1. Principles of Infection Control and Personal Protective Equipment A Brief Overview

2. Transmission of Influenza Virus Among Humans DropletMost likely route. AirbornePossible at close distances. ContactPossible

3. Types of PPE Gloves Gowns Masks Boots (for agricultural settings, not used for human healthcare) Eye protection

4. Types of PPE Gloves Different kinds of gloves –Housekeeper gloves –Clean gloves –Sterile glove Work from clean to dirty Avoid “touch contamination” –Eyes, mouth, nose, surfaces Change gloves between patients

5. Types of PPE Gowns Fully cover torso Have long sleeves Fit snuggly at the wrist

6. Types of PPE Surgical masks –Cotton, paper –Protect against body fluids and large particles Particulate respirators (N95) –Fit testing essential –Protect against small droplets and other airborne particles Alternative materials (barrier) –Tissues, cloth Masks and Respirators: Barriers and Filtration

7. PPE for Standard Precautions Wear: Gloves Gowns Eye Protection and Mask ALL If: Touching respiratory secretions, contaminated items or surfaces, blood, other body fluids Handling soiled clothes, linens, other items with patient body fluids, secretions, or excretions Procedures are likely to generate splashes / sprays of blood, body fluids, secretions, excretions IF IN DOUBT.

8. Sequence for Donning PPE 1.Hand hygiene 2.Gown 3.N95 Particulate respirator –Perform seal check 4.Hair cover 5.Goggles or face shield 6.Gloves

9. Hand Washing Method Wet hands with clean (not hot) water Apply soap Rub hands together for about 20 seconds Rinse with clean water Dry with disposable towel or air dry Use towel to turn off faucet

10. Alcohol-based Hand Rubs Effective if hands not visibly soiled More costly than soap & water Method Apply appropriate (3ml) amount to palms Rub hands together, covering all surfaces until dry

11. Gown Select appropriate type and size Opening may be in back or front Secure at neck and waist If too small, use two gowns –Gown #1 ties in front –Gown #2 ties in back

12. N95 Particulate Respirator Pay attention to size (S, M, L) Place over nose, mouth and chin Fit flexible nose piece over nose bridge Secure on head with elastic Adjust to fit and check for fit: Inhale – respirator should collapse Exhale – check for leakage around face

13. 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

14. Gloves Don gloves last Select correct type and size Insert hands into gloves Extend gloves over gown cuffs

15. Key Infection Control Points Minimize exposures –Plan before entering room Avoid adjusting PPE after patient contact –Do not touch eyes, nose or mouth! Avoid spreading infection –Limit surfaces and items touched Change torn gloves –Wash hands before donning new gloves

16. Duration of PPE Use Gloves –Never reuse Surgical Masks/N95 Respirators –Wear once and discard –Discard if moist Eye Protection –May wash, disinfect, reuse indefinitely

17. Sequence for Removing PPE Remove in anteroom when possible 1.Gloves 2.Hand hygiene 3.Gown (and apron, if worn) 4.Goggles 5.Mask 6.Cap (if worn) 7.Hand hygiene

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

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

20. Removing A Gown 1.Unfasten ties 2.Peel gown away from neck and shoulder 3.Turn contaminated outside toward the inside 4.Fold or roll into a bundle 5.Discard

21. Removing Goggles or A Face Shield Grasp ear or head pieces with ungloved hands Lift away from face Place in designated receptacle for disinfecting or disposal

22. Removing a Mask Lift the bottom elastic over your head first Then lift off the top elastic Discard Don’t touch front of mask

23. If You MUST Reuse PPE.. GOWN Hang gown with outside facing in MASK OR RESPIRATORS Put the mask into the sealable bag May touch the front of the mask, but wash hands immediately after removing Throw away the bag after removing mask – DO NOT REUSE BAG!

24. Hand Washing Between PPE item removal, if hands become visibly contaminated Immediately after removing all PPE Use soap and water or an alcohol- based hand rub

25. Environmental Decontamination Cleaning MUST precede decontamination Disinfectant ineffective if organic matter is present Use mechanical force –Scrubbing –Brushing –Flush with water

26. Environmental Decontamination: Disinfecting Household bleach (diluted) Quaternary ammonia compounds Chlorine compounds (Chloramin B, Presept) Alcohol –Isopropyl 70% or ethyl alcohol 60% Peroxygen compounds Phenolic disinfectants Germicides with a tuberculocidal claim on label Others

27. Using Bleach Solutions 1 First, clean organic material from surfaces or items – wash with soap or detergent and water, rinse, dry. The CDC recommends using 5 tablespoons of liquid bleach per gallon of water. Leave nonporous surfaces (tile, metal, hard plastics, etc.) wet at least 10 minutes and allow to air dry.

28. Using Bleach Solutions 2 Leave porous surfaces (wood, rubber, soft plastics, etc.) wet for 2 minutes. Rinse and air dry. Use household chlorine bleach (5.25 - 6% sodium hypochlorite); do not use scented or color safe bleaches. Use fresh diluted bleach daily! Wear gloves and eye protection!

29. Waste Disposal Use Standard Precautions –Gloves and hand washing –Gown + Eye protection Avoid aerosolization Prevent spills and leaks –Double bag if outside of bag is contaminated Incineration is usually the preferred method

30. Managing Linens and Laundry Use Standard Precautions –Gloves and hand hygiene –Gown –Mask Avoid aerosolization – do not shake Fold or roll heavily soiled laundry –Remove large amounts of solid waste first Place soiled laundry into bag in patient room Wash with normal detergent

31. Summary Influenza transmission occurs mainly through respiratory droplets –Contact can be prevented using PPE –Virus can be inactivated with infection control procedures –Hand washing and cough etiquette are key PPE must be donned and removed appropriately to prevent contamination of wearers and environments Guidelines for using PPE and infection control measures should be practiced until they are routine

32. For Emergencies, you should keep on hand A fresh (no more than six months old) bottle of household chlorine bleach Several N95 particulate respirators Several pairs of disposable gloves At least one disposable coverall or one you can discard.