Airborne Pathogens and Respirator Use. SAINT BARNABAS HEALTH CARE SYSTEM Objectives – The...

Airborne Pathogens and Respirator Use

SAINT BARNABAS HEALTH CARE SYSTEM

Objectives – The Illnesses

Discuss Airborne Diseases and the healthcare provider

How they spreadWho is at riskPossible causesSymptoms


Objectives – EMS Transport

What you should do to protect yourself

General considerationsInfection controlWaste disposalCleaning and DisinfectionFollow-up of EMS personnel


Objectives - The N95 Respirator

What is it? Why do I need it?

How do I use it?

Fit testing

What are the limitations?


Airborne Pathogens

TuberculosisInfluenzaAvian InfluenzaSmallpoxSARS

TuberculosisFamous people who have had TB

Fredric Chopin*Eleanor Roosevelt*Nelson MandelaRingo StarrTom JonesTina Turner

*Died of TB


What is tuberculosis (TB)?Disease caused by bacteria called Mycobacterium tuberculosisChronic bacterial infectionWas once the leading cause of death in USThe number of cases declined in the 1940’s when drugs were developed to treat TBTB is still a problem worldwide (NIAID)

8 million people develop TB yearly3 million die


How is TB spread?Through the air from person to person by coughingUsually attacks lungsTwo stages

Latent TB• asymptomatic and not contagious• can take medication to prevent development of

diseaseActive TB Disease

• May spread to others• May have abnormal chest x-ray• Usually have positive skin test


Symptoms of TB

ChillsFeverWeakness or fatigueSweating while sleeping, Night sweatsCough that lasts longer than 2 weeksPain in chestCoughing up blood or sputum



Risk FactorsClose contact with someone who is infected with TBTraveling to a country where TB is commonImmune compromisedForeign-born individuals and minorities have a higher incidence of developing TB

2002: 50% of US cases were in foreign-born individuals (CDC)2002: 80% of all US TB cases were in ethnic and racial minorities (CDC)


Multi-drug resistant TB (MDR TB)

Bacteria become resistant to antibiotics

Arose from improper use of antibiotics in the treatment of TB

Treatment of one case can cost up to $1.3 million (CDC)45 states and Washington, DC have confirmed cases of MDR TB (CDC)


MDR TB continued

Treatment is difficult and costlyCan develop from not taking proper course of antibiotics for TBMDR TB can be spread by an infected person


How to protect yourself

BCG vaccine for TB is given in many countries, but not the USNot recommended for healthcare workers unless a high percentage of patients are infected with MDR TB (CDC)PPD test if exposure is suspectedUSE proper PPE when in contact with patients who may have TB


Tuberculosis Summary

Chronic bacterial infection spread through the air

Fever, chills, sweating while sleeping, persistent cough, coughing up blood or sputumMDR TBUse proper PPE and get PPD test if exposed

Influenza

“I had a little bird, His name was Enza, I opened the window and in flew Enza.”

-Children’s nursery rhyme about the flu epidemic of 1918


What is influenza (“the flu”)?

Disease caused by a virusRespiratoryMore severe than a cold10%-20% of US residents will

get the flu each year (CDC)Can lead to complications for some people36,000 people die each year from complications (CDC)


Types of influenza virus

Influenza AMost common and most seriousCan lead to epidemics

Influenza BCan also cause epidemicsSymptoms are milder

Influenza CNever connected with large epidemics


How is influenza spread?

Flu season is from November to MarchRespiratory droplets

CoughingSneezingDroplets on objects

Contagious from 1 day before symptoms start to 7 days after symptoms start (CDC)


Symptoms

Cough and congestionFeverHeadacheBody AchesGeneral malaiseSore throat


Vaccine- The Flu Shot

Administered yearlyInjection or nasal spray (FluMist)New vaccine made every yearCan prevent types A and B



Who should get a flu shot? (CDC)

>50 years oldDiabeticLive or work in a nursing homeCompromised immune systemChronic heart, lung, or kidney diseaseWill be more than 3 months pregnant during flu season


Protecting yourself

Get flu shot Use proper PPE around patients suspected of having the fluDisinfect surfaces regularlyKeep yourself healthy during the flu season!

Get enough restEat well


Influenza Summary

Flu season is from November to MarchUse PPEDisinfectGet a flu shot

Avian InfluenzaFebruary 2004: 72,000 chickens were slaughtered in Delaware after two cases of Avian Influenza were found at a poultry farm under contract for Perdue Farms, Inc.


What is Avian Influenza?

Influenza virus that can infect birds and humansType A influenza3 Type A viruses and each have 9 subtypes

H5: can be high or low pathogenic; can cause severe illness or deathH7: can be high or low pathogenic; infections are rare and symptoms are mildH9: low pathogenic; very rare in humans


Transmission

Contact with infected poultry or contaminated surfacesNo documented cases of sustained human to human transmission

Have been isolated incidents of human to human transmission

Monitoring is importantInfluenza viruses have the ability to changeMay gain the ability to spread from person to person


Symptoms

Same as typical flu-like symptomsConjunctivitisPneumoniaSevere respiratory

distress


Incidents of H5 Avian Influenza

1997: Hong Kong- First documented transmission of birds to humans

18 people hospitalized6 died1.5 million chickens slaughtered to prevent further spread of diseasePerson to person transmission was also documented


Incidents of H5 Avian Influenza2003: China and Hong Kong

2 people infected after traveling to China1 diedSource of infection not identified

2004: Thailand and VietnamWHO reported cases of H5 influenza among bird populationsOngoing since January 2003Human cases found in Thailand and Vietnam (WHO)

• 37 reported cases• 26 died• Most recent cases were reported August 12, 2004


Avian Influenza Summary

Can be transmitted from birds to humansTypical flu-like symptoms plus

ConjunctivitisRespiratory distressPneumonia

Use PPE


Questions?

Smallpox

In 1972, a single case of small pox in Yugoslavia led to theinfection of 150 people, 34 deaths, 10,000 people quarantinedand 20 million vaccinated.

-World Health Organization


What is Smallpox?Variola VirusContagious infectious diseaseEliminated in human populationsLaboratory stockpiles existConcern that it may be used as an agent of bioterrorismNo treatmentOnly prevention is vaccineTwo types

Variola majorVariola minor


Variola MajorMost commonSevereVery high feverLarge rash4 types

Ordinary: most frequentModified: occurs in people who have been vaccinated; mildFlat: rare and severeHemmorhagic:rare and severe

Fatality rate of 30% (CDC)



Variola Minor

Less commonLess severe symptomsFatality rate of <1%


From World Health Organization




Transmission

Person to personProlonged contact with infected personContact with infected body fluids or contaminated objectsCan be spread through the air in enclosed settings, but this is rare


VaccineComplete protection if given before exposureIf given within 3 days after exposure, will prevent or greatly lessen severity4-7 days after exposure: lessens severity of diseaseNo protection if given after rash appearsNot widely available to the public at this timeStockpiles are in place in case of an outbreak


Vaccine contraindications (CDC)Vaccinia virus can be spread to others from the injection site of an immunized personEczema and other exfoliative skin conditions

May develop eczema vaccinatumInadvertent autoinnoculation of affected area

• Could develop vaccinia

Immune compromised individualsPregnancyInfants and children

Not given to infants <12 months of ageOnly in emergency situations to children <18 years of age

Breastfeeding mothers should not get the vaccineHeart disease


Protecting yourself

VaccineUse PPE when in contact with infected patient or contaminated fluidsWatch for signs/symptoms of smallpox if you believe you were exposed

Early vaccination after exposure can prevent or lessen the disease


Smallpox Summary

Contagious infectious diseaseTransmitted through close contact with infected personVaccine

SARSSevere Acute Respiratory

SyndromeThe 2003 global SARS outbreak led to over 8,000 people becoming ill, and 774 deaths. It is estimated the panic caused by the disease cost Canada $1 billion in lost tourism and all of Asia over $28 billion. (BBC News)


What is SARS?Center for Disease Control Definition

SARS is a respiratory illness of unknown etiology. It was first identified in February 2003.SARS was first noticed in Southeast Asia. To date more than 100 cases have been reported in the United StatesPublic health experts think that SARS is spread by close contact between people



How SARS SpreadsSARS is most likely spread when someone sick from the disease coughs droplets into the air and someone else breathes the virus in

It is possible that SARS may spread more broadly through the air or from touching an object that is contaminated


Who Is at Risk for SARS?

Individuals having close contact with someone sick from the disease Those sharing a household with someone sick from the diseaseHealthcare providers who do not use the proper infection control techniques when providing care for patients sick from the disease


Possible Causes of SARS

Scientists at the CDC and other laboratories have detected a previously unrecognized coronavirus in patients with SARS.While the new coronavirus is still the leading hypothesis for the cause of SARS, other viruses are still under investigation as potential causes.


What are Coronaviruses

These viruses are a common cause of mild to moderate upper-respiratory illness in humans and are associated with respiratory, gastrointestinal, liver and neurologic disease in animals.Coronaviruses can survive in the environment for as long as three hours.



Symptoms of SARSFever or hot to touchANDCoughANDClinical findings of respiratory distressAND

Travel within 10 days to an area with suspected community transmission OR Close contact within 10 days with a person with a respiratory illness or someone sick from SARS


How to protect yourself

Wear proper respiratory protectionRecognize signs and symptoms of SARS


SARS Summary

Very little known about SARSPossibly spread through droplets in airFever, chills, severe respiratory distressWear respiratory protection


Questions?


Transport of Patients with Suspected Airborne Illness


General Considerations

Patients should be transported using the minimum number of EMT personnel and without non-infectious patients or passengers in the vehicle. Sufficient infection control supplies should be on board.Receiving facilities must be notified prior to transport of infectious patients.


Infection Control - GeneralPPE may not be removed during transport. Personal activities (including: eating, drinking, application of cosmetics, and handling of contact lenses) should not be performed during patient transport. These diseases may be transmitted if residual infectious particles on environmental surfaces are brought into direct contact with the eyes, nose or mouth.


Infection Control – PPEDisposable, non-sterile gloves must be worn for all patient contact. Disposable fluid-resistant gowns should be worn for all patient care activity. Goggles or face-shields must be worn in the patient-care compartment and when working within 6 feet of the patient. Corrective eyeglasses alone are not appropriate protection. N-95 respirators should be worn by personnel in the patient-care compartment at all times.


Infection Control - PPEGloves are removed in the correct manner and discarded in biohazard bags after patient care is completed (e.g., between patients) or when soiled or damaged. Hands must be washed or disinfected with a waterless hand sanitizer immediately after removal of gloves.


Infection Control – Driver & VehicleN-95 respirators should be worn by the driver if the driver's compartment is open to the patient-care compartment. Drivers that provide direct patient care must wear a disposable gown, face shield, and gloves during patient-care activities. Use vehicles with separate ventilation for driver and patient compartments if possible. Maximize air exchange

Open dashboard ventsOpen rear vents to maximum level


Infection Control The patient may wear a paper surgical mask to reduce droplet production, if tolerated. Oxygen delivery with NRB masks may be used for patient oxygen support during transport. CPR should never be performed using mouth-to-mouth or mouth-to-mask.


Infection Control – Patient Care

The BVM should be equipped with a HEPA filter for expired air.When using CPAP ensure that a HEPA filter is attached to the exhalation port.There is no documented additional risk when using aerosol nebulizers if all of the precautions just discussed are used by the health care provider.


Follow-up of EMS PersonnelRecord the following information

Date and route of transport Duration of patient transport Names of personnel in contact with the patient

EMT services should closely monitor personnel who have transported potentially infectious patients for evidence of fever, rash or respiratory illness.

EMT personnel who transport SARS patients should be assessed at least daily for 10 days after transporting a SARS patient (directly or by telephone). If the EMT was exposed to Smallpox, it is important to be vaccinated as soon as possible. May be symptom-free for up to 17 days after contracting the disease.


Follow-up of EMS Personnel

Personnel may continue working during the follow-up period if they have no symptoms of the disease.

Personnel who have transported a SARS patient and become symptomatic within the 10 day follow-up period should be directed to seek medical evaluation and should be reported to the state health department and to the CDC.


Questions?

The N95 Respirator


The N95 RespiratorThe most common respirator used is the disposable particulate type N95.The “N” stands for respirator filters that can be used when no oil is present in the contaminants.The“95” means that the product has been tested and certified by NIOSH to have a filter efficiency level of 95% or greater against particulate aerosols.


Why a Respirator Is NecessaryHealthcare providers work in an environment where there is a risk of disease transmission through airborne infectious particulates.

Respirators, such as the N-95, provide protection from airborne infectious particulates when properly fitted and worn.


OSHA 1910.134 Standards for Respiratory Protection

Medical screening to determine if the employee is physically able to wear a respirator.Fit-test to determine if the respirator fits properly on the employee’s face.Training on the selection, use, storage, and limitations of the respirator used.


The Medical Screening

A licensed health care professional will perform the evaluation using a medical questionnaire. The contents of the medical questionnaire are mandated by OSHA.Administered to the HCW in a confidential manner and the HCW can request to discuss the results of the medical evaluation with the licensed health care professional.


Follow-up Medical Examination Is Performed If:1- If HCW reports medical signs or symptoms that

are related to ability to use the respirator.2- If the supervisor informs employee health of

the need for re-evaluation.3- If information from the respirator program

monitoring activities should indicate any need for re-evaluation.

4- If the workplace conditions significantly change.


FIT TEST Procedure is Done:

1- Before initial use of the respirator

2- Whenever a different size, style, model or make of respirator is used

3- If HCW has a change in facial structure such as: facial trauma, facial surgery, loss of body weight, or dental changes.

4- If the HCW worker notifies the employer that the respirator fit is unacceptable.

5- At least annually


Types of Fit Testing

Qualitative Fit Test: Worker is assessed on a pass/fail basis to determine the adequacy of respirator fit. It relies on the individual’s response to the test agent.Quantitative Fit Test: Assessment of respirator adequacy by numerically measuring the amount of leakage into the respirator.


Fit Testing the RespiratorQualitative Testing

HCW puts on the respirator.Hood is applied over the head.Sweet tasting aerosol mist is introduced into the hood.If the seal is tight the HCW should not experience any sweet taste.The test simulates activities such as turning the head, talking, and other possible activities that might occur during job tasks.


Fit Testing the Respirator Quantitative Testing

HCW puts on respirator attached to PortaCount machine.HCW performs series of movements to test respirator fit.PortaCount machine measures amount of particles leaking into mask.


Cup the respirator in your hand with the nosepiece at your finger tips allowing the headbands to hang freely below hands.

Donning of the N95 Respirator* Step #1

*Always refer to the instructions provided by manufacturer


Position the respirator under your chin with the nosepiece up.

Donning of the N95 Respirator

Step #2


Pull the top strap over your head so it rests high on the back of head.


Step #3


Pull the bottom strap over your head and position it around your neck below ears.


Step #4


Using two hands, mold the nosepiece to the shape of your nose by pushing inward while moving your fingertips down both sides of the nosepiece. Pinching the nosepiece using one hand may result in less effective respirator performance.


Step #5


Fit Check of the N95 Respirator

Face fit check - the respirator seal should be checked before each use. To check fit, place both hands completely over the respirator and exhale. If air leaks around your nose, adjust the nosepiece as described in step 5. If air leaks at respirator edges, adjust the straps back along the sides of your head. Recheck.


Facial HairFacial hair will make the seal loose

and will not provide protection from harmful airborne hazards.

Even just one or two days beard growth can effect the seal.

Males should be clean shaven.

This is to ensure that the respirator is fully protective.


Cup the respirator in your hand to maintain position on face. Pull bottom strap over head.

Removal of the N95 Respirator

Step #1


Still holding respirator in position, pull top strap over head.


Step #2


Remove the respirator from your face

Discard as a Biohazard (Red Bag)


Step #3


Limitations of the N95 Respirator

If this respirator becomes wet, it is no longer effective and must be replaced. The N-95 respirator has the ability to filter particles 1 micrometer with a filter efficiency of > 95%.The N-95 is not intended for protection from organic vapors, toxic gases, or toxic particulates.


Waste DisposalAll solid waste, e.g., Used gloves, dressings, etc., Should be collected in a red biohazard bags for regulated medical waste disposal.Any suctioned fluids and secretions must be sealed to prevent any splashes.


Cleaning and DisinfectionNon-patient-care areas of the vehicle should be cleaned and maintained according to vehicle manufacturer’s recommendations.

Cleaning personnel should wear non-sterile gloves, disposable gowns and face shields while cleaning the patient-care compartment.

Patient-care compartments (including stretchers, railings, medical equipment control panels, and adjacent flooring, walls and work surfaces likely to be directly contaminated during care) should be cleaned using the department approved disinfectant.


Cleaning and DisinfectionSpills of body fluids during transport should be cleaned by placing absorbent material over the spill and collecting the used cleaning material in a biohazard bag. The area of the spill should be cleaned using an EPA-registered hospital disinfectant.Contaminated reusable patient care equipment should be placed in biohazard bags and labeled for cleaning and disinfection.Wear proper PPE when cleaning equipment.


Questions?


For Additional Information

CDCCenter for Disease Control

www.cdc.gov

WHOWorld Health Organization

www.who.int

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Airborne Pathogens and Respirator Use. SAINT BARNABAS HEALTH CARE SYSTEM Objectives – The...

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