Infection Control for Promotores

1. Infection Control for Promotores USA Center for Rural Public Health Preparedness at Texas A&M Health Science Center School of Rural Public Health

2. Welcome! Germs can spread rapidly in a community, so staying informed and active to protect yourself and the community from infectious diseases is essential. Increased awareness will minimize the risk of infection, prevent disease transmission, and preserve a healthy and safe environment. The USA Center for Rural Public Health Preparedness at Texas A&M Health Science Center School of Rural Public Health designed this train-the-trainer activity for promotores. It provides information , ideas, and learning activities for the promotores on how to prevent the spread of infection and keep their communities healthy.

3. OBJECTIVES • Explain how infectious diseases are spread • Provide basic information about common infectious diseases. • Describe basic methods to prevent the spread of disease

4. What is an Infectious Disease? Infection An infection occurs when microorganisms, or germs, enter and multiply in the body. Infectious Disease An infectious disease occurs when the infection damages the body and produces signs and symptoms indicating the body is unhealthy. Infectious Agent Infectious agents are microorganisms such as bacteria, fungi, viruses, protozoa, and parasites that can cause infectious disease. www.mayoclinic.com/health/infectious-disease/ID0004

5. Examples of Infectious Diseases Common Cold Influenza Meningitis Chickenpox Staph / Methicillin-resistant Staphylococcus aureus (MRSA) Tuberculosis Severe Acute Respiratory Syndrome (SARS) Head lice Rabies Salmonellosis Chlamydia Human Immunodeficiency Virus (HIV) Hepatitis A, B, and C www.go.mb.ca/health/publichealth/cdc/fs/infcontshelter.pdf

6. How Are Infectious Diseases Spread? Understanding how infectious diseases are spread is important for minimizing the risk of infection and preventing disease transmission. Three ways in which infectious diseases can be transmitted: Direct transmission Indirect transmission Airborne transmission www.cdc.gov/ncidod/dvrd/spb/mnpages/glossary.htm

7. Direct Transmission Direct transmission occurs when an infectious agent is transferred directly into the body such as through the eyes, nose, mouth, or through a break in the skin such as a cut on the finger. www.cdc.gov/ncidod/dvrd/spb/mnpages/glossary.htm

8. Direct Transmission Infectious agents are spread directly in the following ways: • Person-to-person • through physical contact including touching, biting, hugging, or kissing • Example: MRSA, Hepatitis • Animal-to-person • through physical contact, bites, and scratches • Example: Ringworm, Rabies • Infectious droplets • during coughing, sneezing, talking, singing, and spitting (spread is limited to approximately three feet) • Example: Cold, Influenza

9. Direct Transmission Person-to-person- Hepatitis: • What is hepatitis? • How do we become infected? • What are the symptoms?

10. Hepatitis • Hepatitis is a viral disease causing inflammation of the liver. • Exposure to infected blood (dirty needles) or unprotected sexual intercourse. • Symptoms: Nausea, vomiting , fever, jaundice

11. Direct Transmission Animal to person : Rabies • What is rabies? • How do we become infected? • What are the symptoms?

12. Rabies • Rabies is a viral infection producing an acute illness affecting the central nervous system. • Transmission: Dogs infected by wildlife ( skunks, squirrels, raccoons or rats) • Symptoms: Seizures, paralysis, death

13. Direct Transmission Infectious droplets: Cold • What is a cold? • How do we become infected with a cold? • What are the symptoms?

14. Cold • A cold is a common upper respiratory infection. • Transmission: a virus is transmitted through the droplets by coughing • Symptoms: cough, runny nose, and sometimes sore throat

15. Indirect Transmission Infectious diseases are spread indirectly through vehicles and vectors. Vehicle-borne transmission: Some infectious agents can linger on inanimate objects, such as desks, chairs, computer keyboards, doorknobs, faucets, toys, eating utensils, or clothing. Example: Touching a pencil used by a person infected with the flu and then touching the eyes, nose, or mouth before performing hand hygiene. Other vehicles include food, water, and biological products such as blood and body fluids. Example: Eating peanut butter contaminated with Salmonella, or pepperoni contaminated with E. coli. www.cdc.gov/ncidod/dvrd/spb/mnpages/glossary.htm

16. Indirect Transmission Infectious diseases are spread indirectly through vehicles and vectors. Vehicle-borne transmission: Salmonellosis What is Salmonellosis? How do we become infected with Salmonella? What are the symptoms? www.cdc.gov/ncidod/dvrd/spb/mnpages/glossary.htm

17. Salmonellosis Salmonellosis is an intestinal infection caused by bacteria. Transmission: contaminated food or drinking water Symptoms: Diarrhea, abdominal cramps & fever www.cdc.gov/ncidod/dvrd/spb/mnpages/glossary.htm

18. Indirect Transmission Infectious diseases are spread indirectly through vehicles and vectors. Vector-borne transmission Common vectors: insects, such as mosquitoes, ticks, and lice. Example: Becoming infected with West Nile Virus as a result of being bitten by an infected mosquito,. www.cdc.gov/ncidod/dvrd/spb/mnpages/glossary.htm

19. Indirect Transmission Infectious diseases are also spread indirectly through vectors. Vector-borne transmission: West Nile Virus What is the West Nile Virus? How do become infected with West Nile? What are the symptoms? www.cdc.gov/ncidod/dvrd/spb/mnpages/glossary.htm

20. West Nile Virus West Nile Virus is a viral disease infecting the brain and nervous system resulting in meningitis or encephalitis. Transmission: by mosquitoes feeding on infected birds Symptoms: fever, severe headache, convulsions, coma & death www.cdc.gov/ncidod/dvrd/spb/mnpages/glossary.htm

21. Airborne Transmission Airborne transmission: Spread of infectious agents as aerosols that usually enter the respiratory tract Tiny particles have the ability to remain suspended in the air for long periods of time and travel long distances. Ex: Tuberculosis, chicken pox, and measles An individual can become infected with TB by inhaling infectious airborne particles while on a crowded bus. www.cdc.gov/ncidod/dvrd/spb/mnpages/glossary.htm

22. Airborne Transmission Airborne transmission: Tuberculosis What is tuberculosis (TB)? How do we become infected with TB? What are the symptoms? www.cdc.gov/ncidod/dvrd/spb/mnpages/glossary.htm

23. Tuberculosis Tuberculosis (TB) is a lung disease caused by bacteria. Transmission: sputum droplets by coughing Symptoms: fever, night sweats, weight loss, and chronic cough www.cdc.gov/ncidod/dvrd/spb/mnpages/glossary.htm

24. Promotora’s Role in Identifying Infectious Diseases Does the promotora have a responsibility to the community when an infectious disease is identified? How can we identify an infectious disease? How can we prevent the spread of this disease? www.cdc.gov/ncidod/dvrd/spb/mnpages/glossary.htm

25. PREVENTION • Hand Hygiene • Disinfection • Communication

26. Importance of Hand Hygiene Hand hygiene includes: Hand washing Hand sanitizer Hand washing is the single most important practice to prevent the spread of infectious disease www.cdc.gov/cleanhands

27. Hand Washing Three necessary components of proper hand washing include: Soap Clean water Friction www.cdc.gov/cleanhands/

28. Proper Hand Washing Technique Wet hands with clean warm water. Apply soap and rub hands together to create a lather. Scrub all surfaces of the hands including the palms, back of hands, wrists, between fingers, and under fingernails. Continue washing hands for 20 seconds, about the time it takes to sing the “Happy Birthday” song twice. Rinse hands well to remove all soap. Dry hands completely with a towel or air dryer. If available, use a towel to turn off the faucet and open the door to avoid recontamination. www.cdc.gov/cleanhands/

29. Easy to Miss Areas Proper technique is : Essential to sanitize hands effectively Inadequate or insufficient hand washing causes significant areas of the hands to be missed: fingers, hands, and wrists www.foodlink.org.uk/factfile_c.asp?file=2&chapter=2 /

30. Frequently Missed Areas www.foodlink.org.uk/factfile_c.asp?file=2&chapter=2 /

31. When to Wash Hands After blowing the nose, sneezing, or coughing After going to the bathroom After contact with blood or body fluids, such as saliva, nasal secretions, urine, feces, or vomit (changing diaper) After handling garbage or waste When hands appear soiled Before preparing medicine or handling contact lenses www.cdc.gov/cleanhands/

32. When to Wash Hands (2) Before preparing, serving, or handling food Before eating lunch or snacks When sick or after contact with others who are sick Before and after touching a cut or wound Before and after touching the eyes, nose, or mouth After handling animals, animal waste, or their belongings, such as toys or a leash www.cdc.gov/cleanhands/

33. Waterless Alcohol-basedHand Sanitizer When to Use Substitute when soap and water are not available. Ineffective for cleaning hands that are visibly dirty. Do not substitute when handling or preparing food. Do not overuse; traditional hand washing is best. Supervise children while they use hand sanitizer. Two necessary components Alcohol-based hand sanitizer Friction www.health.state.mn.us/handhygiene/clean.html

34. Waterless Alcohol-based Hand Sanitizer Continued Proper Technique Apply small amount of hand sanitizer to the palm. Rub hands together covering all surfaces, much like when washing hands with soap and water. Rub until hand sanitizer is absorbed completely and hands become dry. www.health.state.mn.us/handhygiene/clean.html

35. Hand Washing & Absenteeism Am J Infect Control 2002; 28: 340-6

36. “A study of 305 school children found that those who washed their hands four times a day had 24% fewer sick days due to respiratory illness and 51% fewer sick days due to upset stomach.” www.cdc.gov

37. Hand Washing Activity Ideas Practice washing hands properly with children. Have them sing the “HAPPY BIRTHDAY” song twice to demonstrate 20 seconds. Post hand washing facts in bathroom stalls For younger kids, place posters in restrooms illustrating children washing hands to encourage hand hygiene.

38. DISINFECTION

39. DEFINITIONS • Cleaning - to remove dirt • Disinfect - to remove or destroy many of the organisms that causes infectious diseases

40. DISINFECTION • SPRAY • WIPE • SPRAY • AIR DRY

41. CLEANING & DISINFECTING • Systemize approach • Work from top to bottom • From back to front

42. PRECAUTIONS FOR DISINFECTION • Wear protective clothing when recommended by the manufacturer and take care to avoid skin contact. • Wash hands thoroughly after use. • Use correct concentration.

43. RULES FOR DISINFECTION • Use at the chemical’s optimum temperature for action. • Using very hot water can be dangerous. If it spills or splashes, it can injure the operator. • Contact time is important. Use according to manufacturer’s recommendation. • Make up fresh solutions to ensure effectiveness.

44. RULES FOR DISINFECTION • A disinfectant should have no substance other than water added. • Combination of chemicals can negate the effect of the active ingredients in products as well as producing unhealthy fumes or causing corrosion. • 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.

45. General Infection Prevention • Encourage everyone to wash hands frequently using soap and water for 15-20 seconds • Substitute alcohol-based hand sanitizer when clean water and soap are unavailable. • Promote appropriate respiratory etiquette: Cover coughs and sneezes with tissue. Throw away tissues immediately and use hand hygiene. If a tissue is not available, sneeze or cough into the elbow or upper sleeve. Follow general infection prevention measures and maintain personal hygiene to reduce the spread of infectious diseases.

46. General Infection Prevention (2) Remain at home when ill and encourage others to do the same. Avoid close contact (less than 3 feet of space) with those who are sick. Maintain and promote good personal hygiene; bathe and wash hands regularly. Discourage touching the eyes, nose, and mouth. Ensure commonly used areas such as door handles, eating surfaces, and desks are clean and disinfected.

47. General Infection Prevention (3) Keep open wounds clean and covered with a bandage until healed. Avoid contact with other people’s wounds and bandages. Discourage sharing eating utensils, glassware, or personal items such as toothbrushes, combs, razors, towels, clothing or other items that come into contact with bare skin. Clean shared sports equipment with antiseptic before each use Avoid skin-to-skin contact with anyone who has a Staph infection. Encourage a healthy lifestyle that includes a nutritious diet and adequate sleep.

48. Additional Considerations When handling animals, it is important to keep in mind the risks of Zoonotic Diseases, or those that are transmissible from animals to humans. The following considerations are important when dealing with animals : Always wash hands very thoroughly after touching animals or their belongings Ensure animals have current vaccinations and receive annual veterinary exams Bathe animals regularly Avoid contact with animal waste or food Only handle a new animal with permission and supervision

49. COMMUNICATION • Awareness is important in the prevention of transmission of infectious organisms to others. • Notify others: • if any special precautions or instructions are necessary • In case of emergency, call supervisor or 911

50. Fun Online Resources • FIGHT BAC! Animated bacteria fighting games http://www.fooddetectives.org/ • CLEAN HANDS COALITION Hand washing resources http://cleaning101.com/files/Clean_Hands_Flyer_2.pdf • LATHER UP FOR GOOD HEALTH! Activities by SOFTSOAP http://www.colgate.com/app/LatherUpForGoodHealth/us/HomePage.cvsp The following are additional informative internet links providing more resources to teach children about infection prevention, including online games that students can explore in the classroom or at home.