20. Types of PPE • Gloves • Gowns • Masks • Boots (for agricultural settings, not used for human healthcare) • Eye protection

21. Types of PPE Gloves • Different kinds of gloves • Housekeeper gloves • Clean gloves • Sterile glove • Work from clean to dirty • Avoid “touch contamination” • Eyes, mouth, nose, surfaces • Change gloves between patients

22. Types of PPE Gowns or Coveralls • Fully cover torso • Have long sleeves • Fit snuggly at the wrist • Coveralls may have hood and/or boots

23. Types of PPE Masks and Respirators: Barriers and Filtration • Surgical masks • Cotton, paper • Protect against body fluids and large particles • Particulate respirators (N95) • Fit testing essential • Protect against small droplets and other airborne particles • Alternative materials (barrier) • Tissues, cloth

24. Types of PPE Particulate Respirators • Three types: disposable, reusable, powered air purifying respirators • Disposable Particulate Respirators • Classified N95, N99, N100, R95, R99, R100, P95, P99, P100 • Letter indicates oil resistance: N = not resistant, R = somewhat resistant, P = strongly resistant • Number is percent of airborne particles filtered (e.g. N95 filters 95% of particles)

25. Types of PPE Boots (non-hospital settings) • Eye Protection • Face shields • Goggles

26. PPE Supplies • Maintain adequate, accessible supplies • Creative alternatives (studies not done to asses effectiveness) • Mask: tissue, scarf • Gown: laboratory coat, scrubs

27. Working with Limited Resources • Avoid reuse of disposable PPE items • Consider reuse of some disposable items only as an urgent, temporary solution • Reuse only if no obvious soiling or damage • When prioritizing PPE purchase • Masks • Gloves • Eye protection

28. Infection Control Precautions

29. Precaution Levels All levels require hand hygiene • Standard Transmission based precautions: • Contact • Droplet • Airborne

30. 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

31. PPE for Standard Precautions Wear: • Gloves • Gowns • Eye Protection and / or Mask • If: • Touching • Respiratory secretions • Contaminated items or surfaces • Blood & body fluids • Soiling clothes with patient body fluids, secretions, or excretions • Procedures are likely to generate splashes / sprays of blood, body fluids, secretions, excretions

32. 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

33. 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

34. 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

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

36. 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

37. Using Bleach Solutions 1 • First, clean organic material from surfaces or items – wash with soap or detergent and water, rinse, dry. • The CDC recommends using 5 tablespoons of liquid bleach per gallon of water. • Leave nonporous surfaces (tile, metal, hard plastics, etc.) wet at least 10 minutes and allow to air dry.

38. Using Bleach Solutions 2 • Leave porous surfaces (wood, rubber, soft plastics, etc.) wet for 2 minutes. Rinse and air dry. • Use household chlorine bleach (5.25 - 6% sodium hypochlorite); do not use scented or color safe bleaches. • Use fresh diluted bleach daily! • Wear gloves and eye protection!

39. Waste Disposal • 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

40. Managing Linens and Laundry • Use Standard Precautions • Gloves and hand hygiene • Gown • Mask • Avoid aerosolization – do not shake • Fold or roll heavily soiled laundry • Remove large amounts of solid waste first • Place soiled laundry into bag in patient room • Wash with normal detergent

41. Preventing Transmission in the Community • Respiratory etiquette • Cover nose / mouth when coughing or sneezing • Hand washing!

42. Droplet Precautions • Prevent infection by large droplets from • Sneezing • Coughing • Talking • Examples • Neisseria meningitidis • Pertussis • Seasonal influenza

43. 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

44. Airborne Precautions Taken in addition to Standard Precautions • Prevent spread of infection through inhalable airborne particles • Use for suspected or actual • Tuberculosis • Measles • Varicella • Variola • Avian Influenza

45. 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

46. Negative Pressure Isolation Room

47. Natural Ventilation Cohorting Room 1 meter

48. Avian Influenza • Currently not easily transmitted human to human • Routes of transmission to humans not known, cannot rule-out any routes • Current transmission from poultry to human or human to human for H5N1 requires very close contact

49. Interviewing - Asymptomatic Exposed Persons and Contacts • Low-risk activity • Routine use of PPE not recommended • Maintain 3 feet distance between interviewer and interviewee • Use proper hand hygiene • May use hand sanitizer (at least 60% alcohol) if hands not visibly soiled

50. Interviewing - Symptomatic Exposed Persons • Higher risk activity • PPE recommended in community and healthcare facility • Contact precautions • Droplet precautions • N95 respirator • In healthcare facility, person should be placed in airborne isolation room • Maintain a distance > 3 feet if possible