What the Cough

Etiquette/ Respiratory

Hygiene?

COUGHING.

(From Policies and Procedures on infection control , May 2010)

Cough etiquette/respiratory hygiene is controlling the spread of pathogens from infected patients ( source control) is key to avoid transmission to unprotected contact.

For diseases transmitted through large droplets or droplet nuclei, respiratory hygiene/ cough etiquette should be applied by all individuals with respiratory symptoms.

All individuals (HCWs, patient and visitors) with signs and symptoms of a respiratory infection should:

Cont…….

Cover their mouth and nose when coughing/sneezing;

Use tissues, handkerchiefs, cloth mask or medical masks if available, as sourcecontrol to contain respiratory secretions and dispose of them into the waste containers;

Use medical mask on a coughing/sneezing person when tolerated and appropriate and perform hand hygiene.

1st TECHNIQUE OF COUGHING

& SNEEZING

2nd TECHNIQUE OF COUGHING

& SNEEZING.

Cont…

Hospital should promote respiratory hygiene/ cough etiquette:

Promote the use of respiratory hygiene/cough etiquette by all HCWs, patient and family members with acute febrile respiratory illness;

Educate HCWs, patient, family members and visitors on the importance of containing respiratory aerosois and secretion to help prevent the transmission of respiratory disease;

Cont…

Consider providing resources for hand hygiene (e.g. dispensers of alcohol-base hand rubs, hand-washing supplied) and respiratory hygiene (e.g. tissues); areas of gatthering,such as waiting rooms, should be prioritized.

WASH YOUR HAND

Cough

Etiquette/Respiratory

hygiene in Healthcare

Settings

(From CDC info 1 Aug. 2009)

DEFINATION

To prevent the transmission of all respiratory infections in healthcare settings, including influenza, the following infection control measures should be implemented at the first point of contact with a potentially infected person. They should be incorporated into infection control practices as one component of Standard Precautions.

Visual Alerts

At the entrance to outpatient facilities (e.g.,

Emergency Departments, Physician Offices, outpatient clinics) instructing patients and persons who accompany them (e.g., family, friends) to inform healthcare personnel of symptoms of a respiratory infection when they first register for care and to practice Respiratory Hygiene/Cough Etiquette.

Masking and Separation of Persons with Respiratory

Symptoms

During periods of increased respiratory infection activity in the community, offer masks to persons who are coughing.

Either procedure masks or surgical masks may be used to contain respiratory secretions.

When space and chair availability permit, encourage coughing persons to sit at least three feet away from others in common waiting areas.

Some facilities may find it logistically easier to institute this recommendation year-round.

We need to be prepared!!

HOW?

Patient Placement

1. Negative pressure room en-suite bath

2. Single room(nurse with door Closed) and en-suite bath

4 single patient room

Air condition with negative pressure

Attached bathroom and toilet.

Single Room/Cohort

Respiratory Protection(N95)

Wear respiratory protection(N95) when entering the room of a patient with known or suspected infectious pulmonary tuberculosis.

Type of Mask

N95 respirator

Duckbill N95 respirator

Mask N95 – Fitting Test LAMPIRAN 2

Step 1 Step 2

Step 3 Step 4 Step 5

Glove and Hand Washing

Glove and Hand WashingAs per standard precautions

When touching blood, body fluids secretions, excretions, contaminated items , mucous membranes, non intact skin.

Face Shield/Eye ProtectionAs per standard precautions

For procedure /activities likely to generate splashes/sprays of blood , body fluids , secretions and excretions.

GownAs per standard precautions

For procedures/ activities likely to generate splashes/sprays of blood , body fluids, secretions and excretions.

TBHierarchy of TB infection Control

Administrative controls (managerial)

Environmental control

Personel protective equipment (PPE)

Screening for HCW

Administrative controls (managerial)

The most important measures of TB infection control is to prevent exposure and reduce transmission to health care workers and patient.

1. Written TB Infection Control Plan.

2. Workplace Risk Assessment

3. Triage and screening of patients

4. Early diagnosis, prompt treatment and isolation

5. Training and education of health care workers

6. Patient education e.g. cough hygiene

Personel Protective Equipment (PPE)

The use of appropriate PPE is important and HCW must be trained to use PPE correctly.

Screening for HCW

Health care workers should be screened for Tuberculosis whenever they are symptomatic. Chest radiograph and Tuberculin Skin Test are not routinely recommended.

Inpatient Setting

All patients with infectious or potentially infectious Tuberculosis should be placed in(Airborne Infection Isolation /Negative Pressure) AII room if possible. However, if AII room is not available, TB patients should be cohorted from non tuberculosis patient, infectious from non infectious TB patients.

Isolation ward or area for TB patients should have maximum natural ventilation, mechanical ventilation by local exaust ventilation and air cleaning methods such as HEPA filter and/or Ultraviolet Germicidal Irradiation (UVGI) whenever appropriate.

All patients suspected or confirm TB should be educated about the importance of cough etiquette (refer to std precaution) and wear surgical or close the mouth/nose when sneezing or coughing.

Cont…

All health care workers handling infectious TB patients should use PPE properly, ideally at least N95 mask. HCW handling non infectious or unconfirmed cases should use N95 whenever possible.

Only minimum number of visitors should be allowed to visit active TB patient in the Ward. Protections for visitor are similar to medical staff.

Outpatient and Emergency

Department

Triage. Triaging patient at the counter should be done to identify high risk patients by history taking (patient with history of cough for more than 2 weeks). Specific waiting area or room for patients are recommended.

Signage directing patients with chronic cough to go to specific or identified counter. These patients should be provided with surgical mask.

Provide N95 respirator for HCW in-charge of triaging.

Cont…

Educate patient with suspected or confirmed infectious TB disease on strict respiratory hygiene and cough etiquette.

Sputum induction room should be made available at OPD.

Ideally patients should be seen in a designated consultation room for TB equipped with appropriate environmental control, good ventilation with or without UV light. HCW should be protected using N95.