780 likes | 1.05k Views
Principles of Infection Control and Personal Protective Equipment. 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
E N D
Principles of Infection Control and Personal Protective Equipment
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)
Session Overview • Routes of disease transmission • Infection control methods and personal protective equipment (PPE) • Infection control precautions • How to put on and remove PPE
Remember… Your first obligation is to protect yourself! If you have any doubt about your safety in any situation, avoid that situation!
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
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
Route of transmission Port Quantity of pathogen Virulence Chain of Infection + Sensitive host
Routes of Transmission • Respiratory • Cough • Sneeze • Fecal-oral • Feces contaminate food, environment, or hands • Vector-borne • Transmitted by insects or other animals
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:
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
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)
Video clip from The Great Fever
Infection Control Methodsand Personal Protective Equipment(PPE)
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
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
Types of PPE • Gloves • Gowns • Masks • Boots (for agricultural settings, not used for human healthcare) • Eye protection
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
Types of PPE Gowns or Coveralls • Fully cover torso • Have long sleeves • Fit snuggly at the wrist • Coveralls may have hood and/or boots
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
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)
Types of PPE Boots (non-hospital settings) • Eye Protection • Face shields • Goggles
PPE Supplies • Maintain adequate, accessible supplies • Creative alternatives (studies not done to asses effectiveness) • Mask: tissue, scarf • Gown: laboratory coat, scrubs
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
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: • 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
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
Environmental Decontamination • Cleaning MUST precede decontamination • Disinfectant ineffective if organic matter is present • Use mechanical force • Scrubbing • Brushing • Flush with water
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
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.
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!
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
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
Preventing Transmission in the Community • Respiratory etiquette • Cover nose / mouth when coughing or sneezing • Hand washing!
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 • Use for suspected or actual • Tuberculosis • Measles • Varicella • Variola • Avian Influenza
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
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
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
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