1. Personal Protective Equipment May, 2007

2. Learning Objectives Demonstrate knowledge of the principles of infection control Recognize gaps in infection control infrastructure Demonstrate proper selection and use of personal protective equipment

3. Personal Protective Equipment (PPE) When used properly can protect you from exposure to infectious agents Know what type of PPE is necessary for the duties you perform and use it correctly

4. Types of PPE Gloves Gowns Masks (surgical and particulate respirator) Eye protection (goggles and face shields)

5. Precaution Levels **All levels require hand hygiene** Standard Transmission based precautions: Contact Droplet Airborne

6. Standard Precautions Prevent the transmission of common infectious agents Hand washing key Assume infectious agent could be present in the patient’s –Blood –Body fluids, secretions, excretions –Non-intact skin –Mucous membranes

7. PPE for Standard Precautions Wear: Gloves Gowns Eye Protection and / or Mask If: Touching –Respiratory secretions –Contaminated items or surfaces –Blood & body fluids Soiling clothes with patient body fluids, secretions, or excretions Procedures are likely to generate splashes / sprays of blood, body fluids, secretions, excretions

8. Droplet Precautions Prevent infection by large droplets from –Sneezing –Coughing –Talking Examples –Neisseria meningitidis –Pertussis –Influenza

9. Transmission of Influenza Viruses Seasonal Influenza in Humans Current Avian Influenza in Humans Droplet most likely route possible Airborne possible at close distances Contact possibleMost likely (bird to human), and possible (human to human)

10. Droplet Precautions Taken in addition to Standard Precautions Place patients in single rooms or cohort 3 feet apart Wear surgical mask within 3 feet or 1 meter of patient Wear face shield or goggles within 3 feet or 1 meter of patient Limit patient movement within facility –Patient wears mask when outside of room

11. Airborne Precautions Taken in addition to Standard Precautions Prevent spread of infection through inhalable particles Examples –Tuberculosis –Measles –Varicella –Variola

12. Airborne Precautions Use for confirmed or suspected avian influenza cases

13. Airborne Precautions for Avian Influenza N95 respirator (or equivalent) for personnel –Check seal with each use Patient in isolation Airborne isolation room, if available –Air exhaust to outside or re-circulated with HEPA filtration Patient to wear a surgical mask if outside of the isolation room

14. Sequence for Donning PPE 1.Wash hands 2.Gown 3.N95 Particulate respirator –Perform seal check 4.Hair cover 5.Goggles or face shield 6.Gloves

15. Sequence for Removing PPE Remove in anteroom when possible 1.Gloves 2.Hand hygiene 3.Gown (and apron, if worn) 4.Goggles 5.Mask 6.Hand hygiene

16. Choosing the Appropriate PPE

17. Avian Influenza Currently not easily transmitted human to human Routes of transmission to humans not known, cannot rule-out any routes Current transmission from poultry to human or human to human for H5N1 requires very close contact

18. Interviewing - Asymptomatic Exposed Persons and Contacts Low-risk activity Routine use of PPE not recommended Maintain >3 feet distance between interviewer and interviewee Use proper hand hygiene –May use hand sanitizer (at least 60% alcohol) if hands not visibly soiled

19. Interviewing - Symptomatic Exposed Persons Higher risk activity PPE recommended in community and healthcare facility –Contact precautions –Droplet precautions –N95 respirator In healthcare facility, person should be placed in airborne isolation room Maintain a distance > 3 feet if possible

20. Specimen Collection – Exposed Persons and Birds High-risk aerosol-generating procedure PPE recommended –Gloves –Gown –Goggles or face-shield –N95 or better respirator

21. Activities Participate in group discussions using the Trainee Guide