Infection Prevention in the Workplace

1. Infection Prevention in the Workplace Next Slide Exit

2. 1. Disease Definitions 2. Infectious Disease Examples 3. Highlight: Influenza 3.1 What is Influenza 3.2 Types of Influenza 3.3 Transmission and symptoms 3.5 Influenza vs. Common Cold 4. Routes of Exposure 5. Types of Transmission 6. Infection Prevention in the University Setting 6.1 Watch for Signs and Symptoms 6.2 Hand Hygiene 6.3.1 Easy to Miss Spots 6.3.2 Proper Handwashing Technique 6.2.3 Alcohol-Based Waterless Hand Sanitizers 6.2.4 When to use Hand Hygiene 6.2.5 Disinfection 7. Review COURSE OUTLINE

3. INTRODUCTION The School of Rural Public Health at the Texas A&M Health Science Center cares about keeping employees and students healthy. No one likes to catch a respiratory illness or other infectious disease from someone at work. Germs can spread rapidly in an office or other workplace setting so it is very important to stay informed and active in protecting yourself and others from the common cold, flu, and other infectious diseases. We all know that simple steps like hand washing are most important in preventing infection but sometimes it is easy to forget exactly how to stay healthy, especially with increased stress at work and school. This course is intended to be a reminder about how to prevent the spread of infectious diseases and maintain a healthy environment in the university setting.

4. DISEASE DEFINITIONS Infectious Disease a disease that is caused by microorganisms such as bacteria, fungi, viruses, protozoa, and parasites that can successfully spread, invade, establish, and grow within a host’s tissues Contagious Disease an infectious disease that is easily transmitted from one person to another

5. INFECTIOUS DISEASE EXAMPLES • Influenza • Cold • Tuberculosis • Chicken Pox • Meningitis • Severe Acute Respiratory Syndrome (SARS) • Salmonellosis and other foodborne illnesses • Human Immunodeficiency Virus (HIV) • Hepatitis A, B and C

6. HIGHLIGHT: INFLUENZA What is Influenza? An acute illness caused by the influenza virus from the family Orthomyxoviridae, much different than the common cold virus Highly infectious disease that can spread rapidly from person to person through airborne droplets of saliva or other body fluids as well as from contaminated surfaces or objects Some strains cause more severe illnesses than others

7. TYPES OF INFLUENZA There are three types of influenza that we hear about today: • Seasonal Flu – mild to severe respiratory illness caused by the influenza virus. It is easily transmitted from human to human. Most people have some immunity. The best protection against seasonal flu is vaccination. 30,000 people die each year from seasonal flu. • Avian Flu (Bird Flu) – an infection caused by the avian influenza virus that occurs naturally among birds worldwide. • Pandemic Flu – global outbreaks of a new strain of influenza. Three pandemics occurred within the last century; the worst killed 20-40 million people worldwide. There is no way to predict what the strain will be or to create vaccinations until it appears.

8. EPIDEMIC VS. PANDEMIC Epidemic • Serious disease outbreak in a single community, population, or region. • Example: Meningitis outbreak within a high school Pandemic • Epidemic spreading around the world affecting hundreds of thousands of people, across many countries. • Example: HIV/AIDS

9. TRANSMISSION AND SYMPTOMS Influenza is easily passed from person to person and is transmitted through breathing in virus containing droplets that are produced when an infected person talks, coughs, or sneezes. You may also spread the flu virus through touching an infected person or surface contaminated with the virus and then touching your own or someone else’s face. Sudden onset of symptoms include fever, headache, aching muscles, severe weakness and respiratory symptoms, i.e. cough, sore throat, difficulty breathing. Incubation estimates vary. The range is generally from 1 to 14 days with most in the range of 2 to 3 days.

10. INFLUENZA VS. COMMON COLD The flu and common cold are respiratory illnesses with shared symptoms but are caused by different viruses. Influenza is a more severe illness than the common cold. http://www.tamiflu.com/consumer_recognizing.asp

11. EXPOSURE Infectious diseases can be transmitted (or spread) through four routes of exposure: • INGESTION • INHALATION • CONTACT • DIRECT • INDIRECT • INJECTION

12. ROUTES OF EXPOSURE: INGESTION Ingestion • Taking an infectious agent into the mouth by consuming contaminated food or water or through hand to mouth route. • Example: eating unwashed fruit or vegetables

13. ROUTES OF EXPOSURE: INHALATION Inhalation • Breathing in droplets of an infectious agent • Example: Invisible droplets from the cough of an employee infected with influenza are inhaled by a coworker

14. ROUTES OF EXPOSURE: CONTACT Contact Direct Contact: contact of eyes, nose, mouth, genitals, skin, cut, or other open wound with an infectious agent or an infected person’s blood, or other body fluid Indirect Contact: infectious agent on inanimate object such as a desk, keyboard, or phone is picked up and introduced into the body

15. ROUTES OF EXPOSURE: INJECTION Injection • Introduction of an infectious agent by way of syringe or needle stick contaminated with infected blood or body fluid, or some other means of skin puncture

16. TRANSMISSION There are three types of transmission: • Direct Transmission – Infectious agents can be spread directly from person to person, animal to person, or through droplet transmission (Ex: Infected person coughs or sneezes). • Indirect Transmission – Infectious diseases can be transmitted via vector borne transmission (Ex: bite from a mosquito transmits Malaria) or vehicle borne transmission (Ex: bacteria on a pencil is ingested when pencil is placed to lips). • Airborne Transmission - Spread of infectious agents through tiny aerosol particles that are smaller than droplet particles and can remain suspended in the air for long periods of time (Ex: Tuberculosis and Chicken Pox).

17. PREVENTION MAINTAINING A CLEAN AND INFECTION FREE ENVIRONMENT IN THE UNIVERSITY SETTING: • Kitchen, food preparation areas, and bathrooms should be cleaned daily. • Spills should be cleaned up immediately. • Common or break areas should be cleaned at least weekly. • Desk, keyboard, mouse, door handles or other furniture should be cleaned occasionally or when needed. High traffic surfaces in a university setting can be a source of many growing pathogens. Main areas should be cleaned when visibly soiled and on a regular basis:

18. PREVENTION CONTINUED Employees and students should make good choices about personal hygiene and illness prevention. • Keep a clean living environment at home • Bathe regularly • Do not share eating utensils, glassware, or personal toilet articles such as combs, razors, towels, or toothbrushes • Wash clothes on a regular basis • Use appropriate respiratory etiquette – cover your cough or sneeze with a tissue, or cough or sneeze into your upper sleeve if you do not have a tissue • Wash hands regularly • Avoid touching eyes, nose, and mouth • Practice other good health habits • Avoid close contact with people who are sick • Stay at home when you are sick • Receive flu shots when available

19. DO NOT BE A TRANSMITTER OF INFECTIOUS DISEASE! • Hand hygiene is extremely important in preventing the spread of infectious diseases. • Cleanse your hands regularly and encourage frequent handwashing among everyone. • Wash hands using soap and water 15-20 seconds several times a day. • Use alcohol-based waterless hand sanitizer when soap and water are not available. • Practice good personal hygiene at work and at home. • Always follow sanitary practices when preparing food.

20. WATCH FOR SYMPTOMS OF INFECTIOUS DISEASES • Fever • Chills • Extreme exhaustion • Bad cough or inflamed throat • Open sore(s) • Skin rash • Vomiting • Diarrhea Use discretion when experiencing these or other symptoms of sickness. It is more beneficial to stay home and recover than to provoke symptoms further or spread disease to others.

21. HAND HYGIENE

22. EASY TO MISS Many adults tend to minimize the importance of handwashing but this is one of the best defenses against the spread of infectious disease. Using proper technique is essential to sanitizing hands effectively. Inadequate handwashing can cause significant areas of the hands to be missed. It is important to cover all areas of your fingers, hands, and wrists.

23. MOST FREQUENTLY MISSED AREAS http://www.foodlink.org.uk/factfile_c.asp?file=2&chapter=2

24. PROPER HANDWASHING Handwashing is the most important step to prevent the spread of infectious agents. Proper handwashing has three necessary ingredients: • Soap • Water • Friction

25. PROPER HANDWASHING TECHNIQUE • Wet hands with warm water • Add soap • Rub hands vigorously for at least 15-20 seconds (as long as it takes to sing the “Happy Birthday” song twice). Wash all surfaces: backs of hands, wrists, between fingers, finger tips, and under fingernails. Remember, jewelry can harbor microorganisms. • Rinse well under running water • Dry with clean towel • Use towel when turning off water and opening door to avoid recontamination

26. WATERLESS ALCOHOL –BASED HAND PRODUCTS • Use when soap and water are not available • Not effective in cleaning hands that are visibly dirty • Convenient for keeping at your work station • Apply product in the palm of one hand, rub hands together, covering all surfaces of hands and fingers, as when washing hands, until hands are dry

27. WHEN TO USE HAND HYGIENE • Before preparing, serving, handling, or eating food • After using the bathroom • After handling raw meat, poultry, or fish • After coughing, sneezing, or blowing your nose • Frequently any time you are sick • Before and after touching eyes, nose, or mouth • After handling an animal or animal waste • After handling garbage

28. WHEN TO USE HAND HYGIENE • Before preparing medication • Before and after treating a cut or wound • After handling unwashed clothing or bedding • Before and after providing assistance to someone ill • After working outside • Any time hands appear soiled • When you arrive at work/school, before and after going on break, and before leaving work/school

29. DEFINITIONS • MICROORGANISMS - living agents such as bacteria, fungi, viruses, protozoa, and parasites that can cause infectious diseases • CLEANING - to remove dirt • DISINFECT - to remove or destroy microorganisms • DISINFECTANT - chemical that removes or destroys microorganisms • DETERGENT - cleaning agent that removes dirt and debris

30. DISINFECTION TECHNIQUE • Spray • Wipe • Spray • Air dry

31. RULES FOR DISINFECTION If you are responsible for cleaning in the university setting, or if you choose to do extra disinfecting of your own workspace, it is important to be informed about the correct usage of disinfectants and cleaners. Too weak of a solution will be ineffective. A stronger solution than is recommended is wasteful and may lead to problems of corrosion with equipment and surfaces, as well as health problems. Residue may also harm feet, eyes, and other sensitive areas.

32. RULES FOR DISINFECTION CONTINUED Equipment and receptacles used with disinfectants should be thoroughly cleaned and rinsed after use. Any organic material present may reduce the effectiveness of the disinfectant. A disinfectant should have no substance other than water added. Combination of chemicals can negate the effect of active ingredients in products as well as produce harmful fumes or cause corrosion.

33. CONCLUSION It is vital to live a healthy lifestyle to protect against illness. This includes eating nutritious foods, getting enough rest, and exercising in addition to the infection prevention and hygiene training presented in this lesson.

34. REVIEW • Keeping a safe and clean environment is important in preventing the growth and spread of infectious organisms. • The “close quarters” situation in many university settings creates a perfect environment for the spread of infectious diseases. • An infectious disease is one that is caused by a microorganism such as a bacterium, virus, fungus, protozoa or other parasite. Examples include Influenza, SARS, HIV/AIDS, Chicken Pox, Meningitis, and the common cold. • Many infectious diseases are contagious, meaning they can be passed from human to human.

35. REVIEW CONTINUED • Influenza is a highly contagious disease that is spread through droplets of saliva transmitted through coughs, sneezes, close contact, and contaminated surfaces. Influenza exists in various forms. Seasonal Flu - mild to severe respiratory illness transmitted human to human each year. The best protection against seasonal flu is vaccination. Avian Flu - caused by the avian Influenza (bird flu) virus that occurs naturally among birds worldwide. Pandemic Flu - global outbreaks of a newly emerged strain of Influenza. • An epidemic is a serious outbreak in a single community, population, or region. A pandemic is an epidemic that exists worldwide, affecting people across many countries.

36. REVIEW CONTINUED • Infectious agents can be taken into the body through four routes of exposure: ingestion, inhalation, contact, or injection. • There are three types of transmission: direct transmission, indirect transmission, and airborne transmission. • Direct transmission is the spread of Infectious agents directly from person to person, animal to person, or through droplet transmission. • Infectious agents can be spread through indirect transmission via vector borne transmission (i.e. mosquito bite) or vehicle borne transmission (i.e. contaminated object). • Airborne transmission is the spread of infectious agents through tiny aerosol particles that are smaller than droplet particles and can remain suspended in the air for long periods of time.

37. REVIEW CONTINUED • Clean hands are the most important step in staying free of infectious disease. • Proper hand hygiene includes washing hands for 15 to 20 seconds under warm running water and scrubbing in between and around fingers, finger tips and nails, palms, backs of hands, and wrists. • Waterless alcohol-based products are effective when soap and water are not available and hands are not visibly dirty. Hand sanitizers work well while on the job and should be rubbed entirely in to cover hands, fingers, and wrists in the same manner as when washing hands.

38. REVIEW CONTINUED • Highly frequented areas should be routinely disinfected to reduce lingering microbes. Employees and students should maintain good hygiene, practice proper cough and sneeze etiquette, wash hands frequently, and take measures to recover when ill. • Hand hygiene should be performed before eating or handling food, after using the bathroom, after coughing, sneezing, or blowing your nose; after handling wastes, garbage, or raw foods; and any other time hands appear dirty or reasonably in need of cleaning. • To disinfect is to remove or destroy microorganisms such as bacteria, fungi, viruses, protozoa, and parasites that can cause infectious diseases. • Chemicals should always be used as described by the manufacturer. Mixing different chemicals is ineffective and can be very dangerous.

39. POST TEST • 1. All of the following are examples of infectious diseases except for: • Tuberculosis • HIV/AIDS • Cancer • Meningitis • Influenza • When is it a good idea to wash your hands? • After using the bathroom • After touching your eyes or mouth • When you are sick • Before touching food • All of the above

40. POST TEST CONTINUED • 3. True or False? • To accomplish a safer level of disinfection you should combine two powerful cleaners such as bleach and ammonia. • 4. True or False? • There has been no instance of a pandemic flu within the past two • centuries.

41. POST TEST CONTINUED • 5. Which of the following choices is true about alcohol-based hand sanitizers • a) They are an ineffective way to reduce the spread of infection at the university. • b) They should be rubbed into hands, covering all surfaces until dry. • c) They are a better method of hand disinfection than soap and warm water. • d) They work well in removing visible dirt from hands. • e) They should be washed off with water at the sink.

42. POST TEST CONTINUED 6. Which area is usually cleaned mostefficiently in typical routine handwashing by adults? a) Finger tips b) Under finger nails c) Back of hands d) Between fingers e) Palms

43. POST TEST CONTINUED 7) Match the following with the appropriate description: 1. INGESTION a) Agent on inanimate object is introduced to the body by the object 2. INHALATION b) A pathogen is contacted, invades, and infects an open wound 3. INDIRECT CONTACT c) Introduction of an infectious agent by way of a syringe or some other means of skin puncture 4. INJECTION d) Breathing in the infectious agent 5. DIRECT CONTACT e) Consumption of an infectious agent by mouth

44. 1) C 2) E 3) F 4) F 5) B 6) E 7) 1) E 2) D 3) A 4) C 5) B ANSWER KEY