11
Pandemic Influenza Pandemic Influenza PreparednessPreparedness
Response Guidance forResponse Guidance forHealthcare Workers Healthcare Workers
and Healthcare and Healthcare EmployersEmployers
Educational material developed through funding from OSHA Susan Harwood Grant #SH-16624-07-60-F-54
22
IntroductionIntroduction
Any Pandemic DiseaseAny Pandemic Disease is a global disease outbreakis a global disease outbreak occurs when a new virus emerges occurs when a new virus emerges spreads where people have no immunityspreads where people have no immunity is a disease for which there is no vaccineis a disease for which there is no vaccine spreads easily person-to-personspreads easily person-to-person causes serious illnesscauses serious illness sweeps around the world in a short timesweeps around the world in a short time
33
Initial Control MeasuresInitial Control Measures
After a pandemic disease starts, After a pandemic disease starts, everyone in the world is at riskeveryone in the world is at risk
Countries might try to delay or stop Countries might try to delay or stop the arrival of the virus throughthe arrival of the virus through border closuresborder closures travel restrictionstravel restrictions quarantinesquarantines
44
Effects of A Severe Effects of A Severe PandemicPandemic
Everyday life would come to a standstill due to high levels of illness, death, social
disruption, and economic loss everyone being ill at the same time interruptions of basic services such as
public transportation and food delivery
55
History of Flu PandemicsHistory of Flu Pandemics
Deaths in USA from past influenza Deaths in USA from past influenza pandemicspandemics 1918 – 500,000 1918 – 500,000 1957 – 70,0001957 – 70,000 1968 – 34,0001968 – 34,000
66
The Public Health ServiceThe Public Health Service
By 1918, most PHS By 1918, most PHS officers understood officers understood how diseases how diseases spreadspread
Without antibiotics, Without antibiotics, PHS officers were PHS officers were limited in their limited in their ability to fight ability to fight diseasedisease
77
Devastation of 1918 Avian Devastation of 1918 Avian FluFlu
The Influenza The Influenza Pandemic Pandemic occurred in occurred in three waves three waves in the United in the United States States throughout throughout 1918 and 1918 and 1919. 1919.
http://www.pandemicflu.gov/
88
1918 – Rapid-paced 1918 – Rapid-paced OutbreaksOutbreaks
The 1918 influenza pandemic The 1918 influenza pandemic occurred too rapidly for the PHS to occurred too rapidly for the PHS to develop a detailed study of the develop a detailed study of the pandemicpandemic
After the pandemic, they developed a After the pandemic, they developed a map with approximate dates of the map with approximate dates of the outbreakoutbreak
99[Credit: Office of the Public Health Service Historian] [Credit: Office of the Public Health Service Historian]
1010
Effects on Healthcare Effects on Healthcare SystemSystem
Healthcare facilities would be Healthcare facilities would be overwhelmed including shortage ofoverwhelmed including shortage of hospital staffhospital staff bedsbeds ventilatorsventilators suppliessupplies
1111
Healthcare Worker Healthcare Worker DemandsDemands
Healthcare will be affected since Healthcare will be affected since healthcare workers will be ill, too healthcare workers will be ill, too ((including first responders, nurses,
physicians, pharmacists, technicians and aides, building maintenance, security and administrative personnel, social workers, laboratory employees, food service, housekeeping, and mortuary personnel)
1212
Healthcare Facility Healthcare Facility Demands Demands
Healthcare will be affected since Healthcare will be affected since healthcare resources will be expected to healthcare resources will be expected to meet non-pandemic associated meet non-pandemic associated healthcare needs in a variety of healthcare needs in a variety of workplace settings workplace settings
(including medical and dental offices, schools, physical and rehabilitation therapy centers, health departments, occupational health clinics, and prisons, free-standing ambulatory care and surgical facilities, and emergency response settings)
1313
Cornerstones of Cornerstones of PreparednessPreparedness
Cornerstones of effective pandemic Cornerstones of effective pandemic influenza preparedness and response influenza preparedness and response Risk AssessmentRisk Assessment Policy DevelopmentPolicy Development Procedure ExecutionProcedure Execution
1414
Each Facility is UniqueEach Facility is Unique
To insure adequate To insure adequate preparation of healthcare preparation of healthcare workersworkers make preparations for each make preparations for each
facility facility collaborate with local, state, collaborate with local, state,
and federal partnersand federal partners follow related standards and follow related standards and
guidelines guidelines
1515
Specific Areas for PlanningSpecific Areas for Planning
Infection Control Plans Risk Communication Tools Self-triage Instructions for Home Care of Flu Patients Diagnosis and Treatment of Staff During a
Pandemic Technical Information Available Through
Internet Sources Supply Checklists
1616Permission of Gary Brookins and the Richmond Times-Dispatch
1717
Summit for Pandemic Summit for Pandemic PlanningPlanning
January 12, 2006January 12, 2006 Pandemic planning Pandemic planning summitsummit The state of West The state of West
VirginiaVirginia HHS and other federal HHS and other federal
agenciesagencies Public health officialsPublic health officials Emergency Emergency
management and management and response leaders response leaders
1818
North AmericaNorth America
The United States Northern Command has The United States Northern Command has a role in protecting our healtha role in protecting our health
Resources are available at their websiteResources are available at their website Information SheetInformation Sheet Personal Training BriefPersonal Training Brief Readiness GuideReadiness Guide NewsletterNewsletter Department of Defense Influenza WatchboardDepartment of Defense Influenza Watchboard
http://www.northcom.mil/Avian%20Flu/http://www.northcom.mil/Avian%20Flu/index.htmlindex.html
1919
PandemicFlu.govPandemicFlu.gov
State Pandemic PlansState Pandemic Plans
http://www.pandemicflu.gov/plan/stathttp://www.pandemicflu.gov/plan/states/stateplans.htmles/stateplans.html
Site contains list of pandemic plans Site contains list of pandemic plans that are currently available on state that are currently available on state websiteswebsites
2020
WV Pandemic PlanningWV Pandemic Planning
Agreement - WV & Agreement - WV & U.S. Dept. of Health U.S. Dept. of Health and Human Servicesand Human Services January 12, 2006January 12, 2006
HHS Secretary Mike HHS Secretary Mike Leavitt and Governor Joe Leavitt and Governor Joe Manchin III signed a Manchin III signed a Planning Resolution Planning Resolution detailing HHS‘s and detailing HHS‘s and West Virginia's shared West Virginia's shared and independent and independent responsibilities for responsibilities for pandemic planningpandemic planning
2121
WV for Pandemic WV for Pandemic PlanningPlanning
WV Federal Funding - 2006WV Federal Funding - 2006 $940,502$940,502 - Phase One funding from U. S. - Phase One funding from U. S.
Dept. of Health and Human Services (HHS) Dept. of Health and Human Services (HHS) for pandemic planning activitiesfor pandemic planning activities
$1,688,192$1,688,192 - revised Phase Two of Health - revised Phase Two of Health and Human Services’ local and state and Human Services’ local and state allocationsallocations
$620,408$620,408 - awarded to help strengthen the - awarded to help strengthen the state's capacity to respond to a pandemic state's capacity to respond to a pandemic influenza outbreak. influenza outbreak.
2222
WV Agencies Involved in WV Agencies Involved in PlanningPlanning
Bureau for Bureau for Public HealthPublic Health
Health and Health and Human Human ResourcesResources
WV WV Department Department of Military of Military Affairs and Affairs and Public Public
2323
WV Pandemic Flu WebsiteWV Pandemic Flu Website http://www.wvflu.org/http://www.wvflu.org/ West Virginia Bureau for Public West Virginia Bureau for Public
Health - Threat PreparednessHealth - Threat Preparedness505 Capitol Street • Suite 200 • 505 Capitol Street • Suite 200 • Charleston, WV 25301Charleston, WV 25301Phone: (304) 558-6900 ext. 2005 Phone: (304) 558-6900 ext. 2005 Fax: (304) 558-0464Fax: (304) 558-0464
2424
2525
WV Pandemic Flu BrochureWV Pandemic Flu Brochure
2626
InfluenzaInfluenza
2727
Influenza - HistoryInfluenza - History
Clinical Background Clinical Background Three pandemics in the 20Three pandemics in the 20thth Century Century Three types: A, B, & CThree types: A, B, & C Only Type A influenza viruses cause pandemicsOnly Type A influenza viruses cause pandemics
Influenza A virus variationsInfluenza A virus variations VirulenceVirulence Infectivity to specific hostsInfectivity to specific hosts Modes of transmissionModes of transmission Clinical presentation of infectionClinical presentation of infection
2828
Influenza Type A: SubtypesInfluenza Type A: Subtypes
Only Type A is divided into subtypesOnly Type A is divided into subtypes Based on presence of two viral surface Based on presence of two viral surface
proteins (antigens)proteins (antigens) Hemagglutin (H) Hemagglutin (H) Neuraminidase (N)Neuraminidase (N)
Number of surface proteins identified in Number of surface proteins identified in influenza A virusesinfluenza A viruses
16 hemagglutinin16 hemagglutinin 9 neuraminidase 9 neuraminidase
2929
Pandemic SubtypesPandemic Subtypes
In the 20In the 20thth Century, 3 different Century, 3 different subtypes have caused pandemicssubtypes have caused pandemics H1N1H1N1 H2N2H2N2 H3N2H3N2
Subtypes are designated as H protein Subtypes are designated as H protein type (1-16) solely, OR followed by the type (1-16) solely, OR followed by the N protein type (1-9)N protein type (1-9)
3030
TerminologyTerminology
Avian (bird) flu is caused by influenza A Avian (bird) flu is caused by influenza A viruses that occur naturally among birdsviruses that occur naturally among birds
Different subtypes of these viruses exist Different subtypes of these viruses exist because of changes in certain proteins on the because of changes in certain proteins on the surface of the influenza A virus and the way surface of the influenza A virus and the way the proteins combinethe proteins combine hemagglutininhemagglutinin [HA][HA] neuraminidase [NA]neuraminidase [NA]
Each combination represents a different Each combination represents a different subtypesubtype
All known subtypes of influenza A viruses can All known subtypes of influenza A viruses can be found in birdsbe found in birds
The avian flu currently of concern is the H5N1 The avian flu currently of concern is the H5N1 subtypesubtype
3131
H5N1 VirusH5N1 Virus
H5N1H5N1 spreading rapidlyspreading rapidly first appeared in Asiafirst appeared in Asia epizootic (an epidemic in epizootic (an epidemic in
nonhumans) nonhumans) panzootic (affecting animals panzootic (affecting animals
of many species, especially of many species, especially over a wide area)over a wide area)
killing tens of millions of killing tens of millions of birdsbirds
spurring the culling of spurring the culling of hundreds of millions of birds hundreds of millions of birds to stem its spreadto stem its spread
Most references to Most references to "bird flu" and H5N1 in "bird flu" and H5N1 in the popular media refer the popular media refer to thisto this strainstrainhttp://en.wikipedia.org/wiki/H5n1
3232
Seasonal InfluenzaSeasonal Influenza
Refers to periodic outbreaks of acute onset viral respiratory infection caused by circulating strains of human influenza A and B viruses
Between 5–20 percent of the population may be infected annually
Most people have some immunity to the currently circulating strains of influenza virus
Thus, the severity and impact of seasonal influenza is substantially less than during pandemics
3333
Avian Influenza: Bird FluAvian Influenza: Bird Flu
Caused by type A influenza viruses that infect wild birds and domestic poultry
Some forms of the avian influenza are worse than others
Generally divided into two groups low pathogenic avian influenza highly pathogenic avian influenza
3434
Low Pathogenic Avian Low Pathogenic Avian InfluenzaInfluenza
Naturally occurs in wild birds and can spread to domestic birds
In general, poses little threat to human health
Has the potential to mutate into highly pathogenic avian influenza and is, therefore, closely monitored
3535
High Pathogenic Avian High Pathogenic Avian InfluenzaInfluenza
Can spread rapidly Has a high death rate in birds H5N1
now rapidly spreading in birds in some parts of the world
one of the few avian influenza viruses to have crossed the species barrier to infect humans
the most deadly of those viruses that have crossed the barrier
3636
Humans and H5N1Humans and H5N1
Most cases of H5N1 infections in humans have resulted from contact with infected poultry or surfaces contaminated with secretion/excretions from infected birds
Spread of H5N1 from person to person has been limited to rare, sporadic cases
H5N1 does not commonly infect humans In humans, there is little or no immune
protection against H5N1 (Information from November 2006)(Information from November 2006)
3737
Influenza Pandemic PatternsInfluenza Pandemic Patterns
Many scientists believe that since no pandemic has occurred since 1968, it is only a matter of time before another pandemic occurs
A pandemic may occur in waves of outbreaks with each wave in a community lasting 8 to 12 weeks
One-to-three waves may occur
3838
Critical Response ElementsCritical Response Elements
Rapid detection of unusual influenza outbreaks
Isolation of possible pandemic viruses Immediate notification of national and
international health authorities
3939
URL: http://www.who.int/en/URL: http://www.who.int/en/ WHO is the directing and coordinating WHO is the directing and coordinating
authority for health within the United Nations authority for health within the United Nations system. It is responsible for providing system. It is responsible for providing leadership on global health matters, shaping leadership on global health matters, shaping the health research agenda, setting norms the health research agenda, setting norms and standards, articulating evidence-based and standards, articulating evidence-based policy options, providing technical support to policy options, providing technical support to countries and monitoring and assessing countries and monitoring and assessing health trends.health trends.
WHO URL for Avian Influenza WHO URL for Avian Influenza http://www.who.int/topics/avian_influenza/en/http://www.who.int/topics/avian_influenza/en/
4040
Public Health Map/GIS Map Public Health Map/GIS Map LibraryLibrary
World : Areas reporting confirmed occurrence of H5N1 avian influenza in poultry and wild birds between January and June 2007
4141
Public Health Map/GIS Map Public Health Map/GIS Map LibraryLibrary
World : Areas reporting confirmed occurrence of H5N1 avian influenza in poultry
and wild birds Since 2003, status as of Dec. 7, 2007 (latest available update)
4242
WHO Pandemic Alert & WHO Pandemic Alert & Response SystemResponse System
URL: http://www.who.int/csr/en/URL: http://www.who.int/csr/en/ Purpose: The world requires a global Purpose: The world requires a global
system that can rapidly identify and system that can rapidly identify and contain public health emergencies contain public health emergencies and reduce unneeded panic and and reduce unneeded panic and disruption of trade, travel and society disruption of trade, travel and society in generalin general
4343
WHO Pandemic Alert WHO Pandemic Alert SystemSystem
Phase 1 & 2Phase 1 & 2 The “Inter-Pandemic Period” There is a novel influenza A virus in
animals but no human cases have been observed
Phase 2 indicates that an animal influenza subtype that poses a risk to humans has been detected
4444
WHO Pandemic Alert WHO Pandemic Alert SystemSystem
Phase 3, 4 & 5Phase 3, 4 & 5 The “Pandemic Alert Period” A novel influenza virus causes human
infection with a new subtype, but does not exhibit efficient and sustained human-to-human transmission
4545
WHO Pandemic Alert WHO Pandemic Alert SystemSystem
Phase 6Phase 6 The “Pandemic Period” A new influenza A virus develops the
capacity for efficient and sustained human-to-human transmission in the general population
The WHO declares that an influenza pandemic is in progress
4646
Sentinel Provider NetworkSentinel Provider Network
Operated by the CDC Operated by the CDC (Centers for Disease Control and (Centers for Disease Control and PreventionPrevention
URL: http://www.cdc.gov/URL: http://www.cdc.gov/
4747
CLINICALCLINICALDIAGNOSISDIAGNOSIS
4848
Clinical Presentation of Clinical Presentation of InfluenzaInfluenza
Varies from “no symptoms” at all in seasonal influenza to “ “fulminant” (fully symptomatic) disease in pandemic strains that result in severe illness and death (even among previously healthy adults and children)No Symptoms --------------------- > Fulminant
4949
Clinical DiagnosisClinical Diagnosis
Clinical Diagnosis of Seasonal Influenza sudden onset of fever respiratory illness muscle aches headaches nonproductive cough sore throat runny nose ear infections gastrointestinal symptoms
5050
Accuracy of DiagnosisAccuracy of Diagnosis
It has been reported that the use of the influenza-like case definition is 63 to 78% accurate in identifying
culture-confirmed cases of influenza (a sensitivity of 63 to 78%)
55 to 71% accurate in excluding influenza (specificity of 55 to 71%)
5151
Clinical Signs & SymptomsClinical Signs & Symptoms
Sensitivity - Sensitivity - The likelihood of a clinical sign or symptom to accurately detect influenza infection in a group of patients
Specificity - TSpecificity - The likelihood of a clinical sign or symptom to exclude influenza infection in a group of patients who do not have influenza
5252
Laboratory DiagnosisLaboratory DiagnosisSeasonal InfluenzaSeasonal Influenza
Seasonal Influenza Commercial rapid testing can detect seasonal
influenza virus in less than 30 minutes Some tests not very sensitive False negative results are common Not all of these tests can distinguish between
influenza A and B virusesHHS/CDC Influenza Laboratory Diagnostic Procedureshttp://www.cdc.gov/flu/professionals/
labdiagnosis.htm
5353
Clinical DiagnosisPandemic Influenza
Patients will likely have clinical signs and symptoms similar to seasonal influenza
Clinical presentation and course of illness may be severe in a higher percentage of the cases of pandemic influenza
5454
Laboratory Diagnosis Avian Influenza
HHS/CDC developed a 4-hour RT-PCR assay to detect gene coding for H5 surface protein of Asian lineage of the highly pathogenic H5N1 avian influenza virus
RT-PCR reagents distributed to approximately 140 designated laboratories of the Laboratory Response Network (LRN)
Laboratories located in all 50 states
5555
Modes of TransmissionSeasonal Influenza
1- Droplet Transmission coughing, sneezing, or talking therapeutic manipulations i. e. suctioning or
bronchoscopy 2 - Airborne Transmission
disseminated by air currents to susceptible individuals can travel significant distances penetrate deep into the lung to the alveoli can establish an infection
3 - Contact Transmission Direct contact - touching skin-to- skin
5656
Modes of TransmissionPandemic Influenza
Transmission - Past Pandemics Person-to-person Airborne
Transmission - Future Pandemics May be possible by
contact with blood CSF (cerebrospinal fluid) feces respiratory secretions mucous membranes of the eye
5757
Treatment and PreventionSeasonal Influenza
Antiviral medications
Vaccinations Intranasal live
attenuated vaccine Injectable,
inactivated trivalent vaccine
5858
Treatment and PreventionPandemic Influenza
Antiviral medications HHS recommends
use of neuraminidase inhibitors zanamivir and oseltamivir because of influenza resistance to amantadine and rimantadine
5959
PosterPoster
A printable poster on A printable poster on the sequences for the sequences for putting on and putting on and taking off PPE, which taking off PPE, which can be used for can be used for employee training employee training and can be posted and can be posted outside respiratory outside respiratory isolation rooms, is isolation rooms, is available at available at http://www.cdc.gov/http://www.cdc.gov/ncidod/sars/ic.htmncidod/sars/ic.htm
6060
Patient Patient Screening Screening
PlanPlan
Screen all patients for influenza-like illness
Routinely implement strategies
6161
Surveillance ActivitiesHealthcare Workers
Keep a register of healthcare workers who have provided care for pandemic influenza-infected
patients recovered from pandemic influenza
Encourage self-reporting by symptomatic healthcare workers
Exclude symptomatic healthcare workers from duty
6262
EpidemicRespiratory
Infection Six levels of alert
corresponding to the type of transmission, the location of the cases, and the presence and type of cases at a particular medical center
6363
Alert Levels
Determined by Readiness Committee use matrix and data collected through
surveillance activities Can be upgraded (or downgraded) by the
committee depending on number of cases other compelling circumstances
At each level of alert Readiness Committee will consider implementing certain actions
As level of alert becomes higher, additional actions are added to actions initiated at lower level
6464
Level: READY
Baseline activities to ensure preparedness in the absence of known active epidemic of ERI in the world
ERI = Epidemic Respiratory Infection
6565
Level: GREEN
Confirmed efficient human-to-human transmission of potentially epidemic contagious respiratory infection present outside the U.S. and bordering countries (Canada and Mexico)
6666
Level: YELLOW
Confirmed human-to-human transmission of potentially epidemic contagious respiratory infection (ERI) documented in the U.S. or bordering countries (Canada or Mexico)
6767
Level: CONTROLLED ORANGE
A case of ERI has been diagnosed at a particular medical center or in an inpatient at a medical center but there has been no documented nosocomial or community spread from this person to others
6868
Level: ORANGE
There is evidence of nosocomial transmission of ERI from known infected patients to other patients, employees, or visitors at a particular medical center, OR there is human-to-human transmission in specified region, or nearby
6969
Level: RED
There is evidence of untraceable or uncontrolled nosocomial transmission of ERI
OR there is widespread human-to-human transmission in a particular region or nearby
7070
Epidemic Respiratory Infections
Patient Flow This chart
shows possible patient responses to risk factor screening questions
7171
ERI Outpatient Management Protocol
For patients with new cough and risk factors associated with epidemic respiratory infection (ERI)
Key points Give patient a mask Require PPE for
anyone visiting patient Evaluate risk factors
Consult with physician
Move patient to room with negative air pressure
Administer tests Coordinate medical
followup if patient is released
Activate ERI plan if patient is admitted
7272
PrinciplesCare of ERI Patients
Minimize Health Care Workers (HCW) contact with the patient
Protect HCWs during contact with patient
Minimize opportunities for exposure to other patients or visitors
7373
ERI Inpatient Management Protocol
This plan will be put into effect when a patient is believed to meet the criteria for an Epidemic
Respiratory Infection by one of the Infectious Disease Physicians, and
needs hospitalization
7474
Self-Triage
Question: You may have influenza
When should you seek additional help from a healthcare provider?
7575
Home Care Guide for Influenza Common
symptoms Supplies to
have on hand Caring for a
person with influenza
When to seek additional medical advice
7676
Symptom and Care Log
for Home Care
Copy, fill out, and bring log sheets to healthcare provider visits
7777
Influenza Diagnostic Table
This table contains references for diagnosis and treatment of staff during an influenza pandemic
Please refer to www.pandemicflu.gov or http://www.pandemicflu.gov/vaccine/#testing for current information and recommendations
7878
Planning Checklists
and Example Plans
Many government and private organizations have developed viable resources including planning checklists example plans communication
plans
7979
Assistance Available fromAssistance Available from
Safety and Health Program Management Guidelines Management leadership and employee
involvement Worksite analysis Hazard prevention and control Safety and health training
8080
INFECTIONINFECTIONCONTROLCONTROL
8181
Infection Control
Use same strategies implemented for any infectious agent facility and environmental controls
engineering controls standard operating procedures
administrative controls personal protective clothing and equipment safe work practices
8282
Standard Precautions
Apply to blood all body fluids, secretions, and excretions
except sweat, regardless of whether or not they contain visible blood
non-intact skin mucous membranes
8383
First, Conduct Risk First, Conduct Risk AssessmentAssessment
Conduct to determine necessary PPE and work practices to avoid contact with blood, body fluids, excretions, and secretions
Will help to customize standard precautions to the healthcare setting of interest
8484
Next, Implement ProceduresNext, Implement Procedures
IncludeInclude Gloves and facial (nose, mouth, and eye)
protection Hand hygiene before and after patient
contact, and after removing gloves or other PPE
Handling and disinfection of patient care equipment, patient rooms, and soiled linen
8585
Then, Use PrecautionsThen, Use Precautions
Contact Precautions Use PPE, dedicated patient care
equipment, limitation of patient movement, private rooms
Droplet Precautions Use surgical masks within 3 feet of a
patient Airborne Precautions
Place patient in a negative pressure room and follow associated precautions
8686
Compliance with Infection Control
“Weak Links” Adherence to hand hygiene Consistent and proper use of PPE Influenza vaccination of healthcare
workers Perform serologic and other testing for
pandemic influenza on healthcare workers with influenza-like illness and who have had likely exposures to pandemic influenza-infected patients
8787
Personal Protective Equipment
Gloves HHS recommends the use of gloves
when there is contact with blood and bodily fluids, including respiratory secretions latex vinyl nitrile other synthetic materials
8888
Personal Protective Equipment
Gowns Healthcare workers should wear an
isolation gown when clothes will come into contact with blood or other bodily fluids (respiratory secretions) during procedures such as intubation when closely holding a pediatric patient
Isolation gowns can be disposable and made of synthetic material reusable and made of washable cloth
8989
Personal Protective Equipment
Goggles/Face Shields Wear goggles and/or face shields if
sprays or splatters of infectious material are likely
if a pandemic influenza patient is coughing
For additional information about eye For additional information about eye protection for infection control, visit protection for infection control, visit NIOSH’s website at NIOSH’s website at http://www.cdc.gov/niosh/topics/eye/eyeinfectious.http://www.cdc.gov/niosh/topics/eye/eyeinfectious.htmlhtml
9090
Personal Protective Equipment
Respiratory Protection Comply with OSHA’s Respiratory
Protection standard (29 CFR 1910.134) to achieve high levels of protection
All respirators used by employees are required to be tested and certified by NIOSH
For a list of all NIOSH-certified respirators (the Certified Equipment List), see http://www.cdc.gov/niosh/celintro.html
9191
Personal Protective Equipment
NIOSH-Certified Respirators NIOSH-certified respirators are marked with theNIOSH-certified respirators are marked with the
manufacturer’s namemanufacturer’s name part numberpart number protection provided by the filter (e.g., N95)protection provided by the filter (e.g., N95) ““NIOSH” NIOSH”
This information is printed on the This information is printed on the facepiecefacepiece exhalation valve cover, orexhalation valve cover, or head strapshead straps
If a respirator does not have these markings If a respirator does not have these markings and does not appear on the Certified and does not appear on the Certified Equipment List, it has not been certified by Equipment List, it has not been certified by NIOSHNIOSH
9292
Required Elements of an Required Elements of an OSHA Respirator ProgramOSHA Respirator Program
1. Selection1. Selection
2. Medical evaluation2. Medical evaluation
3. Fit testing3. Fit testing
4. Use4. Use
5. Maintenance and care5. Maintenance and care
6. Breathing air quality and use6. Breathing air quality and use
7. Training7. Training
8. Program evaluation8. Program evaluation
9393
Filtering FacepieceFiltering Facepiece
A negative pressure particulate respirator with a filter as an integral part of the facepiece OR with the entire facepiece composed of the filtering medium.
3M 1870 - P2 / N95 Flat Fold Respirator Health Care Mask
9494
Medical EvaluationMedical Evaluation
If these masks are required, then:If these masks are required, then: Provide a medical evaluation according to the Provide a medical evaluation according to the
OSHA standardOSHA standard Required to determine employee’s ability to use a Required to determine employee’s ability to use a
respirator before fit testing and userespirator before fit testing and use Identify a PLHCP Identify a PLHCP
Required to perform medical evaluations using a Required to perform medical evaluations using a medical questionnaire medical questionnaire OROR an initial medical an initial medical examination that obtains the same informationexamination that obtains the same information
9595
PLHCPPLHCP
Physician or Other Licensed Health Care Professional
An individual whose legally permitted scope of practice (i.e., license, registration, or certification) allows him / her to independently provide, or be delegated the responsibility to provide, some or all of the health care services required by paragraph (e) Medical evaluation
9696
Medical EvaluationMedical Evaluation Medical EvaluationMedical Evaluation
Must obtain information requested by Must obtain information requested by questionnaire in Sections 1 and 2, questionnaire in Sections 1 and 2, Part A of Appendix CPart A of Appendix C
Follow-up medical examinationFollow-up medical examination Required for employee who gives a positive Required for employee who gives a positive
response to any question among questions response to any question among questions #1 through #8 in Section 2, Part A of App. C #1 through #8 in Section 2, Part A of App. C OROR whose initial medical examination whose initial medical examination demonstrates the need for a follow-up demonstrates the need for a follow-up medical examinationmedical examination
9797
OSHA OSHA Respirator Respirator
Medical Medical Evaluation Evaluation
QuestionnairQuestionnairee
Page 1 of 10Page 1 of 10
9898
Medical EvaluationMedical Evaluation Annual review of medical status is not Annual review of medical status is not
requiredrequired At a minimum, employer must provide At a minimum, employer must provide
additional medical evaluations if:additional medical evaluations if: Employee reports medical signs or Employee reports medical signs or
symptomssymptoms PLHCP, supervisor, or program PLHCP, supervisor, or program
administrator indicates an employee needs administrator indicates an employee needs to be reevaluatedto be reevaluated
Change occurs in workplace conditions that Change occurs in workplace conditions that may increase the burden on an employeemay increase the burden on an employee
9999
Fit TestingFit Testing Employees using tight-fitting facepiece Employees using tight-fitting facepiece
respirators must pass an appropriate respirators must pass an appropriate qualitative fit test (QLFT)qualitative fit test (QLFT) or or quantitative fit test (QNFT)quantitative fit test (QNFT) prior to initial useprior to initial use whenever a different respirator whenever a different respirator
facepiece (size, style, model or make) facepiece (size, style, model or make) is used, andis used, and
at least annually thereafterat least annually thereafter
100100
The respirator used for fit testing MUST be the
same make, model, style, and size of
respirator that will be used by the employee.
Fit Testing
101101
QQuantitative uantitative FFit it TTest - est - QNFTQNFT
An assessment of the adequacy of respirator fit by numerically measuring the amount of leakage into the respirator.
QNFT Protocols–Generated Aerosol (corn oil, salt, DEHP)–Condensation Nuclei Counter (PortaCount)–Controlled Negative Pressure (Dynatech FitTester 3000)
102102
QQualiitative ualiitative FFit it TTestest -- QLFTQLFT
A pass/fail fit test to assess A pass/fail fit test to assess the adequacy of respirator the adequacy of respirator fit that relies on the fit that relies on the individual’s response to the individual’s response to the test agent.test agent.
Isoamyl acetateIsoamyl acetate SaccharinSaccharin BitrexBitrex Irritant smokeIrritant smoke
Saccharin Fit Test Kit
103103
Employees who are required to use Employees who are required to use respirators must be trained such that respirators must be trained such that they can demonstrate knowledge of they can demonstrate knowledge of at leastat least why the respirator is necessary why the respirator is necessary limitations and capabilities of the limitations and capabilities of the
respiratorrespirator effective use in emergency situationseffective use in emergency situations how to don the respiratorhow to don the respirator How to perform user seal check How to perform user seal check
(each time)(each time) recognition of medical signs and recognition of medical signs and
symptomssymptoms Proper disposal of the respiratorProper disposal of the respirator
Training and InformationTraining and Information
104104
HHS/CDC recommends that personal protective equipment be put on in the following order Gown Respirator (or mask, when appropriate) Face shield or goggles Gloves
Upon leaving the room, HHS/CDC recommends that PPE be removed in a way to avoid self-contamination, as follows Gloves Faceshield or goggles Gown Respirator or mask
Personal Protective Equipment
Putting on and Removing PPE
User Seal CheckUser Seal Check
Check the seal each timeCheck the seal each timeyou don the respiratoryou don the respirator
Place one or both hands completelyPlace one or both hands completely
over the middle panelover the middle panel Inhale and exhale sharplyInhale and exhale sharply
If air leaks around your nose, If air leaks around your nose, readjust the readjust the nosepiece nosepiece
If air leaks between the face and face seal of the If air leaks between the face and face seal of the respirator, reposition it and adjust strapsrespirator, reposition it and adjust straps
If you cannot achieve a proper seal, doIf you cannot achieve a proper seal, do not not enter the contaminated areaenter the contaminated area
See your supervisorSee your supervisor
Time / Use LimitationTime / Use Limitation If the respirator becomes If the respirator becomes
damaged, soiled, or damaged, soiled, or breathing becomes difficult, breathing becomes difficult, leave the contaminated area leave the contaminated area and replace the respiratorand replace the respirator
Wear a respirator only onceWear a respirator only once Remove and dispose of a Remove and dispose of a
respirator in an appropriate respirator in an appropriate trash receptacletrash receptacle
Upon re-entry, don a new Upon re-entry, don a new respiratorrespirator
3M #1860 N95 HEALTH CARE RESPIRATOR
Healthcare Healthcare RespiratorRespirator
NIOSH approved as an N95 particulate filter NIOSH approved as an N95 particulate filter respirator respirator
Designed to be fluid resistant to splash and Designed to be fluid resistant to splash and spatter of blood and other infectious materialsspatter of blood and other infectious materials
Intended for use against both mechanically Intended for use against both mechanically generated particulates and thermally generated particulates and thermally generated fumes, plumes and smokesgenerated fumes, plumes and smokes
Applications includeApplications include OR Laser SurgeryOR Laser Surgery ElectrocauteryElectrocautery Other powered medical instrumentsOther powered medical instruments Exposure to Mycobacterium tuberculosisExposure to Mycobacterium tuberculosis Aerosol droplet transfer, e.g. working with Aerosol droplet transfer, e.g. working with SARS patients SARS patients Dental care where aerosol and particleDental care where aerosol and particle exposures are possibleexposures are possible Aerosols created during use and Aerosols created during use and
manipulation of chemotherapy solutionsmanipulation of chemotherapy solutions Removal of casts or other dust producing Removal of casts or other dust producing
activityactivity 107107
3M™ Health Care Particulate Respirator
and Surgical Mask 1870
Healthcare RespiratorHealthcare Respirator Filter efficiency level 95% or Filter efficiency level 95% or
greater against particulate greater against particulate aerosols free of oilaerosols free of oil
Fluid resistantFluid resistant DisposableDisposable May be worn in surgeryMay be worn in surgery Fits a wide range of face sizesFits a wide range of face sizes Meets CDC guidelines for Meets CDC guidelines for
Mycobacterium tuberculosis Mycobacterium tuberculosis exposure controlexposure control
108108
3M™ Health Care Particulate Respirator
and Surgical Mask 1860
Healthcare RespiratorHealthcare Respirator
NIOSH approved as an N95 NIOSH approved as an N95 particulate filter respiratorparticulate filter respirator
Intended for use by operating Intended for use by operating room personnel and health care room personnel and health care workersworkers
Meets CDC guidelines for TB Meets CDC guidelines for TB controlcontrol
Helps protect patients and Helps protect patients and health care workers from the health care workers from the transfer of microorganisms, transfer of microorganisms, blood and bodily fluidsblood and bodily fluids
109109
Kimberly-Clark Fluidshield PFR95
N95 Particulate Filter Respirator and Surgical Mask
Healthcare RespiratorHealthcare Respirator
Moldex 3200 Series N95 Moldex 3200 Series N95 Particulate RespiratorsParticulate Respirators Both an N95 respirator and Both an N95 respirator and
surgical masksurgical mask Latex freeLatex free First and only NIOSH-First and only NIOSH-
approved single strap N95 approved single strap N95 respiratorrespirator
Meets CDC guidelines for TB Meets CDC guidelines for TB exposure control standardsexposure control standards
110110
Moldex 3200 SeriesN95 Particulate
Respirator
111111
SUMMARYSUMMARY
This course has coveredThis course has covered Definition of Pandemic InfluenzaDefinition of Pandemic Influenza Transmission RoutesTransmission Routes Clinical DiagnosisClinical Diagnosis ControlControl PreventionPrevention
112112
Questions?Questions?
Top Related