1. Training structure EFFO Ebola Safety and good quality work
Module 1: Knowledge about Ebola Virus Disease
Module 2:
Community response
Module 3:
Standard pre-cautions
Module 4:
Triage & isolation
Module 5:
Personal protective equipment
Module 6:
Water, disinfection and cleaning
Support from the community
Support from the hospital administration
Support from the population

2. Standard precautions Module 3

3. Learning objectives module 3
General objective
To be able to apply the standard precautions: they are the foundation for the prevention of hospital-acquired infections
Specific objectives
To be able to implement good practices for hand-washing
To be able to put on and remove gloves without the risk of contamination
To know how and when to clean surfaces
To know how to practice respiratory hygiene
To know how to handle pointed and sharp-edged objects   

4. Discussion about good practices
Dangerous germs are prevalent in health facilities
Germs can easily be spread by hand contact
How to avoid contamination ?
Ebola and many other infections are transmitted by contact. Good practices are the foundation for the prevention of hospital-acquired infections.
Incorporate observations made during the coffee-break or before:
Avoid touching your face
The transmission of germs from one individual to another using your hands is the main route of transmission.
Health centres are the places where germs are the most resistant.

5. How to avoid contamination
Touch as few objects as possible.
Wash and disinfect your hands.
Clean surfaces.
Standard precautions
Carry out respiratory hygiene.
Wear gloves.
Discussion : what is hospital practice ?
Bad hospital practices :
Examination of a patient without wearing gloves
Lack of systematic hand-washing before and after a medical examination
Insufficient cleaning of areas where patients are examined…
… with disinfectants which are not suitable
Examination of patients presenting with respiratory problems in a confined environment which is unsafe
Presence of sharp objects
Discussion: What disinfectants are used ?
Emphasise the fact that the Ebola virus is very fragile : it is very sensitive to ordinary disinfectants (such as soap, bleach and alcohol-based cleaning fluids) and physical conditions (heat, sunlight)
Explanation of the items
Avoid accidents.

6. General behaviour – Touch as few objects as possible
RKI
Discuss behaviour during the breaks and work (for example: touch as little as possible, clean beds)
R. Ellwanger

7. General behaviour – Examples
Behaviour in a hospital:
Avoid touching your face with your hands.
Do not share a bottle.
Put your name on your bottle.
Wash your hands before meals (do not dry them on a towel which has already been used).
Check your clothes (wear closed-toe shoes, change your clothes if necessary).
Incorporate observations made during the coffee-break or before :
Avoid touching your face : avoid rubbing your eyes or touching your nostrils and mouth (mucous membranes)
Avoid eating or drinking in areas of potential sepsis in the hospital
Avoid eating with others (sharing the same cutlery)
Avoid wearing clothes which are unsuitable
Avoid wearing scrubs which are unsuitable or dirty scrubs or using the same scrubs
Make fewer physical greetings (such as hand-shakes and hugs)
At the hospital, avoid touching the healthcare equipment (beds, bedpans, oxygen masks, dustbins)

8. Make sure your hands are clean
Gloves and clean hands are essential
To protect yourself ;
To protect your colleagues ;
To protect your patients ;
To protect other people.
Keep your hands clean by:
Washing them with soap and water ;
Using standard disinfectants ;
Wearing gloves.
You can wash your hands with soap or water or, if possible, with a standard hand disinfectant.
Gloves are compulsory when there is a risk of Ebola. The body’s natural barriers (for example, clean hands) are not sufficient.

9. How to wash hands Source: OMS
Wash hands with soap and water when they are visibly soiled.
If not, disinfect your hands by rubbing them together with a hand sanitizer.

10. Skin which is in good condition is a very important natural barrier.
Hand care
Skin which is in good condition is a very important natural barrier.
The frequent use of soap and disinfectants may irritate the skin and make hands dry :
→ Hands need to be cared for regularly.
→ Use hand cream.
Some disinfectants may be better for the skin than washing frequently with soap and water
(example: hand sanitizer, 0.05% bleach)

11. Practical exercise : hand washing
Now let’s put this into practice !
Preparation: water, soap, gloves MI

12. Wearing gloves to protect your hands
If available, use gloves :
They act as an additional barrier
They protect the skin of your hands
Practise putting on and removing gloves to improve protection and avoid contamination
Gloves should be changed regularly !
-Wearing gloves is a complement to clean hands
Gloves are an additional barrier to protect the skin of the hands
Practise putting on and removing gloves : practice makes perfect ! If you do not, you will not necessarily be protected when you wear gloves
Use single-use gloves to examine patients - at least one pair per patient

13. How to put on gloves Source: OMS
Before putting on gloves, clean your hands with a standard hand disinfectant or wash them using soap and water.
Source: OMS

14. How to remove gloves
Aim : be aware of the soiled parts and avoid contamination !
Do not touch the skin with the soiled parts (red).
Practise this technique.
There are a number of techniques to remove gloves. The most important thing to remember is always to avoid touching the skin with the soiled parts or the external parts of the gloves.
NB : if a clean part (green) touches a soiled part (red), this part is then soiled and should no longer touch the skin !
1: Take hold of the most external part of the glove (cuff) without touching the skin or the internal part.
2-3: Turn the glove over on the thumb in order to get hold of the internal part without touching it.
4: Use the same technique using the thumb of the other hand.
5-8: Remove the gloves without touching the skin with the soiled parts.
8: Throw the gloves away in a waste container.
Source: RKI/IBBS

15. After removing your gloves, disinfect or wash your hands !
Removing gloves
After removing your gloves, disinfect or wash your hands !
RKI

16. Practical exercise : Using gloves
Now let’s put this into practice ! MI
RKI
RKI
RKI

17. What to do if there are not enough gloves
In general, do not use the same gloves for different activities.
When you cannot change gloves after treating a patient, disinfect the gloves (for example, with 0.5 % bleach).
Watch out ! Gloves may become porous depending on the disinfectant used, the number of times the gloves have been disinfected, and what the gloves are made of.

18. What to do if there are no gloves
Try to avoid direct patient contact.
If this is not possible :
Wash your hands by rubbing them together with a standard hand disinfectant or wash them with soap and water before and after contact with each patient.
Care for the skin of your hands in order to protect the natural barrier (avoid the development of small lesions).
Avoid touching dirty surfaces.

19. Cleaning surfaces
Clean and disinfect as quickly as possible (everyone !) :
any surface or object contaminated with blood, body fluids, secretions or excretions
At least once a day, clean with water and detergent :
Floors and horizontal work surfaces
Let the surfaces dry naturally before using them again
Use the appropriate disinfectant.
Be meticulous, critical and alert !
Discussion : Cleaning : what is hospital practice ?
Bad cleaning practices :
Washing superficially with large quantities of water
Disinfection without cleaning
Cleaning without wearing suitable protective equipment
Cleaning with water alone
Concentration of unsuitable disinfectants (bleach)
For answers to more detailed questions and more information -> M6, sanitation, hygiene of the premises…

20. Cleaning – Attention ! First clean ; then disinfect
Always start cleaning in the ‘cleanest’ places and ending with the ‘dirtiest’ places
Never sweep or clean without using liquids or dampened materials
Cloths containing dust must not be shaken
Change the cleaning solutions frequently throughout the day
Discuss the reasons for the bringing these points to the public’s attention.
First clean ; then disinfect : To avoid inactivation of the disinfectant by organic matter.
Start cleaning in the ‘cleanest’ areas and move towards the ‘dirtiest’ areas : To avoid the spread of contaminants.
Neither sweep nor clean without using liquids or dampened materials : Cleaning with a wet cloth helps avoid contamination of the air and other surfaces by particles present in the air.
Change the cleaning solutions because they will become contaminated very quickly. It is safe to pour disinfectants down a sink or a drain.

21. Respiratory hygiene
People who present with respiratory problems should take the following precautions :
When you cough or sneeze, cover your nose and mouth with a paper tissue or a mask.
Spit into a disposable tissue.
Throw away used tissues and masks.
If there are no paper tissues, cough or sneeze into your elbow or upper arm.
Wash or disinfect your hands after touching respiratory secretions.
Examine patients in a well-ventilated room (with good air circulation).
Explain and show how to cough and sneeze correctly.

22. Prevention of accidents
Accidents associated with pointed objects are a major problem.
Risks are greatest if barbed or sharp objects are used :
when a patient is agitated.
when the barbed or sharp object is not correctly packaged.
We will discuss special waste/containers later : M6

23. Prevention of accidents
HOW TO AVOID ACCIDENTS
Wear closed-toe shoes.
Make as few venipunctures and laboratory tests as possible.
Ask for help when a patient is agitated and intervention is absolutely necessary.
Never forget that your own protection is the most important !

24. Management of pointed or sharp objects
Be very careful when using pointed or sharp objects :
Never put the cap back on a used needle
Never point the tip of a used needle towards a part of the body or your assistant
Avoid twisting, breaking or manipulating used needles in any way

25. Management of pointed or sharp objects
Disposal of pointed or sharp objects such as syringes, needles, scalpel blades, etc.
Throw these objects into suitable, puncture-proof waste containers.
Place these containers as close as possible to where these objects are being used.
Never carry these objects in your hands.
Make sure that the puncture-proof waste containers for the disposal of pointed and sharp objects are located as close as possible to where these objects are being used in order to reduce the distance between the place of use and disposal. Make sure that they are constantly upright. If the waste container is not close by, never transport pointed and sharp objects in your hands: put them in a kidney dish or similar bowl and then take this to the main waste container.
Prefer plastic containers, cardboard containers can be damaged by fluids.
hemvala40 - Fotolia

26. Standard precautions : key messages I
Touch as little as possible to avoid the spread of germs and contamination.
Wash or disinfect your hands. Clean hands are the foundation of good practices and are the most important means of protection.
Wear gloves. They are additional protection and are a natural barrier to germs. Where there is a risk of Ebola, they are compulsory !
Clean surfaces.
Carry out respiratory hygiene.
Avoid accidents.
Needles are especially dangerous.

27. Standard precautions : key messages II
Standard precautions should be applied
To all patients, regardless of their infection status
At all times
By all hospital staff.
They are vital to protect the health of patients, hospital staff and the community.

28. Thank you for your attention !
Copyright images
© sdp_creations – Fotolia.com
© Jane Osina – Fotolia.com
© theblackrhino – Fotolia.com
©Adam – Fotolia.com
© HuHu Lin – Fotolia.com
© Strezhnev Pavel – Fotolia.com
© vladis_studio - Fotolia.com