OAML June 16, 2005 Protecting Health Care Workers: Infection Control in a Pandemic Brian Schwartz MD Director, Sunnybrook Osler Centre for Prehospital Care Scientific Advisor, Emergency Management Unit MOHLTC

Objectives 1. Definitions 2. Infection control 3. Infection control in a pandemic 4. Personal Protective Equipment 5. What now?

1. Definitions (CPIP): “Clinical” Influenza: Acute onset of fever (usually >38 o C) and cough Sore throat, rhinorrhea, malaise, chills, myalgia & headache may be present Higher predictive value when ‘flu is present in the community

Definitions (CPIP): “Confirmed” Influenza: Laboratory confirmation or Clinical case with epi link to a lab confirmed case

Definitions (CPIP): “Influenza-Like-Illness”: Acute onset of respiratory illness with fever (>38 C) and cough and with one or more of:  Sore throat, arthralgia, myalgia or prostration which could be due to influenza virus (no other cause identified)

2. Infection Control A mighty creature is the germ, Though smaller than the pachyderm His strange delight he often pleases By giving people strange diseases Ogden Nash

Influenza A virus Transmission in droplets > 5 microns Incubation period 1-3 days Infectious from day before symptoms for 3-5 days after (7 in children) Virus survives 5 minutes on hands, 12 hours on cloth, 1-2 days on surfaces

Infection Control Health care settings are encouraged to implement policies to limit unprotected contact with infected patients including:

Infection Control Minimizing crowding and maintaining one metre separation between patients Accommodating patients with symptoms in a separate area away from other patients Cohorting influenza patients in areas with other influenza patients

Routine &Droplet Precautions Accessible hand hygiene stations and signage Encouraging “cough etiquette” [cover mouth with hand (then wash)] or tissue

3. Infection Control in a Pandemic Cohorting patients will be a priority Patients who have ILI should be segregated from others Ideally ILI patients should be cared for by immune or prophyllaxed HCW’s HCWs should wear PPE (unless they have seroconverted or are on prophylaxis)

Routine &Droplet Precautions Hand hygiene (i.e., washing hands or using alcohol based hand rub or sanitizer: before seeing the patient, after seeing the patient and before touching the face, and after removing and disposing of personal protective equipment)

OAML June 16, 2005 Personal Protective Equipment What is a person to do?

This?

These?

Or This?

OAML June 16, 2005 Personal Protective Equipment Health care workers (HCWs) use routine & droplet precautions with patients presenting with FRI/ILI:

Droplet Precautions A surgical mask covering the user’s nose and mouth when providing direct care Eye protection when providing direct care

Droplet Precautions Interaction with patient that minimize contact with droplets (e.g., sitting next to rather than in front of a coughing patient when taking a history or conducting an examination)

Routine &Droplet Precautions Hand hygiene (i.e., washing hands or using alcohol based hand rub or sanitizer: before seeing the patient, after seeing the patient and before touching the face, and after removing and disposing of personal protective equipment)

Contact & Droplet Precautions Appropriate gloves when they are likely to have contact with body fluids or to touch contaminated surfaces Gowns during procedures when clothing might be contaminated

PPE Removal 1. Remove gloves 2. Remove gown (if applicable) 3. Hand hygiene for 15 seconds 4. Exit room

PPE Removal 5. Hand hygiene for 15 seconds 6. Remove protective eyewear 7. Remove mask 8. Hand hygiene for 15 seconds

Don’t Forget…. Contact precautions (gloves, gowns if appropriate and hand hygiene) for managing/disposing of equipment and cleaning/disinfecting the environment

OAML June 16, 2005 What about a mask for the patient? We may not have enough and masks for HCWs are more important if patients are cohorted

Key points about protecting patients: The same precautions used to protect health care workers will also protect patients Hand hygiene is essential in preventing the spread of influenza

Key points about protecting patients: Health care workers should encourage all patients to practice hand hygiene and use a “cough etiquette”- mask or tissue to cover their mouth when coughing If patients see health care workers using such precautions consistently, they are more likely to do the same

So what do we do now? Practice excellent infection control day to day Get your ‘flu shot Read the relevant sections of OHPIP on the beach during your vacation

Questions: Thank You