1. CHARISSA FAY BORJA-TABORA, MD, FPPS,FPIDSP
CHAIR, INFECTION PREVENTION AND CONTROL COMMITTEE
RITM

2. Objective
Understand the importance of infection control in preventing healthcare-associated infection
Know basic infection control practices such as standard precautions and Hand Hygiene
Suggested Reading:
WHO Aide-Memoire: Infection Prevention
WHO Aide-Memoire: Standard Precautions
WHO Aide-Memoire: Hand Hygiene
Hand out/materials
How top Hand Rub poster
How to Hand Wash poster
Competency Checklist (x 1each person) (photocopy)
Hand Hygiene Quiz (x 1each person) (photocopy)
Water-Based Paint
Sterile Gloves (Exam Gloves acceptable; 1 set for each person)

3. Infection occurs when all six links in the chain are intact.
Chain of Infection
Certain conditions must be met in order for a microbe or infectious disease to be spread from person to person.
Infection occurs when all six links in the chain are intact.
Source: OSHA

4. Ebola and the Chain of Infection in Healthcare Facilities
Pathogenic Microorganism:
Ebola virus
Reservoir:
Patient infected with Ebola
Means of Escape:
Blood and body fluids (blood, saliva, urine, sperm etc.)
Mode of Transmission:
Direct contact with blood and body fluids of infected person
Contact with contaminated surfaces/equipment
Means of Entry:
Non-intact skin, mucous membranes, sharps injury
Host Susceptibility:
Poor nutrition, stress, exhaustion, non-intact skin

5. Infection Control What? Breaking the chain of infection
Why? Prevent infections within health facilities
How? Consistent practice of protocols that prevent an infectious agent moving from one host to another
Who? Protects:
Patients
HCWs
Visitors
Other staff

6. “If carefully implemented, Infection Prevention and Control measures will reduce or stop the spread of the [Ebola] virus and protect health-care workers (HCWs) and others.”
-WHO 2014
Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever in Health-Care Settings, with Focus on Ebola

7. So how strong is infection control at your facility?
Infection Control can:
Stop/reduce the spread of Ebola
Protect Health care workers
So how strong is infection control at your facility?

8. Core Components for Infection Prevention & Control (IPC) Programs
Checklist
 Organization of IPC program
 Technical guidelines
 Human resources (training, staffing, occupational health)
 Surveillance of diseases and monitoring of practices
 Microbiology laboratory support
 Clean and safe environment
 Monitoring and evaluation of IPC program
 Links with public health and other services
Slide adapted and used with permission from World Health Organization

9. INFECTION CONTROL PREPAREDNESS CHECKLIST
Done and completed
On going
Not Started
FACILITY
Review triage and placement procedure and ensure that treatment and isolation areas have been identified x
Inspect identified treatment areas to check if they meet IPC recommendations (floor plan, adequate ventilation, electricity and water, comfort room etc/)
Ensure that all Airborne Infection Isolation Rooms (AIIR) are functioning correctly and are appropriately monitored for airflow and exhaust handling. (Calibration of measuring devices, check HEPA filter status)
Ensure that healthcare personnel have ready access, including via telephone, to medical consultation.
Post appropriate signage alerting healthcare personnel to isolation status, PPE required, proper hygiene, and handling/management of infected patients and contaminated supplies.  x
Develop contingency plans for staffing, logistics, budget, procurement, security, and treatment.

10. INFECTION CONTROL PREPAREDNESS CHECKLIST ADMINISTRATIVE GUIDANCE
Done and completed
On going
Not Started
ADMINISTRATIVE GUIDANCE
Review your hospital’s infection control procedures to ensure adequate implementation for preventing the spread of Ebola. Review consistency with DOH, WHO, CDC guidelines. x
Review policies and procedures for screening, minimizing healthcare personnel exposure, isolation, medical consultation appropriate for Ebola exposure and/or illness, and monitoring and management of potentially exposed healthcare personnel  x
Review roles of the infection control practitioner to:
Ensure appropriate infection control procedures are being followed, including for lab, food, environmental services, and other personnel, and
Maintain updated case definitions, management, surveillance and reporting recommendations.

11. INFECTION CONTROL PREPAREDNESS CHECKLIST ADMINISTRATIVE GUIDANCE
Done and completed
On going
Not Started
ADMINISTRATIVE GUIDANCE
Review and distribute the Guidelines for Environmental Infection Control in Health-Care Facilities. x
Review laboratory procedures for appropriate specimen collection, transport, and testing of specimens from patients who are suspected to be infected with Ebola virus.
Review policies and procedures for screening and work restrictions for exposed or ill healthcare personnel, and develop sick leave policies for healthcare personnel that are flexible and consistent with recommendations,
Review protocols for sharps injuries
Ensure all HCP handling EVD patients proper medical clearance

12. INFECTION CONTROL PREPAREDNESS CHECKLIST
Done and completed
On going
Not Started
TRAINING
Review ICP training status of all personnel. All training requirements in PPE and infection control should be met x
Educate and train HCP on the following areas:
Management and exposure precautions for suspected or confirmed Ebola cases
Proper use of PPE (donning and doffing)
Hand Hygiene
Respiratory fit test
Sick leave policies
Safe sharp practices
Waste Management
Review environmental cleaning procedures and provide education/refresher training for cleaning staff
Conduct education and refresher training with healthcare personnel on Ebola for special pathogen handling in the laboratory.
Review plans for special handling of linens, supplies, and equipment
Provide education/refresher training for healthcare personnel responsible for cleaning.

13. INFECTION CONTROL PREPAREDNESS CHECKLIST
Done and completed
On going
Not Started
SUPPLIES
Ensure an adequate supply, for all healthcare personnel, of:
• Impermeable gowns (fluid resistant or impermeable),
• Gloves,
• Shoe covers, boots, and booties, and
• Appropriate combination of the following:
o Eye protection (face shield or goggles),
o Facemasks (goggles or face shield must be worn with facemasks),
o N95 respirators (for use during aerosol-generating procedures)
• Other infection control supplies (e.g. hand hygiene supplies). x
Conduct a detailed inventory of available supply of PPE suitable for standard, contact and droplet precautions.
Ensure Ebola PPE supplies are maintained in triage, ED, and all patient care areas.

14. INFECTION CONTROL PREPAREDNESS CHECKLIST
Done and completed
On going
Not Started
ASSESS
Conduct spot checks and inspections of triage staff to determine if they are incorporating screening procedures and are able to initiate notification, isolation, and PPE procedures for your hospital. x
Spot-check frequently to be sure standard, contact and droplet infection control and isolation guidelines are being followed, including safe putting on and removing PPE.

15. How will you strengthen your IPC?
Administrative support
Checklists/Audit
Ebola coordinator:
Appointed staff member to oversee adherence to the infection control measures in your facility
The professional in charge of infection control in the facility
The focal person to coordinate Ebola activities and advise
-WHO 2014

16. Breaking the Chain of Infection
Activity/Discussion:
In what ways can we break the chain of infection for Ebola in healthcare?

17. Breaking the Chain of Infection
Reservoir: Patient infected with Ebola
Signage and screening at entrances to healthcare settings
Early identification of possible cases
Separation: Isolation or cohorting of possible cases
Care and monitoring of people exposed
Means of Escape from the patient: Blood and body fluids
Safe handling of human remains
Symptomatic treatment of patients

18. Breaking the Chain of Infection
Mode of Transmission: Direct contact with blood and body fluids of or contaminated surfaces/equipment
Decontamination of equipment
Regular and rigorous environmental cleaning
Linen and waste management
Spatial separation
Strategies to reduce aerosols
Means of Entry: Non-intact skin, mucous membranes, sharps injury
Hand hygiene
Standard Precautions including respiratory etiquette
PPE: correct use of physical barriers for care
Sharps safety
Safe processing of lab samples
Safe handling of body fluids
Host Susceptibility:
Future - Vaccines?

19. Standard Precautions

20. When are Standard Precautions Needed?
Basic essential component of infection control
Applied to every patient
1st line of protection from Ebola transmission in health facilities
Ebola symptoms are non-specific
Apply to ALL patients

21. Standard Precautions Include
Hand hygiene
Gloves before anticipated contact with body fluids, mucous membrane, non-intact skin and contaminated items
Gown and Eye protection before procedures and patient-care activities likely to involve contact with or projection of blood or body fluids.
Best practices for injection safety
Safe handling and disposal of sharp instruments
Safe cleaning and disinfection of the environment
Correct re-processing of reusable equipment
Adequate laundry and waste management
WHO 2014

22. KEY PRINCIPLES FOR EBOLA
Prior to working with Ebola patients, all healthcare workers involved in the care of Ebola patients must have received repeated training and have demonstrated competency in performing all Ebola-related infection control practices and procedures, and specifically in donning/doffing proper PPE.
While working in PPE, healthcare workers caring for Ebola patients should have no skin exposed.
The overall safe care of Ebola patients in a facility must be overseen by an onsite manager at all times, and each step of every PPE donning/doffing procedure must be supervised by a trained observer to ensure proper completion of established PPE protocols.

23. How well are standard Precautions per WHO standards currently implemented in your facility?

24. “Ebola is an unforgiving and a frightening disease
“Ebola is an unforgiving and a frightening disease. But it can be defeated if we work together in solidarity and with effective coordination”
UN Deputy Secretary General Jan Eliasson

25. Resources
WHO 2014 Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever in Health-Care Settings, with Focus on Ebola
WHO 2011 Aide-Memoire Infection Control: Core components of infection prevention and control programmes in health care
WHO Standard Precautions in Health Care