Post on 27-Jan-2016
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Infection Control Aspects of Infection Control Aspects of Influenza Influenza
Chariya Sangsajja, M.D.Chariya Sangsajja, M.D.
BIDI, DDC, MOPHBIDI, DDC, MOPH
October 2011October 2011
Large respiratory droplet: distance<,=6 ft.Large respiratory droplet: distance<,=6 ft. Contact with large respiratory dropletContact with large respiratory droplet Airborne transmission over longer Airborne transmission over longer
distances has not been documenteddistances has not been documented
Human-to-Human Human-to-Human Transmission of Transmission of Influenza(1)Influenza(1)
Human-to-Human Human-to-Human Transmission of Influenza (2)Transmission of Influenza (2)
Smaller droplet nuclei at close-range Smaller droplet nuclei at close-range exposureexposure ?, may be important under ?, may be important under special condition; e.g. aerosol- producing special condition; e.g. aerosol- producing proceduresprocedures
All respiratory secretions and bodily All respiratory secretions and bodily fluidsfluids, including diarrheal stools are , including diarrheal stools are considered to be potentially infectiousconsidered to be potentially infectious
Administrative controlsAdministrative controlsEnvironmental/ engineering Environmental/ engineering
controlscontrolsPersonal protective equiPersonal protective equipmentspments
WHO :CWHO :Categories of Infection ategories of Infection Prevention and ControlsPrevention and Controls
US CDC: Fundamental Elements US CDC: Fundamental Elements to Prevent Influenza to Prevent Influenza
Transmission (1)Transmission (1) Seasonal Influenza vaccineSeasonal Influenza vaccine Respiratory hygiene and cough Respiratory hygiene and cough
etiquetteetiquetteAppropriate management of ill Appropriate management of ill
HCWsHCWs
US CDC: Fundamental Elements US CDC: Fundamental Elements to Prevent Influenza to Prevent Influenza
Transmission (2)Transmission (2)
Adherence to IC precautions for Adherence to IC precautions for all patient-care activities and all patient-care activities and aerosol-generating proceduresaerosol-generating procedures
Implementing environmental and Implementing environmental and engineering IC measuresengineering IC measures
Administrative Control Strategies Administrative Control Strategies (1)(1)
: Hospital Policy & Plan: Hospital Policy & Plan: : Monitor influenza activitiesMonitor influenza activities:: Clinical and IC practices Clinical and IC practices
guidelinesguidelines:: Education, training and monitoringEducation, training and monitoring: : Minimize potential exposuresMinimize potential exposures
Hospital PreparednessHospital Preparedness
Isolation Isolation RoomRoom
Training
ExerciseExercise
Clinical Clinical Practice Practice
GuidelinesGuidelines
Hand Hygiene Training Program
Minimize Potential ExposuresMinimize Potential Exposures
During periods of increased influenza During periods of increased influenza activity, minimizing OPD and ER activity, minimizing OPD and ER visits for visits for patients with mild ILI who are patients with mild ILI who are not at increased risk for complications not at increased risk for complications from influenzafrom influenza
Set up Set up Hotline CenterHotline Center Visitors screening for ILI symptomsVisitors screening for ILI symptoms
Administrative Control Administrative Control Strategies Strategies (2)(2)
: Implementing respiratory hygiene & : Implementing respiratory hygiene & cough etiquette programs cough etiquette programs
:Triage system, alerting sign :Triage system, alerting sign managing patient flowmanaging patient flow
:Provide facemask, alcohol hand-:Provide facemask, alcohol hand-rub at facility access pointrub at facility access point
:Provide space and separate area :Provide space and separate area for ILI patientsfor ILI patients
Infection Control Infection Control RecommendationsRecommendations
Standard precautionsStandard precautions: hand hygiene, : hand hygiene, glovesgloves
: Droplet precautions: Droplet precautions Respiratory hygiene/cough eRespiratory hygiene/cough etiquettetiquette Use cautions when performing Use cautions when performing
aerosol-generating proceduresaerosol-generating procedures
Respiratory Hygiene / Cough Respiratory Hygiene / Cough EtiquetteEtiquette
Apply to all patients with respiratory illnessApply to all patients with respiratory illness Posting visual alertsPosting visual alerts Source control measuresSource control measures Early recognition, separation and isolationEarly recognition, separation and isolation Droplet precautionsDroplet precautions Hand HygieneHand Hygiene Waste managementWaste management
Alerting Poster
Droplet precautionby using mask
1
2
3Steps to take off the surgical mask
Sink at patient waiting area
Posting visual alerts
Early recognition and
early implementation of
IC practices
Screening site Screening site
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แยกจุ�ดคั�ดกรองมี ระยะห่�างจุากผู้��ป่�วย
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การเคัลื่��อนย�ายผู้��ป่�วย
การแยกผู้��ป่�วย ILI ที่ � OPD
ห่�องตรวจุโรคัไข้�ห่ว�ดให่ญ่�ห่�องตรวจุโรคัไข้�ห่ว�ดให่ญ่�
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Portable X-RayPortable X-Ray
การแยกผู้��ป่�วยที่ �ห่�องฉุ�กเฉุ(น
Administrative Controls Strategies(3)Administrative Controls Strategies(3)
Isolation ward/roomIsolation ward/roomLimiting the numberLimiting the number of persons in of persons in
present in patient roompresent in patient roomScreening personnel and visitorsScreening personnel and visitorsPatients and visitors Patients and visitors
recommendationsrecommendations
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Patient PlacementPatient Placement
Single room Single room : confirmed case, : confirmed case, suspected case ,suspected case ,
Cohort ward Cohort ward : confirmed cases : confirmed cases AIIRAIIR: patients who need : patients who need
mechanical ventilationmechanical ventilation
Single RoomSingle Room
Patient Placement
Cohort Ward
AIIRAIIR
Bamras 34 04/21/23
Airborne Infection Isolation Room
Cohort WardCohort Ward
Patient recommendationsPatient recommendations
Hand hygieneHand hygienePersonal hygiene Personal hygiene surgical masksurgical mask Post discharge Post discharge
recommendationsrecommendations
Family Members/Visitors Family Members/Visitors RecommendationsRecommendations
Visitor Limiting Visitor Limiting Visitor Screening : ILI, high Visitor Screening : ILI, high
risk grouprisk group PPE PPE Hand Hygiene Hand Hygiene
Monitor and Manage Ill HCWs(1)Monitor and Manage Ill HCWs(1)
Screening for ILI before they Screening for ILI before they come on duty, register formcome on duty, register form
HCWs ILI surveillance system, HCWs ILI surveillance system, self monitoring form, self-self monitoring form, self-reporting and isolatingreporting and isolating
Develop sick leave policies for Develop sick leave policies for HCWsHCWs
Monitor and Manage Ill HCWs(2)Monitor and Manage Ill HCWs(2)
Stop patient-care activities, Stop patient-care activities, don a don a facemask, promptly notify ICNfacemask, promptly notify ICN
Keeping personnel with mild ILI Keeping personnel with mild ILI at home to reduce the risk of at home to reduce the risk of spreading influenzaspreading influenza
HCWHCW ILI Monitoring FormILI Monitoring Form
Day1Day1 Day2Day2 Day3Day3 Day4Day4 Day5Day5
Date…………Date………….. Date…………Date………….. Date…………Date………….. Date…………Date………….. Date…………Date…………..
AM temp……AM temp…… AM temp……AM temp…… AM temp……AM temp…… AM temp……AM temp…… AM temp………AM temp………
PM temp………PM temp……… PM temp………PM temp……… PM temp………PM temp……… PM temp……PM temp…… PM temp………PM temp………
ILI symptoms:ILI symptoms:No…....Yes…No…....Yes…
ILI symptoms:ILI symptoms:No…....Yes…No…....Yes…
ILI symptoms:ILI symptoms:No…....Yes…No…....Yes…
ILI symptoms:ILI symptoms:No…....Yes…No…....Yes…
ILI symptoms:ILI symptoms:No…....Yes……No…....Yes……
Day6Day6 Day7Day7 Day8Day8 Day9Day9 Day10Day10
Date…………Date………….. Date…………Date………….. Date…………Date………….. Date…………Date………….. Date…………Date…………..
AM temp……AM temp…… AM temp……AM temp…… AM temp……AM temp…… AM temp……AM temp…… AM temp………AM temp………
PM temp………PM temp……… PM temp………PM temp……… PM temp………PM temp……… PM temp……PM temp…… PM temp………PM temp………
ILI symptoms:ILI symptoms:No…....Yes…No…....Yes…
ILI symptoms:ILI symptoms:No…....Yes…No…....Yes…
ILI symptoms:ILI symptoms:No…....Yes…No…....Yes…
ILI symptoms:ILI symptoms:No…....Yes…No…....Yes…
ILI symptoms:ILI symptoms:No…....Yes……No…....Yes……
Monitor and Manage Ill HCWs(3)Monitor and Manage Ill HCWs(3)
Exclude from work until 24 hours after Exclude from work until 24 hours after they no longer feverthey no longer fever
Considered for temporary Considered for temporary reassignment or exclusion from work reassignment or exclusion from work for 7 days from symptoms onset or for 7 days from symptoms onset or until the resolution of symptoms until the resolution of symptoms whichever is longer whichever is longer
Engineering Controls(1)Engineering Controls(1) Separate triage areas, installing Separate triage areas, installing
partitionspartitions Using local exhaust ventilationUsing local exhaust ventilation for for
aerosol generating procedures or aerosol generating procedures or perform in AIIRperform in AIIR
Using hood/Bio-safety cabinet in Using hood/Bio-safety cabinet in laboratorylaboratory
Aerosol-generating Aerosol-generating procedures produce large & procedures produce large &
small particle aerosolssmall particle aerosols BronchoscopyBronchoscopy
Sputum inductionSputum induction
ET intubation and ET intubation and
extubation extubation
CPR CPR
Open suctioningOpen suctioning
of airwaysof airways
AutopsiesAutopsies
Non-invasive Non-invasive
positive pressure positive pressure
ventilationventilation
NP swab/aspirationNP swab/aspiration
Aerosolized Aerosolized
medicationmedication
High-frequency High-frequency
ventilationventilation
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ห่�องตรวจุโรคัไข้�ห่ว�ดให่ญ่�ห่�องตรวจุโรคัไข้�ห่ว�ดให่ญ่�
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Bio-safety Cabinet
Engineering ControlsEngineering Controls
Using closed suctioning systemsUsing closed suctioning systems Using high efficiency particulate Using high efficiency particulate
filters on mechanical and bag filters on mechanical and bag ventilatorsventilators
Ensuring effective ventilation and Ensuring effective ventilation and thorough environmentalthorough environmental surface surface hygienehygiene
Closed circuit suctioning system
Bacterial / virus HEPA Bacterial / virus HEPA filterfilter
Personal Protective Equipments Personal Protective Equipments (PPE)(PPE)
SuppliesSupplies TrainingTraining
ProperProper PPEPPE MonitoringMonitoring
PPE: Seasonal and Pandemic PPE: Seasonal and Pandemic Flu 2009Flu 2009
Surgical maskSurgical mask
N-95 mask, GogglesN-95 mask, Goggles:: Aerosol- Aerosol-generatinggenerating
proceduresprocedures GOWNGOWN GLOVESGLOVES
Aerosol-generating Aerosol-generating procedures produce large & procedures produce large &
small particle aerosolssmall particle aerosols BronchoscopyBronchoscopy
Sputum inductionSputum induction
ET intubation and ET intubation and
extubation extubation
CPR CPR
Open suctioningOpen suctioning
of airwaysof airways
AutopsiesAutopsies
Non-invasive Non-invasive
positive pressure positive pressure
ventilationventilation
NP swab/aspirationNP swab/aspiration
Aerosolized Aerosolized
medicationmedication
High-frequency High-frequency
ventilationventilation
Research on Influenza ICResearch on Influenza IC
PPE: N-95 mask vs surgical maskPPE: N-95 mask vs surgical mask
:Unpublished multiple hospital study :Unpublished multiple hospital study in Chinain China
:N-95 provided 75% protection :N-95 provided 75% protection against lab-confirmed fluagainst lab-confirmed flu
:N-95 were 42% more effective than :N-95 were 42% more effective than surgical mask over allsurgical mask over all
Research on Influenza ICResearch on Influenza IC
Household influenza transmission: Household influenza transmission: Cowling B.,et alCowling B.,et al
: HH+alcohol hand rub vs.: HH+alcohol hand rub vs.
HH+facemask vs. control gr.HH+facemask vs. control gr.
: Substantial and significant benefits : Substantial and significant benefits of facemask and HH if implement of facemask and HH if implement within 36 hours of index case ILI within 36 hours of index case ILI onsetonset
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