Infection Prevention and Control for Epidemic- and Pandemic-Prone

Acute Respiratory Diseases

Influenza Training Package

Learning Objectives

Describe basic infection-control principles.

Discuss core infection-control measures in health-care settings.

Influenza Training Package

Presentation Overview

Basic infection control principles

Core infection control measures used in health care settings

Influenza Training Package

Basic Infection Control Principles

Influenza Training Package

Aim of Infection Control

Basic infection control measures reduce risk of transmission of pathogens from a known or unknown source

Influenza Training Package

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Quantity ofpathogen

Virulence Routes of transmission

Susceptiblehost

Portal of entry into

host

Chain of Infection

Influenza Training Package

Routes of TransmissionContact: Infections spread by direct or indirect contact

with patients or the patient-care environment (e.g., shigellosis, viral hemorrhagic fevers)

Droplet: Infections spread by large droplets generated by coughs, sneezes, etc. (e.g., Neisseria meningitidis, pertussis)

Airborne (droplet nuclei): Infections spread by particles that remain infectious while suspended in the air (TB, measles, varicella, and variola)

Influenza Training Package

Breaking the Chain of Infection

•Source control measures-Cough etiquette, cleaning, disinfection

•Modes of transmission-Contact: hand hygiene-Droplet: distance from source >1 m-Airborne: ventilation-Vector: bednets

•Portal of entry into the host-Adding barriers, e.g., PPE

•Host -Strengthen host defences, e.g., vaccination

Influenza Training Package

Seasonal Influenza in Humans

SARS and Current Avian Influenza in Humans

Droplet most likely route most likely route (SARS) possible (AI)

Airborne possible during aerosol generating procedures

possible during aerosol generating procedures

Contact possible most likely route (SARS)

H5N1: (bird to human), and possible (human to human)

Transmission of Epidemic- and Pandemic-Prone Acute Respiratory Diseases

Influenza Training Package

Core Infection Control Measures in

Health Care Settings

Influenza Training Package

● Early recognition and reporting

● Infection control precautions

● Hand hygiene: alcohol-based hand rub, hand washing

● PPE: gloves, gowns, masks/respirators, eye protection

Core Infection Control Measures in Health Care Settings (1)

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Core Infection Control Measures in Health Care Settings (2)

● Patient accommodation

● Environmental cleaning and waste disposal

● Occupational health management

WHO

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Prevention is Primary

CDC

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Early Recognition in Health Care Facilities

Health care facility staff must quickly identify and separate potential sources of infection from susceptible hosts

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How to identify rapidly

Rapid identification of Patients with Epidemic- or Pandemic-Prone Acute Respiratory Diseases:

Clinical indications– Severe acute febrile respiratory illness (e.g., fever > 38°C, cough, shortness

of breath)

– Exposure history consistent with ARD of potential concern

Epidemiological indications– History of travel to area affected by ARDs

– Possible occupational exposure

– Unprotected contact with ARDs patient(s)

Influenza Training Package

Infection Control Precautions

Standard precautions– Should be applied for ALL patients

Transmission-based precautions* – Contact – Droplet – Airborne

*Transmission-based precautions are often used empirically, according to the clinical syndrome and the likely etiological agent

Influenza Training Package

Standard Precautions•Hand hygiene

•Respiratory hygiene/cough etiquette

•Use of personal protective equipment (PPE)

•Prevention of needle sticks/sharps injuries

•Cleaning and disinfection of the environment and equipment

Influenza Training Package

Droplet PrecautionsProtection against respiratory pathogens

transmitted by large droplets

In addition to Standard Precautions:– Use a medical mask when < 1 m of patient – Maintain a distance ≥ 1 meter between infectious

patient and others – Place patient in a single room or cohort with similar

patients – Limit patient movement

Influenza Training Package

Contact PrecautionsProtection against contact with large droplets

In addition to Standard Precautions:– Use non-sterile, clean, disposable gloves, gown, apron

(only if gown is not impermeable)– Use disposable or dedicated reusable equipment (which

must be cleaned and disinfected before use on other patients)

– Limit patient contact with non-infected persons– Place patient in a single room or cohort with similar

patients

Influenza Training Package

Airborne PrecautionsProtection against inhalation of tiny infectious

droplet nuclei

In addition to Standard Precautions: – Use particulate respirator – Place the patient in adequately ventilated room (≥ 12

air changes per hour)– Limit patient movement

Use airborne precautions for performance of any aerosol-generating procedures associated with pathogen transmission

Influenza Training Package

Hand HygieneHand hygiene should be performed:

– before and after any direct contact with a patient– after contact with blood, body fluids, secretions and

excretions– after contact with items contaminated with blood, body

fluids, secretions and excretions, including respiratory secretions

Use alcohol-based hand rub or wash hands with soap and water

– Wash hands if visibly soiled

Influenza Training Package

Respiratory Hygiene and Cough EtiquettePart of standard precautions

Education of health care workers, patients and visitors

Source control measures (e.g., cover cough to prevent dissemination of infectious droplets)

Hand hygiene

Spatial separation (> 1 meter) of persons with acute febrile respiratory symptoms

Personal Protective Equipment

Courtesy of K. Harriman

Influenza Training Package

Types of PPE Used in Healthcare Settings

Gloves – protect hands

Gowns/aprons – protect skin and/or clothing

Masks and respirators– protect mouth/nose

– Respirators – protect respiratory tract from airborne infectious agents

Goggles – protect eyes

Face shields – protect face, mouth, nose, and eyes

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PPE for Standard Precautions: Based on Risk Assessment

IF direct contact with blood & body fluids, secretions, excretions, mucous membranes, non-intact skin– Gloves– Gown

IF there is the risk of spills onto the body and/or face– Gloves– Gown – Face protection (mask plus eye protection goggle or

visor; face shield)

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PPE for Transmission-Based PrecautionsUsed in addition to Standard Precautions

Contact Precautions – Gloves – Gown

Droplet Precautions – Medical mask

Airborne Precautions – Particulate respirator

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Masks and Respirators: Barriers and Filtration

Surgical masks– Protect against body fluids and

large particles

Particulate respirators (e.g., N95)– Protect against small particles

and other airborne particles

Alternative materials (barriers)– Tissues, cloth

Influenza Training Package

HH Gloves Gown Medical Mask

Particulate Respirator

Eye Protection

Entry to isolation room/area, but no anticipated patient contact

Y

Risk Asst

Risk Asst

Risk Asst N

Risk Asst

Close contact (< 1 meter) with infected patient in or out of isolation room/area

Y

Y Y Y N Y

Performance of aerosol-generating procedure on patient Y Y Y N Y Y

PPE for Persons Providing Care for Patients with Acute Febrile Respiratory Illness, Including Patients with

Suspected or Confirmed AI Infection

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PPE for Interviewing Exposed Persons and Contacts of ARDs Patients Asymptomatic exposed persons and contacts (low-risk)

– Routine use of PPE not recommended

– Maintain 1 meter distance between interviewer and interviewee

– Use proper hand hygiene

Symptomatic exposed persons (higher-risk)

– PPE recommended in community and health care facility: Contact and Droplet Precautions

– In health care facility, person should be placed in adequately ventilated room (≥ 12 air changes per hour), if possible

– Maintain a distance of > 1 meter, if possible

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PPE for Specimen Collection – Exposed Persons

Collecting respiratory specimens is a high-risk, aerosol-generating procedure

PPE recommended– Gloves– Gown– Goggles or face shield– N95 or higher level respirator

CDC

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●Isolate patients with droplet or airborne spread diseases from other patients●Separate wards, areas, or establish rooms for infectious patients where isolation facilities do not exist●Only those patients with epidemiological and clinical information suggestive of a similar diagnosis should share rooms

●Separate patients by at least 1 meter

Patient Accommodation

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1 meter

Patient accommodation: Natural Ventilation Room

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Duration of IC measures for Avian and Pandemic Influenza

Adults and adolescents > 12 years of age – from time of admission until 7 days after symptoms resolved

Infants and children ≤ 12 years of age – from time of admission until 21 days after symptoms resolved

For immunocompromised patients, pathogen shedding may be protracted

Influenza Training Package

•Environmental cleaning:

Use appropriate procedures for the routine cleaning and disinfection of environmental and other frequently touched surfaces

•Waste disposal:

Treat waste contaminated with blood, bodily fluids, secretions and excretions as clinical waste, in accordance with local regulations

Environmental Cleaning and Waste Disposal

WHO

Influenza Training Package

Waste DisposalUse 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

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Autopsy Precautions for Influenza A (H5N1)

Follow standard PPE procedures for autopsies

Anyone handling a corpse should follow standard precautions for blood and body fluids

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Occupational Health Management During an Outbreak

Monitor staff who work with patients with an infectious disease of potential concern for symptoms

Screen for symptoms of influenza-like illness among staff reporting for duty (fever, cough)

WHO

Influenza Training Package

Implementation of Core Infection Control Measures During Rapid Containment Early recognition and reporting

Infection control precautions

Hand hygiene

PPE: gloves, gowns, masks/respirators, eye protection

Patient accommodation

Environmental cleaning and waste disposal

Occupational health management

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Hospital Preparedness: Key Points

Apply standard precautions routinely in all health-care settings

Place all patients (suspected or confirmed with an infectious ARD) in a room or area separate from other patients

Practice both standard and droplet precautions when caring for patients with infectious ARD

Important Components for HC Facility Infection Prevention and Control Program

•Available supplies and equipment (PPE, disinfectants)

•Policies and guidelines for procedures

•Ongoing educational programs for healthcare facility staff

•Process for monitoring staff health to identify and to prevent staff-to-patient and patient-to-staff spread of infection

Jamaica IC Guidelines

Influenza Training Package

Infection Control for ARD in Heath Care Settings Infection Control for ARD in Heath Care Settings

Symptoms acute ILI

Investigation for ARD of potential concern

Confirmed ARD of potential concern

Single room adequately ventilated (≥ 12 air changes per hour), if possible

Standard and droplet precautions

Different diagnosis

Reassess precautions

+ Risk Factor

Report to Public Health Authorities

WHO

Single room adequately ventilated, if possible

Patient Infection control precautions

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Environmental Decontamination

Cleaning MUST precede decontamination

Disinfectant ineffective if organic matter is present

Use mechanical force– Scrubbing– Brushing– Flush with water

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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

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Using Bleach Solutions

First clean organic material from surfaces or items

Wipe nonporous surfaces with sponge or wet cloth– Allow to dry

Use fresh diluted bleach daily!