Infection Control for LPHA Train the Trainer Course August 25, 2005 PPE Exercise Session 6 Infection Control for LPHA Train the Trainer Course August 25, 2005

Objectives Demonstrate the ability to don and remove PPE correctly Demonstrate the ability to select and wear the appropriate PPE in given situations

PPE exercise Order of Donning PPE Gown Mask or respirator Goggles or face shield gloves

PPE exercise Order of Removing PPE Gloves Goggles or face shield Gown Mask or respirator

PPE exercise Type of PPE used is based on: disease/symptoms = modes of transmission tasks/procedures

PPE exercise (see notes pages for answers) Scenario 1: A mass smallpox vaccination clinic has been initiated in your jurisdiction due to cases on the east and west coasts. You are a worker assigned to administer smallpox vaccine at the vaccination station. What disease is of concern? What mode(s) of transmission is (are) involved? What PPE should you wear? Why? Where should you dispose of used PPE? --vaccinia from the vaccine vial (not smallpox, as there are no cases currently in the area) --vaccinia can be spread by contact with the contents of the vial of vaccine, by direct contact with a vaccination site, or indirect contact with items contaminated with the vaccine. --Wear disposable gloves and gowns when handling the vaccine vial and when vaccinating. --to protect hands, skin, and clothing from contamination --It is possible to contaminate gowns and gloves with the vaccinia virus from the vaccine vial, so used PPE should be placed in a biohazard bag for disposal

PPE exercise Scenario 2: You are a public health nurse administering immunizations at your local health department immunization clinic. What PPE would you wear? Why? Where would you dispose of PPE? What mode(s) of transmission and what diseases are of concern? --Perhaps disposable gloves --If a job tasks results in “reasonable anticipation” of a blood or body fluid exposure, one should wear PPE for protection. “Reasonable anticipation” means if the task routinely results in blood exposure, not, for instance, only once every several months or so. Thus if you don’t often get blood on your hands when you administer “shots,” you don’t have to wear gloves. If you do, then you should wear them. One always has to do an assessment of chances of exposure, except for tasks that involve venous or arterial access, in which case OSHA always requires use of gloves. For all other tasks, the worker has to decide. --dispose of PPE dripping or saturated with blood or other body fluids into red biohazard bags, otherwise dispose of in regular plastic bags for routine disposal. --mode of transmission is by direct contact with blood or body fluids onto mucous membranes or nonintact skin, or indirectly through a needlestick. --diseases of concern are HIV, HBV, HCV, and many other bloodborne pathogens.

PPE exercise Scenario 3: You are assigned to do directly observed therapy on a TB case in your county. You will be visiting the client in his home. What mode(s) of transmission is (are) of concern? What PPE will you wear? Why? At what point will you begin wearing the PPE? In addition to donning the PPE, what step should you take? Where/when will you remove the PPE? Where will you dispose the PPE? --airborne transmission --a NIOSH certified, fit tested N95 respirator --to filter infectious particles from the potentially contaminated air in the infected person’s environment --before you enter the air space where the infected person is located—i.e. before entering their home or place where they are currently being housed --perform fit check steps to ensure the respirator is placed correctly and fits properly --after leaving the shared air space—outside the person’s home or place of confinement --in the regular trash

PPE exercise Scenario 4 : A mom and her three children are sitting in the waiting area of your facility. One of the children becomes sick and you need to clean up the emesis in the waiting area. What PPE would you select for the task? Why? Describe the steps to clean the area. How would you dispose of used PPE? How would you dispose of the cleaning items (towels, rags, cloths)? --gown, gloves, surgical mask --one has to assume a GI illness that is spread by direct contact with an ill person, or direct contact with infectious body fluids, so the PPE is worn to protect hands, skin, and clothing. The surgical mask is worn to prevent ingestion of infectious particles that may be aerosolized during the clean-up process --remove visible soilage first with a cloth or paper towel, then disinfect the area with a freshly made (within 24 hours) 1:100 dilution of bleach, or a 1:10 dilution of bleach (stable for 30 days) --disposable items such as towels, rags, cloths saturated or dripping with body fluids should be disposed of in a red biohazard bag, items not saturated can go into regular trash (remember, regular trash is handled with standard precautions)—same is true for the used PPE. If using re-usable rags or towels, they should be collected in a leak-proof plastic bag and handled with standard precautions, as should all laundry.

PPE exercise Scenario 5: You need to visit a suspect SARS case on home isolation to collect a blood specimen. He has had a fever and cough for 3 days, and is not improving. He will be able to come to the door to let you in, however. When you arrive, you realize he lives in a mobile home with no entry—you will be in the patient’s immediate environment the moment you step in to the home. It is December, and the temperature is 5 degrees below zero.

PPE exercise Scenario 5 What mode(s) of transmission is(are) involved? What PPE will you wear? Why? When and where will you put it on? What might you consider telling the patient before arriving? When and where will you remove PPE? How will you dispose of it? What other equipment do you need? --airborne and contact --gown, gloves, NIOSH approved, fit tested N95 respirator, and goggles --to protect hands, skin, eyes, and clothing from direct or indirect contact, and to protect the respiratory system from inhalation of infectious particles --before entering the home, which in this case means it needs to be put on in the car or outside --that you will be wearing protective gear, and why, so he/she is prepared for your appearance --outside—after exiting the home and before entering the car (to prevent contamination of the car) --follow the same rules for PPE disposal—items saturated with blood or other body fluids should be placed in red biohazard bags, otherwise in regular plastic bags for disposal in regular trash --blood collection equipment and disposable cloths on which to place the equipment Note: Although placing of PPE outside the home may pique the interest of neighbors, there is no violation of the patient’s privacy, since the wearing of PPE does not reveal a specific diagnosis (this is similar to placing isolation signs outside hospital rooms, which also does not reveal a diagnosis).

PPE exercise Scenario 6: It is Tuesday and that means Hmong refugees in your area will be bringing in their stool samples for you to package for shipment to WSLH. Mode(s) of transmission? PPE? Why? Where should the specimens be processed? What should be done after they are processed? --direct contact with the stool specimen or indirectly from items contaminated with the contents --disposable gloves when handling the specimen; disposable gown if contamination of skin or clothing is anticipated—PPE is worn to prevent contamination of hands --in a designated area, where other activities such as patient care, eating, drinking, do not occur --removal of gloves, hand washing, and routine disinfection of surfaces and items in the specimen processing area

PPE exercise Scenario 7: It is health screening day and many clients are at your facility waiting for their BP checks and cholesterol screening. You notice an elderly woman with cold-like symptoms, including a cough. What, if anything, should you do? What mode of transmission is of concern? What PPE, if any, would be used? Who would wear it? --separate her from the others as quickly as possible, ask her to wear a surgical mask if she must be screened that day. Otherwise it is best for her to leave and come back when well. --droplet, contact --surgical mask by patient if in a common area; surgical mask by staff when within 3 feet of her

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 608-267-7711 gwen.borlaug@wisconsin.gov