PI M4 Infection Control Jan07 PDF
PI M4 Infection Control Jan07 PDF
PI M4 Infection Control Jan07 PDF
Bibliography none
Details explanation can be found in WHO documents such as the interim infection
control guidelines, available at http://tinyurl.com/p7hma or
http://www.wpro.who.int/NR/rdonlyres/EA6D9DF3-688D-4316-91DF-
5553E7B1DBCD/0/InfectionControlAIinhumansWHOInterimGuidelinesfor2.pdf
SLIDE 1
Module 4
Infection prevention and control
SLIDE 2
Objectives
As the majority of transmission occurs when infected people come into close contact
with others, the 3 main measures recommended generally are :
• Cough/respiratory etiquette
Wear masks if available.
Sneeze/cough into your sleeve or cover with tissue or scarf or
mask.
If you have coughed/sneezed into your hands, wash hands
immediately with soap and water.
• Hand washing
Before eating or feeding others, after coughing/sneezing, after
touching patients or their bed sheets, clothes and utensils, before
and after preparing food, after going to the toilet, after removing
masks or gloves.
• In some instances, depending on the risk, PPE (personal protective equipment) such
as masks or eye protection must be worn. This will be discussed later.
Risk assessment
• The main priority is to control the infection at its source - the patient. If the patient's
cough/sneeze is covered, they will not transmit it to others.
• When a sick individual coughs or sneezes, they must cover their mouth and nose
with a mask or paper tissue or cloth or cough/sneeze into their sleeves to prevent
infectious respiratory droplets from being inhaled by others who are near them,
thereby transmitting the infection to them.
• The next priority is to protect care givers and health care staff as they are frequently
in close contact with sick patients and thus have a much higher risk of getting
infected.
Distancing/separation
z In the home, distance/separate the sick person from those who are
well as much as possible
– (more details on infection prevention at home on slides 7-8)
SLIDE 7
– Wash clothes and bed linen (and scarves) that have been in contact
with the patient's respiratory secretions or stools.
• Running water and soap should be used for washing and dry items in the sun.
• The caregiver should also take measures to prevent disease transmission and protect
themselves.
• If possible, ONE caregiver should be identified to take care of the sick person.
• The other family members should try to limit close contact with the sick person.
SLIDE 10
– This can be done with signs or posters so that people with such
symptoms can self-select their appropriate waiting room
• The mask is important not only in preventing an influenza patient from transmitting
the disease but also in protecting those patients who do have respiratory symptoms
from another disease and not necessarily have influenza from contracting influenza
as well. The mask will help to protect these patients. It is important that all patients
in the respiratory health facility or waiting area keep this mask on as long as they are
in close contact with other patients and health staff.
• If all beds are used by patients who are very severely ill and are likely to die, there
will be no space for those that could survive if helped.
• Conversely, milder cases should be managed at home not to overwhelm the health
units.
• Activities that are not absolutely necessary immediately and that could be performed
at a later time, should be deferred, since this will reduce the burden on health
systems and prevent these individuals from unnecessary risk of contracting
influenza in the health care setting.
Pandemic influenza preparedness and mitigation in refugee and displaced populations. 11
WHO Training modules for humanitarian agencies.
Module 4 - infection prevention and control
SLIDE 14
Preventing infection in healthcare facilities
(the inpatient ward -1 )
z The inpatient ward for patients with suspected influenza must
be separate from other inpatient wards
SLIDE 15
z Restrict access
z Limit visitors
z Dedicated equipment
SLIDE 17
z Masks
– patients (source) when in close contact with others (receptors)
– health care workers and care givers when in close contact with anyone with
respiratory symptoms
– other essential staff – when in close contact with anyone with respiratory
symptoms
• Care givers and health care staff must also be protected as they have close contact
with patients.
• Masks are used to prevent the inhalation of droplets. When droplets are very small
they are called small particle aerosols and require special masks that have a capacity
to filter such particles (these type of masks are called particulate respirators).
• Eye protection (goggles or face shields) are used to avoid droplet contact with the
eyes. Individuals who wear glasses have some protection against droplets that are
dispersed directly towards the eye.
• Gloves, gowns and aprons prevent contact between the infectious germ and the skin.
Masks (1)
z Health-care workers who have direct close contact with
influenza patients should wear a particulate respirator* if
available or a tightly-fitting surgical mask and eye protection
– or a tightly-fitting scarf or a piece of cloth over the nose and
mouth, if masks are unavailable
*special masks that should be used according to manufacturer's specifications
• If masks are not available, a scarf or a tissue that covers the mouth and nose will
help to retain the droplets that transmit the disease.
• Certain procedures produce very small respiratory particles, smaller than the usual
droplets. Some of these procedures include: endotracheal intubation, suctioning, or
taking throat or nasopharyngeal swabs.
• These very small particles are called small particle aerosols which travel further and
require the use of masks that have a better fit to prevent disease transmission. These
special masks are termed particulate respirators and have technical names such as
N95 or EU FFP2.
• Do not perform those procedures if you can not take the adequate precautions.
• Before reading the slide you should ask two or three volunteers, health unit medical
staff, to put a mask on.
• Once the mask is on, he or she must show how well the mask is fitted to his/her
face.
• Ask other participants to comment on how they performed. Ask them to keep the
masks on until slide 25.
Putting on a mask
Place fingertips of
Pull top strap over your
Position mask both hands at top of
Cup mask in your head resting it high at
under your chin the metal nosepiece.
hand with the the top back of your
with the Mould nosepiece to
nosepiece at your head.
nosepiece up. shape of your nose.
fingertips allowing Pull the bottom strap Do not pinch
the headbands to over your head and nosepiece
hang freely below position it around the
your hand. neck below ears.
Masks (2)
Masks (3)
z Masks should be thrown away (or scarves removed & washed)
– when leaving isolation wards, OR
– every 4 hours OR
– when wet or visibly soiled
• Masks have to be changed when they are wet and anyone touching the mask must
wash their hands afterwards.
• If a scarf is issued it should the washed twice a day with water and soap to destroy
the virus that remains trapped in the cloth.
• Hands must be washed after any contact with used masks, scarves or tissues.
• Other essential staff such as food distributors or water handlers or security personnel
may come in close contact with large numbers of people who are potentially
infected, and therefore should also be protected.
• They do not need to wear masks at all times but only when they are in close contact
with people for example when distributing rations
Removing a mask
z Do NOT touch the mask itself.
z If no elastics, untie.
z Discard
• The presenter should say that a used mask may be contaminated and should be
removed without having contact with the filtering surface.
• The volunteers (who have kept their masks on since slide 22) should now remove
their masks one by one following the instructions.
• If possible, provide a mask to each participant and allow them to practise the
placement and removal of it.
Gowns
SLIDE 27
Removing gowns
• Unfasten ties
Gloves
z Gloves should be worn if contact with blood and body fluids is
anticipated, but are not a substitute for hand hygiene
– Before all patient contact
– Before all cleaning
– Before handling soiled linen & waste or contact with lab specimens
• See if any of the participants with the gloves on have contaminated themselves.
Removing gloves
• Discard
• Ask each of the participants with the gloves on to demonstrate removal of gloves as
described in the slide.
• Other participants should be able to comment on who managed the procedure the
best and why.
• All participants should then practise putting on and removing gloves 1-2 times.
z Dirty z Clean
– Outside front – Inside
– Contact with – Outside back
• body sites, – Ties on head
and back
• materials,
• environmental
surfaces
SLIDE 32
Hand hygiene
• Virus particles can be found on hands after coughing/sneezing, on sick people, their
clothes, surfaces and objects that have been in contact with sick people, on used
PPE such as masks, gloves, gowns.
• Hand washing after contact with any of the above is crucial. If you have been in
contact with patients, wash your hands before interacting or attending to another
person, be this a patient, a colleague or family..
• Soap helps to get rid of most viruses and bacteria but usually does not kill the
viruses or bacteria themselves. However, soap does have a direct action on the
influenza virus and helps to kill it because it destroys the lipid capsule that protects
the virus.
• Wash hands with water and soap. Hot water is not necessary. Soap destroys the
virus
• Alcohol-based gels are very effective but more expensive, they will be limited to
health structures.
Wet hands with apply enough rub hands palm to right palm over left
water soap to cover all palm dorsum with interlaced
hand surfaces fingers and vice versa
rinse hands with dry thoroughly with use towel to turn …and your hands
water a single use towel off faucet are safe.
Apply a palmful of the Rub hands palm to Right palm over left
product in a cupped palm dorsum with interlaced
hand and cover all fingers and vice versa
surfaces.
SLIDE 37
z Used PPE and other waste material from respiratory health facility
should be placed in "biohazard" waste bags inside the room where
waste comes from. At collection, this bag can be put inside another
bag outside the room and then treated as "normal"
z Incinerate waste
• Careful handling and cleaning of patient care equipment and soiled linen must be
ensured so not to produce aerosols when handling soiled objects.
z Identify burial sites in advance and ensure capacity for large numbers of bodies.
z If splashing of body fluids anticipated, use hair cover and face shield (preferably) or
goggles
z Family should wear gloves and gowns and perform hand hygiene
z Seal body in impermeable body bag prior to transfer to mortuary or burial site