1. Ebola Virus Disease & PPE Used in Emergency Environment Settings

2. Program Goal Recognize Sign & Symptoms of Ebola Patient Assessment Recommendations Improve personnel safety in the emergency environment through appropriate use of PPE

3. Ebola Virus Disease

4. The current Ebola outbreak in West Africa has increased the possibility of patients with Ebola traveling from the affected countries to the United States.

5. Ebola Virus Disease The likelihood of contracting Ebola is extremely low unless a person has direct unprotected contact with the blood or body fluids (like urine, saliva, feces, vomit, sweat, and semen) of a person who is sick with Ebola or direct handling of bats or nonhuman primates from areas with Ebola outbreaks.

6. Ebola Virus Disease The incubation period for Ebola, from exposure to when signs or symptoms appear, ranges from 2 to 21 days (most commonly 8-10 days). Any Ebola patient with signs or symptoms should be considered infectious.

7. Ebola Virus Disease Patient Assessment Recommendations: –If the patient has symptoms of Ebola, then ask the patient about risk factors within the past 3 weeks before the onset of symptoms, including: –Contact with blood or body fluids of a patient known to have or suspected to have Ebola –Residence in—or travel to— a country where an Ebola outbreak is occurring.

8. Ebola Virus Disease Patient Assessment Recommendations: –If Valley Comm advises that you are responding to a possible “infected patient” you should put on the PPE appropriate for suspected cases of Ebola before entering the scene. –Keep the patient separated from other persons as much as possible.

9. Ebola Virus Disease Patient Assessment Recommendations: –Use caution when approaching a patient with Ebola. – Illness can cause delirium, with erratic behavior that can place EMS personnel at risk of infection, e.g., flailing or staggering.

10. Ebola Virus Disease Patient Assessment Recommendations: All patients should be assessed for symptoms of Ebola, Patients with a Fever of 101.5 degrees Fahrenheit, additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage).

11. Ebola Virus Disease For Additional Information on Patient Assessment Recommendations: http://www.cdc.gov/vhf/ebola/hcp/interim- guidance-emergency-medical-services-systems- 911-public-safety-answering-points-management- patients-known-suspected-united-states.html

12. Ebola Virus Disease When risk of Ebola is elevated it is important to ask questions about: –Residence in, or travel to, a country where an Ebola outbreak is occurring in the last 21days… –Signs and symptoms of Ebola (such as fever, vomiting, diarrhea); and Other risk factors, like having touched someone who is sick with Ebola

13. Ebola Virus Disease Patient Assessment Recommendations: –Based on the presence of symptoms and risk factors, put on or continue to wear appropriate PPE and follow the scene safety guidelines for suspected case of Ebola. –If there are no risk factors, proceed with normal EMS care.

14. Ebola Virus Disease Use of Personal protective equipment (PPE) Use of standard, contact, and droplet precautions is sufficient for most situations when treating a patient with a suspected case of Ebola as defined above. EMS personnel should wear: Gloves Gown (fluid resistant or impermeable) Eye protection (goggles or face shield that fully covers the front and sides of the face) Facemask

15. Ebola Virus Disease Use of Personal protective equipment (PPE) Additional PPE might be required in certain situations: (e.g., large amounts of blood and body fluids present in the environment), including but not limited to double gloving, disposable shoe covers, and leg coverings

16. Ebola Virus Disease Recommended PPE should be used by EMS personnel as follows PPE should be worn upon entry into the scene and continued to be worn until personnel are no longer in contact with the patient. PPE should be carefully removed without contaminating one’s eyes, mucous membranes, or clothing with potentially infectious materials.

17. Ebola Virus Disease Recommended PPE should be used by EMS personnel as follows PPE should be double bagged in a Bio-Hazzard Bag then placed into a Bio-Hazzard waste container and held in a secure location. If Bunker Gear becomes exposed if should be double bagged Bio-Hazzard Bag then placed into a Bio-Hazzard waste container, cleaned and disinfected according to the manufacturer's instructions.

18. Ebola Virus Disease If blood, body fluids, secretions, or excretions from a patient with suspected Ebola come into direct contact with the EMS provider’s skin or mucous membranes, then the EMS provider should immediately stop working. They should wash the affected skin surfaces with soap and water and report exposure to the on-duty Battalion Chief.

19. Ebola Virus Disease For Additional Information Operations: Chief Olson Infectious Control & Reporting: Chief Plumlee Safety & Training: Chief Pennington

20. Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Emergency Environment Settings

21. Personal Protective Equipment Definition “specialized clothing or equipment worn by an employee for protection against infectious materials” (OSHA)

22. PPE Used Emergency Environment Settings Gloves – protect hands Gowns/aprons – protect skin and/or clothing Masks– protect mouth/nose Goggles – protect eyes Face shields – protect face, mouth, nose, and eyes

23. PPE Used Emergency Environment Settings Additional PPE might be required in certain situations (e.g., large amounts of blood and body fluids present in the environment), including but not limited to double gloving, disposable shoe covers, and leg coverings.

24. Factors Influencing PPE Selection Type of exposure anticipated –Splash/spray versus touch –Category of isolation precautions Durability and appropriateness for the task Fit

25. Gloves Purpose – patient care, environmental cleanup, other One or two pair Single use

26. Do’s and Don’ts of Glove Use Work from “clean to dirty” Limit opportunities for “touch contamination” - protect yourself, others, and the environment –Don’t touch your face or adjust PPE with contaminated gloves –Don’t touch environmental surfaces except as necessary during patient care

27. Do’s and Don’ts of Glove Use (cont’d) Discard in appropriate receptacle –Never wash or reuse disposable gloves

28. Gowns Purpose of use Gowns should fully cover the torso, fit comfortably over the body, and have long sleeves that fit snuggly at the wrist.

29. Face Protection Masks – protect nose and mouth –Should fully cover nose and mouth and prevent fluid penetration Goggles – protect eyes –Should fit snuggly over and around eyes –Personal glasses not a substitute for goggles –Antifog feature improves clarity

30. Face Protection Face shields – protect face, nose, mouth, and eyes –Should cover forehead, extend below chin and wrap around side of face

31. Respiratory Protection Purpose – protect from inhalation of infectious aerosols (e.g., Mycobacterium tuberculosis) PPE type for respiratory protection –N95 Particulate respirators

32. For additional information on respirators…. http://www.cdc.gov/niosh/npptl/respirators/ respsars.html http://www.cdc.gov/niosh/99-143.html http://www.cdc.gov/niosh/topics/respirators PPE Use in Healthcare Settings

33. How to Safely Don, Use, and Remove PPE

34. Key Points About PPE Don before contact with the patient, generally before entering the room Use the buddy system to ensure your PPE is Doned correctly without any skin exposure Use carefully – don’t spread contamination Remove and discard carefully, either at the doorway or immediately outside patient room; remove respirator outside room Immediately perform hand hygiene

35. Sequence* for Donning PPE Gown first Mask or respirator Goggles or face shield Gloves *Combination of PPE will affect sequence – be practical

36. How to Don a Gown Select appropriate type and size Opening is in the back Secure at neck and waist If gown is too small, use two gowns –Gown #1 ties in front –Gown #2 ties in back

37. How to Don a Mask Place over nose, mouth and chin Fit flexible nose piece over nose bridge Secure on head with ties or elastic Adjust to fit

38. How to Don a Particulate Respirator Select a fit tested respirator Place over nose, mouth and chin Fit flexible nose piece over nose bridge Secure on head with elastic Adjust to fit Perform a fit check – –Inhale – respirator should collapse –Exhale – check for leakage around face

39. How to Don Eye and Face Protection Position goggles over eyes and secure to the head using the ear pieces or headband Position face shield over face and secure on brow with headband Adjust to fit comfortably

40. How to Don Gloves Don gloves last Select correct type and size Insert hands into gloves Extend gloves over isolation gown cuffs

41. How to Safely Use PPE Keep gloved hands away from face Avoid touching or adjusting other PPE Remove gloves if they become torn; perform hand hygiene before donning new gloves Limit surfaces and items touched

42. How to Safely Remove PPE

43. “Contaminated” and “Clean” Areas of PPE Contaminated – outside front Areas of PPE that have or are likely to have been in contact with body sites, materials, or environmental surfaces where the infectious organism may reside Clean – inside, outside back, ties on head and back Areas of PPE that are not likely to have been in contact with the infectious organism

44. Sequence for Removing PPE Gloves Face shield or goggles Gown Mask

45. Where to Remove PPE At doorway, before leaving patient room or in another room* Remove Mask outside room, after door has been closed* *Ensure that hand hygiene facilities are available at the point needed, e.g., sink soap &water or appropriate commercial hand disinfectant cleaner

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

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

48. Remove Goggles or Face Shield Grasp ear or head pieces with ungloved hands Lift away from face Place in designated receptacle for reprocessing or disposal

49. Removing Isolation Gown Unfasten ties Peel gown away from neck and shoulder Turn contaminated outside toward the inside Fold or roll into a bundle Discard

50. Removing a Particulate Respirator Lift the bottom elastic over your head first Then lift off the top elastic Discard

51. Removing a Mask Untie the bottom, then top, tie Remove from face Discard

52. Hand Hygiene Perform hand hygiene immediately after removing PPE. –If hands become visibly contaminated during PPE removal, wash hands before continuing to remove PPE Wash hands with soap and water or appropriate commercial hand disinfectant cleaner *Ensure that hand hygiene facilities are available at the point needed, e.g., sink soap &water or appropriate commercial hand disinfectant cleaner

53. Standard and Expanded Isolation Precautions

54. Standard Precautions Previously called Universal Precautions Assumes blood and body fluid of ANY patient could be infectious Recommends PPE and other infection control practices to prevent transmission in any healthcare setting Decisions about PPE use determined by type interaction with patient

55. PPE for Standard Precautions (1) Gloves – Use when touching blood, body fluids, secretions, excretions, contaminated items; for touching mucus membranes and nonintact skin Gowns – Use during procedures and patient care activities when contact of clothing, exposed skin with blood/body fluids, secretions, or excretions is anticipated

56. PPE for Standard Precautions (2) Mask and goggles or a face shield – Use during patient care activities likely to generate splashes or sprays of blood, body fluids, secretions, or excretions PPE Use in Healthcare Settings

57. PPE for Expanded Precautions Expanded Precautions include –Contact Precautions –Droplet Precautions –Airborne Infection Isolation PPE Use in Healthcare Settings

58. PPE Use in Healthcare Settings: Final Thoughts PPE is available to protect you from exposure to infectious agents. Know what type of PPE is necessary for the duties you perform and use it correctly