1. Airborne Pathogens and Respirator Use

2. Objectives – The Illnesses
Discuss Airborne Diseases and the healthcare provider
How they spread
Who is at risk
Possible causes
Symptoms
SAINT BARNABAS HEALTH CARE SYSTEM

3. Objectives – EMS Transport
What you should do to protect yourself
General considerations
Infection control
Waste disposal
Cleaning and Disinfection
Follow-up of EMS personnel
SAINT BARNABAS HEALTH CARE SYSTEM

4. Objectives - The N95 Respirator
What is it? Why do I need it?
How do I use it?
Fit testing
What are the limitations?
SAINT BARNABAS HEALTH CARE SYSTEM

5. SAINT BARNABAS HEALTH CARE SYSTEM
Airborne Pathogens
Tuberculosis
Influenza
Avian Influenza
Smallpox
SARS
SAINT BARNABAS HEALTH CARE SYSTEM

6. Tuberculosis Famous people who have had TB Fredric Chopin*
Eleanor Roosevelt*
Nelson Mandela
Ringo Starr
Tom Jones
Tina Turner
*Died of TB

7. What is tuberculosis (TB)?
Disease caused by bacteria called Mycobacterium tuberculosis
Chronic bacterial infection
Was once the leading cause of death in US
The number of cases declined in the 1940’s when drugs were developed to treat TB
TB is still a problem worldwide (NIAID)
8 million people develop TB yearly
3 million die
SAINT BARNABAS HEALTH CARE SYSTEM

8. SAINT BARNABAS HEALTH CARE SYSTEM
How is TB spread?
Through the air from person to
person by coughing
Usually attacks lungs
Two stages
Latent TB
asymptomatic and not contagious
can take medication to prevent development of disease
Active TB Disease
May spread to others
May have abnormal chest x-ray
Usually have positive skin test
SAINT BARNABAS HEALTH CARE SYSTEM

9. SAINT BARNABAS HEALTH CARE SYSTEM
Symptoms of TB
Chills
Fever
Weakness or fatigue
Sweating while sleeping, Night sweats
Cough that lasts longer than 2 weeks
Pain in chest
Coughing up blood or sputum
SAINT BARNABAS HEALTH CARE SYSTEM

10. SAINT BARNABAS HEALTH CARE SYSTEM

11. SAINT BARNABAS HEALTH CARE SYSTEM
Risk Factors
Close contact with someone who is infected with TB
Traveling to a country where TB is common
Immune compromised
Foreign-born individuals and minorities have a higher incidence of developing TB
2002: 50% of US cases were in foreign-born individuals (CDC)
2002: 80% of all US TB cases were in ethnic and racial minorities (CDC)
SAINT BARNABAS HEALTH CARE SYSTEM

12. Multi-drug resistant TB (MDR TB)
Bacteria become resistant
to antibiotics
Arose from improper use of
antibiotics in the treatment of TB
Treatment of one case can cost up to $1.3 million (CDC)
45 states and Washington, DC have confirmed cases of MDR TB (CDC)
SAINT BARNABAS HEALTH CARE SYSTEM

13. SAINT BARNABAS HEALTH CARE SYSTEM
MDR TB continued
Treatment is difficult and costly
Can develop from not taking proper course of antibiotics for TB
MDR TB can be spread by an infected person
SAINT BARNABAS HEALTH CARE SYSTEM

14. How to protect yourself
BCG vaccine for TB is given in many countries, but not the US
Not recommended for healthcare workers unless a high percentage of patients are infected with MDR TB (CDC)
PPD test if exposure is suspected
USE proper PPE when in contact with patients who may have TB
SAINT BARNABAS HEALTH CARE SYSTEM

15. SAINT BARNABAS HEALTH CARE SYSTEM
Tuberculosis Summary
Chronic bacterial infection
spread through the air
Fever, chills, sweating while sleeping, persistent cough, coughing up blood or sputum
MDR TB
Use proper PPE and get PPD test if exposed
SAINT BARNABAS HEALTH CARE SYSTEM

16. Influenza “I had a little bird, His name was Enza,
I opened the window and in flew Enza.”
-Children’s nursery rhyme about the flu epidemic of 1918

17. What is influenza (“the flu”)?
Disease caused by a virus
Respiratory
More severe than a cold
10%-20% of US residents will
get the flu each year (CDC)
Can lead to complications for some people
36,000 people die each year from complications (CDC)
SAINT BARNABAS HEALTH CARE SYSTEM

18. Types of influenza virus
Influenza A
Most common and most serious
Can lead to epidemics
Influenza B
Can also cause epidemics
Symptoms are milder
Influenza C
Never connected with large epidemics
SAINT BARNABAS HEALTH CARE SYSTEM

19. How is influenza spread?
Flu season is from November to March
Respiratory droplets
Coughing
Sneezing
Droplets on objects
Contagious from 1 day before symptoms start to 7 days after symptoms start (CDC)
SAINT BARNABAS HEALTH CARE SYSTEM

20. SAINT BARNABAS HEALTH CARE SYSTEM
Symptoms
Cough and congestion
Fever
Headache
Body Aches
General malaise
Sore throat
SAINT BARNABAS HEALTH CARE SYSTEM

21. SAINT BARNABAS HEALTH CARE SYSTEM
Vaccine- The Flu Shot
Administered yearly
Injection or nasal spray (FluMist)
New vaccine made every year
Can prevent types A and B
SAINT BARNABAS HEALTH CARE SYSTEM

22. SAINT BARNABAS HEALTH CARE SYSTEM

23. Who should get a flu shot? (CDC)
>50 years old
Diabetic
Live or work in a nursing home
Compromised immune system
Chronic heart, lung, or kidney disease
Will be more than 3 months pregnant during flu season
SAINT BARNABAS HEALTH CARE SYSTEM

24. SAINT BARNABAS HEALTH CARE SYSTEM
Protecting yourself
Get flu shot
Use proper PPE around patients suspected of having the flu
Disinfect surfaces regularly
Keep yourself healthy during the flu season!
Get enough rest
Eat well
SAINT BARNABAS HEALTH CARE SYSTEM

25. SAINT BARNABAS HEALTH CARE SYSTEM
Influenza Summary
Flu season is from November to March
Use PPE
Disinfect
Get a flu shot
SAINT BARNABAS HEALTH CARE SYSTEM

26. Avian Influenza
February 2004: 72,000 chickens were slaughtered in Delaware after two cases of Avian Influenza were found at a poultry farm under contract for Perdue Farms, Inc.

27. What is Avian Influenza?
Influenza virus that can infect birds and humans
Type A influenza
3 Type A viruses and each have 9 subtypes
H5: can be high or low pathogenic; can cause severe illness or death
H7: can be high or low pathogenic; infections are rare and symptoms are mild
H9: low pathogenic; very rare in humans
SAINT BARNABAS HEALTH CARE SYSTEM

28. SAINT BARNABAS HEALTH CARE SYSTEM
Transmission
Contact with infected poultry or contaminated surfaces
No documented cases of sustained human to human transmission
Have been isolated incidents of human to human transmission
Monitoring is important
Influenza viruses have the ability to change
May gain the ability to spread from person to person
SAINT BARNABAS HEALTH CARE SYSTEM

29. SAINT BARNABAS HEALTH CARE SYSTEM
Symptoms
Same as typical flu-like symptoms
Conjunctivitis
Pneumonia
Severe respiratory
distress
SAINT BARNABAS HEALTH CARE SYSTEM

30. Incidents of H5 Avian Influenza
1997: Hong Kong- First documented transmission of birds to humans
18 people hospitalized
6 died
1.5 million chickens slaughtered to prevent further spread of disease
Person to person transmission was also documented
SAINT BARNABAS HEALTH CARE SYSTEM

31. Incidents of H5 Avian Influenza
2003: China and Hong Kong
2 people infected after traveling to China
1 died
Source of infection not identified
2004: Thailand and Vietnam
WHO reported cases of H5 influenza among bird populations
Ongoing since January 2003
Human cases found in Thailand and Vietnam (WHO)
37 reported cases
26 died
Most recent cases were reported August 12, 2004
SAINT BARNABAS HEALTH CARE SYSTEM

32. Avian Influenza Summary
Can be transmitted from birds to humans
Typical flu-like symptoms plus
Conjunctivitis
Respiratory distress
Pneumonia
Use PPE
SAINT BARNABAS HEALTH CARE SYSTEM

33. SAINT BARNABAS HEALTH CARE SYSTEM
Questions?
SAINT BARNABAS HEALTH CARE SYSTEM

34. Smallpox In 1972, a single case of small pox in Yugoslavia led to the
infection of 150 people, 34 deaths, 10,000 people quarantined
and 20 million vaccinated.
-World Health Organization

35. SAINT BARNABAS HEALTH CARE SYSTEM
What is Smallpox?
Variola Virus
Contagious infectious disease
Eliminated in human populations
Laboratory stockpiles exist
Concern that it may be used as an agent of bioterrorism
No treatment
Only prevention is vaccine
Two types
Variola major
Variola minor
SAINT BARNABAS HEALTH CARE SYSTEM

36. SAINT BARNABAS HEALTH CARE SYSTEM
Variola Major
Most common
Severe
Very high fever
Large rash
4 types
Ordinary: most frequent
Modified: occurs in people who have been vaccinated; mild
Flat: rare and severe
Hemmorhagic:rare and severe
Fatality rate of 30% (CDC)
SAINT BARNABAS HEALTH CARE SYSTEM

37. SAINT BARNABAS HEALTH CARE SYSTEM

38. SAINT BARNABAS HEALTH CARE SYSTEM
Variola Minor
Less common
Less severe symptoms
Fatality rate of <1%
SAINT BARNABAS HEALTH CARE SYSTEM

39. SAINT BARNABAS HEALTH CARE SYSTEM
From World Health Organization
SAINT BARNABAS HEALTH CARE SYSTEM

40. SAINT BARNABAS HEALTH CARE SYSTEM

41. SAINT BARNABAS HEALTH CARE SYSTEM

42. SAINT BARNABAS HEALTH CARE SYSTEM
Transmission
Person to person
Prolonged contact with infected person
Contact with infected body fluids or contaminated objects
Can be spread through the air in enclosed settings, but this is rare
SAINT BARNABAS HEALTH CARE SYSTEM

43. SAINT BARNABAS HEALTH CARE SYSTEM
Vaccine
Complete protection if given before exposure
If given within 3 days after exposure, will prevent or greatly lessen severity
4-7 days after exposure: lessens severity of disease
No protection if given after rash appears
Not widely available to the public at this time
Stockpiles are in place in case of an outbreak
SAINT BARNABAS HEALTH CARE SYSTEM

44. Vaccine contraindications (CDC)
Vaccinia virus can be spread to others from the injection site of an immunized person
Eczema and other exfoliative skin conditions
May develop eczema vaccinatum
Inadvertent autoinnoculation of affected area
Could develop vaccinia
Immune compromised individuals
Pregnancy
Infants and children
Not given to infants <12 months of age
Only in emergency situations to children <18 years of age
Breastfeeding mothers should not get the vaccine
Heart disease
SAINT BARNABAS HEALTH CARE SYSTEM

45. SAINT BARNABAS HEALTH CARE SYSTEM
Protecting yourself
Vaccine
Use PPE when in contact with infected patient or contaminated fluids
Watch for signs/symptoms of smallpox if you believe you were exposed
Early vaccination after exposure can prevent or lessen the disease
SAINT BARNABAS HEALTH CARE SYSTEM

46. SAINT BARNABAS HEALTH CARE SYSTEM
Smallpox Summary
Contagious infectious disease
Transmitted through close contact with infected person
Vaccine
SAINT BARNABAS HEALTH CARE SYSTEM

47. SARS Severe Acute Respiratory Syndrome
The 2003 global SARS outbreak led to over 8,000 people becoming ill, and 774 deaths. It is estimated the panic caused by the disease cost Canada $1 billion in lost tourism and all of Asia over $28 billion.
(BBC News)

48. What is SARS? Center for Disease Control Definition
SARS is a respiratory illness of unknown etiology. It was first identified in February 2003.
SARS was first noticed in Southeast Asia. To date more than 100 cases have been reported in the United States
Public health experts think that SARS is spread by close contact between people
SAINT BARNABAS HEALTH CARE SYSTEM

49. SAINT BARNABAS HEALTH CARE SYSTEM

50. SAINT BARNABAS HEALTH CARE SYSTEM
How SARS Spreads
SARS is most likely spread when someone sick from the disease coughs droplets into the air and someone else breathes the virus in
It is possible that SARS may spread more broadly through the air or from touching an object that is contaminated
SAINT BARNABAS HEALTH CARE SYSTEM

51. SAINT BARNABAS HEALTH CARE SYSTEM
Who Is at Risk for SARS?
Individuals having close contact with someone sick from the disease
Those sharing a household with someone sick from the disease
Healthcare providers who do not use the proper infection control techniques when providing care for patients sick from the disease
SAINT BARNABAS HEALTH CARE SYSTEM

52. Possible Causes of SARS
Scientists at the CDC and other laboratories have detected a previously unrecognized coronavirus in patients with SARS.
While the new coronavirus is still the leading hypothesis for the cause of SARS, other viruses are still under investigation as potential causes.
SAINT BARNABAS HEALTH CARE SYSTEM

53. What are Coronaviruses
These viruses are a common cause of mild to moderate upper-respiratory illness in humans and are associated with respiratory, gastrointestinal, liver and neurologic disease in animals.
Coronaviruses can survive in the environment for as long as three hours.
SAINT BARNABAS HEALTH CARE SYSTEM

54. SAINT BARNABAS HEALTH CARE SYSTEM

55. SAINT BARNABAS HEALTH CARE SYSTEM
Symptoms of SARS
Fever or hot to touch
AND
Cough
Clinical findings of respiratory distress
Travel within 10 days to an area with suspected community transmission OR
Close contact within 10 days with a person with a respiratory illness or someone sick from SARS
SAINT BARNABAS HEALTH CARE SYSTEM

56. How to protect yourself
Wear proper respiratory protection
Recognize signs and symptoms of SARS
SAINT BARNABAS HEALTH CARE SYSTEM

57. SAINT BARNABAS HEALTH CARE SYSTEM
SARS Summary
Very little known about SARS
Possibly spread through droplets in air
Fever, chills, severe respiratory distress
Wear respiratory protection
SAINT BARNABAS HEALTH CARE SYSTEM

58. SAINT BARNABAS HEALTH CARE SYSTEM
Questions?
SAINT BARNABAS HEALTH CARE SYSTEM

59. Transport of Patients with Suspected Airborne Illness
SAINT BARNABAS HEALTH CARE SYSTEM

60. General Considerations
Patients should be transported using the minimum number of EMT personnel and without non-infectious patients or passengers in the vehicle.
Sufficient infection control supplies should be on board.
Receiving facilities must be notified prior to transport of infectious patients.
SAINT BARNABAS HEALTH CARE SYSTEM

61. Infection Control - General
PPE may not be removed during transport.
Personal activities (including: eating, drinking, application of cosmetics, and handling of contact lenses) should not be performed during patient transport.
These diseases may be transmitted if residual infectious particles on environmental surfaces are brought into direct contact with the eyes, nose or mouth.
SAINT BARNABAS HEALTH CARE SYSTEM

62. Infection Control – PPE
Disposable, non-sterile gloves must be worn for all patient contact.
Disposable fluid-resistant gowns should be worn for all patient care activity.
Goggles or face-shields must be worn in the patient-care compartment and when working within 6 feet of the patient. Corrective eyeglasses alone are not appropriate protection.
N-95 respirators should be worn by personnel in the patient-care compartment at all times.
SAINT BARNABAS HEALTH CARE SYSTEM

63. Infection Control - PPE
Gloves are removed in the correct manner and discarded in biohazard bags after patient care is completed (e.g., between patients) or when soiled or damaged.
Hands must be washed or disinfected with a waterless hand sanitizer immediately after removal of gloves.
SAINT BARNABAS HEALTH CARE SYSTEM

64. Infection Control – Driver & Vehicle
N-95 respirators should be worn by the driver if the driver's compartment is open to the patient-care compartment.
Drivers that provide direct patient care must wear a disposable gown, face shield, and gloves during patient-care activities.
Use vehicles with separate ventilation for driver and patient compartments if possible.
Maximize air exchange
Open dashboard vents
Open rear vents to maximum level
SAINT BARNABAS HEALTH CARE SYSTEM

65. SAINT BARNABAS HEALTH CARE SYSTEM
Infection Control
The patient may wear a paper surgical mask to reduce droplet production, if tolerated.
Oxygen delivery with NRB masks may be used for patient oxygen support during transport.
CPR should never be performed using mouth-to-mouth or mouth-to-mask.
SAINT BARNABAS HEALTH CARE SYSTEM

66. Infection Control – Patient Care
The BVM should be equipped with a HEPA filter for expired air.
When using CPAP ensure that a HEPA filter is attached to the exhalation port.
There is no documented additional risk when using aerosol nebulizers if all of the precautions just discussed are used by the health care provider.
SAINT BARNABAS HEALTH CARE SYSTEM

67. Follow-up of EMS Personnel
Record the following information
Date and route of transport
Duration of patient transport
Names of personnel in contact with the patient
EMT services should closely monitor personnel who have transported potentially infectious patients for evidence of fever, rash or respiratory illness.
EMT personnel who transport SARS patients should be assessed at least daily for 10 days after transporting a SARS patient (directly or by telephone).
If the EMT was exposed to Smallpox, it is important to be vaccinated as soon as possible. May be symptom-free for up to 17 days after contracting the disease.
SAINT BARNABAS HEALTH CARE SYSTEM

68. Follow-up of EMS Personnel
Personnel may continue working during the follow-up period if they have no symptoms of the disease.
Personnel who have transported a SARS patient and become symptomatic within the 10 day follow-up period should be directed to seek medical evaluation and should be reported to the state health department and to the CDC.
SAINT BARNABAS HEALTH CARE SYSTEM

69. SAINT BARNABAS HEALTH CARE SYSTEM
Questions?
SAINT BARNABAS HEALTH CARE SYSTEM

70. The N95 Respirator

71. SAINT BARNABAS HEALTH CARE SYSTEM
The N95 Respirator
The most common respirator used is the disposable particulate type N95.
The “N” stands for respirator filters that can be used when no oil is present in the contaminants.
The“95” means that the product has been tested and certified by NIOSH to have a filter efficiency level of 95% or greater against particulate aerosols.
SAINT BARNABAS HEALTH CARE SYSTEM

72. Why a Respirator Is Necessary
Healthcare providers work in an environment where there is a risk of disease transmission through airborne infectious particulates.
Respirators, such as the N-95, provide protection from airborne infectious particulates when properly fitted and worn.
SAINT BARNABAS HEALTH CARE SYSTEM

73. OSHA 1910.134 Standards for Respiratory Protection
Medical screening to determine if the employee is physically able to wear a respirator.
Fit-test to determine if the respirator fits properly on the employee’s face.
Training on the selection, use, storage, and limitations of the respirator used.
SAINT BARNABAS HEALTH CARE SYSTEM

74. SAINT BARNABAS HEALTH CARE SYSTEM
The Medical Screening
A licensed health care professional will perform the evaluation using a medical questionnaire.
The contents of the medical questionnaire are mandated by OSHA.
Administered to the HCW in a confidential manner and the HCW can request to discuss the results of the medical evaluation with the licensed health care professional.
SAINT BARNABAS HEALTH CARE SYSTEM

75. Follow-up Medical Examination Is Performed If:
1- If HCW reports medical signs or symptoms that are related to ability to use the respirator.
2- If the supervisor informs employee health of the need for re-evaluation.
3- If information from the respirator program monitoring activities should indicate any need for re-evaluation.
4- If the workplace conditions significantly change.
SAINT BARNABAS HEALTH CARE SYSTEM

76. FIT TEST Procedure is Done:
1- Before initial use of the respirator
2- Whenever a different size, style, model or make of respirator is used
3- If HCW has a change in facial structure such as: facial trauma, facial surgery, loss of body weight, or dental changes.
4- If the HCW worker notifies the employer that the respirator fit is unacceptable.
5- At least annually
SAINT BARNABAS HEALTH CARE SYSTEM

77. SAINT BARNABAS HEALTH CARE SYSTEM
Types of Fit Testing
Qualitative Fit Test: Worker is assessed on a pass/fail basis to determine the adequacy of respirator fit. It relies on the individual’s response to the test agent.
Quantitative Fit Test: Assessment of respirator adequacy by numerically measuring the amount of leakage into the respirator.
SAINT BARNABAS HEALTH CARE SYSTEM

78. Fit Testing the Respirator Qualitative Testing
HCW puts on the respirator.
Hood is applied over the head.
Sweet tasting aerosol mist is introduced into the hood.
If the seal is tight the HCW should not experience any sweet taste.
The test simulates activities such as turning the head, talking, and other possible activities that might occur during job tasks.
SAINT BARNABAS HEALTH CARE SYSTEM

79. Fit Testing the Respirator Quantitative Testing
HCW puts on respirator attached to PortaCount machine.
HCW performs series of movements to test respirator fit.
PortaCount machine measures amount of particles leaking into mask.
SAINT BARNABAS HEALTH CARE SYSTEM

80. Donning of the N95 Respirator* Step #1
Cup the respirator in your hand with the nosepiece at your finger tips allowing the headbands to hang freely below hands.
*Always refer to the instructions provided by manufacturer
SAINT BARNABAS HEALTH CARE SYSTEM

81. Donning of the N95 Respirator Step #2
Position the respirator under your chin with the nosepiece up.
SAINT BARNABAS HEALTH CARE SYSTEM

82. Donning of the N95 Respirator Step #3
Pull the top strap over your head so it rests high on the back of head.
SAINT BARNABAS HEALTH CARE SYSTEM

83. Donning of the N95 Respirator Step #4
Pull the bottom strap over your head and position it around your neck below ears.
SAINT BARNABAS HEALTH CARE SYSTEM

84. Donning of the N95 Respirator Step #5
Using two hands, mold the nosepiece to the shape of your nose by pushing inward while moving your fingertips down both sides of the nosepiece.
Pinching the nosepiece using one hand may result in less effective respirator performance.
SAINT BARNABAS HEALTH CARE SYSTEM

85. Fit Check of the N95 Respirator
Face fit check - the respirator seal should be checked before each use.
To check fit, place both hands completely over the respirator and exhale.
If air leaks around your nose, adjust the nosepiece as described in step 5.
If air leaks at respirator edges, adjust the straps back along the sides of your head.
Recheck.
Fit Check of the N95 Respirator
SAINT BARNABAS HEALTH CARE SYSTEM

86. SAINT BARNABAS HEALTH CARE SYSTEM
Facial Hair
Facial hair will make the seal loose and will not provide protection from harmful airborne hazards.
Even just one or two days beard growth can effect the seal.
Males should be clean shaven.
This is to ensure that the respirator is fully protective.
SAINT BARNABAS HEALTH CARE SYSTEM

87. Removal of the N95 Respirator Step #1
Cup the respirator in your hand to maintain position on face.
Pull bottom strap over head.
SAINT BARNABAS HEALTH CARE SYSTEM

88. Removal of the N95 Respirator Step #2
Still holding respirator in position, pull top strap over head.
SAINT BARNABAS HEALTH CARE SYSTEM

89. Removal of the N95 Respirator Step #3
Remove the respirator from your face
Discard as a Biohazard (Red Bag)
SAINT BARNABAS HEALTH CARE SYSTEM

90. Limitations of the N95 Respirator
If this respirator becomes wet, it is no longer effective and must be replaced.
The N-95 respirator has the ability to filter particles 1 micrometer with a filter efficiency of > 95%.
The N-95 is not intended for protection from organic vapors, toxic gases, or toxic particulates.
SAINT BARNABAS HEALTH CARE SYSTEM

91. SAINT BARNABAS HEALTH CARE SYSTEM
Waste Disposal
All solid waste, e.g., Used gloves, dressings, etc., Should be collected in a red biohazard bags for regulated medical waste disposal.
Any suctioned fluids and secretions must be sealed to prevent any splashes.
SAINT BARNABAS HEALTH CARE SYSTEM

92. Cleaning and Disinfection
Non-patient-care areas of the vehicle should be cleaned and maintained according to vehicle manufacturer’s recommendations.
Cleaning personnel should wear non-sterile gloves, disposable gowns and face shields while cleaning the patient-care compartment.
Patient-care compartments (including stretchers, railings, medical equipment control panels, and adjacent flooring, walls and work surfaces likely to be directly contaminated during care) should be cleaned using the department approved disinfectant.
SAINT BARNABAS HEALTH CARE SYSTEM

93. Cleaning and Disinfection
Spills of body fluids during transport should be cleaned by placing absorbent material over the spill and collecting the used cleaning material in a biohazard bag.
The area of the spill should be cleaned using an EPA-registered hospital disinfectant.
Contaminated reusable patient care equipment should be placed in biohazard bags and labeled for cleaning and disinfection.
Wear proper PPE when cleaning equipment.
SAINT BARNABAS HEALTH CARE SYSTEM

94. SAINT BARNABAS HEALTH CARE SYSTEM
Questions?
SAINT BARNABAS HEALTH CARE SYSTEM

95. For Additional Information
CDC
Center for Disease Control
WHO
World Health Organization
SAINT BARNABAS HEALTH CARE SYSTEM