Dr. Michael O. Oji Chair, Infection Control, Lagoon Hospitals Infection Control Ambassador for Society for Healthcare Epidemiology of America (SHEA)

 Learning Objectives  Introduction  Definitions  Infection Control Precautions  Indications and Types  Appropriate Use  Challenges  Conclusion  Recommendations  References

 Understand what are PPEs.  Understand basic principles of Infection Control Precautions.  Understand Appropriate Use.  Understand the Risks and how to manage them.

“We must never accept that injury, illness or death is the cost of doing business." President Obama; April 2014 "No one should have to sacrifice their life for their livelihood, because a nation built on the dignity of work must provide safe working conditions for its people." Secretary of Labor Thomas E. Perez.

specialized clothing or equipment worn by an employee for protection against hazardous/ infectious materials. Specialized Personal Protective Equipment

Infection control precautions are a set of standard recommendations designed to reduce the risk of transmission of infectious agents from body fluids or environmental surfaces that contain infectious agents.  Standard  Contact  Droplet  Airborne  Full Barrier

Previously called Universal Precautions Assumes blood and body fluid of ANY patient could be infectious Recommends PPE and other infection control practices to prevent transmission in any healthcare setting Decisions about PPE use determined by type of clinical interaction with patient

Gloves – Use when touching blood, body fluids, secretions, excretions, contaminated items; for touching mucus membranes and non intact skin. Gowns – Use during procedures and patient care activities when contact of clothing/ exposed skin with blood/body fluids, secretions, or excretions is anticipated

 Mask and goggles or a face shield – Use during patient care activities likely to generate splashes or sprays of blood, body fluids, secretions, or excretions

Giving a bed bath? Suctioning oral secretions? Transporting a patient in a wheel chair? Responding to an emergency where blood is spurting? Drawing blood from a vein? Cleaning an incontinent patient with diarrhea? Irrigating a wound? Taking vital signs

Giving a bed bath? Generally none Suctioning oral secretions? Gloves and mask/goggles or a face shield – sometimes gown Transporting a patient in a wheel chair? Depends on the pt- gloves,face-mask? Responding to an emergency where blood is spurting? Gloves, fluid-resistant gown, mask/goggles or a face shield Drawing blood from a vein? Gloves Cleaning an incontinent patient with diarrhea? Gloves w/wo gown Irrigating a wound? Gloves, gown, mask/goggles or a face shield Taking vital signs? –Generally none

Contact Precautions – Gown and gloves for contact with patient or environment of care (e.g., medical equipment, environmental surfaces) In some instances these are required for entering patient’s environment Droplet Precautions – Surgical masks within 3 feet of patient Airborne Infection Isolation – Particulate r eNegative pressure isolation room also required spirator

Contact Precautions – Gown and gloves for contact with patient or environment of care (e.g., medical equipment, environmental surfaces) In some instances these are required for entering patient’s environment  MRSA  VRE  EVD

 Droplet Precautions – Surgical masks within 3 feet of patient  Common cold  Influenza  EVD

 Airborne Infection Isolation – Particulate respirator  >3feet  TB  ?EVD

 Gloves and Gowns  Head and Shoe covers  Eye and face protection Apron Face Shield Respirator Strapping Hazmat Suit Boot Glove Goggle Head Cover

Required for Standard and Expanded Precautions Perform… –Immediately after removing PPE –Between patient contacts Wash hands thoroughly with soap and water or use alcohol-based hand rub

 Gloves  Gowns  Shoes and Head Covers  Masks and Respirators  Face and Eye Protection

 Directly handling potentially infectious or contaminated surfaces.  Change when visibly soiled, torn or punctured.  Part of Standard or Contact Precaution  Hand Hygiene on Removing gloves.

Don gloves last Select correct type and size Insert hands into gloves Extend gloves over isolation gown cuffs

 Protect from potentially infectious material  Cover torso, close body fitting, arms to wrists.  Appropriate: Disposable, Re- Useable, Fluid- Resistant, Non-Fluid resistant, Sterile,Clean  Standard and Contact P.

 Barrier for Environmental Protection.  Use for Haemorrahgic diseases  When sprays or airborne exposure  Must be worn as part of FBP

 M. protects nose and mouth from splattered body fluids.  R. filters air before inhalation  Disposable R N95  Powered Air Purifying R. (PAPR)  Self Contained Breathing Apparatus R. (SCBA)

Gown first Mask or respirator Goggles or face shield Gloves  Combination of PPE will affect sequence – be practical

Select appropriate type and size Opening is in the back Secure at neck and waist If gown is too small, use two gowns –Gown #1 ties in front –Gown #2 ties in back

Place over nose, mouth and chin Fit flexible nose piece over nose bridge Secure on head with ties or elastic Adjust to fit

Select a fit tested respirator Place over nose, mouth and chin Fit flexible nose piece over nose bridge Secure on head with elastic Adjust to fit Perform a fit check – –Inhale – respirator should collapse –Exhale – check for leakage around face

 Protect mucous membranes of eyes, nose, mouth and facial skin.  Part of Standard & Resp. Precaution.

Position goggles over eyes and secure to the head using the ear pieces or headband Position face shield over face and secure on brow with headband Adjust to fit comfortably

Keep gloved hands away from face Avoid touching or adjusting other PPE Remove gloves if they become torn; perform hand hygiene before donning new gloves Limit surfaces and items touched Head Cover Goggle Shield Respirator strappingApron Hazmat Suit Gloves Boots

 Who or What?  What is the Risk?  What Precaution type?  What Components?  Manufacturers Specifications?  Donning and Doffing?  Unidirectional?  Appropriate Disposal  Documentation

HCW/PPEs Patien t? Compon ents? Enviro nment ? Risk ?

 MRSA  TB  HiNI  EVD/ Haemorrahgic Fevers

 An Assistant?  Pre-planned & Sequential.  Remove apron  Shoe covers and Outer gloves and shoe cover.  Step into Hazard Bag

Contaminated – outside front Areas of PPE that have or are likely to have been in contact with body sites, materials, or environmental surfaces where the infectious organism may reside Clean – inside, outside back, ties on head and back Areas of PPE that are not likely to have been in contact with the infectious organism

Gloves Face shield or goggles Gown Mask or respirator

At doorway, before leaving patient room or in anteroom* Remove respirator outside room, after door has been closed*  *Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub

Normal Environ. n Clean Area Deconta mination Area Patien t Care Area

Grasp outside edge near wrist Peel away from hand, turning glove inside- out Hold in opposite gloved hand

Slide ungloved finger under the wrist of the remaining glove Peel off from inside, creating a bag for both gloves Discard

Grasp ear or head pieces with ungloved hands Lift away from face Place in designated receptacle for reprocessing or disposal

Unfasten ties Peel gown away from neck and shoulder Turn contaminated outside toward the inside Fold or roll into a bundle Discard

Untie the bottom, then top, tie Remove from face Discard

 Lift the bottom elastic over your head first  Then lift off the top elastic  Discard

 Cost  Availability  Training  Appropriate Use  Appropriate Disposal

 Cost  Availability  Training  Appropriate Use  Appropriate Disposal

 Correct PPE Use  Protect yourself and others

 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. CDC.  WHO. Standard Precautions in HealthCare. Oct Infection Control