Personal Protective EquipmentPersonal Protective EquipmentSession 5Session 5

Infection Control for LPHAInfection Control for LPHA

Train the Trainer CourseTrain the Trainer Course

August 25, 2005 August 25, 2005

ObjectivesObjectives

• Understand the principles of using Understand the principles of using PPEPPE

• Be familiar with federal regulations Be familiar with federal regulations related to PPE userelated to PPE use

• Be able to select the appropriate Be able to select the appropriate PPE to reduce risk of communicable PPE to reduce risk of communicable disease transmissiondisease transmission

PPEPPEPrinciplesPrinciples

• used as last resort when exposure used as last resort when exposure cannot be eliminated by cannot be eliminated by engineering controls or work engineering controls or work practicespractices

• must use for all exposuresmust use for all exposures• can opt out if it interferes with health can opt out if it interferes with health

care or public safety servicescare or public safety services• use is not dependent on length or use is not dependent on length or

frequency of exposure frequency of exposure

Chain of InfectionChain of Infection

Agent↓

Reservoir↓

Portal of exit↓

Mode of transmission↓

Portal of entry↓

Susceptible host

PPEPPEPrinciplesPrinciples

When selecting PPE, consider:When selecting PPE, consider:1.1. areas that need protectionareas that need protection– eyes, nose, moutheyes, nose, mouth– hands, skin, clothinghands, skin, clothing– respiratory tractrespiratory tract

2.2. tasks, procedures performedtasks, procedures performed – generation of splashes, spraysgeneration of splashes, sprays– proximity to patient/clientproximity to patient/client

PPEPPEFederal RegulationsFederal Regulations29 CFR 1910.103029 CFR 1910.1030

• Employer must:Employer must:– supply appropriate PPEsupply appropriate PPE– ensure employees use PPEensure employees use PPE– ensure PPE is readily available in needed ensure PPE is readily available in needed

sizessizes– clean, launder, repair, dispose of PPEclean, launder, repair, dispose of PPE– provide initial and annual trainingprovide initial and annual training

PPEPPEFederal RegulationsFederal Regulations

29 CFR 1910.132 29 CFR 1910.132

• Employee must:Employee must:– demonstrate ability to properly usedemonstrate ability to properly use– use it appropriatelyuse it appropriately

PPEPPE Standard precautions Standard precautions

Protect mucous membranes of Protect mucous membranes of eyes, nose, and mouth when eyes, nose, and mouth when anticipating splashes/sprays of anticipating splashes/sprays of blood or body fluids to the face. blood or body fluids to the face. – surgical masks and gogglessurgical masks and goggles– procedural masksprocedural masks

PPEPPE Standard precautions Standard precautions

• Considerations:Considerations:– eye protection must have side shieldseye protection must have side shields– masks need to be fluid resistantmasks need to be fluid resistant• withstand pressure of at least 160mm/Hgwithstand pressure of at least 160mm/Hg• available with ear loops or tiesavailable with ear loops or ties

– if deemed necessary to protect one area if deemed necessary to protect one area of face, all areas must be protected of face, all areas must be protected (eyes, nose, mouth)(eyes, nose, mouth)

PPEPPE Standard precautions Standard precautions

• Protect skin and prevent soiling of Protect skin and prevent soiling of clothing when anticipating clothing when anticipating splashes/sprays to the body.splashes/sprays to the body.– clean, non-sterile gowns (cloth or clean, non-sterile gowns (cloth or

disposable)disposable)– apronsaprons– lab coatslab coats– coverallscoveralls

PPEPPE Standard precautions Standard precautions

• Considerations:Considerations:– select gown appropriate for activity and select gown appropriate for activity and

amount of fluid likely to be encounteredamount of fluid likely to be encountered• fluid resistant vs. imperviousfluid resistant vs. impervious

PPEPPE Standard precautions Standard precautions

• Protect hands when touching blood, Protect hands when touching blood, body fluids, urine, feces, specimens, body fluids, urine, feces, specimens, contaminated itemscontaminated items– clean, nonsterile (non-latex) glovesclean, nonsterile (non-latex) gloves

PPEPPE Standard precautions Standard precautions

• Considerations:Considerations:– must wear gloves for phlebotomymust wear gloves for phlebotomy– gloves are put on just before touchinggloves are put on just before touching

• bloodblood• body fluidsbody fluids• mucous membranesmucous membranes• non-intact skinnon-intact skin

– change between clientschange between clients– change between tasks on same person if task change between tasks on same person if task

creates heavy contaminationcreates heavy contamination

PPEPPE Standard precautions Standard precautions

• Considerations:Considerations:– change if they become tornchange if they become torn– remove gloves promptly after use, remove gloves promptly after use,

before touching non-contaminated before touching non-contaminated itemsitems

– wash hands immediately after removing wash hands immediately after removing glovesgloves

– never wash gloved handsnever wash gloved hands

PPEPPE Standard precautions Standard precautions

Other PPE such as caps, shoe covers, Other PPE such as caps, shoe covers, boots are needed only if gross boots are needed only if gross contamination is expected.contamination is expected.

PPEPPE Contact precautions Contact precautions

In addition to practicing standard In addition to practicing standard precautions, wear gown and gloves precautions, wear gown and gloves when in contact withwhen in contact with– infected personinfected person– infected person’s environmentinfected person’s environment– contaminated items and surfacescontaminated items and surfaces– persons who are incontinent or who persons who are incontinent or who

have uncontrolled wound drainage or have uncontrolled wound drainage or diarrhea diarrhea

PPEPPE Droplet precautions Droplet precautions

In addition to practicing standard In addition to practicing standard precautions, wear a surgical or precautions, wear a surgical or procedural mask whenprocedural mask when– within 3 feet of the infected person, ORwithin 3 feet of the infected person, OR– have the infected person wear a mask have the infected person wear a mask

when in contact with other persons, if when in contact with other persons, if possible possible

PPEPPE Airborne precautions Airborne precautions

In addition to practicing In addition to practicing standard precautions, wear a standard precautions, wear a NIOSH certified, fit-tested N-95 NIOSH certified, fit-tested N-95 respirator when entering area respirator when entering area where air is shared with where air is shared with infected person. infected person.

PPEPPE Airborne precautions Airborne precautions

• Do not enter premises of infected person Do not enter premises of infected person if not fit tested.if not fit tested.

• Staff susceptible to measles or Staff susceptible to measles or chickenpox should not have contact with chickenpox should not have contact with infected persons.infected persons.

• Persons with known immunity to measles Persons with known immunity to measles and chickenpox do not need to wear and chickenpox do not need to wear respirators. respirators.

• Infected person should wear a surgical Infected person should wear a surgical mask when outside of isolation. mask when outside of isolation.

PPEPPERemoval and DisposalRemoval and Disposal

• Remove immediately after use, Remove immediately after use, before contaminating clean items before contaminating clean items and surfaces.and surfaces.

• Remove before leaving exam room, Remove before leaving exam room, or remove away from person’s or remove away from person’s immediate environment if on home immediate environment if on home visit.visit.

PPE PPE Removal and DisposalRemoval and Disposal

• Wash hands immediately after Wash hands immediately after removal and disposal.removal and disposal.

• PPE may be discarded in regular PPE may be discarded in regular trash unless saturated with blood or trash unless saturated with blood or body fluids. body fluids. – place saturated PPE in biohazard bag place saturated PPE in biohazard bag – home visit disposal: place PPE in home visit disposal: place PPE in

plastic bag before discarding in regular plastic bag before discarding in regular trashtrash

PPE PPE Removal and DisposalRemoval and Disposal

N-95 respirators must not be N-95 respirators must not be removed until outside the area of removed until outside the area of shared air. Place in regular trash shared air. Place in regular trash unless saturated with blood, body unless saturated with blood, body fluids. fluids.

ReferencesReferences

• Siegel et al. CDC HICPAC, “Guidelines for Isolation Precautions: Siegel et al. CDC HICPAC, “Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Preventing Transmission of Infectious Agents in Healthcare Settings, 2007.” Settings, 2007.” http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdfhttp://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf

• OSHA Bloodborne Pathogens Standard, 29 CFROSHA Bloodborne Pathogens Standard, 29 CFR 1910.1030 1910.1030– http://www.osha.gov/SLTC/bloodbornepathogens/index.htmlhttp://www.osha.gov/SLTC/bloodbornepathogens/index.html

• Personal Protective Equipment Education, APIC, August, 2005Personal Protective Equipment Education, APIC, August, 2005– www.apic.orgwww.apic.org

Infection Control Principles Infection Control Principles and Practicesand Practices

Gwen Borlaug, CIC, MPHGwen Borlaug, CIC, MPH

Infection Control EpidemiologistInfection Control Epidemiologist

Bureau of Communicable DiseasesBureau of Communicable Diseases

1 West Wilson Street Room 3181 West Wilson Street Room 318

Madison, WI 53701Madison, WI 53701

608-267-7711608-267-7711gwen.borlaug@wisconsin.govgwen.borlaug@wisconsin.gov