Infection Prevention and Control of Epidemic and Pandemic in Health Care
Infection Prevention and Control for Epidemic- and Pandemic-Prone Acute Respiratory Diseases.
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Transcript of Infection Prevention and Control for Epidemic- and Pandemic-Prone Acute Respiratory Diseases.
Influenza Training Package
Learning Objectives
Describe basic infection-control principles.
Discuss core infection-control measures in health-care settings.
Influenza Training Package
Presentation Overview
Basic infection control principles
Core infection control measures used in health care settings
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Aim of Infection Control
Basic infection control measures reduce risk of transmission of pathogens from a known or unknown source
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Quantity ofpathogen
Virulence Routes of transmission
Susceptiblehost
Portal of entry into
host
Chain of Infection
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Routes of TransmissionContact: Infections spread by direct or indirect contact
with patients or the patient-care environment (e.g., shigellosis, viral hemorrhagic fevers)
Droplet: Infections spread by large droplets generated by coughs, sneezes, etc. (e.g., Neisseria meningitidis, pertussis)
Airborne (droplet nuclei): Infections spread by particles that remain infectious while suspended in the air (TB, measles, varicella, and variola)
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Breaking the Chain of Infection
•Source control measures-Cough etiquette, cleaning, disinfection
•Modes of transmission-Contact: hand hygiene-Droplet: distance from source >1 m-Airborne: ventilation-Vector: bednets
•Portal of entry into the host-Adding barriers, e.g., PPE
•Host -Strengthen host defences, e.g., vaccination
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Seasonal Influenza in Humans
SARS and Current Avian Influenza in Humans
Droplet most likely route most likely route (SARS) possible (AI)
Airborne possible during aerosol generating procedures
possible during aerosol generating procedures
Contact possible most likely route (SARS)
H5N1: (bird to human), and possible (human to human)
Transmission of Epidemic- and Pandemic-Prone Acute Respiratory Diseases
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● Early recognition and reporting
● Infection control precautions
● Hand hygiene: alcohol-based hand rub, hand washing
● PPE: gloves, gowns, masks/respirators, eye protection
Core Infection Control Measures in Health Care Settings (1)
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Core Infection Control Measures in Health Care Settings (2)
● Patient accommodation
● Environmental cleaning and waste disposal
● Occupational health management
WHO
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Early Recognition in Health Care Facilities
Health care facility staff must quickly identify and separate potential sources of infection from susceptible hosts
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How to identify rapidly
Rapid identification of Patients with Epidemic- or Pandemic-Prone Acute Respiratory Diseases:
Clinical indications– Severe acute febrile respiratory illness (e.g., fever > 38°C, cough, shortness
of breath)
– Exposure history consistent with ARD of potential concern
Epidemiological indications– History of travel to area affected by ARDs
– Possible occupational exposure
– Unprotected contact with ARDs patient(s)
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Infection Control Precautions
Standard precautions– Should be applied for ALL patients
Transmission-based precautions* – Contact – Droplet – Airborne
*Transmission-based precautions are often used empirically, according to the clinical syndrome and the likely etiological agent
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Standard Precautions•Hand hygiene
•Respiratory hygiene/cough etiquette
•Use of personal protective equipment (PPE)
•Prevention of needle sticks/sharps injuries
•Cleaning and disinfection of the environment and equipment
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Droplet PrecautionsProtection against respiratory pathogens
transmitted by large droplets
In addition to Standard Precautions:– Use a medical mask when < 1 m of patient – Maintain a distance ≥ 1 meter between infectious
patient and others – Place patient in a single room or cohort with similar
patients – Limit patient movement
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Contact PrecautionsProtection against contact with large droplets
In addition to Standard Precautions:– Use non-sterile, clean, disposable gloves, gown, apron
(only if gown is not impermeable)– Use disposable or dedicated reusable equipment (which
must be cleaned and disinfected before use on other patients)
– Limit patient contact with non-infected persons– Place patient in a single room or cohort with similar
patients
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Airborne PrecautionsProtection against inhalation of tiny infectious
droplet nuclei
In addition to Standard Precautions: – Use particulate respirator – Place the patient in adequately ventilated room (≥ 12
air changes per hour)– Limit patient movement
Use airborne precautions for performance of any aerosol-generating procedures associated with pathogen transmission
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Hand HygieneHand hygiene should be performed:
– before and after any direct contact with a patient– after contact with blood, body fluids, secretions and
excretions– after contact with items contaminated with blood, body
fluids, secretions and excretions, including respiratory secretions
Use alcohol-based hand rub or wash hands with soap and water
– Wash hands if visibly soiled
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Respiratory Hygiene and Cough EtiquettePart of standard precautions
Education of health care workers, patients and visitors
Source control measures (e.g., cover cough to prevent dissemination of infectious droplets)
Hand hygiene
Spatial separation (> 1 meter) of persons with acute febrile respiratory symptoms
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Types of PPE Used in Healthcare Settings
Gloves – protect hands
Gowns/aprons – protect skin and/or clothing
Masks and respirators– protect mouth/nose
– Respirators – protect respiratory tract from airborne infectious agents
Goggles – protect eyes
Face shields – protect face, mouth, nose, and eyes
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PPE for Standard Precautions: Based on Risk Assessment
IF direct contact with blood & body fluids, secretions, excretions, mucous membranes, non-intact skin– Gloves– Gown
IF there is the risk of spills onto the body and/or face– Gloves– Gown – Face protection (mask plus eye protection goggle or
visor; face shield)
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PPE for Transmission-Based PrecautionsUsed in addition to Standard Precautions
Contact Precautions – Gloves – Gown
Droplet Precautions – Medical mask
Airborne Precautions – Particulate respirator
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Masks and Respirators: Barriers and Filtration
Surgical masks– Protect against body fluids and
large particles
Particulate respirators (e.g., N95)– Protect against small particles
and other airborne particles
Alternative materials (barriers)– Tissues, cloth
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HH Gloves Gown Medical Mask
Particulate Respirator
Eye Protection
Entry to isolation room/area, but no anticipated patient contact
Y
Risk Asst
Risk Asst
Risk Asst N
Risk Asst
Close contact (< 1 meter) with infected patient in or out of isolation room/area
Y
Y Y Y N Y
Performance of aerosol-generating procedure on patient Y Y Y N Y Y
PPE for Persons Providing Care for Patients with Acute Febrile Respiratory Illness, Including Patients with
Suspected or Confirmed AI Infection
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PPE for Interviewing Exposed Persons and Contacts of ARDs Patients Asymptomatic exposed persons and contacts (low-risk)
– Routine use of PPE not recommended
– Maintain 1 meter distance between interviewer and interviewee
– Use proper hand hygiene
Symptomatic exposed persons (higher-risk)
– PPE recommended in community and health care facility: Contact and Droplet Precautions
– In health care facility, person should be placed in adequately ventilated room (≥ 12 air changes per hour), if possible
– Maintain a distance of > 1 meter, if possible
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PPE for Specimen Collection – Exposed Persons
Collecting respiratory specimens is a high-risk, aerosol-generating procedure
PPE recommended– Gloves– Gown– Goggles or face shield– N95 or higher level respirator
CDC
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●Isolate patients with droplet or airborne spread diseases from other patients●Separate wards, areas, or establish rooms for infectious patients where isolation facilities do not exist●Only those patients with epidemiological and clinical information suggestive of a similar diagnosis should share rooms
●Separate patients by at least 1 meter
Patient Accommodation
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Duration of IC measures for Avian and Pandemic Influenza
Adults and adolescents > 12 years of age – from time of admission until 7 days after symptoms resolved
Infants and children ≤ 12 years of age – from time of admission until 21 days after symptoms resolved
For immunocompromised patients, pathogen shedding may be protracted
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•Environmental cleaning:
Use appropriate procedures for the routine cleaning and disinfection of environmental and other frequently touched surfaces
•Waste disposal:
Treat waste contaminated with blood, bodily fluids, secretions and excretions as clinical waste, in accordance with local regulations
Environmental Cleaning and Waste Disposal
WHO
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Waste DisposalUse Standard Precautions
– Gloves and hand washing– Gown + Eye protection
Avoid aerosolization
Prevent spills and leaks– Double bag if outside of bag is contaminated
Incineration is usually the preferred method
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Autopsy Precautions for Influenza A (H5N1)
Follow standard PPE procedures for autopsies
Anyone handling a corpse should follow standard precautions for blood and body fluids
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Occupational Health Management During an Outbreak
Monitor staff who work with patients with an infectious disease of potential concern for symptoms
Screen for symptoms of influenza-like illness among staff reporting for duty (fever, cough)
WHO
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Implementation of Core Infection Control Measures During Rapid Containment Early recognition and reporting
Infection control precautions
Hand hygiene
PPE: gloves, gowns, masks/respirators, eye protection
Patient accommodation
Environmental cleaning and waste disposal
Occupational health management
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Hospital Preparedness: Key Points
Apply standard precautions routinely in all health-care settings
Place all patients (suspected or confirmed with an infectious ARD) in a room or area separate from other patients
Practice both standard and droplet precautions when caring for patients with infectious ARD
Important Components for HC Facility Infection Prevention and Control Program
•Available supplies and equipment (PPE, disinfectants)
•Policies and guidelines for procedures
•Ongoing educational programs for healthcare facility staff
•Process for monitoring staff health to identify and to prevent staff-to-patient and patient-to-staff spread of infection
Jamaica IC Guidelines
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Infection Control for ARD in Heath Care Settings Infection Control for ARD in Heath Care Settings
Symptoms acute ILI
Investigation for ARD of potential concern
Confirmed ARD of potential concern
Single room adequately ventilated (≥ 12 air changes per hour), if possible
Standard and droplet precautions
Different diagnosis
Reassess precautions
+ Risk Factor
Report to Public Health Authorities
WHO
Single room adequately ventilated, if possible
Patient Infection control precautions
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Environmental Decontamination
Cleaning MUST precede decontamination
Disinfectant ineffective if organic matter is present
Use mechanical force– Scrubbing– Brushing– Flush with water
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Environmental Decontamination: Disinfecting
Household bleach (diluted)
Quaternary ammonia compounds
Chlorine compounds (Chloramin B, Presept)
Alcohol– Isopropyl 70% or
ethyl alcohol 60%
Peroxygen compounds
Phenolic disinfectants
Germicides with a tuberculocidal claim on label
Others