1. Personal Protective Equipment Session 5 Infection Control for LPHA Train the Trainer Course August 25, 2005

2. Objectives Understand the principles of using PPEUnderstand the principles of using PPE Be familiar with federal regulations related to PPE useBe familiar with federal regulations related to PPE use Be able to select the appropriate PPE to reduce risk of communicable disease transmissionBe able to select the appropriate PPE to reduce risk of communicable disease transmission

3. PPE Principles used as last resort when exposure cannot be eliminated by engineering controls or work practicesused as last resort when exposure cannot be eliminated by engineering controls or work practices must use for all exposuresmust use for all exposures can opt out if it interferes with health care or public safety servicescan opt out if it interferes with health care or public safety services use is not dependent on length or frequency of exposureuse is not dependent on length or frequency of exposure

4. Chain of Infection Agent ↓ Reservoir ↓ Portal of exit ↓ Mode of transmission ↓ Portal of entry ↓ Susceptible host

5. PPE Principles When selecting PPE, consider: 1.areas that need protection –eyes, nose, mouth –hands, skin, clothing –respiratory tract 2.tasks, procedures performed –generation of splashes, sprays –proximity to patient/client

6. PPE Federal Regulations 29 CFR 1910.1030 Employer must:Employer must: – supply appropriate PPE –ensure employees use PPE –ensure PPE is readily available in needed sizes –clean, launder, repair, dispose of PPE –provide initial and annual training

7. PPE Federal Regulations 29 CFR 1910.132 Employee must:Employee must: –demonstrate ability to properly use –use it appropriately

8. PPE Standard precautions Protect mucous membranes of eyes, nose, and mouth when anticipating splashes/sprays of blood or body fluids to the face. Protect mucous membranes of eyes, nose, and mouth when anticipating splashes/sprays of blood or body fluids to the face. –surgical masks and goggles –procedural masks

9. PPE Standard precautions Considerations:Considerations: –eye protection must have side shields –masks need to be fluid resistant withstand pressure of at least 160mm/Hgwithstand pressure of at least 160mm/Hg available with ear loops or tiesavailable with ear loops or ties –if deemed necessary to protect one area of face, all areas must be protected (eyes, nose, mouth)

10. PPE Standard precautions Protect skin and prevent soiling of clothing when anticipating splashes/sprays to the body.Protect skin and prevent soiling of clothing when anticipating splashes/sprays to the body. –clean, non-sterile gowns (cloth or disposable) –aprons –lab coats –coveralls

11. PPE Standard precautions Considerations:Considerations: –select gown appropriate for activity and amount of fluid likely to be encountered fluid resistant vs. imperviousfluid resistant vs. impervious

12. PPE Standard precautions Protect hands when touching blood, body fluids, urine, feces, specimens, contaminated itemsProtect hands when touching blood, body fluids, urine, feces, specimens, contaminated items –clean, nonsterile (non-latex) gloves

13. PPE Standard precautions Considerations:Considerations: –must wear gloves for phlebotomy –gloves are put on just before touching bloodblood body fluidsbody fluids mucous membranesmucous membranes non-intact skinnon-intact skin –change between clients –change between tasks on same person if task creates heavy contamination

14. PPE Standard precautions Considerations:Considerations: –change if they become torn –remove gloves promptly after use, before touching non-contaminated items –wash hands immediately after removing gloves –never wash gloved hands

15. PPE Standard precautions Other PPE such as caps, shoe covers, boots are needed only if gross contamination is expected. Other PPE such as caps, shoe covers, boots are needed only if gross contamination is expected.

16. PPE Contact precautions In addition to practicing standard precautions, wear gown and gloves when in contact with In addition to practicing standard precautions, wear gown and gloves when in contact with –infected person –infected person’s environment –contaminated items and surfaces –persons who are incontinent or who have uncontrolled wound drainage or diarrhea

17. PPE Droplet precautions In addition to practicing standard precautions, wear a surgical or procedural mask when In addition to practicing standard precautions, wear a surgical or procedural mask when –within 3 feet of the infected person, OR –have the infected person wear a mask when in contact with other persons, if possible

18. PPE Airborne precautions In addition to practicing standard precautions, wear a NIOSH certified, fit-tested N-95 respirator when entering area where air is shared with infected person. In addition to practicing standard precautions, wear a NIOSH certified, fit-tested N-95 respirator when entering area where air is shared with infected person.

19. PPE Airborne precautions Do not enter premises of infected person if not fit tested.Do not enter premises of infected person if not fit tested. Staff susceptible to measles or chickenpox should not have contact with infected persons.Staff susceptible to measles or chickenpox should not have contact with infected persons. Persons with known immunity to measles and chickenpox do not need to wear respirators.Persons with known immunity to measles and chickenpox do not need to wear respirators. Infected person should wear a surgical mask when outside of isolation.Infected person should wear a surgical mask when outside of isolation.

20. PPE Removal and Disposal Remove immediately after use, before contaminating clean items and surfaces.Remove immediately after use, before contaminating clean items and surfaces. Remove before leaving exam room, or remove away from person’s immediate environment if on home visit.Remove before leaving exam room, or remove away from person’s immediate environment if on home visit.

21. PPE Removal and Disposal Wash hands immediately after removal and disposal.Wash hands immediately after removal and disposal. PPE may be discarded in regular trash unless saturated with blood or body fluids.PPE may be discarded in regular trash unless saturated with blood or body fluids. –place saturated PPE in biohazard bag –home visit disposal: place PPE in plastic bag before discarding in regular trash

22. PPE Removal and Disposal N-95 respirators must not be removed until outside the area of shared air. Place in regular trash unless saturated with blood, body fluids. N-95 respirators must not be removed until outside the area of shared air. Place in regular trash unless saturated with blood, body fluids.

23. References Siegel et al. CDC HICPAC, “Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, 2007.” http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdfSiegel et al. CDC HICPAC, “Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, 2007.” http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf OSHA Bloodborne Pathogens Standard, 29 CFR 1910.1030OSHA Bloodborne Pathogens Standard, 29 CFR 1910.1030 –http://www.osha.gov/SLTC/bloodbornepathogens/index.html http://www.osha.gov/SLTC/bloodbornepathogens/index.html Personal Protective Equipment Education, APIC, August, 2005Personal Protective Equipment Education, APIC, August, 2005 –www.apic.org www.apic.org

24. Infection Control Principles and Practices Gwen Borlaug, CIC, MPH Infection Control Epidemiologist Bureau of Communicable Diseases 1 West Wilson Street Room 318 Madison, WI 53701 608-267-7711gwen.borlaug@wisconsin.gov