1. Training structure EFFO Safety and good quality work
Module 1: Ebola Virus Disease
Module 2:
Epidemic control on different levels
Module 3:
Standard precautions & disinfection
Module 4:
Screening & isolation
Module 5:
Personal protective equipment
Module 6:
Waste management & cleaning
Support from the community
Support from the hospital administration
Support from the population

2. Standard precautions & disinfection
Module 3

3. Learning objectives module 3
General objective
Know and being able to apply the standard precautions to prevent 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 to handle pointed and sharp-edged objects
To know how to use disinfectant solutions
To know how and when to clean surfaces
To know how to practice respiratory hygiene    3

4. Discussion about good practices
How to avoid contamination ?
Dangerous germs are prevalent in health facilities
Germs can easily be spread by hand contact
Ebola and many other infections are transmitted by contact.
Good practices are the foundation for the prevention of hospital-acquired infections.
Group discussion
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. 4

5. How to avoid contamination ?
Touch as few objects as possible
Clean surfaces
Wash and disinfect your hands
Standard precautions
Carry out respiratory hygiene
Wear gloves
Group discussion
What is hospital practice?
Examples of bad practices in hospital:
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
What disinfectants are used ?
Emphasise the fact that the Ebola virus is very fragile : it is very sensitive to ordinary disinfectants (such as soap, chlorine solution and alcohol-based cleaning fluids) and physical conditions (heat, sunlight)
Avoid accidents 5

6. General behaviour - Note! Touch as few objects as possible
Source: RKI
Touch as few objects as possible
Gruppe discussion
Discuss behaviour during the breaks and work (for example: touch as little as possible, clean beds)
Source: RKI 6

7. General behaviour - examples
In a hospital:
Avoid touching your face
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, … )
Group discussion
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 without gloves (beds, bedpans, oxygen masks, dustbins) 7

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
Following hand hygiene by
Washing them with soap and water
Using standard disinfectants
Wearing gloves
Additional information
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 an infectious disease. The body’s natural barriers (for example, clean hands) are not sufficient. 8

9. How to wash hands Source: WHO Additional information
Wash hands with soap and water when they are visibly soiled.
If not, disinfect your hands. 9

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 10

11. Practical exercise : hand washing
Now let’s put this into practice !
Note
Water and Soap need to be prepared in advance of the preparation
Source: RKI 11

12. Wearing gloves to protect your hands
If available, use gloves for
an additional barrier for your hands
Protecting the skin of your hands
Practise putting on and removing gloves to improve protection and avoid contamination
Gloves should be changed regularly !
One patient – one action – one pair of gloves
Additional information
Wearing gloves is a complement to clean hands
In order to safely put on and removing gloves this needs to be practiced regularly. If not, safety by wearing gloves might be fake.
Use single-use gloves to examine patients - at least one pair per patient 12

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

14. How to remove gloves 8: Throw the gloves away in a waste container.
Additional information
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.
If a clean part (green) touches a soiled part (red), this part is then soiled and should no longer touch the skin !
Approach:
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.
Basic principal: Being aware of a clean side (here: green) and a possibly dirty side (here: red) and avoid contamination. Clean on clean - dirty on dirty!
Do not touch the skin with the dirty parts (red).
Practise this technique.
Source: RKI 14

15. Removing gloves
After removing your gloves  disinfect or wash your hands !
Source: RKI 15

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

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 % chlorine solution).
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. Damaged gloves might not protect adequately. 17

18. What to do if there are no gloves ?
Try to avoid direct patient contact as far as possible.
If this is not possible :
Use standard hand disinfectants or wash your hands 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. Chlorine solution Before using chlorine solution
Is it the right product?
Which concentration?
Correct production process?
Correct storage?
Safe use of chlorine solution
Before using
chlorine
solution
Group discussion
which practices are in place at the hospital?
Which disinfectants are used?
Repetition: The Ebola virus is not stable!

20. Chlorine solution - the right product?
When using chlorine solution you have to pay attention to an appropriate product.
The label might use different names
"Bleach"
"Sodium hypochlorite“
"Aqueous solution of sodium hypochlorite"
“Eau de Javel“
Be careful: Products sold as „bleach“ can sometimes contain other highly toxic chemicals.
Source: RKI

21. Chlorine solution – correct concentration 0,05 %
Are you using the correct concentration for what you are doing?
For disinfecting contaminated surfaces or objects
For washing gloved hands
For washing bare hands
0,5 %
0,05 %
Additional information
There is one exception! If there is contamination in the red zone, the skin areas affected must be disinfected using bleach at 0.5% concentration!
Literature

22. Chlorine solution - production
If it is prepared locally: chlorine solution must be prepared fresh every day
Label the recipients with the concentration and the date and time of production!
Producing chlorine solution is not easy: quantities, products, controlling the pH, … → you have to learn the process and practice!
Source: CDC
Chlorlösung
0,5 %
14. April 2015, 08:00 Uhr
Literature

23. Chlorine solution - storage
Replace the solutions when they are contaminated: the chlorine is no longer active!
Keep solutions for a maximum of 24 hours - prepare a fresh solution every day.
Always use a lid to cover buckets.
Keep solutions out of sunlight.
Source: RKI
Literature
Source: CDC 23

24. Chlorine solution – safe use
Highly concentrated chlorine solution: avoid contact with skin
Do not put chlorine solution in your eyes or mouth.
When preparing and handling chlorine solution: always ware gloves, goggles, a mask and an apron.
Avoid splashes.
Never mix chlorine solution with soap or other solutions: the chlorine may be deactivated and it will no longer be able to disinfect sufficiently. a) b)
Source a), b): CDC 24

25. Cleaning surfaces
Group discussion
Cleaning: Which practices are being followed in the hospital?
Examples for bad practices:
Washing with too much water
Disinfection without cleaning
Cleaning without proper personal protective equipment
Cleaning only with water
Inappropriate concentration of the disinfectant (chlorine solution)
Clean and disinfect as soon as possible (everyone’s task !) :
any surface or object contaminated with blood, body fluids, secretions or excretions
At least once a day, clean with water and detergent :
Floors and work surfaces
Let the surfaces dry naturally before using them again
Use the appropriate disinfectant
Be meticulous, critical and alert ! 25

26. Cleaning – Attention ! First clean - then disinfect
Group discussion
About reasons for these security measures
First clean, then disinfect: To avoid inactivation of the disinfectant by organic matter.
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.
Start cleaning in the ‘cleanest’ areas and move towards the ‘dirtiest’ areas : To avoid the spread of contaminants.
Change the cleaning solutions because they will become contaminated very quickly. It is safe to pour disinfectants down a sink or a drain.
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 26

27. 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
Have single use tissues
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)
Note
Explain and show how to cough and sneeze correctly 27

28. Prevention of accidents (I)
Accidents associated with pointed objects are a major risk for infection.
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
Note:
Information on waste management in Module 6 28

29. Prevention of accidents (II)
How to avoid accidents?
Wear closed-toe shoes
Make as few venipunctures and invasive tests as possible
Ask for help when a patient is agitated and intervention is absolutely necessary
Never forget that your own safety is the most important ! 29

30. Management of pointed or sharp objects (I)
Be very careful when using pointed or sharp objects !
No Recapping! (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 30

31. Management of pointed or sharp objects (II)
Additional information
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.
Disposal of pointed or sharp objects:
 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 (rather on a tray or kidney dish)
Source: hemvala40 - Fotolia 31

32. Overview on standard precautions
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!
Clean surfaces!
Carry out respiratory hygiene!
Avoid accidents!
Needles are especially dangerous! 32

33. Standard precautions: key messages
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. 33

34. 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 34