5 Infection Control 110309
-
Upload
tri-novia-kumalasari -
Category
Documents
-
view
16 -
download
0
Transcript of 5 Infection Control 110309
TRAINING ON OUTBREAK INVESTIGATION
TOPIC 4
INFECTION CONTROL
DRAFT Version
DRAFT Version
During outbreak investigation
TOPIC 4
INFECTION CONTROL
DRAFT Version
At the end of the session, the participants will be able to: Explain the importance of promoting culture of safety Identify common situations during an outbreak investigation when the
investigator is likely to be exposed to sources of infection Describe standard precautions and transmission-based precautions Explain the uses of different types of personal protective equipment (PPE) Demonstrate hand washing, putting on and removing PPE and particulate
respiratory seal check Identify challenges in the use of PPE
Below is the summary table of recommended activities for the topic Infection control, their objectives and suggested timing in the training.
LEARNING OBJECTIVES
RECOMMENDED ACTIVITIES
Table 5—1. Summary of recommended activities
5-1
Activity Number
Title Objective Timing
Before During After
1 Skills Station (should have all the posters available)
To practice participants on donning of PPE, hand hygiene, disinfection, chlorine solution preparation, par-ticulate respirator seal check, etc.
+++
+++
+++
2 Droplet vs Aerosol To show difference between droplet and aerosol
+++ ++
3 Mime-Precaution To enumerate safety precaution components
+++ + +++
4 Match the mask To identify appropriate mask for specific transmission
++ +++ ++
5 Video on Donning PPE and hand hygiene
To demonstrate wearing and taking off PPE and hand hygiene
++ +++ ++
DRAFT Version
During an outbreak investigation, it is important that staff/investigators try their best to prevent self from being infected by patients or other possible sources. This topic is about protecting you and your staff from infections caused by dangerous pathogens and its immediate environment. Standard precautions require that health workers in the field assume that the blood and the body substances of all patients are potential sources of infection, regardless of the diagnosis, or presumed infectious status. Additional precautions are needed for diseases transmitted by air, droplets and through contact.
A culture of Safety Improving worker safety requires an organization-wide commitment to creating, implementing, evaluating and maintaining effective and current safety practices – a culture of safety. Establishing an effective culture of safety also requires that both personal safety and safety of others are responsibilities inherent to both the managers and the staff. This means respecting and adhering to the standards and protocols, being aware of personal safety and safety of others by providing immediate feedback or correcting incorrect behaviour positively.
Risk of infection during an outbreak During an outbreak, staff can be infected in many ways. More notably are the following situations when staff are the most at risk:
a. needle stick injury during specimen collection and other procedures b. breach in the use of PPE – not using PPE, improperly fitted PPE or re-
using single-use PPE c. from aerosol-generating procedures d. being exposed to an asymptomatic but infected patient
Standard Precaution Standard precautions are precautionary measures that help limit infections to health workers, patients and relatives. Experiences from previous outbreaks have shown that further disease transmissions e.g., nosocomial transmission, could
SUMMARY CONTENTS
In hospital setting, recapping of needles after taking blood samples is the most common cause of needle stick injury.
5-2
DRAFT Version
have been prevented if basic level of infection control precautions are followed. Treating all patients with the “standard” precautions involves work practices that are essential to provide a high level of protection to patients, health care workers, relatives, etc. These are:
Hand hygiene Respiratory hygiene and cough etiquette – which are added to standard
precautions to control transmission of respiratory infections if a patient has respiratory symptoms.
Use of personal protective equipment (PPE) based on risk assessment to avoid direct contact with patient's blood, body fluids, secretions and non-intact skin
Prevention of needle sticks/sharps injuries and Cleaning and disinfection of the environment and equipment
Transmission-based precaution For certain transmissible or highly pathogenic infections, transmission-based precautions are used IN ADDITION to standard precautions. These are:
a. Contact precaution, b. Droplet precaution and, c. Airborne precautions
Standard precautions should be: in PLACE ALL the time – whether or not there is
recognized outbreak practiced for ALL PATIENTS – regardless of diagnosis
Since the infecting agent may not be known at the time of admission to a health care facility, transmission-based precautions are used empirically, according to the clinical syndrome and the likely aetiologic agent (based on a risk assessment), and then modified when the pathogen is identified or stopped if a transmissible infectious disease etiology is ruled out.
5-3
DRAFT Version
Table 5—2. Transmission-based precautions, organisms implicated and recommended PPE.
Personal Protective Equipment (PPE) Personal protective equipment or PPE is designed to act as a barrier to hazardous agents encountered by health workers in the hospital or while conducting outbreak investigation. Personal protective equipment reduces, but does not completely eliminate, the risk of acquiring an infection. It is important that it is used effectively, correctly and at all times where contact with blood and body fluids of patients may occur.
Personal Protective Equipments (PPE) are comprised of:
Transmission - based
Precautions Transmission Example
Organisms Commonly implicated
Recommended PPE
Contact Direct – indirect contact with patient/ environment
shigellosis, Ebola hemorrhagic fever, MRSA
Gloves, gowns
Droplet Cough, sneeze Neisseria meningitidis, pertussis, pneumonias, diptheria, influ-enza, mumps
Surgical mask, goggles + standard precaution
Airborne Particle suspended in the air (<5μ)
TB, measles, varicella, and vari-ola
N 95, goggles + standard precau-tion
Staff must also be aware that use of personal protective equipment does not replace the need to follow basic infection control measures such as hand hygiene.
MEDICAL MASK GOWN PROTECTIVE EYEWEAR GLOVES
Figure 5—1. Personal protective equipment (PPE)
5-4
DRAFT Version
Items that are not PPE include caps for hair which function more for staff comfort and closed footwear or boots. Boots are used only to avoid accidents and sharp objects.
How to’s The accompanying PowerPoint presentation on Infection Control provides us with steps on the following:
a. Wearing and taking off PPE b. Particulate respirator seal check c. Hand-rub with alcohol d. Hand washing with soap and water
Hand Hygiene Hand washing is the simplest and most effective way of preventing the transmission of infection. Hand washing should be performed during these circumstances:
Table 5—3. When to perform hand hygiene
Availability of alcohol-based hand rubs is critical in promoting effective hand hygiene practices especially in setting without access to running water. This approach has led to increased compliance in hand hygiene and decreased health care-associated infection.
Immediately Before Between After
Upon arriving at work
Direct contact with patient
Procedures on the same pa-tient where soiling of hands is
likely
Contact with patient
Putting on gloves for clinical and invasive procedures
Removal of gloves
Preparing handling, serving, or eating food
Removal of other personal protective equipment
Leaving work
Contact with blood, body flu-ids, secretions, excretions, wounds exudates, contami-
nated items Contact with items/surfaces
known or likely to be contami-nated
Personal body functions such as using the toilet, and wiping
or blowing one's nose
Wash hands with soap and water when visibly dirty or soiled with blood or other body fluids, or if exposure to potential spore-forming organisms is strongly suspected or proven or after using the restroom. Preferably use an alcohol-based hand rub for routine hand antisepsis.
5-5
DRAFT Version
Challenges in using PPE and strategies to improve safety PPE is one of the vital components of a system of safety controls and preventive measures in health facilities or in the field. Recent studies have shown that despite expert recommendations and high risk conditions, health care workers tend to use PPE less. Below are some of the challenges in PPE use. Studies were conducted in a hospital setting although the findings can also be noted in field setting:
Too busy or no time to wear PPE Health staff do not consider themselves high risk in contracting the
disease Patient did not appear high risk Interference with skills Discomfort Perception that precautions are ineffective Availability of supply and ready access to it Cost of the PPE Community/patient perception e.g., alien looking, creates fear
Strategies to improve safety (after Goldfrank, 2008)
Leadership and commitment to safety Emphasis on education and training Improving feedback and enforcement Clarify relevant work practices
Activity 1 – Skills Station Objectives:
To practice participants on donning of PPE, hand hygiene, disinfection, chlorine solution preparation, particulate respirator seal check, etc.
Estimated Time
Throughout the session. Participants can go and try to practice during breaks, lunch time, etc
Materials (see Annex B page 8 –31) 1. PPEs, particulate respirator mask, soap and water, alcohol hand rub,
chlorine solution 2. Posters showcasing steps in wearing and taking off PPE, particulate
respirator seal check, hand washing, alcohol hand rub, chlorine solution preparation
DETAILS OF RECOMMENDED ACTIVITIES
5-6
DRAFT Version
3. Containers for water, soap, water receiver (when performing hand washing, etc.)
Process
1. Provide stations (desks) for each topics: PPE, respirator seal check, hand washing, chlorine solution
2. Train organizing team member or participant on specific skills and allow them to oversee skills practice by participants.
3. Participants can practice several times. (Note: In case of limited supplies of PPE, participants maybe requested to keep one e.g., mask and share others e.g., gown for practice purpose with clear explanation that this should not be the case in actual investigation.)
Activity 2 – Droplet vs Aerosol Objectives
To show difference between droplet and aerosol
Estimated Time 5 minutes
Materials
1. Video clip on aerosol vs droplet production 2. LCD/ DVD player
Process
1. Run the video clip on aerosol and droplet 2. Let patient discuss when aerosol and droplets are generated. This can be
followed by discussion on example of disease with transmitted through aerosol or droplet as well as the PPE to use.
Activity 3 – Mime Precaution Objectives
To enumerate safety precaution components
Estimated Time 30 minutes
5-7
Figure 5—2. Skills station set-up
DRAFT Version
Materials Small pieces of paper to draw group who will perform the activity Process 1. In a small piece of paper, write Silent Movie Actors and leave the other pieces
blank. The group who picked the paper with Silent Movie Actors on it will perform the activity
2. Ask the participants to guess what standard precaution is being acted out by the silent movie actors
3. Write down the standard precautions correctly guessed. 4. Encourage participants to create mnemonics or any easy-to-remember action
to illustrate standard precautions.
Activity 4 – Match the Mask Objectives
To identify appropriate mask for specific transmission
Estimated Time 30 minutes
Materials (see Annex B page 8 –32) 1. Slides containing scenario and question whether mask is needed and what
particular mask 2. LCD/ Computer 3. Score sheet Process 1. Divide the group into four. Flash the scenario and ask the group to discuss and
provide the answer. Allow time for the group to give reason to their answers 2. Score correct answers on displayed score sheet. 3. The group with the most correct answer wins.
Standard Precautions Hand hygiene Respiratory hygiene and cough etiquette have been
added to standard precautions to control transmis-sion of respiratory infections.
Use of personal protective equipment (PPE) based on risk assessment to avoid direct contact with patient's blood, body fluids, secretions and non-intact skin
Prevention of needle sticks/sharps injuries and Cleaning and disinfection of the environment and equip-
ment
5-8
DRAFT Version
Activity 5 – Video on donning PPE and performing hand hygiene Objectives
To demonstrate a) wearing and taking off PPE and b) hand hygiene Estimated Time
15 minutes Materials
1. Video clips on a) wearing and taking off PPE and b) performing hand hygiene
2. LCD/ DVD player Process
1. Run the video clips 2. Allow discussion on variations in wearing and taking off PPE and draw
conclusions/ summary.
Goldfrank, L.R., Liverman, C.T., eds. Preparing for an influenza pandemic: personal protective equipment for healthcare workers. Washington, D.C., The National Academies Press, 2008 Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care. Interim Guidelines. Geneva, World Health Organization, 2007 (WHO/CDS/EPR/2007.6) Laboratory biosafety manual. 3rd ed. Geneva, World Health Organization. 2004. (WHO/CDS/CSR/LYO/2004.11) WHO Guidelines in hand hygiene in health care (Advanced Draft): A summary. Geneva. World Health Organization, 2005 (WHO/EIP/SPO/QPS/05.2)
REFERENCES
5-9
DRAFT Version
NOTE: The following pages contain transcripts of the presentations included in this topic. The embedded transcripts aim to assist facilitators in explaining the content of the slides. The slides and transcripts (slide notes) can be modified and adapted based on facilitator’s objectives and needs of the trainees. “Karaoke-type” presentation (directly reading the contents of the slides and transcripts) is strongly discouraged.
5-10
THOUGHTS, COMMENTS, NEW GAMES AND VARIATIONS
DRAFT Version
SLIDE 1
SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S ESEARO –CSR Training on Outbreak Investigation
Infection ControlA good epidemiologist is a safe epidemiologist
Infection control During an outbreak investigation, it is important that staff/investigators try their best to prevent self from being infected by patients or other possible sources. This presentation is about protecting you and your staff from infections caused by dangerous pathogens. Standard precautions require that health workers in the field assume that the blood and the body substances of all patients are potential sources of infection, regardless of the diagnosis, or presumed infec-tious status. Additional precautions are needed for diseases transmit-ted by air, droplets and through contact. In the field, it is important that maximum protection is provided to staff. Most of the time, staff are faced to work in resource limited set-tings. It may happen that discrepancies exist between what is ideal and what can be achieved/ provided in terms of staff protection. Aside from limited resources, there might be cases whereby wearing bulky items may limit movement hence further increase danger and lead to a situation where a breach of methods is more likely to occur.
SLIDE 2
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
Learning Objectives
• At the end of the session, the participants will be able to:– Explain the importance of promoting culture of safety
– Identify common situations during an outbreak investigation when the investigator is likely to be exposed to sources of infection
– Describe standard precautions and transmission-based precautions
– Explain the uses of different types of personal protective equipment (PPE)
– Demonstrate putting on and removing PPE– Demonstrate hand washing
Learning objectives At the end of the session, the participants will be able to: Explain the importance of promoting culture of safety Identify common situations during an outbreak investigation
when the investigator is likely to be exposed to sources of infec-tion
Describe standard precautions and transmission-based precau-tions
Explain the uses of different types of personal protective equip-ment (PPE)
Demonstrate putting on and removing PPE Demonstrate hand washing
SLIDE 3
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
A Culture of Safety
• Follow standard protocols
• Always be aware of your safety
• Change incorrect behavior in a positive way
A culture of safety In infection control, for overall safety, it is important to ensure the following: Follow organizational protocols, standard guidelines should be
regularly practiced. Awareness of staff/ health workers on safety measures (attitude)
as well as the organization’s commitment to safety Commitment of the team leader to identify, correct and change
erroneous behavior of staff and co-workers to minimize and avoid risk of infection
INFECTION CONTROL Transcript
5-11
DRAFT Version
5-12
SLIDE 4
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
Raise Awareness!
• Stop and think• Assess the risk• Prepare appropriate
precautionary measures
• Use PPE• Don’t expose yourself or your
staff to danger!
Raise awareness Before going to the field, staff should be able to reflect on the impor-tance of safety culture/ behaviour/ attitude. This means: Collect as much information as possible regarding the possible
situation (or infection, if this is known) you are to deal with. This includes consideration of staff vaccination status in relation to the kind of disease to be investigated.
Assess the risk Prepare appropriate precautionary measures before moving self/
staff for investigation/ sample collection Use personal protective equipment Strike a balance between the overall benefit of the action and the
safety of self/staff. Do not expose yourself or your staff to unnec-essary danger.
SLIDE 5
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
Risk of infection when assisting in an outbreak
Staff may become infected because of: – needle stick injury– breach in the use of PPE – during an aerosol-generating
procedure – before a patient is recognised as
infectious
Risk of infection when assisting in an outbreak During an outbreak, staff can be infected from the following: Injuries by needle stick during specimen collection. This occurs
most commonly when trying to RECAP the needles after taking blood samples.
Use of PPE that has not been properly fitted e.g., gloves, masks. Staff should wear PPE that is appropriate for the degree of pa-tient contact and the type of infection (if this is known). All person-nel who may need to use an N-95 respirator (face mask) should be trained and fit-tested in use. Most PPE should not be re-used.
Failure to perform hand hygiene From aerosol-generating procedures e.g., intubation, suctioning,
nebulisation, cough-inducing procedures e.g. in SARS clusters identified in Toronto, Hong Kong, Singapore and Hanoi (http://www2a.cdc.gov/PHTN/webcast/SARSII/Chiarello5-8.pdf)
An infected patient who is not recognized as an infection risk (for example, a person who is not yet manifesting signs and symp-toms)
SLIDE 6
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
Standard Precaution
SHOULD be:• IN PLACE ALL of the time
– Whether or not there is a recognized outbreak
• PRACTICED for ALL patients– Regardless of diagnosis
Standard precautions limit health care worker’s contact with secretions, skin lesions, mucus membranes, blood and other body fluids.
Standard precautions Standard precautions should be followed routinely for all types of pa-tient contact that may involve exposure to blood or body fluids irre-spective of whether or not there is a recognized infectious risk or out-break. Standard precautions are used for all patients regardless of their diag-noses to ensure protection of the health care worker and the patient.
DRAFT Version
SLIDE 7
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
Standard Precaution
• Standard Precautions include– Hand hygiene
– Respiratory hygiene and cough etiquette – Use of personal protective equipment (PPE)
– Prevention of needle sticks/sharps injuries– Cleaning and disinfection of the environment and
equipment
Standard precautions Treating all patients by applying standard precaution measures involve work practices that are essential to provide a high level of protection to patients, health care workers and visitors. These are:
Hand hygiene
Respiratory hygiene and cough etiquette – which are added to standard precautions to control transmission of respiratory infec-tions if a patient has respiratory symptoms.
Use of personal protective equipment (PPE) based on risk as-sessment to avoid direct contact with patient's blood, body fluids, secretions and non-intact skin
Prevention of needle sticks/sharps injuries and
Cleaning and disinfection of the environment and equipment
SLIDE 8
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
Transmission-based Precautions
• USED for certain transmissible or highly pathogenic infections
• Contact, droplet, and airborne precautions each aim to block different routes of transmission
• USED in addition to standard precautions
Transmission-based precautions For certain transmissible or highly pathogenic infections, transmission-based precautions are used in addition to standard precautions. Con-tact, droplet, and airborne precautions are meant to prevent exposure to pathogens contracted through these means. Since the infecting agent may not be known at the time of admission to a health care facility, transmission-based precautions are used empirically, according to the clinical syndrome and the likely aeti-ologic agent (based on a risk assessment), and then modified when the pathogen is identified or stopped if a transmissible infectious dis-ease etiology is ruled out. It’s important to note that these guidelines are for clinical patient care and investigation in the field. Procedures in the laboratory or autopsy suite, etc. where mechanical generation of fine aerosols might occur, require different types or degrees of protection.
SLIDE 9
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
Transmission-Based Precautions
TB, measles, varicella, and variola
Neisseria meningitidis, pertussis, pneumonias, diptheria, influenza, mumps
shigellosis, Ebola hemorrhagic fever, MRSA
Organisms
commonly
implicated
N 95, goggles + standard precaution
Particle suspended in the air (<5μ)
Airborne
Surgical mask, goggles + standard precaution
Cough, sneezeDroplet
Gloves, gownsDirect – indirect contact with patient/ environment
Contact
Recommended PPE
ExampleTransmission
Transmission-based precautions Contact: Diseases which are transmitted by this route include MRSA, enteric infections and most skin infections. Gloves and gowns must be worn and contaminated surfaces cleaned Apply for infections that are spread through direct or indirect contact with patients or patient-care environment (e.g., shigellosis, Ebola hem-orrhagic fever, MRSA). Droplet: droplets are usually generated from the infected person dur-ing coughing, sneezing, talking or when health care workers undertake procedures such as tracheal suctioning. Wear surgical mask and gog-gles in addition to standard precautions. Apply for infections spread by large droplets generated by coughs, sneezes, etc. (e.g., Neisseria meningitidis, pertussis, pneumonias, diptheria, influenza, mumps). Airborne: Airborne transmission when particles < 5 micron in size are disseminated into the air. These particles can remain suspended into the air for long periods of time, especially when bounded to dust parti-cles. Use mask N95 and goggles in addition to standard precautions Apply for infections spread by particles <5μ that remain infectious and suspended into the air (TB, measles, varicella, and variola).
5-13
DRAFT Version
5-14
SLIDE 10
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
Personal Protective Equipment
Personal protective equipment (PPE) PPEs are comprised of:
gloves
gowns
eye protection
medical masks
Items that are not PPE:
Caps for the hair – only for the comfort of HCWs
Closed footwear – only to avoid accidents with sharp objects
SLIDE 11
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
Personal Protective Equipment
• Reduces but does NOT completely eliminate the risk of acquiring infection
• Important that it is used
– Effectively
– Correctly– At all times
• DOES NOT replace basic infection control measures like HAND HYGIENE.
where contact with blood and body fluids may occur
Personal protective equipment (PPE) Personal protective equipment reduces but does not completely elimi-nate the risk of acquiring an infection. it is important that it is used effectively, correctly and at all times where contact with blood and body fluids of patients may occur. Staff must also be aware that use of personal protective equipment does not replace the need to follow basic infection control measures such as hand hygiene.
SLIDE 12
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
Putting on PPE (if all is needed)
Wash hands
Wash hands
Putting on PPE There has been much discussion regarding the order of putting on and taking off personal protective equipment. The order for putting on personal protective equipment is not important, what is important is the staff’s knowledge on how contamination while wearing PPE be prevented. The following sequence is an example of one of the order when full personal protective equipment is worn: 1. Wash hands. 2. Wear scrub suit or old set of thin clothes before entering the
designated changing room or area (optional) 3. Put the gown on. 4. If required, wear boots /or shoe covers with trousers tucked
inside. (optional) 5. Wash hands. 6. Put the cap on. 7. Put the mask on. 8. Wear an impermeable apron if necessary. (optional) 9. Wear protective eye wear/ goggles. 10. Wash hands and dry them. 11. Wear gloves with gown sleeve cuff tucked into glove.
DRAFT Version
SLIDE 13
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
Taking off PPE
Taking off PPE The order in which personal protective equipment is removed is not as important as the principle behind choosing such an order. The key principle is that when removing personal protective equipment the wearer should avoid contact with blood, body fluids, secretions, excre-tions and other contaminants. When hands become contaminated they should be washed or decontaminated with 70% alcohol solution. An example of how to remove personal protective equipment is given. 1. Using gloved hands, untie the gown string if tied in front and
remove shoe covers. 2. Remove gown and apron, without contaminating clothing under-
neath. Touch only inside of gown and apron while removing. Place in appropriate disposal bag.
3. Remove gloves (fingers under cuff of second glove to avoid contact between skin and outside of gloves) and discard in an appropriate manner.
4. Wash hands. 5. Remove cap. 6. Remove eye protection from behind. Put eye protection in a
separate container for reprocessing 7. Remove mask from behind 8. Wash hands up to elbows thoroughly with soap and water, dry
or decontaminate in 70% alcohol before leaving facility.
SLIDE 14
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
PPE Materials
GlovesDifferent kinds of gloves
– Household gloves– Clean gloves (protect
yourself) – Sterile gloves (also protect
the patient from infection –use for sterile sites)
Do’s – Work from clean to dirty– Avoid “touch contamination”
• Eyes, mouth, nose, surfaces– Change gloves between
patients
PPE materials: Gloves First we will discuss gloves. Gloves protect the user against contami-nation with infectious material, but it is important to realize that gloves may become sources of contamination if they are not used properly. There are different kinds of gloves that are used for different pur-poses. Thick rubber gloves may be used for cleaning or household purposes in a patient’s room. Clean gloves can be used for general contact in the room or with the patient, while sterile gloves should be used when collecting specimens or conducting any type of medical procedure on the patient. Here are some “do’s” of glove use: Work from clean to dirty. This is a basic principle of infection control. In the context of working with possible or confirmed avian influenza patients, it refers to touching clean body sites or surfaces before you touch dirty or heavily contaminated areas. Limit opportunities for “touch contamination” - protect yourself, others and environmental surfaces. An example of “touch contami-nation” is when someone wearing gloves touches his or her face or adjusts glasses with gloves that have been in contact with a patient. Touch contamination can potentially expose a person to infectious agents. Think about environmental surfaces, too, and avoid unneces-sarily touching them with contaminated gloves. Surfaces such as light switches and door and cabinet knobs can become contaminated if touched by soiled gloves. Change gloves as needed, if this is possible. If gloves become torn or heavily soiled and additional patient care tasks must be performed, then change the gloves before starting the next task. Always change gloves after use on each patient, and discard them in the nearest appropriate receptacle. Patient care gloves should never be washed and used again. Washing gloves does not necessarily make them safe for reuse; it may not be possible to eliminate all microorganisms and washing can make the gloves more prone to tearing or leaking.
5-15
DRAFT Version
5-16
SLIDE 15
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
PPE Materials: Gowns
Gowns
• Fully cover torso
• Have long sleeves
• Fit snuggly at the wrist
PPE materials: Gowns Gowns are generally the preferred PPE for clothing, but aprons occa-sionally are used where limited contamination is anticipated. If con-tamination of the arms can be anticipated, a gown should be se-lected. Gowns should fully cover the torso, fit comfortably over the body, and have long sleeves that fit snuggly at the wrist.
SLIDE 16
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
PPE Materials: MasksMasks and Respirators: Barriers and Filtration
• Surgical masks– Cotton, paper
• Particulate respirators (N95)– Fit testing essential
• Alternative materials (barrier)– Tissues, cloth
PPE materials: Masks Masks are another type of PPE. Wear masks that fully cover your nose and mouth to prevent fluid penetration. Masks should fit snugly, so ones with a flexible nose piece and that can be secured to the head with string ties or elastic are preferable. Respirators that filter the air before it is inhaled have been designed to protect the respiratory tract from airborne transmission of infectious agents. A commonly used respirator in healthcare settings is the N95 particulate respirator. The device has a sub-micron filter capable of excluding particles that are less than 5 microns in diameter. Prior to use, respirators should be fit tested for the appropriate size. And you should always check your respirator before use to make sure it has a proper seal. If surgical masks and respirators are not available, other materials such as tissues and cloth may be used to cover the nose and mouth. While the efficacy of these materials has not been scientifically evalu-ated, they are probably better than no mouth covering at all.
SLIDE 17
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
Performing a particulate respirator seal check
Performing a particulate respirator seal check The slide presents step-wise manner in performing a particulate res-pirator seal check.
SLIDE 18
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
PPE Materials
Eye Protection– Face shields– Goggles
PPE materials: Goggles Eye protection is important. Goggles provide barrier protection for the eyes. Personal prescription lenses do not provide optimal eye protec-tion and should not be used as a substitute for goggles. Goggles should fit snuggly over and around the eyes or personal prescription lenses. You can use a face shield as a substitute to wearing a mask or goggles. The face shield should cover the forehead, extend below the chin, and wrap around the side of the face.
DRAFT Version
SLIDE 19
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
Ensure you have everything you require before starting a task
Ensure that no mucosal surface is exposed
Check PPE is being correctly put on ( mirror / observer)
Avoid self contamination while using the PPE
Do not touch face, mask, eye wear etc
Avoid self contamination on removal of the PPE
Remember where you could be contaminated
Avoid contamination of others
Avoid contamination of the environment
Dispose of PPE immediately and safely
Pointers on how to safely use PPEPPE does not provide 100 % protection
Pointers on how to safely use PPE Personal protective equipment reduces but does not completely elimi-nate the risk of acquiring an infection. it is important that it is used effectively, correctly and at all times, where contact with blood and body fluids of patients may occur. Staff must also be aware that use of personal protective equipment does not replace the need to follow basic infection control measures such as hand hygiene.
SLIDE 20
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
Hand hygiene – when to perform
Immediately– Upon arriving at work
Before– Direct contact with patient
– Putting on gloves for clinical and invasive procedures (e.g. administering intravascular injections, intravenous injections)
– Preparing handling, serving, or eating food
– Leaving work
Hand hygiene – when to perform Hand washing is the simplest and most effective way of preventing the transmission of infection. Hand washing should be performed during these circumstances: Immediately
Upon arriving at work
Before
Direct contact with patient
Putting on gloves for clinical and invasive procedures (e.g. ad-ministering intravascular injections, intravenous injections)
Preparing handling, serving, or eating food
Leaving work
SLIDE 21
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
Hand hygiene – when to perform
Between– Procedures on the same patient where soiling of hands is likely
After– Contact with patient
– Removal of gloves
– Removal of other personal protective equipment– Contact with blood, body fluids, secretions, excretions, wounds
exudates, contaminated items– Contact with items/surfaces known or likely to be contaminated
– Personal body functions such as using the toilet, and wiping or blowing one's nose
Hand hygiene – when to perform (continuation) Between
Procedures on the same patient where soiling of hands is likely After
Contact with patient
Removal of gloves
Removal of other personal protective equipment
Contact with blood, body fluids, secretions, excretions, wounds exudates, contaminated items
Contact with items/surfaces known or likely to be contaminated
Personal body functions such as using the toilet, and wiping or blowing one's nose
SLIDE 22
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
How to hand rub with alcohol-based formulation
Hand hygiene – how to hand rub with alcohol-based formulation The slide provides a step-wise manner in performing hand rub with alcohol-based formulation. An alcohol-based hand product should be used if hands are NOT visibly soiled or contaminated and when access to soap and water are not available at the moment.
5-17
DRAFT Version
5-18
SLIDE 23
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
How to perform hand washing
Hand hygiene – how to hand wash The slide provides a step-wise manner in performing hand washing with soap and water. Hands that are visibly dirty or contaminated with body fluids should be washed with soap and water.
SLIDE 24
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
Typical parts missed
Typical parts missed Washing hands should be done properly so as to ensure that no major parts are missed. Typical parts missed are shown in the slides when hand washing is not done properly.
SLIDE 25
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
PPE Use: Challenges
• Reasons for not wearing PPE:– Too busy or no time– Do not consider themselves high risk– Can tell which patients are high risk– Interference with skills, dexterity,
communicating– Physical discomfort– Perception that precautions are ineffective
PPE use: Challenges PPE is one of the vital components of a system of safety controls and preventive measures in health facilities or in the field. Recent studies have shown that despite expert recommendations and high risk conditions, health care workers tend to use PPE less. Below are some of the challenges in PPE use. Studies were con-ducted in a hospital setting although may apply in the field setting:
Too busy or no time to wear PPE
Health staff do not consider themselves high risk in contract-ing the disease
Patient did not appear high risk. Some staff even expressed that they can tell which patient are high risk
Interference with skills particularly dexterity, communicating, health worker – patient relationship and in recognizing people
Physical discomfort
Perception that precautions are ineffective
SLIDE 26
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
PPE Use: Challenges
• Reasons for not wearing PPE:– Availability of supply and ready access to it– Cost of the PPE– Community/patient perception e.g., some staff
are careful not to upset patient
PPE use: Challenges (continuation) Below are some of the challenges in PPE use. Studies were con-ducted in a hospital setting although may apply in the field setting (continuation)
Availability of supply and ready access to it
Cost of the PPE
Community/patient perception - alien looking, creates fear, some staff are careful not to upset patient - pressure from community as they do not want to be handled by “ghosts” - a case during Ebola outbreak in recent period
DRAFT Version
SLIDE 27
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
Strategies for improving safety
• Leadership and commitment to safety
• Emphasis on education and training– Risk perception
• Improving feedback and enforcement• Clarify relevant work practices
Strategies for improving safety Promoting culture of safety necessitate strong management leader-ship and commitment. This includes providing opportunity to enhance understanding of staff in the importance of safety adherence. This can be done through continued education and training, improving feed-back and enforcement of safety procedures among staff.
SLIDE 28
Name of Presentation SEARO – CSR Training on Outbreak InvestigationE P I D E M I C A L E R T A N D R E S P O N S E
Infection ControlSEARO –CSR Training on Outbreak Investigation
Be Alert / vigilant
• A – Be Alert• B – Use Barrier protection• C – Clean and Disinfect• D – Dispose of waste• E – Evaluate and Feed back
Be alert/ vigilant Finally infection control can be summarized as ABCDE: A – Be Alert – be conscious of your environment and the situation you
are in B – Use Barrier protection – use appropriate PPE/ immunization if
necessary C – Clean and Disinfect – perform hand hygiene all the time D – Dispose of waste – dispose waste properly E – Evaluate and Feed back – review infection control measures and
further improve
5-19
SEARO CSR Subunit in Bangkok Permanent Secretary Building No. 3, 4th Floor
Ministry of Public Health, Tiwanon Road Nonthaburi 11000 Thailand
Telephone No.: +66 2 580 7534 to 35
Facsimile: +66 2 580 7537 Email Address: [email protected] Website: www.searo.who.int/csrsubunitbkk