Universal Respiratory Etiquette Strategy for Healthcare Facility Encourage patients to alert staff it they have respiratory illness Provide surgical mask or tissue to all patients with respiratory illness Separate patients with respiratory illness to other patients in waiting area. Use droplet precautions Provide hand hygiene materials in OPD WHO
General I nform ation General I nform ation About Personal About Personal Protective Equipm ent Protective Equipm ent
Personal Protective Equipm ent Definition: specialized clothing or equipm ent w orn by an em ployee for protection against infectious m aterials.
Types of PPE � Gloves – protect hands � Gow ns/ aprons – protect skin and/ or clothing � Mouth covering m aterials– � Masks – prevent fluid penetration � Respirators – protect respiratory tract from airborne infectious agents � Eye protection � Goggles – protect eyes � Face shields – protect face, mouth, nose, and eyes � Boots – prevent spreading by tracking
PPE for Standard Precautions 1 . Gloves � W hen touching: � Blood � Body fluids � Secretions � Excretions � Contaminated items � Mucous membranes � Non-intact skin
๏ Sterile gloves
๏ Medical examination gloves ๏ General purpose gloves
PPE Materials Gloves � W ork from clean to dirty � Avoid “touch contam ination” � Face, surfaces � Change gloves
Changing gloves � as soon as they are torn or punctured � after contact with one individual is complete and before care is provided to another ; and � when performing separate procedures on the same patients and there is a risk of transmitting infection from one part of the body to another
Recom m endations for Gloving Remove gloves that are torn, cut or punctured Do not wash, disinfect or sterilize gloves for reuse
Increase in Methicillin – Resistant Staphylococcus aureus Acquisition Rate and Change in Pathogen Pattern Associated With an Outbreak of Severe Acute Respiratory Syndrome 2 2 – bed I CU Upgrading of IC precaution w earing of gloves and gow ns all the tim e!!! Change in ATB prescribing practices Extensive use of steroids Yap F, et al. CID 2004; 39: 511-6
POLI CY!!! “ Gloves w hen needed but w ash hands At every opportunity ” Hand hygiene com pliance 100% - in isolation wards 78 – 95% - in general wards QMH
PPE Materials 2 . Gow ns � Fully cover torso � Have long sleeves � Fit snugly at the w rist
PPE for Standard Precautions 2 . Gow ns � Use w hen contact of clothing and/ or exposed skin w ith: � Blood � Body fluids � Secretions � Excretions � Contaminated items
Gow ns � Should be im pervious m aterial � Gow ns should be w orn by patients during essential transport to other areas of the hospital � Outside surface of the gow n should be considered as being potentially contam inated at all tim es during use � Should not be reused from one patient to another patient. � I f gow ns are in short supply and gow ns are to be reused clear protocols and procedures should be developed to m inim ize the risk of contam ination during reuse.
Apron � W ear the apron over the gow n � Plastic reusable aprons protect the w earer skin and clothing/ uniform / scrub suite from contam ination from splashing w hen w orking in an isolation room / area � Select w ater repellent, plastic aprons, preferably disposable or single use. � I f disposable aprons are not available reusable plastic aprons w ill need to be cleaned and disinfected betw een use on the sam e patient and betw een uses on different patients
PPE Materials 3 . Mouth covering m aterials � Surgical m asks � Particulate respirators � Fit testing � Alternative m aterials � Tissues � Cloth � Better than no covering
N95 Medical mask
Surgical mask : 1- 5 microns
high efficiency particulate air (HEPA) respirators (0. 3 micrometers)
Masks � Following the manufactures instructions for positioning the mask and undertaking a user "fit test" or "user seal check ” � N95 and standard surgical masks should only be used once and discarded � If supply is short and N95 masks are to be reused clear protocols and procedures should be developed to minimize the risk of contamination during reuse and storage of the mask between reuse.
PPE Materials 4 . Eye protection � Face shields � Goggles
PPE for Standard Precautions Eye protection � Mask and goggles or a face shield � Use w hen patient care activities likely to generate splash or spray of: � Blood � Body fluids � Secretions � Excretions Photo: CDC Greg Knobloch
Face shields and protective eyewear For protection of face if splashes is likely
Protective Eyew ear/ Goggles/ visors/ faceshields � Protect the m ucous m em branes of the w earer against droplet transm ission and exposure in the event of a splash. � Ordinary spectacles do not provide adequate protection and protective eyew ear/ goggles/ visor or a faceshield should be w orn in addition to spectacles � Protective eyew ear/ goggles/ visor or a faceshield should be w orn at all tim es w hen in the isolation room / area.
Protective Eyewear
PPE Materials 5 . Boots � Disposable or w ashable � Prevent spread or contam ination by tracking
How to Put on and How to Put on and Rem ove Personal Rem ove Personal Protective Equipm ent Protective Equipm ent
Sequence for Donning PPE w ith Avian I nfluenza Patients 1 . Hand hygiene 2 . Gow n 3 . Particulate respirator � Perform seal check 4 . Hair cover ( for aerosol-generating procedures) 5 . Goggles or face shield 6 . Gloves
How to Don a Gow n � Select appropriate type and size � Opening m ay be in back or front � Secure at neck and w aist � I f gow n is too sm all, use tw o gow ns � Gown # 1 ties in front � Gown # 2 ties in back
How to Don a Mask � Place over nose, m outh and chin � Fit flexible nose piece over nose bridge � Secure on head w ith ties or elastic � Adjust to fit
How to Don a Particulate Respirator � Select a fit tested respirator � Place over nose, m outh and chin � Fit flexible nose piece over nose bridge � Secure on head w ith elastic � Adjust to fit � Perform a fit check – � Inhale – respirator should collapse � Exhale – check for leakage around face
Proper selection of size - m ask � Fit test - is the procedure to select the appropriate size of mask - is performed only once � Fit check - is the procedure to check for face seal - is performed every time you wear mask
Fit Checking
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 w ith headband � Adjust to fit com fortably
Step for donning PPE (1) 1 2 Source: Manual on Avian Flu clinical management for HCWs, Committee on prevention and control for Avian Flu, Thai MOPH, Nov 2005.
Step for donning PPE (2) 3 4 Source: Manual on Avian Flu clinical management for HCWs, Committee on prevention and control for Avian Flu, Thai MOPH, Nov 2005.
Step for donning PPE (3) 5 6 Source: Manual on Avian Flu clinical management for HCWs, Committee on prevention and control for Avian Flu, Thai MOPH, Nov 2005.
How to Don Gloves � Don gloves last � Select correct type and size � I nsert hands into gloves � Extend gloves over isolation gow n cuffs
How to Safely Use PPE � Keep gloved hands aw ay from face � Avoid touching or adjusting other PPE � Rem ove gloves if they becom e torn; perform hand hygiene before donning new gloves � Lim it surfaces and item s touched
Sequence for Rem oving PPE w ith Avian I nfluenza Patients � Rem ove in anteroom � If no anteroom, remove without contaminating environment 1 . Gloves 2 . Face shield or goggles 3 . Hair cover 4 . Gow n � Perform hand hygiene 5 . Mask or respirator 6 . Perform hand hygiene
Rem ove Goggles or Face Shield � Grasp ear or head pieces w ith ungloved hands � Lift aw ay from face � Place in designated receptacle for disinfecting or disposal
Rem oving I solation Gow n � Unfasten ties � Peel gow n aw ay from neck and shoulder � Turn contam inated outside tow ard the inside � Fold or roll into a bundle � Discard
How to Rem ove Gloves ( 1 ) Outside of gloves is contaminated! � Grasp outside edge near w rist � Peel aw ay from hand, turning glove inside-out � Hold in opposite gloved hand
How to Rem ove Gloves ( 2 ) � Slide ungloved finger under the w rist of the rem aining glove � Peel off from inside, creating a bag for both gloves � Discard
Rem oving a Mask � Untie the bottom , then top, tie � Rem ove from face � Discard
Rem oving a Particulate Respirator � Lift the bottom elastic over your head first � Then lift off the top elastic � Discard
PPE for exposure PPE for exposure w ith Avian w ith Avian I nfluenza cases I nfluenza cases
Determ ine Expected Exposures � Contact w ith � Infected individuals � Individuals suspected to be infected � Potentially contaminated substances � Potentially contaminated surfaces/ items � High-risk procedures � Corpses � Animals
Supplies of PPE � Have supplies ready � Use locally produced PPE, or order from elsew here � Creative alternatives � Mask: tissue, scarf � Boots: plastic bags � Gown: laboratory coat, scrubs
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