1. Principles of Infection Control and Personal Protective Equipment A Brief Overview

2. Why Should I Care? Because if you become sick or injured, you become part of the problem instead of being part of the solution.

3. Why Should I Care? We would never intentionally send you into a situation requiring extensive PPE. However, basic PPE would be prudent if dealing with the general public during a pandemic or other situation where exposure to harmful substances could occur.

4. Why Should I Care? You could find yourself in a situation where PPE would reduce your chances of being harmed. For example, think about the chemical fire in Marietta in May, 2014. Basic PPE could prevent inhalation of particulates, eye exposure. But know what PPE can’t do!

5. Why Should I Care? Lives will be saved if bystanders can provide initial care to survivors of an incident: manage bleeding, blocked airways, burns, hypothermia, drowning. All MRC members should strive to be able to help in this way. Some basic PPE could protect you.

6. Transmission of Influenza Virus Among Humans DropletMost likely route. AirbornePossible at close distances. ContactPossible

7. Types of PPE Gloves Gowns/coveralls Masks/respirators Footwear Covers Eye protection

8. Types of PPE Gloves Different kinds of gloves –Housekeeper gloves –Clean gloves –Sterile glove Work from clean to dirty Avoid “touch contamination” –Eyes, mouth, nose, surfaces Change gloves between patients

9. Types of PPE Coveralls Cover torso, legs, arms May include attached foot coverings, hood, and/or gloves

10. Types of PPE Surgical masks –Cotton, paper –Protect against body fluids and large particles Particulate respirators (N95) –Fit testing essential –Protect against small droplets and other airborne particles Alternative materials (barrier) –Tissues, cloth Masks and Respirators: Barriers and Filtration

11. PPE for Standard Precautions Wear: Gloves Gown or coverall Eye Protection and Mask ALL If: Touching respiratory secretions, contaminated items or surfaces, blood, other body fluids Handling soiled clothes, linens, other items with patient body fluids, secretions, or excretions Procedures are likely to generate splashes / sprays of blood, body fluids, secretions, excretions IF IN DOUBT.

12. Sequence for Donning PPE 1.STOP! Assess the situation. Should I even be here??? 2.Determine what level of PPE is needed. 3.Engage trained observer or buddy. 4.Carefully inspect all items. Look for rips, tears, any other sign of damage. 5.Don’t forget gravity! 6.Remove jewelry, trim nails if longer than ¼”

13. Sequence for Donning PPE 7.Hand hygiene 8.Shoe covers if not part of coverall 9.Inner gloves (inside gown/coverall cuffs) 10.Gown/coverall and hood 11.N95 Particulate respirator 12.If needed, outer gloves (outside cuffs) 13.Goggles or face shield 14.Verify

14. Hand Washing Method Wet hands with clean (not hot) water Apply soap Rub hands together for about 20 seconds Rinse with clean water Dry with disposable towel or air dry Use towel to turn off faucet

15. Alcohol-based Hand Rubs Effective if hands not visibly soiled More costly than soap & water Method Apply appropriate (3ml) amount to palms Rub hands together, covering all surfaces until dry

16. Gloves Select correct type and size Insert hands into gloves Pull up so no wrinkles or sagging

17. Coverall Select appropriate type and size. If no attached hood or foot covering, consider whether they are needed This is not a fashion statement – choose a size that fits loosely and allows you to move freely. If separate, don foot covering before gloves, hood after respirator

18. Coverall Sit down to pull on legs, then put on arms and hood If too large, roll sleeves and/or legs under (so they won’t catch and retain any contaminant) Tape cuffs to gloves (fold tape end under) If separate foot covering, tape cuffs

19. N95 Particulate Respirator Pay attention to size (S, M, L) Place over nose, mouth and chin Fit flexible nose piece over nose bridge Secure on head with elastic (inside hood) Adjust to fit and check for fit: Inhale – respirator should collapse Exhale – check for leakage around face Facial hair a problem? Use PAPR.

20. Goggles Position goggles over eyes and secure to the head using the ear pieces or headband Adjust to fit comfortably

21. Gloves Don outer gloves last Select correct type and size Insert hands into gloves Extend gloves over gown cuffs and tape

22. Key Infection Control Points Minimize exposures –Plan before entering room Avoid adjusting PPE after patient contact –Do not touch eyes, nose or mouth! Avoid spreading infection –Limit surfaces and items touched Change torn gloves –Wash hands before donning new gloves

23. Duration of PPE Use Gloves –Never reuse Surgical Masks/N95 Respirators –Wear once and discard –Discard if moist Eye Protection –May wash, disinfect, reuse indefinitely

24. Sequence for Removing PPE Remove in anteroom when possible 1.Engage trained observer or buddy. 2.Disinfect outer gloves, remove, discard 3.Inspect and disinfect inner gloves 4.Remove goggles 5.Disinfect inner gloves 6.Remove coverall (hood first if separate) 7.Disinfect inner gloves (replace if attached to coverall

25. Sequence for Removing PPE 8.Remove foot covering (if separate) 9.Change inner gloves 10.Remove N95 respirator 11.Disinfect new inner gloves 12.Disinfect shoes 13.Disinfect inner gloves 14.Remove and discard inner gloves 15.Perform hand hygiene 16.Review self for contaminants 17.Exit the doffing area.

26. Removing Gloves (1) Grasp outside edge near wrist Peel away from hand, turning glove inside-out Hold in opposite gloved hand

27. Removing Gloves (2) Slide ungloved finger under the wrist of the remaining glove Peel off from inside, creating a bag for both gloves Discard

28. Removing Goggles Grasp where elastic band joins to goggle Pull gently away from face Lift up over hood and back; don’t let elastic snap! Discard properly

29. Removing Coveralls 1.If particulate contamination, rinse or wipe coverall with damp towels 2.Gently pull any zipper cover away from zipper 3.Use mirror to make sure you don’t touch bare skin 4.Grasp zipper tab with two fingers of one hand and gently unzip 5.Disinfect gloves 6.Peel away from neck and shoulder, rolling inside of coverall over outside 7.Once rolled down as far as practical while standing, sit down on clean chair 8.Remove one leg at a time, discard coverall 3.Turn contaminated outside toward the inside 4.Fold or roll into a bundle 5.Discard

30. Removing The N95 Respirator Don’t touch front of mask! Lift the bottom elastic over your head first Gently lift the top elastic over your head, allowing the mask to fall forward Discard

31. Hand Washing Wash thoroughly immediately after removing all PPE Use soap and water. An alcohol- based hand rub may be used only if soap and water are not available

32. Environmental Decontamination Cleaning MUST precede decontamination Disinfectant ineffective if organic matter is present Use mechanical force –Scrubbing –Brushing –Flush with water

33. Environmental Decontamination: Disinfecting Household bleach (diluted) Quaternary ammonia compounds Chlorine compounds (Chloramin B, Presept) Alcohol –Isopropyl 70% or ethyl alcohol 60% Peroxygen compounds Phenolic disinfectants Germicides with a tuberculocidal claim on label Others

34. Using Bleach Solutions 1 First, clean organic material from surfaces or items – wash with soap or detergent and water, rinse, dry. The CDC recommends using 5 tablespoons of liquid bleach per gallon of water. Leave nonporous surfaces (tile, metal, hard plastics, etc.) wet at least 10 minutes and allow to air dry.

35. Using Bleach Solutions 2 Leave porous surfaces (wood, rubber, soft plastics, etc.) wet for 2 minutes. Rinse and air dry. Use household chlorine bleach (5.25 - 6% sodium hypochlorite); do not use scented or color safe bleaches. Use fresh diluted bleach daily! Wear gloves and eye protection!

36. Waste Disposal Use Standard Precautions –Gloves and hand washing –Gown + Eye protection Avoid aerosolization Prevent spills and leaks –Double bag if outside of bag is contaminated Incineration is usually the preferred method

37. Managing Linens and Laundry Use Standard Precautions –Gloves and hand hygiene –Gown –Mask Avoid aerosolization – do not shake Fold or roll heavily soiled laundry –Remove large amounts of solid waste first Place soiled laundry into bag in patient room Wash with normal detergent

38. Summary Contact with contaminants can be prevented using correct PPE Viruses can be inactivated with infection control procedures Hand washing is key PPE must be donned and removed appropriately to prevent contamination of wearers and environments Guidelines for using PPE and infection control measures should be practiced until they are routine

39. For Emergencies, you should keep on hand A fresh (no more than six months old) bottle of household chlorine bleach Several N95 particulate respirators Several pairs of disposable gloves At least one disposable coverall or one you can discard.

40. Remember… Your first obligation is to protect yourself! If you have any doubt about your safety in any situation, avoid that situation!

41. For more information Standard Precautions http://www.cdc.gov/HAI/settings/outpatie nt/outpatient-care-gl-standared- precautions.html

42. For more information Donning/Doffing PPE http://www.cdc.gov/vhf/ebola/hcp/ppe- training/n95Respirator_Coveralls/donni ng_01.htmlhttp://www.cdc.gov/vhf/ebola/hcp/ppe- training/n95Respirator_Coveralls/donni ng_01.html http://www.cdc.gov/vhf/ebola/hcp/ppe- training/n95Respirator_Coveralls/doffin g_01.htmlhttp://www.cdc.gov/vhf/ebola/hcp/ppe- training/n95Respirator_Coveralls/doffin g_01.html