89
Swine Flu • An outbreak of a virulent form of influenza has developed in Mexico. • With spring breakers and other travelers cases are popping up like zits on a teenager.
Swine Flu
bull An outbreak of a virulent form of influenza has developed in Mexico
bull With spring breakers and other travelers cases are popping up like zits on a teenager
What causes Swine Flu
bull Swine Flu is a respiratory infection caused by the Influenza A virus
bull The influenza virus is a primitive virus that affects both mammals and birds
What is a virus
bull A virus is a microscopic object that is significantly smaller than a bacterium
bull Viruses do not contain the cellular stuff to reproduce Instead when they enter the cell of a host they hijack the cellrsquos biochemical process in order to replicate and produce millions of new viruses
How many types of influenza are there
bull There are three major types of influenza virusbull Influenza A The most virulent which normally reside in aquatic birds
but have been known to ldquojump speciesrdquo as seen in the current outbreak
bull Influenza Bbull And Influenza C
What is the current strain
bull The current swine flu strain in question is H1N1bull H1N1 is thought to have caused the Spanish flu
in 1918 which killed approximately 50-100 million people worldwide
What are the symptoms of swine flu
bull Feverbull Coughbull Sore throatbull Body achesbull Headache bull Chillsbull Fatiguebull Diarrheabull vomiting
Whats different with this batch
bull Influenza A is primarily a respiratory virus The strain of swine flu in Mexico appears to be more virulent than strains seen in the United States
bull It tends to affect people between 25 and 45 years of age as opposed to the normal strains that affect older adults
How is Swine flu spread
bull Mainly person-to-person through coughing or sneezing from infected individuals
bull Some infections can occur by touching something with flu viruses on it and then touching the mouth or nose
Slowing the spread
bull Use Standard Precautionsbull Frequent hand washingbull Use mask when treating patients that are
coughing or sneezingbull Get plenty of sleepbull Maintain adequate nutrition
How about a vaccine
bull There is not enough time to develop a vaccine administer it and wait for the personrsquos body to manufacture antibodies for the swine flu
Whats the treatment
bull Tamiflu or Relenza seem to help with swine flubull The drugs will not prevent infectionbull Influenza A tends to develop resistance to
antiviral agents quickly
Whatrsquos the current who phase
bull As of April 29 2009 the current World Health Organization pandemic alert is at 4
bull Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause ldquocommunity-level outbreaksrdquo The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted Phase 4 indicates a significant risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion
Rational behind phase 4
bull Virus has increased human-to-human transmissibility but is not well adapted to humans and remains highly localized so that its spread may be possibly be delayed or contained
Update
bull Mid day April 29 WHO raised the alert to Phase 5 Phase 5 Is characterized by human-to-human spread of the virus into at least two countries in one WHO region While most countries will not be affected at this stage the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization communication and implementation of the planned mitigation measures is short
Rational
bull Virus is more adapted to humans and therefore more easily transmissible among humans It spreads in lager clusters but spread is localized This is likely to be the last chance for massive coordinated global intervention targeted to one or more foci to delay or contain spread
St Louis County Health Guidance
bull On April 28 St Louis County Department of Health issued an alert
Working Case Definition
bull Fever of gt=378 degrees C (100 degrees F) plus cough or sore throat AND
bull Travel to an area where swine flu is confirmed or contact to a known case
Home Isolation
bull CDC strongly recommends home isolation of cases
bull Persons who develop influenza-like-illness should be strongly encouraged to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved
Medical Care
bull Persons with ILI and wish to seek medical care should contact their medical care provider by phone
bull Persons who have difficulty breathing or shortness of breath or are believed to be severely ill should seek immediate medical attention
Infection Control
bull The CDC recommends that standard droplet and contact precautions be used for all patient care activities for ILI patients
bull Maintain hand washing hygiene
Interim Guidance for Emergency Medical Services (EMS) Systems
and9-1-1 Public Safety Answering
Points (PSAPs) for Management ofPatients with Confirmed or
Suspected Swine-Origin Influenza A(H1N1) Infection
Infectious Period
bull Persons with swine-origin influenza A (H1N1) virus infection should be considered potentially infectious from one day before to 7 days following illness
onset bull Persons who continue to be ill longer than 7 days after
illness onset should be considered potentially contagious until symptoms have resolved
bull Children especially younger children might potentially be contagious for longer periods
Case Definitions for Infection with Swine-origin Influenza A
(H1N1) Virus (S-OIV)bull A confirmed case of S-OIV infection is defined as a person with an acute febrile
respiratory illness with laboratory confirmed S-OIV infection at CDC bybull one or more of the following testsbull 1 real-time RT-PCRbull 2 viral culturebull A probable case of S-OIV infection is defined as a person with an acute febrile
respiratory illness who is positive for influenza A but negative for H1 andbull H3 by influenza RT-PCRbull A suspected case of S-OIV infection is defined as a person with acute febrile
respiratory illness with onsetbull 1048698 within 7 days of close contact with a person who is a confirmed case of S-OIV
infection orbull 1048698 within 7 days of travel to community either within the United States or internationally
where there are one or more confirmed cases of S-OIVbull infection orbull 1048698 resides in a community where there are one or more confirmed cases of S-OIV
infection
Recommendations for 9-1-1 Public Safety Answering Points(PSAP)
bull It is important for the PSAPs to question callers to ascertain if there is anyone at the incident location who is possibly afflicted by the swine-origin
bull influenza A (H1N1) virus to communicate the possible risk to EMS personnel prior to arrival and to assign the appropriate EMS resources PSAPs should
bull review existing medical dispatch procedures and coordinate any modifications with their EMS medical director and in coordination with their local
bull department of public healthbull Interim recommendationsbull 1048698 PSAP call takers should screen all callers for any symptoms of acute febrile
respiratory illness Callers should be asked if they or someone at thebull incident location has had nasal congestion cough fever or other flu-like symptomsbull 1048698 If the PSAP call taker suspects a caller is noting symptoms of acute febrile
respiratory febrile illness they should make sure any firstbull responders and EMS personnel are aware of the potential for ldquoacute febrile respiratory
illnessrdquo before the responders arrive on scene
If there HAS NOT been swine-origin influenza reported in the geographic area (httpwwwcdcgovswineflu) EMS providers should assess all patients as
follows
bull 1048698 Step 1 EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine
bull respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza
bull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following nasal congestion rhinorrhea
bull sore throat or cough)bull 1048698 If no acute febrile respiratory illness proceed with normal EMS carebull 1048698 If symptoms of acute febrile respiratory illness then assess all patients for travel to a
geographic area with confirmed cases of swine-originbull influenza within the last 7 days or close contact with someone with travel to these areasbull 1048698 If travel exposure don appropriate PPE for suspected case of swine-origin influenzabull 1048698 If no travel exposure place a standard surgical mask on the patient (if tolerated) and use
appropriate PPE for cases of acute febrilebull respiratory illness without suspicion of swine-origin influenza (as described in PPE section)
If the CDC confirmed swine-origin influenza in the geographic area (httpwwwcdcgovswineflu )
bull 1048698 Step 1 Address scene safetybull 1048698 If PSAP advises potential for acute febrile respiratory illness symptoms on scene
EMS personnel should don PPE for suspected cases ofbull swine-origin influenza prior to entering scenebull 1048698 If PSAP has not identified individuals with symptoms of acute febrile respiratory
illness on scene EMS personnel should stay more than 6bull feet away from patient and bystanders with symptoms and exercise appropriate
routine respiratory droplet precautions while assessing allbull patients for suspected cases of swine-origin influenzabull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following nasal congestion rhinorrheabull sore throat or cough)bull 1048698 If no symptoms of acute febrile respiratory illness provide routine EMS carebull 1048698 If symptoms of acute febrile respiratory illness don appropriate PPE for suspected
case of swine-origin influenza if not already on
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
What causes Swine Flu
bull Swine Flu is a respiratory infection caused by the Influenza A virus
bull The influenza virus is a primitive virus that affects both mammals and birds
What is a virus
bull A virus is a microscopic object that is significantly smaller than a bacterium
bull Viruses do not contain the cellular stuff to reproduce Instead when they enter the cell of a host they hijack the cellrsquos biochemical process in order to replicate and produce millions of new viruses
How many types of influenza are there
bull There are three major types of influenza virusbull Influenza A The most virulent which normally reside in aquatic birds
but have been known to ldquojump speciesrdquo as seen in the current outbreak
bull Influenza Bbull And Influenza C
What is the current strain
bull The current swine flu strain in question is H1N1bull H1N1 is thought to have caused the Spanish flu
in 1918 which killed approximately 50-100 million people worldwide
What are the symptoms of swine flu
bull Feverbull Coughbull Sore throatbull Body achesbull Headache bull Chillsbull Fatiguebull Diarrheabull vomiting
Whats different with this batch
bull Influenza A is primarily a respiratory virus The strain of swine flu in Mexico appears to be more virulent than strains seen in the United States
bull It tends to affect people between 25 and 45 years of age as opposed to the normal strains that affect older adults
How is Swine flu spread
bull Mainly person-to-person through coughing or sneezing from infected individuals
bull Some infections can occur by touching something with flu viruses on it and then touching the mouth or nose
Slowing the spread
bull Use Standard Precautionsbull Frequent hand washingbull Use mask when treating patients that are
coughing or sneezingbull Get plenty of sleepbull Maintain adequate nutrition
How about a vaccine
bull There is not enough time to develop a vaccine administer it and wait for the personrsquos body to manufacture antibodies for the swine flu
Whats the treatment
bull Tamiflu or Relenza seem to help with swine flubull The drugs will not prevent infectionbull Influenza A tends to develop resistance to
antiviral agents quickly
Whatrsquos the current who phase
bull As of April 29 2009 the current World Health Organization pandemic alert is at 4
bull Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause ldquocommunity-level outbreaksrdquo The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted Phase 4 indicates a significant risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion
Rational behind phase 4
bull Virus has increased human-to-human transmissibility but is not well adapted to humans and remains highly localized so that its spread may be possibly be delayed or contained
Update
bull Mid day April 29 WHO raised the alert to Phase 5 Phase 5 Is characterized by human-to-human spread of the virus into at least two countries in one WHO region While most countries will not be affected at this stage the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization communication and implementation of the planned mitigation measures is short
Rational
bull Virus is more adapted to humans and therefore more easily transmissible among humans It spreads in lager clusters but spread is localized This is likely to be the last chance for massive coordinated global intervention targeted to one or more foci to delay or contain spread
St Louis County Health Guidance
bull On April 28 St Louis County Department of Health issued an alert
Working Case Definition
bull Fever of gt=378 degrees C (100 degrees F) plus cough or sore throat AND
bull Travel to an area where swine flu is confirmed or contact to a known case
Home Isolation
bull CDC strongly recommends home isolation of cases
bull Persons who develop influenza-like-illness should be strongly encouraged to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved
Medical Care
bull Persons with ILI and wish to seek medical care should contact their medical care provider by phone
bull Persons who have difficulty breathing or shortness of breath or are believed to be severely ill should seek immediate medical attention
Infection Control
bull The CDC recommends that standard droplet and contact precautions be used for all patient care activities for ILI patients
bull Maintain hand washing hygiene
Interim Guidance for Emergency Medical Services (EMS) Systems
and9-1-1 Public Safety Answering
Points (PSAPs) for Management ofPatients with Confirmed or
Suspected Swine-Origin Influenza A(H1N1) Infection
Infectious Period
bull Persons with swine-origin influenza A (H1N1) virus infection should be considered potentially infectious from one day before to 7 days following illness
onset bull Persons who continue to be ill longer than 7 days after
illness onset should be considered potentially contagious until symptoms have resolved
bull Children especially younger children might potentially be contagious for longer periods
Case Definitions for Infection with Swine-origin Influenza A
(H1N1) Virus (S-OIV)bull A confirmed case of S-OIV infection is defined as a person with an acute febrile
respiratory illness with laboratory confirmed S-OIV infection at CDC bybull one or more of the following testsbull 1 real-time RT-PCRbull 2 viral culturebull A probable case of S-OIV infection is defined as a person with an acute febrile
respiratory illness who is positive for influenza A but negative for H1 andbull H3 by influenza RT-PCRbull A suspected case of S-OIV infection is defined as a person with acute febrile
respiratory illness with onsetbull 1048698 within 7 days of close contact with a person who is a confirmed case of S-OIV
infection orbull 1048698 within 7 days of travel to community either within the United States or internationally
where there are one or more confirmed cases of S-OIVbull infection orbull 1048698 resides in a community where there are one or more confirmed cases of S-OIV
infection
Recommendations for 9-1-1 Public Safety Answering Points(PSAP)
bull It is important for the PSAPs to question callers to ascertain if there is anyone at the incident location who is possibly afflicted by the swine-origin
bull influenza A (H1N1) virus to communicate the possible risk to EMS personnel prior to arrival and to assign the appropriate EMS resources PSAPs should
bull review existing medical dispatch procedures and coordinate any modifications with their EMS medical director and in coordination with their local
bull department of public healthbull Interim recommendationsbull 1048698 PSAP call takers should screen all callers for any symptoms of acute febrile
respiratory illness Callers should be asked if they or someone at thebull incident location has had nasal congestion cough fever or other flu-like symptomsbull 1048698 If the PSAP call taker suspects a caller is noting symptoms of acute febrile
respiratory febrile illness they should make sure any firstbull responders and EMS personnel are aware of the potential for ldquoacute febrile respiratory
illnessrdquo before the responders arrive on scene
If there HAS NOT been swine-origin influenza reported in the geographic area (httpwwwcdcgovswineflu) EMS providers should assess all patients as
follows
bull 1048698 Step 1 EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine
bull respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza
bull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following nasal congestion rhinorrhea
bull sore throat or cough)bull 1048698 If no acute febrile respiratory illness proceed with normal EMS carebull 1048698 If symptoms of acute febrile respiratory illness then assess all patients for travel to a
geographic area with confirmed cases of swine-originbull influenza within the last 7 days or close contact with someone with travel to these areasbull 1048698 If travel exposure don appropriate PPE for suspected case of swine-origin influenzabull 1048698 If no travel exposure place a standard surgical mask on the patient (if tolerated) and use
appropriate PPE for cases of acute febrilebull respiratory illness without suspicion of swine-origin influenza (as described in PPE section)
If the CDC confirmed swine-origin influenza in the geographic area (httpwwwcdcgovswineflu )
bull 1048698 Step 1 Address scene safetybull 1048698 If PSAP advises potential for acute febrile respiratory illness symptoms on scene
EMS personnel should don PPE for suspected cases ofbull swine-origin influenza prior to entering scenebull 1048698 If PSAP has not identified individuals with symptoms of acute febrile respiratory
illness on scene EMS personnel should stay more than 6bull feet away from patient and bystanders with symptoms and exercise appropriate
routine respiratory droplet precautions while assessing allbull patients for suspected cases of swine-origin influenzabull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following nasal congestion rhinorrheabull sore throat or cough)bull 1048698 If no symptoms of acute febrile respiratory illness provide routine EMS carebull 1048698 If symptoms of acute febrile respiratory illness don appropriate PPE for suspected
case of swine-origin influenza if not already on
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
What is a virus
bull A virus is a microscopic object that is significantly smaller than a bacterium
bull Viruses do not contain the cellular stuff to reproduce Instead when they enter the cell of a host they hijack the cellrsquos biochemical process in order to replicate and produce millions of new viruses
How many types of influenza are there
bull There are three major types of influenza virusbull Influenza A The most virulent which normally reside in aquatic birds
but have been known to ldquojump speciesrdquo as seen in the current outbreak
bull Influenza Bbull And Influenza C
What is the current strain
bull The current swine flu strain in question is H1N1bull H1N1 is thought to have caused the Spanish flu
in 1918 which killed approximately 50-100 million people worldwide
What are the symptoms of swine flu
bull Feverbull Coughbull Sore throatbull Body achesbull Headache bull Chillsbull Fatiguebull Diarrheabull vomiting
Whats different with this batch
bull Influenza A is primarily a respiratory virus The strain of swine flu in Mexico appears to be more virulent than strains seen in the United States
bull It tends to affect people between 25 and 45 years of age as opposed to the normal strains that affect older adults
How is Swine flu spread
bull Mainly person-to-person through coughing or sneezing from infected individuals
bull Some infections can occur by touching something with flu viruses on it and then touching the mouth or nose
Slowing the spread
bull Use Standard Precautionsbull Frequent hand washingbull Use mask when treating patients that are
coughing or sneezingbull Get plenty of sleepbull Maintain adequate nutrition
How about a vaccine
bull There is not enough time to develop a vaccine administer it and wait for the personrsquos body to manufacture antibodies for the swine flu
Whats the treatment
bull Tamiflu or Relenza seem to help with swine flubull The drugs will not prevent infectionbull Influenza A tends to develop resistance to
antiviral agents quickly
Whatrsquos the current who phase
bull As of April 29 2009 the current World Health Organization pandemic alert is at 4
bull Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause ldquocommunity-level outbreaksrdquo The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted Phase 4 indicates a significant risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion
Rational behind phase 4
bull Virus has increased human-to-human transmissibility but is not well adapted to humans and remains highly localized so that its spread may be possibly be delayed or contained
Update
bull Mid day April 29 WHO raised the alert to Phase 5 Phase 5 Is characterized by human-to-human spread of the virus into at least two countries in one WHO region While most countries will not be affected at this stage the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization communication and implementation of the planned mitigation measures is short
Rational
bull Virus is more adapted to humans and therefore more easily transmissible among humans It spreads in lager clusters but spread is localized This is likely to be the last chance for massive coordinated global intervention targeted to one or more foci to delay or contain spread
St Louis County Health Guidance
bull On April 28 St Louis County Department of Health issued an alert
Working Case Definition
bull Fever of gt=378 degrees C (100 degrees F) plus cough or sore throat AND
bull Travel to an area where swine flu is confirmed or contact to a known case
Home Isolation
bull CDC strongly recommends home isolation of cases
bull Persons who develop influenza-like-illness should be strongly encouraged to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved
Medical Care
bull Persons with ILI and wish to seek medical care should contact their medical care provider by phone
bull Persons who have difficulty breathing or shortness of breath or are believed to be severely ill should seek immediate medical attention
Infection Control
bull The CDC recommends that standard droplet and contact precautions be used for all patient care activities for ILI patients
bull Maintain hand washing hygiene
Interim Guidance for Emergency Medical Services (EMS) Systems
and9-1-1 Public Safety Answering
Points (PSAPs) for Management ofPatients with Confirmed or
Suspected Swine-Origin Influenza A(H1N1) Infection
Infectious Period
bull Persons with swine-origin influenza A (H1N1) virus infection should be considered potentially infectious from one day before to 7 days following illness
onset bull Persons who continue to be ill longer than 7 days after
illness onset should be considered potentially contagious until symptoms have resolved
bull Children especially younger children might potentially be contagious for longer periods
Case Definitions for Infection with Swine-origin Influenza A
(H1N1) Virus (S-OIV)bull A confirmed case of S-OIV infection is defined as a person with an acute febrile
respiratory illness with laboratory confirmed S-OIV infection at CDC bybull one or more of the following testsbull 1 real-time RT-PCRbull 2 viral culturebull A probable case of S-OIV infection is defined as a person with an acute febrile
respiratory illness who is positive for influenza A but negative for H1 andbull H3 by influenza RT-PCRbull A suspected case of S-OIV infection is defined as a person with acute febrile
respiratory illness with onsetbull 1048698 within 7 days of close contact with a person who is a confirmed case of S-OIV
infection orbull 1048698 within 7 days of travel to community either within the United States or internationally
where there are one or more confirmed cases of S-OIVbull infection orbull 1048698 resides in a community where there are one or more confirmed cases of S-OIV
infection
Recommendations for 9-1-1 Public Safety Answering Points(PSAP)
bull It is important for the PSAPs to question callers to ascertain if there is anyone at the incident location who is possibly afflicted by the swine-origin
bull influenza A (H1N1) virus to communicate the possible risk to EMS personnel prior to arrival and to assign the appropriate EMS resources PSAPs should
bull review existing medical dispatch procedures and coordinate any modifications with their EMS medical director and in coordination with their local
bull department of public healthbull Interim recommendationsbull 1048698 PSAP call takers should screen all callers for any symptoms of acute febrile
respiratory illness Callers should be asked if they or someone at thebull incident location has had nasal congestion cough fever or other flu-like symptomsbull 1048698 If the PSAP call taker suspects a caller is noting symptoms of acute febrile
respiratory febrile illness they should make sure any firstbull responders and EMS personnel are aware of the potential for ldquoacute febrile respiratory
illnessrdquo before the responders arrive on scene
If there HAS NOT been swine-origin influenza reported in the geographic area (httpwwwcdcgovswineflu) EMS providers should assess all patients as
follows
bull 1048698 Step 1 EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine
bull respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza
bull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following nasal congestion rhinorrhea
bull sore throat or cough)bull 1048698 If no acute febrile respiratory illness proceed with normal EMS carebull 1048698 If symptoms of acute febrile respiratory illness then assess all patients for travel to a
geographic area with confirmed cases of swine-originbull influenza within the last 7 days or close contact with someone with travel to these areasbull 1048698 If travel exposure don appropriate PPE for suspected case of swine-origin influenzabull 1048698 If no travel exposure place a standard surgical mask on the patient (if tolerated) and use
appropriate PPE for cases of acute febrilebull respiratory illness without suspicion of swine-origin influenza (as described in PPE section)
If the CDC confirmed swine-origin influenza in the geographic area (httpwwwcdcgovswineflu )
bull 1048698 Step 1 Address scene safetybull 1048698 If PSAP advises potential for acute febrile respiratory illness symptoms on scene
EMS personnel should don PPE for suspected cases ofbull swine-origin influenza prior to entering scenebull 1048698 If PSAP has not identified individuals with symptoms of acute febrile respiratory
illness on scene EMS personnel should stay more than 6bull feet away from patient and bystanders with symptoms and exercise appropriate
routine respiratory droplet precautions while assessing allbull patients for suspected cases of swine-origin influenzabull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following nasal congestion rhinorrheabull sore throat or cough)bull 1048698 If no symptoms of acute febrile respiratory illness provide routine EMS carebull 1048698 If symptoms of acute febrile respiratory illness don appropriate PPE for suspected
case of swine-origin influenza if not already on
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
How many types of influenza are there
bull There are three major types of influenza virusbull Influenza A The most virulent which normally reside in aquatic birds
but have been known to ldquojump speciesrdquo as seen in the current outbreak
bull Influenza Bbull And Influenza C
What is the current strain
bull The current swine flu strain in question is H1N1bull H1N1 is thought to have caused the Spanish flu
in 1918 which killed approximately 50-100 million people worldwide
What are the symptoms of swine flu
bull Feverbull Coughbull Sore throatbull Body achesbull Headache bull Chillsbull Fatiguebull Diarrheabull vomiting
Whats different with this batch
bull Influenza A is primarily a respiratory virus The strain of swine flu in Mexico appears to be more virulent than strains seen in the United States
bull It tends to affect people between 25 and 45 years of age as opposed to the normal strains that affect older adults
How is Swine flu spread
bull Mainly person-to-person through coughing or sneezing from infected individuals
bull Some infections can occur by touching something with flu viruses on it and then touching the mouth or nose
Slowing the spread
bull Use Standard Precautionsbull Frequent hand washingbull Use mask when treating patients that are
coughing or sneezingbull Get plenty of sleepbull Maintain adequate nutrition
How about a vaccine
bull There is not enough time to develop a vaccine administer it and wait for the personrsquos body to manufacture antibodies for the swine flu
Whats the treatment
bull Tamiflu or Relenza seem to help with swine flubull The drugs will not prevent infectionbull Influenza A tends to develop resistance to
antiviral agents quickly
Whatrsquos the current who phase
bull As of April 29 2009 the current World Health Organization pandemic alert is at 4
bull Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause ldquocommunity-level outbreaksrdquo The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted Phase 4 indicates a significant risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion
Rational behind phase 4
bull Virus has increased human-to-human transmissibility but is not well adapted to humans and remains highly localized so that its spread may be possibly be delayed or contained
Update
bull Mid day April 29 WHO raised the alert to Phase 5 Phase 5 Is characterized by human-to-human spread of the virus into at least two countries in one WHO region While most countries will not be affected at this stage the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization communication and implementation of the planned mitigation measures is short
Rational
bull Virus is more adapted to humans and therefore more easily transmissible among humans It spreads in lager clusters but spread is localized This is likely to be the last chance for massive coordinated global intervention targeted to one or more foci to delay or contain spread
St Louis County Health Guidance
bull On April 28 St Louis County Department of Health issued an alert
Working Case Definition
bull Fever of gt=378 degrees C (100 degrees F) plus cough or sore throat AND
bull Travel to an area where swine flu is confirmed or contact to a known case
Home Isolation
bull CDC strongly recommends home isolation of cases
bull Persons who develop influenza-like-illness should be strongly encouraged to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved
Medical Care
bull Persons with ILI and wish to seek medical care should contact their medical care provider by phone
bull Persons who have difficulty breathing or shortness of breath or are believed to be severely ill should seek immediate medical attention
Infection Control
bull The CDC recommends that standard droplet and contact precautions be used for all patient care activities for ILI patients
bull Maintain hand washing hygiene
Interim Guidance for Emergency Medical Services (EMS) Systems
and9-1-1 Public Safety Answering
Points (PSAPs) for Management ofPatients with Confirmed or
Suspected Swine-Origin Influenza A(H1N1) Infection
Infectious Period
bull Persons with swine-origin influenza A (H1N1) virus infection should be considered potentially infectious from one day before to 7 days following illness
onset bull Persons who continue to be ill longer than 7 days after
illness onset should be considered potentially contagious until symptoms have resolved
bull Children especially younger children might potentially be contagious for longer periods
Case Definitions for Infection with Swine-origin Influenza A
(H1N1) Virus (S-OIV)bull A confirmed case of S-OIV infection is defined as a person with an acute febrile
respiratory illness with laboratory confirmed S-OIV infection at CDC bybull one or more of the following testsbull 1 real-time RT-PCRbull 2 viral culturebull A probable case of S-OIV infection is defined as a person with an acute febrile
respiratory illness who is positive for influenza A but negative for H1 andbull H3 by influenza RT-PCRbull A suspected case of S-OIV infection is defined as a person with acute febrile
respiratory illness with onsetbull 1048698 within 7 days of close contact with a person who is a confirmed case of S-OIV
infection orbull 1048698 within 7 days of travel to community either within the United States or internationally
where there are one or more confirmed cases of S-OIVbull infection orbull 1048698 resides in a community where there are one or more confirmed cases of S-OIV
infection
Recommendations for 9-1-1 Public Safety Answering Points(PSAP)
bull It is important for the PSAPs to question callers to ascertain if there is anyone at the incident location who is possibly afflicted by the swine-origin
bull influenza A (H1N1) virus to communicate the possible risk to EMS personnel prior to arrival and to assign the appropriate EMS resources PSAPs should
bull review existing medical dispatch procedures and coordinate any modifications with their EMS medical director and in coordination with their local
bull department of public healthbull Interim recommendationsbull 1048698 PSAP call takers should screen all callers for any symptoms of acute febrile
respiratory illness Callers should be asked if they or someone at thebull incident location has had nasal congestion cough fever or other flu-like symptomsbull 1048698 If the PSAP call taker suspects a caller is noting symptoms of acute febrile
respiratory febrile illness they should make sure any firstbull responders and EMS personnel are aware of the potential for ldquoacute febrile respiratory
illnessrdquo before the responders arrive on scene
If there HAS NOT been swine-origin influenza reported in the geographic area (httpwwwcdcgovswineflu) EMS providers should assess all patients as
follows
bull 1048698 Step 1 EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine
bull respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza
bull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following nasal congestion rhinorrhea
bull sore throat or cough)bull 1048698 If no acute febrile respiratory illness proceed with normal EMS carebull 1048698 If symptoms of acute febrile respiratory illness then assess all patients for travel to a
geographic area with confirmed cases of swine-originbull influenza within the last 7 days or close contact with someone with travel to these areasbull 1048698 If travel exposure don appropriate PPE for suspected case of swine-origin influenzabull 1048698 If no travel exposure place a standard surgical mask on the patient (if tolerated) and use
appropriate PPE for cases of acute febrilebull respiratory illness without suspicion of swine-origin influenza (as described in PPE section)
If the CDC confirmed swine-origin influenza in the geographic area (httpwwwcdcgovswineflu )
bull 1048698 Step 1 Address scene safetybull 1048698 If PSAP advises potential for acute febrile respiratory illness symptoms on scene
EMS personnel should don PPE for suspected cases ofbull swine-origin influenza prior to entering scenebull 1048698 If PSAP has not identified individuals with symptoms of acute febrile respiratory
illness on scene EMS personnel should stay more than 6bull feet away from patient and bystanders with symptoms and exercise appropriate
routine respiratory droplet precautions while assessing allbull patients for suspected cases of swine-origin influenzabull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following nasal congestion rhinorrheabull sore throat or cough)bull 1048698 If no symptoms of acute febrile respiratory illness provide routine EMS carebull 1048698 If symptoms of acute febrile respiratory illness don appropriate PPE for suspected
case of swine-origin influenza if not already on
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
What is the current strain
bull The current swine flu strain in question is H1N1bull H1N1 is thought to have caused the Spanish flu
in 1918 which killed approximately 50-100 million people worldwide
What are the symptoms of swine flu
bull Feverbull Coughbull Sore throatbull Body achesbull Headache bull Chillsbull Fatiguebull Diarrheabull vomiting
Whats different with this batch
bull Influenza A is primarily a respiratory virus The strain of swine flu in Mexico appears to be more virulent than strains seen in the United States
bull It tends to affect people between 25 and 45 years of age as opposed to the normal strains that affect older adults
How is Swine flu spread
bull Mainly person-to-person through coughing or sneezing from infected individuals
bull Some infections can occur by touching something with flu viruses on it and then touching the mouth or nose
Slowing the spread
bull Use Standard Precautionsbull Frequent hand washingbull Use mask when treating patients that are
coughing or sneezingbull Get plenty of sleepbull Maintain adequate nutrition
How about a vaccine
bull There is not enough time to develop a vaccine administer it and wait for the personrsquos body to manufacture antibodies for the swine flu
Whats the treatment
bull Tamiflu or Relenza seem to help with swine flubull The drugs will not prevent infectionbull Influenza A tends to develop resistance to
antiviral agents quickly
Whatrsquos the current who phase
bull As of April 29 2009 the current World Health Organization pandemic alert is at 4
bull Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause ldquocommunity-level outbreaksrdquo The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted Phase 4 indicates a significant risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion
Rational behind phase 4
bull Virus has increased human-to-human transmissibility but is not well adapted to humans and remains highly localized so that its spread may be possibly be delayed or contained
Update
bull Mid day April 29 WHO raised the alert to Phase 5 Phase 5 Is characterized by human-to-human spread of the virus into at least two countries in one WHO region While most countries will not be affected at this stage the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization communication and implementation of the planned mitigation measures is short
Rational
bull Virus is more adapted to humans and therefore more easily transmissible among humans It spreads in lager clusters but spread is localized This is likely to be the last chance for massive coordinated global intervention targeted to one or more foci to delay or contain spread
St Louis County Health Guidance
bull On April 28 St Louis County Department of Health issued an alert
Working Case Definition
bull Fever of gt=378 degrees C (100 degrees F) plus cough or sore throat AND
bull Travel to an area where swine flu is confirmed or contact to a known case
Home Isolation
bull CDC strongly recommends home isolation of cases
bull Persons who develop influenza-like-illness should be strongly encouraged to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved
Medical Care
bull Persons with ILI and wish to seek medical care should contact their medical care provider by phone
bull Persons who have difficulty breathing or shortness of breath or are believed to be severely ill should seek immediate medical attention
Infection Control
bull The CDC recommends that standard droplet and contact precautions be used for all patient care activities for ILI patients
bull Maintain hand washing hygiene
Interim Guidance for Emergency Medical Services (EMS) Systems
and9-1-1 Public Safety Answering
Points (PSAPs) for Management ofPatients with Confirmed or
Suspected Swine-Origin Influenza A(H1N1) Infection
Infectious Period
bull Persons with swine-origin influenza A (H1N1) virus infection should be considered potentially infectious from one day before to 7 days following illness
onset bull Persons who continue to be ill longer than 7 days after
illness onset should be considered potentially contagious until symptoms have resolved
bull Children especially younger children might potentially be contagious for longer periods
Case Definitions for Infection with Swine-origin Influenza A
(H1N1) Virus (S-OIV)bull A confirmed case of S-OIV infection is defined as a person with an acute febrile
respiratory illness with laboratory confirmed S-OIV infection at CDC bybull one or more of the following testsbull 1 real-time RT-PCRbull 2 viral culturebull A probable case of S-OIV infection is defined as a person with an acute febrile
respiratory illness who is positive for influenza A but negative for H1 andbull H3 by influenza RT-PCRbull A suspected case of S-OIV infection is defined as a person with acute febrile
respiratory illness with onsetbull 1048698 within 7 days of close contact with a person who is a confirmed case of S-OIV
infection orbull 1048698 within 7 days of travel to community either within the United States or internationally
where there are one or more confirmed cases of S-OIVbull infection orbull 1048698 resides in a community where there are one or more confirmed cases of S-OIV
infection
Recommendations for 9-1-1 Public Safety Answering Points(PSAP)
bull It is important for the PSAPs to question callers to ascertain if there is anyone at the incident location who is possibly afflicted by the swine-origin
bull influenza A (H1N1) virus to communicate the possible risk to EMS personnel prior to arrival and to assign the appropriate EMS resources PSAPs should
bull review existing medical dispatch procedures and coordinate any modifications with their EMS medical director and in coordination with their local
bull department of public healthbull Interim recommendationsbull 1048698 PSAP call takers should screen all callers for any symptoms of acute febrile
respiratory illness Callers should be asked if they or someone at thebull incident location has had nasal congestion cough fever or other flu-like symptomsbull 1048698 If the PSAP call taker suspects a caller is noting symptoms of acute febrile
respiratory febrile illness they should make sure any firstbull responders and EMS personnel are aware of the potential for ldquoacute febrile respiratory
illnessrdquo before the responders arrive on scene
If there HAS NOT been swine-origin influenza reported in the geographic area (httpwwwcdcgovswineflu) EMS providers should assess all patients as
follows
bull 1048698 Step 1 EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine
bull respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza
bull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following nasal congestion rhinorrhea
bull sore throat or cough)bull 1048698 If no acute febrile respiratory illness proceed with normal EMS carebull 1048698 If symptoms of acute febrile respiratory illness then assess all patients for travel to a
geographic area with confirmed cases of swine-originbull influenza within the last 7 days or close contact with someone with travel to these areasbull 1048698 If travel exposure don appropriate PPE for suspected case of swine-origin influenzabull 1048698 If no travel exposure place a standard surgical mask on the patient (if tolerated) and use
appropriate PPE for cases of acute febrilebull respiratory illness without suspicion of swine-origin influenza (as described in PPE section)
If the CDC confirmed swine-origin influenza in the geographic area (httpwwwcdcgovswineflu )
bull 1048698 Step 1 Address scene safetybull 1048698 If PSAP advises potential for acute febrile respiratory illness symptoms on scene
EMS personnel should don PPE for suspected cases ofbull swine-origin influenza prior to entering scenebull 1048698 If PSAP has not identified individuals with symptoms of acute febrile respiratory
illness on scene EMS personnel should stay more than 6bull feet away from patient and bystanders with symptoms and exercise appropriate
routine respiratory droplet precautions while assessing allbull patients for suspected cases of swine-origin influenzabull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following nasal congestion rhinorrheabull sore throat or cough)bull 1048698 If no symptoms of acute febrile respiratory illness provide routine EMS carebull 1048698 If symptoms of acute febrile respiratory illness don appropriate PPE for suspected
case of swine-origin influenza if not already on
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
What are the symptoms of swine flu
bull Feverbull Coughbull Sore throatbull Body achesbull Headache bull Chillsbull Fatiguebull Diarrheabull vomiting
Whats different with this batch
bull Influenza A is primarily a respiratory virus The strain of swine flu in Mexico appears to be more virulent than strains seen in the United States
bull It tends to affect people between 25 and 45 years of age as opposed to the normal strains that affect older adults
How is Swine flu spread
bull Mainly person-to-person through coughing or sneezing from infected individuals
bull Some infections can occur by touching something with flu viruses on it and then touching the mouth or nose
Slowing the spread
bull Use Standard Precautionsbull Frequent hand washingbull Use mask when treating patients that are
coughing or sneezingbull Get plenty of sleepbull Maintain adequate nutrition
How about a vaccine
bull There is not enough time to develop a vaccine administer it and wait for the personrsquos body to manufacture antibodies for the swine flu
Whats the treatment
bull Tamiflu or Relenza seem to help with swine flubull The drugs will not prevent infectionbull Influenza A tends to develop resistance to
antiviral agents quickly
Whatrsquos the current who phase
bull As of April 29 2009 the current World Health Organization pandemic alert is at 4
bull Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause ldquocommunity-level outbreaksrdquo The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted Phase 4 indicates a significant risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion
Rational behind phase 4
bull Virus has increased human-to-human transmissibility but is not well adapted to humans and remains highly localized so that its spread may be possibly be delayed or contained
Update
bull Mid day April 29 WHO raised the alert to Phase 5 Phase 5 Is characterized by human-to-human spread of the virus into at least two countries in one WHO region While most countries will not be affected at this stage the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization communication and implementation of the planned mitigation measures is short
Rational
bull Virus is more adapted to humans and therefore more easily transmissible among humans It spreads in lager clusters but spread is localized This is likely to be the last chance for massive coordinated global intervention targeted to one or more foci to delay or contain spread
St Louis County Health Guidance
bull On April 28 St Louis County Department of Health issued an alert
Working Case Definition
bull Fever of gt=378 degrees C (100 degrees F) plus cough or sore throat AND
bull Travel to an area where swine flu is confirmed or contact to a known case
Home Isolation
bull CDC strongly recommends home isolation of cases
bull Persons who develop influenza-like-illness should be strongly encouraged to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved
Medical Care
bull Persons with ILI and wish to seek medical care should contact their medical care provider by phone
bull Persons who have difficulty breathing or shortness of breath or are believed to be severely ill should seek immediate medical attention
Infection Control
bull The CDC recommends that standard droplet and contact precautions be used for all patient care activities for ILI patients
bull Maintain hand washing hygiene
Interim Guidance for Emergency Medical Services (EMS) Systems
and9-1-1 Public Safety Answering
Points (PSAPs) for Management ofPatients with Confirmed or
Suspected Swine-Origin Influenza A(H1N1) Infection
Infectious Period
bull Persons with swine-origin influenza A (H1N1) virus infection should be considered potentially infectious from one day before to 7 days following illness
onset bull Persons who continue to be ill longer than 7 days after
illness onset should be considered potentially contagious until symptoms have resolved
bull Children especially younger children might potentially be contagious for longer periods
Case Definitions for Infection with Swine-origin Influenza A
(H1N1) Virus (S-OIV)bull A confirmed case of S-OIV infection is defined as a person with an acute febrile
respiratory illness with laboratory confirmed S-OIV infection at CDC bybull one or more of the following testsbull 1 real-time RT-PCRbull 2 viral culturebull A probable case of S-OIV infection is defined as a person with an acute febrile
respiratory illness who is positive for influenza A but negative for H1 andbull H3 by influenza RT-PCRbull A suspected case of S-OIV infection is defined as a person with acute febrile
respiratory illness with onsetbull 1048698 within 7 days of close contact with a person who is a confirmed case of S-OIV
infection orbull 1048698 within 7 days of travel to community either within the United States or internationally
where there are one or more confirmed cases of S-OIVbull infection orbull 1048698 resides in a community where there are one or more confirmed cases of S-OIV
infection
Recommendations for 9-1-1 Public Safety Answering Points(PSAP)
bull It is important for the PSAPs to question callers to ascertain if there is anyone at the incident location who is possibly afflicted by the swine-origin
bull influenza A (H1N1) virus to communicate the possible risk to EMS personnel prior to arrival and to assign the appropriate EMS resources PSAPs should
bull review existing medical dispatch procedures and coordinate any modifications with their EMS medical director and in coordination with their local
bull department of public healthbull Interim recommendationsbull 1048698 PSAP call takers should screen all callers for any symptoms of acute febrile
respiratory illness Callers should be asked if they or someone at thebull incident location has had nasal congestion cough fever or other flu-like symptomsbull 1048698 If the PSAP call taker suspects a caller is noting symptoms of acute febrile
respiratory febrile illness they should make sure any firstbull responders and EMS personnel are aware of the potential for ldquoacute febrile respiratory
illnessrdquo before the responders arrive on scene
If there HAS NOT been swine-origin influenza reported in the geographic area (httpwwwcdcgovswineflu) EMS providers should assess all patients as
follows
bull 1048698 Step 1 EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine
bull respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza
bull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following nasal congestion rhinorrhea
bull sore throat or cough)bull 1048698 If no acute febrile respiratory illness proceed with normal EMS carebull 1048698 If symptoms of acute febrile respiratory illness then assess all patients for travel to a
geographic area with confirmed cases of swine-originbull influenza within the last 7 days or close contact with someone with travel to these areasbull 1048698 If travel exposure don appropriate PPE for suspected case of swine-origin influenzabull 1048698 If no travel exposure place a standard surgical mask on the patient (if tolerated) and use
appropriate PPE for cases of acute febrilebull respiratory illness without suspicion of swine-origin influenza (as described in PPE section)
If the CDC confirmed swine-origin influenza in the geographic area (httpwwwcdcgovswineflu )
bull 1048698 Step 1 Address scene safetybull 1048698 If PSAP advises potential for acute febrile respiratory illness symptoms on scene
EMS personnel should don PPE for suspected cases ofbull swine-origin influenza prior to entering scenebull 1048698 If PSAP has not identified individuals with symptoms of acute febrile respiratory
illness on scene EMS personnel should stay more than 6bull feet away from patient and bystanders with symptoms and exercise appropriate
routine respiratory droplet precautions while assessing allbull patients for suspected cases of swine-origin influenzabull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following nasal congestion rhinorrheabull sore throat or cough)bull 1048698 If no symptoms of acute febrile respiratory illness provide routine EMS carebull 1048698 If symptoms of acute febrile respiratory illness don appropriate PPE for suspected
case of swine-origin influenza if not already on
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Whats different with this batch
bull Influenza A is primarily a respiratory virus The strain of swine flu in Mexico appears to be more virulent than strains seen in the United States
bull It tends to affect people between 25 and 45 years of age as opposed to the normal strains that affect older adults
How is Swine flu spread
bull Mainly person-to-person through coughing or sneezing from infected individuals
bull Some infections can occur by touching something with flu viruses on it and then touching the mouth or nose
Slowing the spread
bull Use Standard Precautionsbull Frequent hand washingbull Use mask when treating patients that are
coughing or sneezingbull Get plenty of sleepbull Maintain adequate nutrition
How about a vaccine
bull There is not enough time to develop a vaccine administer it and wait for the personrsquos body to manufacture antibodies for the swine flu
Whats the treatment
bull Tamiflu or Relenza seem to help with swine flubull The drugs will not prevent infectionbull Influenza A tends to develop resistance to
antiviral agents quickly
Whatrsquos the current who phase
bull As of April 29 2009 the current World Health Organization pandemic alert is at 4
bull Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause ldquocommunity-level outbreaksrdquo The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted Phase 4 indicates a significant risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion
Rational behind phase 4
bull Virus has increased human-to-human transmissibility but is not well adapted to humans and remains highly localized so that its spread may be possibly be delayed or contained
Update
bull Mid day April 29 WHO raised the alert to Phase 5 Phase 5 Is characterized by human-to-human spread of the virus into at least two countries in one WHO region While most countries will not be affected at this stage the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization communication and implementation of the planned mitigation measures is short
Rational
bull Virus is more adapted to humans and therefore more easily transmissible among humans It spreads in lager clusters but spread is localized This is likely to be the last chance for massive coordinated global intervention targeted to one or more foci to delay or contain spread
St Louis County Health Guidance
bull On April 28 St Louis County Department of Health issued an alert
Working Case Definition
bull Fever of gt=378 degrees C (100 degrees F) plus cough or sore throat AND
bull Travel to an area where swine flu is confirmed or contact to a known case
Home Isolation
bull CDC strongly recommends home isolation of cases
bull Persons who develop influenza-like-illness should be strongly encouraged to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved
Medical Care
bull Persons with ILI and wish to seek medical care should contact their medical care provider by phone
bull Persons who have difficulty breathing or shortness of breath or are believed to be severely ill should seek immediate medical attention
Infection Control
bull The CDC recommends that standard droplet and contact precautions be used for all patient care activities for ILI patients
bull Maintain hand washing hygiene
Interim Guidance for Emergency Medical Services (EMS) Systems
and9-1-1 Public Safety Answering
Points (PSAPs) for Management ofPatients with Confirmed or
Suspected Swine-Origin Influenza A(H1N1) Infection
Infectious Period
bull Persons with swine-origin influenza A (H1N1) virus infection should be considered potentially infectious from one day before to 7 days following illness
onset bull Persons who continue to be ill longer than 7 days after
illness onset should be considered potentially contagious until symptoms have resolved
bull Children especially younger children might potentially be contagious for longer periods
Case Definitions for Infection with Swine-origin Influenza A
(H1N1) Virus (S-OIV)bull A confirmed case of S-OIV infection is defined as a person with an acute febrile
respiratory illness with laboratory confirmed S-OIV infection at CDC bybull one or more of the following testsbull 1 real-time RT-PCRbull 2 viral culturebull A probable case of S-OIV infection is defined as a person with an acute febrile
respiratory illness who is positive for influenza A but negative for H1 andbull H3 by influenza RT-PCRbull A suspected case of S-OIV infection is defined as a person with acute febrile
respiratory illness with onsetbull 1048698 within 7 days of close contact with a person who is a confirmed case of S-OIV
infection orbull 1048698 within 7 days of travel to community either within the United States or internationally
where there are one or more confirmed cases of S-OIVbull infection orbull 1048698 resides in a community where there are one or more confirmed cases of S-OIV
infection
Recommendations for 9-1-1 Public Safety Answering Points(PSAP)
bull It is important for the PSAPs to question callers to ascertain if there is anyone at the incident location who is possibly afflicted by the swine-origin
bull influenza A (H1N1) virus to communicate the possible risk to EMS personnel prior to arrival and to assign the appropriate EMS resources PSAPs should
bull review existing medical dispatch procedures and coordinate any modifications with their EMS medical director and in coordination with their local
bull department of public healthbull Interim recommendationsbull 1048698 PSAP call takers should screen all callers for any symptoms of acute febrile
respiratory illness Callers should be asked if they or someone at thebull incident location has had nasal congestion cough fever or other flu-like symptomsbull 1048698 If the PSAP call taker suspects a caller is noting symptoms of acute febrile
respiratory febrile illness they should make sure any firstbull responders and EMS personnel are aware of the potential for ldquoacute febrile respiratory
illnessrdquo before the responders arrive on scene
If there HAS NOT been swine-origin influenza reported in the geographic area (httpwwwcdcgovswineflu) EMS providers should assess all patients as
follows
bull 1048698 Step 1 EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine
bull respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza
bull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following nasal congestion rhinorrhea
bull sore throat or cough)bull 1048698 If no acute febrile respiratory illness proceed with normal EMS carebull 1048698 If symptoms of acute febrile respiratory illness then assess all patients for travel to a
geographic area with confirmed cases of swine-originbull influenza within the last 7 days or close contact with someone with travel to these areasbull 1048698 If travel exposure don appropriate PPE for suspected case of swine-origin influenzabull 1048698 If no travel exposure place a standard surgical mask on the patient (if tolerated) and use
appropriate PPE for cases of acute febrilebull respiratory illness without suspicion of swine-origin influenza (as described in PPE section)
If the CDC confirmed swine-origin influenza in the geographic area (httpwwwcdcgovswineflu )
bull 1048698 Step 1 Address scene safetybull 1048698 If PSAP advises potential for acute febrile respiratory illness symptoms on scene
EMS personnel should don PPE for suspected cases ofbull swine-origin influenza prior to entering scenebull 1048698 If PSAP has not identified individuals with symptoms of acute febrile respiratory
illness on scene EMS personnel should stay more than 6bull feet away from patient and bystanders with symptoms and exercise appropriate
routine respiratory droplet precautions while assessing allbull patients for suspected cases of swine-origin influenzabull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following nasal congestion rhinorrheabull sore throat or cough)bull 1048698 If no symptoms of acute febrile respiratory illness provide routine EMS carebull 1048698 If symptoms of acute febrile respiratory illness don appropriate PPE for suspected
case of swine-origin influenza if not already on
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
How is Swine flu spread
bull Mainly person-to-person through coughing or sneezing from infected individuals
bull Some infections can occur by touching something with flu viruses on it and then touching the mouth or nose
Slowing the spread
bull Use Standard Precautionsbull Frequent hand washingbull Use mask when treating patients that are
coughing or sneezingbull Get plenty of sleepbull Maintain adequate nutrition
How about a vaccine
bull There is not enough time to develop a vaccine administer it and wait for the personrsquos body to manufacture antibodies for the swine flu
Whats the treatment
bull Tamiflu or Relenza seem to help with swine flubull The drugs will not prevent infectionbull Influenza A tends to develop resistance to
antiviral agents quickly
Whatrsquos the current who phase
bull As of April 29 2009 the current World Health Organization pandemic alert is at 4
bull Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause ldquocommunity-level outbreaksrdquo The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted Phase 4 indicates a significant risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion
Rational behind phase 4
bull Virus has increased human-to-human transmissibility but is not well adapted to humans and remains highly localized so that its spread may be possibly be delayed or contained
Update
bull Mid day April 29 WHO raised the alert to Phase 5 Phase 5 Is characterized by human-to-human spread of the virus into at least two countries in one WHO region While most countries will not be affected at this stage the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization communication and implementation of the planned mitigation measures is short
Rational
bull Virus is more adapted to humans and therefore more easily transmissible among humans It spreads in lager clusters but spread is localized This is likely to be the last chance for massive coordinated global intervention targeted to one or more foci to delay or contain spread
St Louis County Health Guidance
bull On April 28 St Louis County Department of Health issued an alert
Working Case Definition
bull Fever of gt=378 degrees C (100 degrees F) plus cough or sore throat AND
bull Travel to an area where swine flu is confirmed or contact to a known case
Home Isolation
bull CDC strongly recommends home isolation of cases
bull Persons who develop influenza-like-illness should be strongly encouraged to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved
Medical Care
bull Persons with ILI and wish to seek medical care should contact their medical care provider by phone
bull Persons who have difficulty breathing or shortness of breath or are believed to be severely ill should seek immediate medical attention
Infection Control
bull The CDC recommends that standard droplet and contact precautions be used for all patient care activities for ILI patients
bull Maintain hand washing hygiene
Interim Guidance for Emergency Medical Services (EMS) Systems
and9-1-1 Public Safety Answering
Points (PSAPs) for Management ofPatients with Confirmed or
Suspected Swine-Origin Influenza A(H1N1) Infection
Infectious Period
bull Persons with swine-origin influenza A (H1N1) virus infection should be considered potentially infectious from one day before to 7 days following illness
onset bull Persons who continue to be ill longer than 7 days after
illness onset should be considered potentially contagious until symptoms have resolved
bull Children especially younger children might potentially be contagious for longer periods
Case Definitions for Infection with Swine-origin Influenza A
(H1N1) Virus (S-OIV)bull A confirmed case of S-OIV infection is defined as a person with an acute febrile
respiratory illness with laboratory confirmed S-OIV infection at CDC bybull one or more of the following testsbull 1 real-time RT-PCRbull 2 viral culturebull A probable case of S-OIV infection is defined as a person with an acute febrile
respiratory illness who is positive for influenza A but negative for H1 andbull H3 by influenza RT-PCRbull A suspected case of S-OIV infection is defined as a person with acute febrile
respiratory illness with onsetbull 1048698 within 7 days of close contact with a person who is a confirmed case of S-OIV
infection orbull 1048698 within 7 days of travel to community either within the United States or internationally
where there are one or more confirmed cases of S-OIVbull infection orbull 1048698 resides in a community where there are one or more confirmed cases of S-OIV
infection
Recommendations for 9-1-1 Public Safety Answering Points(PSAP)
bull It is important for the PSAPs to question callers to ascertain if there is anyone at the incident location who is possibly afflicted by the swine-origin
bull influenza A (H1N1) virus to communicate the possible risk to EMS personnel prior to arrival and to assign the appropriate EMS resources PSAPs should
bull review existing medical dispatch procedures and coordinate any modifications with their EMS medical director and in coordination with their local
bull department of public healthbull Interim recommendationsbull 1048698 PSAP call takers should screen all callers for any symptoms of acute febrile
respiratory illness Callers should be asked if they or someone at thebull incident location has had nasal congestion cough fever or other flu-like symptomsbull 1048698 If the PSAP call taker suspects a caller is noting symptoms of acute febrile
respiratory febrile illness they should make sure any firstbull responders and EMS personnel are aware of the potential for ldquoacute febrile respiratory
illnessrdquo before the responders arrive on scene
If there HAS NOT been swine-origin influenza reported in the geographic area (httpwwwcdcgovswineflu) EMS providers should assess all patients as
follows
bull 1048698 Step 1 EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine
bull respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza
bull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following nasal congestion rhinorrhea
bull sore throat or cough)bull 1048698 If no acute febrile respiratory illness proceed with normal EMS carebull 1048698 If symptoms of acute febrile respiratory illness then assess all patients for travel to a
geographic area with confirmed cases of swine-originbull influenza within the last 7 days or close contact with someone with travel to these areasbull 1048698 If travel exposure don appropriate PPE for suspected case of swine-origin influenzabull 1048698 If no travel exposure place a standard surgical mask on the patient (if tolerated) and use
appropriate PPE for cases of acute febrilebull respiratory illness without suspicion of swine-origin influenza (as described in PPE section)
If the CDC confirmed swine-origin influenza in the geographic area (httpwwwcdcgovswineflu )
bull 1048698 Step 1 Address scene safetybull 1048698 If PSAP advises potential for acute febrile respiratory illness symptoms on scene
EMS personnel should don PPE for suspected cases ofbull swine-origin influenza prior to entering scenebull 1048698 If PSAP has not identified individuals with symptoms of acute febrile respiratory
illness on scene EMS personnel should stay more than 6bull feet away from patient and bystanders with symptoms and exercise appropriate
routine respiratory droplet precautions while assessing allbull patients for suspected cases of swine-origin influenzabull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following nasal congestion rhinorrheabull sore throat or cough)bull 1048698 If no symptoms of acute febrile respiratory illness provide routine EMS carebull 1048698 If symptoms of acute febrile respiratory illness don appropriate PPE for suspected
case of swine-origin influenza if not already on
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Slowing the spread
bull Use Standard Precautionsbull Frequent hand washingbull Use mask when treating patients that are
coughing or sneezingbull Get plenty of sleepbull Maintain adequate nutrition
How about a vaccine
bull There is not enough time to develop a vaccine administer it and wait for the personrsquos body to manufacture antibodies for the swine flu
Whats the treatment
bull Tamiflu or Relenza seem to help with swine flubull The drugs will not prevent infectionbull Influenza A tends to develop resistance to
antiviral agents quickly
Whatrsquos the current who phase
bull As of April 29 2009 the current World Health Organization pandemic alert is at 4
bull Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause ldquocommunity-level outbreaksrdquo The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted Phase 4 indicates a significant risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion
Rational behind phase 4
bull Virus has increased human-to-human transmissibility but is not well adapted to humans and remains highly localized so that its spread may be possibly be delayed or contained
Update
bull Mid day April 29 WHO raised the alert to Phase 5 Phase 5 Is characterized by human-to-human spread of the virus into at least two countries in one WHO region While most countries will not be affected at this stage the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization communication and implementation of the planned mitigation measures is short
Rational
bull Virus is more adapted to humans and therefore more easily transmissible among humans It spreads in lager clusters but spread is localized This is likely to be the last chance for massive coordinated global intervention targeted to one or more foci to delay or contain spread
St Louis County Health Guidance
bull On April 28 St Louis County Department of Health issued an alert
Working Case Definition
bull Fever of gt=378 degrees C (100 degrees F) plus cough or sore throat AND
bull Travel to an area where swine flu is confirmed or contact to a known case
Home Isolation
bull CDC strongly recommends home isolation of cases
bull Persons who develop influenza-like-illness should be strongly encouraged to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved
Medical Care
bull Persons with ILI and wish to seek medical care should contact their medical care provider by phone
bull Persons who have difficulty breathing or shortness of breath or are believed to be severely ill should seek immediate medical attention
Infection Control
bull The CDC recommends that standard droplet and contact precautions be used for all patient care activities for ILI patients
bull Maintain hand washing hygiene
Interim Guidance for Emergency Medical Services (EMS) Systems
and9-1-1 Public Safety Answering
Points (PSAPs) for Management ofPatients with Confirmed or
Suspected Swine-Origin Influenza A(H1N1) Infection
Infectious Period
bull Persons with swine-origin influenza A (H1N1) virus infection should be considered potentially infectious from one day before to 7 days following illness
onset bull Persons who continue to be ill longer than 7 days after
illness onset should be considered potentially contagious until symptoms have resolved
bull Children especially younger children might potentially be contagious for longer periods
Case Definitions for Infection with Swine-origin Influenza A
(H1N1) Virus (S-OIV)bull A confirmed case of S-OIV infection is defined as a person with an acute febrile
respiratory illness with laboratory confirmed S-OIV infection at CDC bybull one or more of the following testsbull 1 real-time RT-PCRbull 2 viral culturebull A probable case of S-OIV infection is defined as a person with an acute febrile
respiratory illness who is positive for influenza A but negative for H1 andbull H3 by influenza RT-PCRbull A suspected case of S-OIV infection is defined as a person with acute febrile
respiratory illness with onsetbull 1048698 within 7 days of close contact with a person who is a confirmed case of S-OIV
infection orbull 1048698 within 7 days of travel to community either within the United States or internationally
where there are one or more confirmed cases of S-OIVbull infection orbull 1048698 resides in a community where there are one or more confirmed cases of S-OIV
infection
Recommendations for 9-1-1 Public Safety Answering Points(PSAP)
bull It is important for the PSAPs to question callers to ascertain if there is anyone at the incident location who is possibly afflicted by the swine-origin
bull influenza A (H1N1) virus to communicate the possible risk to EMS personnel prior to arrival and to assign the appropriate EMS resources PSAPs should
bull review existing medical dispatch procedures and coordinate any modifications with their EMS medical director and in coordination with their local
bull department of public healthbull Interim recommendationsbull 1048698 PSAP call takers should screen all callers for any symptoms of acute febrile
respiratory illness Callers should be asked if they or someone at thebull incident location has had nasal congestion cough fever or other flu-like symptomsbull 1048698 If the PSAP call taker suspects a caller is noting symptoms of acute febrile
respiratory febrile illness they should make sure any firstbull responders and EMS personnel are aware of the potential for ldquoacute febrile respiratory
illnessrdquo before the responders arrive on scene
If there HAS NOT been swine-origin influenza reported in the geographic area (httpwwwcdcgovswineflu) EMS providers should assess all patients as
follows
bull 1048698 Step 1 EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine
bull respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza
bull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following nasal congestion rhinorrhea
bull sore throat or cough)bull 1048698 If no acute febrile respiratory illness proceed with normal EMS carebull 1048698 If symptoms of acute febrile respiratory illness then assess all patients for travel to a
geographic area with confirmed cases of swine-originbull influenza within the last 7 days or close contact with someone with travel to these areasbull 1048698 If travel exposure don appropriate PPE for suspected case of swine-origin influenzabull 1048698 If no travel exposure place a standard surgical mask on the patient (if tolerated) and use
appropriate PPE for cases of acute febrilebull respiratory illness without suspicion of swine-origin influenza (as described in PPE section)
If the CDC confirmed swine-origin influenza in the geographic area (httpwwwcdcgovswineflu )
bull 1048698 Step 1 Address scene safetybull 1048698 If PSAP advises potential for acute febrile respiratory illness symptoms on scene
EMS personnel should don PPE for suspected cases ofbull swine-origin influenza prior to entering scenebull 1048698 If PSAP has not identified individuals with symptoms of acute febrile respiratory
illness on scene EMS personnel should stay more than 6bull feet away from patient and bystanders with symptoms and exercise appropriate
routine respiratory droplet precautions while assessing allbull patients for suspected cases of swine-origin influenzabull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following nasal congestion rhinorrheabull sore throat or cough)bull 1048698 If no symptoms of acute febrile respiratory illness provide routine EMS carebull 1048698 If symptoms of acute febrile respiratory illness don appropriate PPE for suspected
case of swine-origin influenza if not already on
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
How about a vaccine
bull There is not enough time to develop a vaccine administer it and wait for the personrsquos body to manufacture antibodies for the swine flu
Whats the treatment
bull Tamiflu or Relenza seem to help with swine flubull The drugs will not prevent infectionbull Influenza A tends to develop resistance to
antiviral agents quickly
Whatrsquos the current who phase
bull As of April 29 2009 the current World Health Organization pandemic alert is at 4
bull Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause ldquocommunity-level outbreaksrdquo The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted Phase 4 indicates a significant risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion
Rational behind phase 4
bull Virus has increased human-to-human transmissibility but is not well adapted to humans and remains highly localized so that its spread may be possibly be delayed or contained
Update
bull Mid day April 29 WHO raised the alert to Phase 5 Phase 5 Is characterized by human-to-human spread of the virus into at least two countries in one WHO region While most countries will not be affected at this stage the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization communication and implementation of the planned mitigation measures is short
Rational
bull Virus is more adapted to humans and therefore more easily transmissible among humans It spreads in lager clusters but spread is localized This is likely to be the last chance for massive coordinated global intervention targeted to one or more foci to delay or contain spread
St Louis County Health Guidance
bull On April 28 St Louis County Department of Health issued an alert
Working Case Definition
bull Fever of gt=378 degrees C (100 degrees F) plus cough or sore throat AND
bull Travel to an area where swine flu is confirmed or contact to a known case
Home Isolation
bull CDC strongly recommends home isolation of cases
bull Persons who develop influenza-like-illness should be strongly encouraged to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved
Medical Care
bull Persons with ILI and wish to seek medical care should contact their medical care provider by phone
bull Persons who have difficulty breathing or shortness of breath or are believed to be severely ill should seek immediate medical attention
Infection Control
bull The CDC recommends that standard droplet and contact precautions be used for all patient care activities for ILI patients
bull Maintain hand washing hygiene
Interim Guidance for Emergency Medical Services (EMS) Systems
and9-1-1 Public Safety Answering
Points (PSAPs) for Management ofPatients with Confirmed or
Suspected Swine-Origin Influenza A(H1N1) Infection
Infectious Period
bull Persons with swine-origin influenza A (H1N1) virus infection should be considered potentially infectious from one day before to 7 days following illness
onset bull Persons who continue to be ill longer than 7 days after
illness onset should be considered potentially contagious until symptoms have resolved
bull Children especially younger children might potentially be contagious for longer periods
Case Definitions for Infection with Swine-origin Influenza A
(H1N1) Virus (S-OIV)bull A confirmed case of S-OIV infection is defined as a person with an acute febrile
respiratory illness with laboratory confirmed S-OIV infection at CDC bybull one or more of the following testsbull 1 real-time RT-PCRbull 2 viral culturebull A probable case of S-OIV infection is defined as a person with an acute febrile
respiratory illness who is positive for influenza A but negative for H1 andbull H3 by influenza RT-PCRbull A suspected case of S-OIV infection is defined as a person with acute febrile
respiratory illness with onsetbull 1048698 within 7 days of close contact with a person who is a confirmed case of S-OIV
infection orbull 1048698 within 7 days of travel to community either within the United States or internationally
where there are one or more confirmed cases of S-OIVbull infection orbull 1048698 resides in a community where there are one or more confirmed cases of S-OIV
infection
Recommendations for 9-1-1 Public Safety Answering Points(PSAP)
bull It is important for the PSAPs to question callers to ascertain if there is anyone at the incident location who is possibly afflicted by the swine-origin
bull influenza A (H1N1) virus to communicate the possible risk to EMS personnel prior to arrival and to assign the appropriate EMS resources PSAPs should
bull review existing medical dispatch procedures and coordinate any modifications with their EMS medical director and in coordination with their local
bull department of public healthbull Interim recommendationsbull 1048698 PSAP call takers should screen all callers for any symptoms of acute febrile
respiratory illness Callers should be asked if they or someone at thebull incident location has had nasal congestion cough fever or other flu-like symptomsbull 1048698 If the PSAP call taker suspects a caller is noting symptoms of acute febrile
respiratory febrile illness they should make sure any firstbull responders and EMS personnel are aware of the potential for ldquoacute febrile respiratory
illnessrdquo before the responders arrive on scene
If there HAS NOT been swine-origin influenza reported in the geographic area (httpwwwcdcgovswineflu) EMS providers should assess all patients as
follows
bull 1048698 Step 1 EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine
bull respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza
bull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following nasal congestion rhinorrhea
bull sore throat or cough)bull 1048698 If no acute febrile respiratory illness proceed with normal EMS carebull 1048698 If symptoms of acute febrile respiratory illness then assess all patients for travel to a
geographic area with confirmed cases of swine-originbull influenza within the last 7 days or close contact with someone with travel to these areasbull 1048698 If travel exposure don appropriate PPE for suspected case of swine-origin influenzabull 1048698 If no travel exposure place a standard surgical mask on the patient (if tolerated) and use
appropriate PPE for cases of acute febrilebull respiratory illness without suspicion of swine-origin influenza (as described in PPE section)
If the CDC confirmed swine-origin influenza in the geographic area (httpwwwcdcgovswineflu )
bull 1048698 Step 1 Address scene safetybull 1048698 If PSAP advises potential for acute febrile respiratory illness symptoms on scene
EMS personnel should don PPE for suspected cases ofbull swine-origin influenza prior to entering scenebull 1048698 If PSAP has not identified individuals with symptoms of acute febrile respiratory
illness on scene EMS personnel should stay more than 6bull feet away from patient and bystanders with symptoms and exercise appropriate
routine respiratory droplet precautions while assessing allbull patients for suspected cases of swine-origin influenzabull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following nasal congestion rhinorrheabull sore throat or cough)bull 1048698 If no symptoms of acute febrile respiratory illness provide routine EMS carebull 1048698 If symptoms of acute febrile respiratory illness don appropriate PPE for suspected
case of swine-origin influenza if not already on
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Whats the treatment
bull Tamiflu or Relenza seem to help with swine flubull The drugs will not prevent infectionbull Influenza A tends to develop resistance to
antiviral agents quickly
Whatrsquos the current who phase
bull As of April 29 2009 the current World Health Organization pandemic alert is at 4
bull Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause ldquocommunity-level outbreaksrdquo The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted Phase 4 indicates a significant risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion
Rational behind phase 4
bull Virus has increased human-to-human transmissibility but is not well adapted to humans and remains highly localized so that its spread may be possibly be delayed or contained
Update
bull Mid day April 29 WHO raised the alert to Phase 5 Phase 5 Is characterized by human-to-human spread of the virus into at least two countries in one WHO region While most countries will not be affected at this stage the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization communication and implementation of the planned mitigation measures is short
Rational
bull Virus is more adapted to humans and therefore more easily transmissible among humans It spreads in lager clusters but spread is localized This is likely to be the last chance for massive coordinated global intervention targeted to one or more foci to delay or contain spread
St Louis County Health Guidance
bull On April 28 St Louis County Department of Health issued an alert
Working Case Definition
bull Fever of gt=378 degrees C (100 degrees F) plus cough or sore throat AND
bull Travel to an area where swine flu is confirmed or contact to a known case
Home Isolation
bull CDC strongly recommends home isolation of cases
bull Persons who develop influenza-like-illness should be strongly encouraged to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved
Medical Care
bull Persons with ILI and wish to seek medical care should contact their medical care provider by phone
bull Persons who have difficulty breathing or shortness of breath or are believed to be severely ill should seek immediate medical attention
Infection Control
bull The CDC recommends that standard droplet and contact precautions be used for all patient care activities for ILI patients
bull Maintain hand washing hygiene
Interim Guidance for Emergency Medical Services (EMS) Systems
and9-1-1 Public Safety Answering
Points (PSAPs) for Management ofPatients with Confirmed or
Suspected Swine-Origin Influenza A(H1N1) Infection
Infectious Period
bull Persons with swine-origin influenza A (H1N1) virus infection should be considered potentially infectious from one day before to 7 days following illness
onset bull Persons who continue to be ill longer than 7 days after
illness onset should be considered potentially contagious until symptoms have resolved
bull Children especially younger children might potentially be contagious for longer periods
Case Definitions for Infection with Swine-origin Influenza A
(H1N1) Virus (S-OIV)bull A confirmed case of S-OIV infection is defined as a person with an acute febrile
respiratory illness with laboratory confirmed S-OIV infection at CDC bybull one or more of the following testsbull 1 real-time RT-PCRbull 2 viral culturebull A probable case of S-OIV infection is defined as a person with an acute febrile
respiratory illness who is positive for influenza A but negative for H1 andbull H3 by influenza RT-PCRbull A suspected case of S-OIV infection is defined as a person with acute febrile
respiratory illness with onsetbull 1048698 within 7 days of close contact with a person who is a confirmed case of S-OIV
infection orbull 1048698 within 7 days of travel to community either within the United States or internationally
where there are one or more confirmed cases of S-OIVbull infection orbull 1048698 resides in a community where there are one or more confirmed cases of S-OIV
infection
Recommendations for 9-1-1 Public Safety Answering Points(PSAP)
bull It is important for the PSAPs to question callers to ascertain if there is anyone at the incident location who is possibly afflicted by the swine-origin
bull influenza A (H1N1) virus to communicate the possible risk to EMS personnel prior to arrival and to assign the appropriate EMS resources PSAPs should
bull review existing medical dispatch procedures and coordinate any modifications with their EMS medical director and in coordination with their local
bull department of public healthbull Interim recommendationsbull 1048698 PSAP call takers should screen all callers for any symptoms of acute febrile
respiratory illness Callers should be asked if they or someone at thebull incident location has had nasal congestion cough fever or other flu-like symptomsbull 1048698 If the PSAP call taker suspects a caller is noting symptoms of acute febrile
respiratory febrile illness they should make sure any firstbull responders and EMS personnel are aware of the potential for ldquoacute febrile respiratory
illnessrdquo before the responders arrive on scene
If there HAS NOT been swine-origin influenza reported in the geographic area (httpwwwcdcgovswineflu) EMS providers should assess all patients as
follows
bull 1048698 Step 1 EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine
bull respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza
bull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following nasal congestion rhinorrhea
bull sore throat or cough)bull 1048698 If no acute febrile respiratory illness proceed with normal EMS carebull 1048698 If symptoms of acute febrile respiratory illness then assess all patients for travel to a
geographic area with confirmed cases of swine-originbull influenza within the last 7 days or close contact with someone with travel to these areasbull 1048698 If travel exposure don appropriate PPE for suspected case of swine-origin influenzabull 1048698 If no travel exposure place a standard surgical mask on the patient (if tolerated) and use
appropriate PPE for cases of acute febrilebull respiratory illness without suspicion of swine-origin influenza (as described in PPE section)
If the CDC confirmed swine-origin influenza in the geographic area (httpwwwcdcgovswineflu )
bull 1048698 Step 1 Address scene safetybull 1048698 If PSAP advises potential for acute febrile respiratory illness symptoms on scene
EMS personnel should don PPE for suspected cases ofbull swine-origin influenza prior to entering scenebull 1048698 If PSAP has not identified individuals with symptoms of acute febrile respiratory
illness on scene EMS personnel should stay more than 6bull feet away from patient and bystanders with symptoms and exercise appropriate
routine respiratory droplet precautions while assessing allbull patients for suspected cases of swine-origin influenzabull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following nasal congestion rhinorrheabull sore throat or cough)bull 1048698 If no symptoms of acute febrile respiratory illness provide routine EMS carebull 1048698 If symptoms of acute febrile respiratory illness don appropriate PPE for suspected
case of swine-origin influenza if not already on
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Whatrsquos the current who phase
bull As of April 29 2009 the current World Health Organization pandemic alert is at 4
bull Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause ldquocommunity-level outbreaksrdquo The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted Phase 4 indicates a significant risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion
Rational behind phase 4
bull Virus has increased human-to-human transmissibility but is not well adapted to humans and remains highly localized so that its spread may be possibly be delayed or contained
Update
bull Mid day April 29 WHO raised the alert to Phase 5 Phase 5 Is characterized by human-to-human spread of the virus into at least two countries in one WHO region While most countries will not be affected at this stage the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization communication and implementation of the planned mitigation measures is short
Rational
bull Virus is more adapted to humans and therefore more easily transmissible among humans It spreads in lager clusters but spread is localized This is likely to be the last chance for massive coordinated global intervention targeted to one or more foci to delay or contain spread
St Louis County Health Guidance
bull On April 28 St Louis County Department of Health issued an alert
Working Case Definition
bull Fever of gt=378 degrees C (100 degrees F) plus cough or sore throat AND
bull Travel to an area where swine flu is confirmed or contact to a known case
Home Isolation
bull CDC strongly recommends home isolation of cases
bull Persons who develop influenza-like-illness should be strongly encouraged to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved
Medical Care
bull Persons with ILI and wish to seek medical care should contact their medical care provider by phone
bull Persons who have difficulty breathing or shortness of breath or are believed to be severely ill should seek immediate medical attention
Infection Control
bull The CDC recommends that standard droplet and contact precautions be used for all patient care activities for ILI patients
bull Maintain hand washing hygiene
Interim Guidance for Emergency Medical Services (EMS) Systems
and9-1-1 Public Safety Answering
Points (PSAPs) for Management ofPatients with Confirmed or
Suspected Swine-Origin Influenza A(H1N1) Infection
Infectious Period
bull Persons with swine-origin influenza A (H1N1) virus infection should be considered potentially infectious from one day before to 7 days following illness
onset bull Persons who continue to be ill longer than 7 days after
illness onset should be considered potentially contagious until symptoms have resolved
bull Children especially younger children might potentially be contagious for longer periods
Case Definitions for Infection with Swine-origin Influenza A
(H1N1) Virus (S-OIV)bull A confirmed case of S-OIV infection is defined as a person with an acute febrile
respiratory illness with laboratory confirmed S-OIV infection at CDC bybull one or more of the following testsbull 1 real-time RT-PCRbull 2 viral culturebull A probable case of S-OIV infection is defined as a person with an acute febrile
respiratory illness who is positive for influenza A but negative for H1 andbull H3 by influenza RT-PCRbull A suspected case of S-OIV infection is defined as a person with acute febrile
respiratory illness with onsetbull 1048698 within 7 days of close contact with a person who is a confirmed case of S-OIV
infection orbull 1048698 within 7 days of travel to community either within the United States or internationally
where there are one or more confirmed cases of S-OIVbull infection orbull 1048698 resides in a community where there are one or more confirmed cases of S-OIV
infection
Recommendations for 9-1-1 Public Safety Answering Points(PSAP)
bull It is important for the PSAPs to question callers to ascertain if there is anyone at the incident location who is possibly afflicted by the swine-origin
bull influenza A (H1N1) virus to communicate the possible risk to EMS personnel prior to arrival and to assign the appropriate EMS resources PSAPs should
bull review existing medical dispatch procedures and coordinate any modifications with their EMS medical director and in coordination with their local
bull department of public healthbull Interim recommendationsbull 1048698 PSAP call takers should screen all callers for any symptoms of acute febrile
respiratory illness Callers should be asked if they or someone at thebull incident location has had nasal congestion cough fever or other flu-like symptomsbull 1048698 If the PSAP call taker suspects a caller is noting symptoms of acute febrile
respiratory febrile illness they should make sure any firstbull responders and EMS personnel are aware of the potential for ldquoacute febrile respiratory
illnessrdquo before the responders arrive on scene
If there HAS NOT been swine-origin influenza reported in the geographic area (httpwwwcdcgovswineflu) EMS providers should assess all patients as
follows
bull 1048698 Step 1 EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine
bull respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza
bull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following nasal congestion rhinorrhea
bull sore throat or cough)bull 1048698 If no acute febrile respiratory illness proceed with normal EMS carebull 1048698 If symptoms of acute febrile respiratory illness then assess all patients for travel to a
geographic area with confirmed cases of swine-originbull influenza within the last 7 days or close contact with someone with travel to these areasbull 1048698 If travel exposure don appropriate PPE for suspected case of swine-origin influenzabull 1048698 If no travel exposure place a standard surgical mask on the patient (if tolerated) and use
appropriate PPE for cases of acute febrilebull respiratory illness without suspicion of swine-origin influenza (as described in PPE section)
If the CDC confirmed swine-origin influenza in the geographic area (httpwwwcdcgovswineflu )
bull 1048698 Step 1 Address scene safetybull 1048698 If PSAP advises potential for acute febrile respiratory illness symptoms on scene
EMS personnel should don PPE for suspected cases ofbull swine-origin influenza prior to entering scenebull 1048698 If PSAP has not identified individuals with symptoms of acute febrile respiratory
illness on scene EMS personnel should stay more than 6bull feet away from patient and bystanders with symptoms and exercise appropriate
routine respiratory droplet precautions while assessing allbull patients for suspected cases of swine-origin influenzabull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following nasal congestion rhinorrheabull sore throat or cough)bull 1048698 If no symptoms of acute febrile respiratory illness provide routine EMS carebull 1048698 If symptoms of acute febrile respiratory illness don appropriate PPE for suspected
case of swine-origin influenza if not already on
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Rational behind phase 4
bull Virus has increased human-to-human transmissibility but is not well adapted to humans and remains highly localized so that its spread may be possibly be delayed or contained
Update
bull Mid day April 29 WHO raised the alert to Phase 5 Phase 5 Is characterized by human-to-human spread of the virus into at least two countries in one WHO region While most countries will not be affected at this stage the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization communication and implementation of the planned mitigation measures is short
Rational
bull Virus is more adapted to humans and therefore more easily transmissible among humans It spreads in lager clusters but spread is localized This is likely to be the last chance for massive coordinated global intervention targeted to one or more foci to delay or contain spread
St Louis County Health Guidance
bull On April 28 St Louis County Department of Health issued an alert
Working Case Definition
bull Fever of gt=378 degrees C (100 degrees F) plus cough or sore throat AND
bull Travel to an area where swine flu is confirmed or contact to a known case
Home Isolation
bull CDC strongly recommends home isolation of cases
bull Persons who develop influenza-like-illness should be strongly encouraged to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved
Medical Care
bull Persons with ILI and wish to seek medical care should contact their medical care provider by phone
bull Persons who have difficulty breathing or shortness of breath or are believed to be severely ill should seek immediate medical attention
Infection Control
bull The CDC recommends that standard droplet and contact precautions be used for all patient care activities for ILI patients
bull Maintain hand washing hygiene
Interim Guidance for Emergency Medical Services (EMS) Systems
and9-1-1 Public Safety Answering
Points (PSAPs) for Management ofPatients with Confirmed or
Suspected Swine-Origin Influenza A(H1N1) Infection
Infectious Period
bull Persons with swine-origin influenza A (H1N1) virus infection should be considered potentially infectious from one day before to 7 days following illness
onset bull Persons who continue to be ill longer than 7 days after
illness onset should be considered potentially contagious until symptoms have resolved
bull Children especially younger children might potentially be contagious for longer periods
Case Definitions for Infection with Swine-origin Influenza A
(H1N1) Virus (S-OIV)bull A confirmed case of S-OIV infection is defined as a person with an acute febrile
respiratory illness with laboratory confirmed S-OIV infection at CDC bybull one or more of the following testsbull 1 real-time RT-PCRbull 2 viral culturebull A probable case of S-OIV infection is defined as a person with an acute febrile
respiratory illness who is positive for influenza A but negative for H1 andbull H3 by influenza RT-PCRbull A suspected case of S-OIV infection is defined as a person with acute febrile
respiratory illness with onsetbull 1048698 within 7 days of close contact with a person who is a confirmed case of S-OIV
infection orbull 1048698 within 7 days of travel to community either within the United States or internationally
where there are one or more confirmed cases of S-OIVbull infection orbull 1048698 resides in a community where there are one or more confirmed cases of S-OIV
infection
Recommendations for 9-1-1 Public Safety Answering Points(PSAP)
bull It is important for the PSAPs to question callers to ascertain if there is anyone at the incident location who is possibly afflicted by the swine-origin
bull influenza A (H1N1) virus to communicate the possible risk to EMS personnel prior to arrival and to assign the appropriate EMS resources PSAPs should
bull review existing medical dispatch procedures and coordinate any modifications with their EMS medical director and in coordination with their local
bull department of public healthbull Interim recommendationsbull 1048698 PSAP call takers should screen all callers for any symptoms of acute febrile
respiratory illness Callers should be asked if they or someone at thebull incident location has had nasal congestion cough fever or other flu-like symptomsbull 1048698 If the PSAP call taker suspects a caller is noting symptoms of acute febrile
respiratory febrile illness they should make sure any firstbull responders and EMS personnel are aware of the potential for ldquoacute febrile respiratory
illnessrdquo before the responders arrive on scene
If there HAS NOT been swine-origin influenza reported in the geographic area (httpwwwcdcgovswineflu) EMS providers should assess all patients as
follows
bull 1048698 Step 1 EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine
bull respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza
bull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following nasal congestion rhinorrhea
bull sore throat or cough)bull 1048698 If no acute febrile respiratory illness proceed with normal EMS carebull 1048698 If symptoms of acute febrile respiratory illness then assess all patients for travel to a
geographic area with confirmed cases of swine-originbull influenza within the last 7 days or close contact with someone with travel to these areasbull 1048698 If travel exposure don appropriate PPE for suspected case of swine-origin influenzabull 1048698 If no travel exposure place a standard surgical mask on the patient (if tolerated) and use
appropriate PPE for cases of acute febrilebull respiratory illness without suspicion of swine-origin influenza (as described in PPE section)
If the CDC confirmed swine-origin influenza in the geographic area (httpwwwcdcgovswineflu )
bull 1048698 Step 1 Address scene safetybull 1048698 If PSAP advises potential for acute febrile respiratory illness symptoms on scene
EMS personnel should don PPE for suspected cases ofbull swine-origin influenza prior to entering scenebull 1048698 If PSAP has not identified individuals with symptoms of acute febrile respiratory
illness on scene EMS personnel should stay more than 6bull feet away from patient and bystanders with symptoms and exercise appropriate
routine respiratory droplet precautions while assessing allbull patients for suspected cases of swine-origin influenzabull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following nasal congestion rhinorrheabull sore throat or cough)bull 1048698 If no symptoms of acute febrile respiratory illness provide routine EMS carebull 1048698 If symptoms of acute febrile respiratory illness don appropriate PPE for suspected
case of swine-origin influenza if not already on
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Update
bull Mid day April 29 WHO raised the alert to Phase 5 Phase 5 Is characterized by human-to-human spread of the virus into at least two countries in one WHO region While most countries will not be affected at this stage the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization communication and implementation of the planned mitigation measures is short
Rational
bull Virus is more adapted to humans and therefore more easily transmissible among humans It spreads in lager clusters but spread is localized This is likely to be the last chance for massive coordinated global intervention targeted to one or more foci to delay or contain spread
St Louis County Health Guidance
bull On April 28 St Louis County Department of Health issued an alert
Working Case Definition
bull Fever of gt=378 degrees C (100 degrees F) plus cough or sore throat AND
bull Travel to an area where swine flu is confirmed or contact to a known case
Home Isolation
bull CDC strongly recommends home isolation of cases
bull Persons who develop influenza-like-illness should be strongly encouraged to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved
Medical Care
bull Persons with ILI and wish to seek medical care should contact their medical care provider by phone
bull Persons who have difficulty breathing or shortness of breath or are believed to be severely ill should seek immediate medical attention
Infection Control
bull The CDC recommends that standard droplet and contact precautions be used for all patient care activities for ILI patients
bull Maintain hand washing hygiene
Interim Guidance for Emergency Medical Services (EMS) Systems
and9-1-1 Public Safety Answering
Points (PSAPs) for Management ofPatients with Confirmed or
Suspected Swine-Origin Influenza A(H1N1) Infection
Infectious Period
bull Persons with swine-origin influenza A (H1N1) virus infection should be considered potentially infectious from one day before to 7 days following illness
onset bull Persons who continue to be ill longer than 7 days after
illness onset should be considered potentially contagious until symptoms have resolved
bull Children especially younger children might potentially be contagious for longer periods
Case Definitions for Infection with Swine-origin Influenza A
(H1N1) Virus (S-OIV)bull A confirmed case of S-OIV infection is defined as a person with an acute febrile
respiratory illness with laboratory confirmed S-OIV infection at CDC bybull one or more of the following testsbull 1 real-time RT-PCRbull 2 viral culturebull A probable case of S-OIV infection is defined as a person with an acute febrile
respiratory illness who is positive for influenza A but negative for H1 andbull H3 by influenza RT-PCRbull A suspected case of S-OIV infection is defined as a person with acute febrile
respiratory illness with onsetbull 1048698 within 7 days of close contact with a person who is a confirmed case of S-OIV
infection orbull 1048698 within 7 days of travel to community either within the United States or internationally
where there are one or more confirmed cases of S-OIVbull infection orbull 1048698 resides in a community where there are one or more confirmed cases of S-OIV
infection
Recommendations for 9-1-1 Public Safety Answering Points(PSAP)
bull It is important for the PSAPs to question callers to ascertain if there is anyone at the incident location who is possibly afflicted by the swine-origin
bull influenza A (H1N1) virus to communicate the possible risk to EMS personnel prior to arrival and to assign the appropriate EMS resources PSAPs should
bull review existing medical dispatch procedures and coordinate any modifications with their EMS medical director and in coordination with their local
bull department of public healthbull Interim recommendationsbull 1048698 PSAP call takers should screen all callers for any symptoms of acute febrile
respiratory illness Callers should be asked if they or someone at thebull incident location has had nasal congestion cough fever or other flu-like symptomsbull 1048698 If the PSAP call taker suspects a caller is noting symptoms of acute febrile
respiratory febrile illness they should make sure any firstbull responders and EMS personnel are aware of the potential for ldquoacute febrile respiratory
illnessrdquo before the responders arrive on scene
If there HAS NOT been swine-origin influenza reported in the geographic area (httpwwwcdcgovswineflu) EMS providers should assess all patients as
follows
bull 1048698 Step 1 EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine
bull respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza
bull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following nasal congestion rhinorrhea
bull sore throat or cough)bull 1048698 If no acute febrile respiratory illness proceed with normal EMS carebull 1048698 If symptoms of acute febrile respiratory illness then assess all patients for travel to a
geographic area with confirmed cases of swine-originbull influenza within the last 7 days or close contact with someone with travel to these areasbull 1048698 If travel exposure don appropriate PPE for suspected case of swine-origin influenzabull 1048698 If no travel exposure place a standard surgical mask on the patient (if tolerated) and use
appropriate PPE for cases of acute febrilebull respiratory illness without suspicion of swine-origin influenza (as described in PPE section)
If the CDC confirmed swine-origin influenza in the geographic area (httpwwwcdcgovswineflu )
bull 1048698 Step 1 Address scene safetybull 1048698 If PSAP advises potential for acute febrile respiratory illness symptoms on scene
EMS personnel should don PPE for suspected cases ofbull swine-origin influenza prior to entering scenebull 1048698 If PSAP has not identified individuals with symptoms of acute febrile respiratory
illness on scene EMS personnel should stay more than 6bull feet away from patient and bystanders with symptoms and exercise appropriate
routine respiratory droplet precautions while assessing allbull patients for suspected cases of swine-origin influenzabull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following nasal congestion rhinorrheabull sore throat or cough)bull 1048698 If no symptoms of acute febrile respiratory illness provide routine EMS carebull 1048698 If symptoms of acute febrile respiratory illness don appropriate PPE for suspected
case of swine-origin influenza if not already on
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Rational
bull Virus is more adapted to humans and therefore more easily transmissible among humans It spreads in lager clusters but spread is localized This is likely to be the last chance for massive coordinated global intervention targeted to one or more foci to delay or contain spread
St Louis County Health Guidance
bull On April 28 St Louis County Department of Health issued an alert
Working Case Definition
bull Fever of gt=378 degrees C (100 degrees F) plus cough or sore throat AND
bull Travel to an area where swine flu is confirmed or contact to a known case
Home Isolation
bull CDC strongly recommends home isolation of cases
bull Persons who develop influenza-like-illness should be strongly encouraged to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved
Medical Care
bull Persons with ILI and wish to seek medical care should contact their medical care provider by phone
bull Persons who have difficulty breathing or shortness of breath or are believed to be severely ill should seek immediate medical attention
Infection Control
bull The CDC recommends that standard droplet and contact precautions be used for all patient care activities for ILI patients
bull Maintain hand washing hygiene
Interim Guidance for Emergency Medical Services (EMS) Systems
and9-1-1 Public Safety Answering
Points (PSAPs) for Management ofPatients with Confirmed or
Suspected Swine-Origin Influenza A(H1N1) Infection
Infectious Period
bull Persons with swine-origin influenza A (H1N1) virus infection should be considered potentially infectious from one day before to 7 days following illness
onset bull Persons who continue to be ill longer than 7 days after
illness onset should be considered potentially contagious until symptoms have resolved
bull Children especially younger children might potentially be contagious for longer periods
Case Definitions for Infection with Swine-origin Influenza A
(H1N1) Virus (S-OIV)bull A confirmed case of S-OIV infection is defined as a person with an acute febrile
respiratory illness with laboratory confirmed S-OIV infection at CDC bybull one or more of the following testsbull 1 real-time RT-PCRbull 2 viral culturebull A probable case of S-OIV infection is defined as a person with an acute febrile
respiratory illness who is positive for influenza A but negative for H1 andbull H3 by influenza RT-PCRbull A suspected case of S-OIV infection is defined as a person with acute febrile
respiratory illness with onsetbull 1048698 within 7 days of close contact with a person who is a confirmed case of S-OIV
infection orbull 1048698 within 7 days of travel to community either within the United States or internationally
where there are one or more confirmed cases of S-OIVbull infection orbull 1048698 resides in a community where there are one or more confirmed cases of S-OIV
infection
Recommendations for 9-1-1 Public Safety Answering Points(PSAP)
bull It is important for the PSAPs to question callers to ascertain if there is anyone at the incident location who is possibly afflicted by the swine-origin
bull influenza A (H1N1) virus to communicate the possible risk to EMS personnel prior to arrival and to assign the appropriate EMS resources PSAPs should
bull review existing medical dispatch procedures and coordinate any modifications with their EMS medical director and in coordination with their local
bull department of public healthbull Interim recommendationsbull 1048698 PSAP call takers should screen all callers for any symptoms of acute febrile
respiratory illness Callers should be asked if they or someone at thebull incident location has had nasal congestion cough fever or other flu-like symptomsbull 1048698 If the PSAP call taker suspects a caller is noting symptoms of acute febrile
respiratory febrile illness they should make sure any firstbull responders and EMS personnel are aware of the potential for ldquoacute febrile respiratory
illnessrdquo before the responders arrive on scene
If there HAS NOT been swine-origin influenza reported in the geographic area (httpwwwcdcgovswineflu) EMS providers should assess all patients as
follows
bull 1048698 Step 1 EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine
bull respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza
bull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following nasal congestion rhinorrhea
bull sore throat or cough)bull 1048698 If no acute febrile respiratory illness proceed with normal EMS carebull 1048698 If symptoms of acute febrile respiratory illness then assess all patients for travel to a
geographic area with confirmed cases of swine-originbull influenza within the last 7 days or close contact with someone with travel to these areasbull 1048698 If travel exposure don appropriate PPE for suspected case of swine-origin influenzabull 1048698 If no travel exposure place a standard surgical mask on the patient (if tolerated) and use
appropriate PPE for cases of acute febrilebull respiratory illness without suspicion of swine-origin influenza (as described in PPE section)
If the CDC confirmed swine-origin influenza in the geographic area (httpwwwcdcgovswineflu )
bull 1048698 Step 1 Address scene safetybull 1048698 If PSAP advises potential for acute febrile respiratory illness symptoms on scene
EMS personnel should don PPE for suspected cases ofbull swine-origin influenza prior to entering scenebull 1048698 If PSAP has not identified individuals with symptoms of acute febrile respiratory
illness on scene EMS personnel should stay more than 6bull feet away from patient and bystanders with symptoms and exercise appropriate
routine respiratory droplet precautions while assessing allbull patients for suspected cases of swine-origin influenzabull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following nasal congestion rhinorrheabull sore throat or cough)bull 1048698 If no symptoms of acute febrile respiratory illness provide routine EMS carebull 1048698 If symptoms of acute febrile respiratory illness don appropriate PPE for suspected
case of swine-origin influenza if not already on
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
St Louis County Health Guidance
bull On April 28 St Louis County Department of Health issued an alert
Working Case Definition
bull Fever of gt=378 degrees C (100 degrees F) plus cough or sore throat AND
bull Travel to an area where swine flu is confirmed or contact to a known case
Home Isolation
bull CDC strongly recommends home isolation of cases
bull Persons who develop influenza-like-illness should be strongly encouraged to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved
Medical Care
bull Persons with ILI and wish to seek medical care should contact their medical care provider by phone
bull Persons who have difficulty breathing or shortness of breath or are believed to be severely ill should seek immediate medical attention
Infection Control
bull The CDC recommends that standard droplet and contact precautions be used for all patient care activities for ILI patients
bull Maintain hand washing hygiene
Interim Guidance for Emergency Medical Services (EMS) Systems
and9-1-1 Public Safety Answering
Points (PSAPs) for Management ofPatients with Confirmed or
Suspected Swine-Origin Influenza A(H1N1) Infection
Infectious Period
bull Persons with swine-origin influenza A (H1N1) virus infection should be considered potentially infectious from one day before to 7 days following illness
onset bull Persons who continue to be ill longer than 7 days after
illness onset should be considered potentially contagious until symptoms have resolved
bull Children especially younger children might potentially be contagious for longer periods
Case Definitions for Infection with Swine-origin Influenza A
(H1N1) Virus (S-OIV)bull A confirmed case of S-OIV infection is defined as a person with an acute febrile
respiratory illness with laboratory confirmed S-OIV infection at CDC bybull one or more of the following testsbull 1 real-time RT-PCRbull 2 viral culturebull A probable case of S-OIV infection is defined as a person with an acute febrile
respiratory illness who is positive for influenza A but negative for H1 andbull H3 by influenza RT-PCRbull A suspected case of S-OIV infection is defined as a person with acute febrile
respiratory illness with onsetbull 1048698 within 7 days of close contact with a person who is a confirmed case of S-OIV
infection orbull 1048698 within 7 days of travel to community either within the United States or internationally
where there are one or more confirmed cases of S-OIVbull infection orbull 1048698 resides in a community where there are one or more confirmed cases of S-OIV
infection
Recommendations for 9-1-1 Public Safety Answering Points(PSAP)
bull It is important for the PSAPs to question callers to ascertain if there is anyone at the incident location who is possibly afflicted by the swine-origin
bull influenza A (H1N1) virus to communicate the possible risk to EMS personnel prior to arrival and to assign the appropriate EMS resources PSAPs should
bull review existing medical dispatch procedures and coordinate any modifications with their EMS medical director and in coordination with their local
bull department of public healthbull Interim recommendationsbull 1048698 PSAP call takers should screen all callers for any symptoms of acute febrile
respiratory illness Callers should be asked if they or someone at thebull incident location has had nasal congestion cough fever or other flu-like symptomsbull 1048698 If the PSAP call taker suspects a caller is noting symptoms of acute febrile
respiratory febrile illness they should make sure any firstbull responders and EMS personnel are aware of the potential for ldquoacute febrile respiratory
illnessrdquo before the responders arrive on scene
If there HAS NOT been swine-origin influenza reported in the geographic area (httpwwwcdcgovswineflu) EMS providers should assess all patients as
follows
bull 1048698 Step 1 EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine
bull respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza
bull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following nasal congestion rhinorrhea
bull sore throat or cough)bull 1048698 If no acute febrile respiratory illness proceed with normal EMS carebull 1048698 If symptoms of acute febrile respiratory illness then assess all patients for travel to a
geographic area with confirmed cases of swine-originbull influenza within the last 7 days or close contact with someone with travel to these areasbull 1048698 If travel exposure don appropriate PPE for suspected case of swine-origin influenzabull 1048698 If no travel exposure place a standard surgical mask on the patient (if tolerated) and use
appropriate PPE for cases of acute febrilebull respiratory illness without suspicion of swine-origin influenza (as described in PPE section)
If the CDC confirmed swine-origin influenza in the geographic area (httpwwwcdcgovswineflu )
bull 1048698 Step 1 Address scene safetybull 1048698 If PSAP advises potential for acute febrile respiratory illness symptoms on scene
EMS personnel should don PPE for suspected cases ofbull swine-origin influenza prior to entering scenebull 1048698 If PSAP has not identified individuals with symptoms of acute febrile respiratory
illness on scene EMS personnel should stay more than 6bull feet away from patient and bystanders with symptoms and exercise appropriate
routine respiratory droplet precautions while assessing allbull patients for suspected cases of swine-origin influenzabull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following nasal congestion rhinorrheabull sore throat or cough)bull 1048698 If no symptoms of acute febrile respiratory illness provide routine EMS carebull 1048698 If symptoms of acute febrile respiratory illness don appropriate PPE for suspected
case of swine-origin influenza if not already on
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Working Case Definition
bull Fever of gt=378 degrees C (100 degrees F) plus cough or sore throat AND
bull Travel to an area where swine flu is confirmed or contact to a known case
Home Isolation
bull CDC strongly recommends home isolation of cases
bull Persons who develop influenza-like-illness should be strongly encouraged to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved
Medical Care
bull Persons with ILI and wish to seek medical care should contact their medical care provider by phone
bull Persons who have difficulty breathing or shortness of breath or are believed to be severely ill should seek immediate medical attention
Infection Control
bull The CDC recommends that standard droplet and contact precautions be used for all patient care activities for ILI patients
bull Maintain hand washing hygiene
Interim Guidance for Emergency Medical Services (EMS) Systems
and9-1-1 Public Safety Answering
Points (PSAPs) for Management ofPatients with Confirmed or
Suspected Swine-Origin Influenza A(H1N1) Infection
Infectious Period
bull Persons with swine-origin influenza A (H1N1) virus infection should be considered potentially infectious from one day before to 7 days following illness
onset bull Persons who continue to be ill longer than 7 days after
illness onset should be considered potentially contagious until symptoms have resolved
bull Children especially younger children might potentially be contagious for longer periods
Case Definitions for Infection with Swine-origin Influenza A
(H1N1) Virus (S-OIV)bull A confirmed case of S-OIV infection is defined as a person with an acute febrile
respiratory illness with laboratory confirmed S-OIV infection at CDC bybull one or more of the following testsbull 1 real-time RT-PCRbull 2 viral culturebull A probable case of S-OIV infection is defined as a person with an acute febrile
respiratory illness who is positive for influenza A but negative for H1 andbull H3 by influenza RT-PCRbull A suspected case of S-OIV infection is defined as a person with acute febrile
respiratory illness with onsetbull 1048698 within 7 days of close contact with a person who is a confirmed case of S-OIV
infection orbull 1048698 within 7 days of travel to community either within the United States or internationally
where there are one or more confirmed cases of S-OIVbull infection orbull 1048698 resides in a community where there are one or more confirmed cases of S-OIV
infection
Recommendations for 9-1-1 Public Safety Answering Points(PSAP)
bull It is important for the PSAPs to question callers to ascertain if there is anyone at the incident location who is possibly afflicted by the swine-origin
bull influenza A (H1N1) virus to communicate the possible risk to EMS personnel prior to arrival and to assign the appropriate EMS resources PSAPs should
bull review existing medical dispatch procedures and coordinate any modifications with their EMS medical director and in coordination with their local
bull department of public healthbull Interim recommendationsbull 1048698 PSAP call takers should screen all callers for any symptoms of acute febrile
respiratory illness Callers should be asked if they or someone at thebull incident location has had nasal congestion cough fever or other flu-like symptomsbull 1048698 If the PSAP call taker suspects a caller is noting symptoms of acute febrile
respiratory febrile illness they should make sure any firstbull responders and EMS personnel are aware of the potential for ldquoacute febrile respiratory
illnessrdquo before the responders arrive on scene
If there HAS NOT been swine-origin influenza reported in the geographic area (httpwwwcdcgovswineflu) EMS providers should assess all patients as
follows
bull 1048698 Step 1 EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine
bull respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza
bull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following nasal congestion rhinorrhea
bull sore throat or cough)bull 1048698 If no acute febrile respiratory illness proceed with normal EMS carebull 1048698 If symptoms of acute febrile respiratory illness then assess all patients for travel to a
geographic area with confirmed cases of swine-originbull influenza within the last 7 days or close contact with someone with travel to these areasbull 1048698 If travel exposure don appropriate PPE for suspected case of swine-origin influenzabull 1048698 If no travel exposure place a standard surgical mask on the patient (if tolerated) and use
appropriate PPE for cases of acute febrilebull respiratory illness without suspicion of swine-origin influenza (as described in PPE section)
If the CDC confirmed swine-origin influenza in the geographic area (httpwwwcdcgovswineflu )
bull 1048698 Step 1 Address scene safetybull 1048698 If PSAP advises potential for acute febrile respiratory illness symptoms on scene
EMS personnel should don PPE for suspected cases ofbull swine-origin influenza prior to entering scenebull 1048698 If PSAP has not identified individuals with symptoms of acute febrile respiratory
illness on scene EMS personnel should stay more than 6bull feet away from patient and bystanders with symptoms and exercise appropriate
routine respiratory droplet precautions while assessing allbull patients for suspected cases of swine-origin influenzabull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following nasal congestion rhinorrheabull sore throat or cough)bull 1048698 If no symptoms of acute febrile respiratory illness provide routine EMS carebull 1048698 If symptoms of acute febrile respiratory illness don appropriate PPE for suspected
case of swine-origin influenza if not already on
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Home Isolation
bull CDC strongly recommends home isolation of cases
bull Persons who develop influenza-like-illness should be strongly encouraged to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved
Medical Care
bull Persons with ILI and wish to seek medical care should contact their medical care provider by phone
bull Persons who have difficulty breathing or shortness of breath or are believed to be severely ill should seek immediate medical attention
Infection Control
bull The CDC recommends that standard droplet and contact precautions be used for all patient care activities for ILI patients
bull Maintain hand washing hygiene
Interim Guidance for Emergency Medical Services (EMS) Systems
and9-1-1 Public Safety Answering
Points (PSAPs) for Management ofPatients with Confirmed or
Suspected Swine-Origin Influenza A(H1N1) Infection
Infectious Period
bull Persons with swine-origin influenza A (H1N1) virus infection should be considered potentially infectious from one day before to 7 days following illness
onset bull Persons who continue to be ill longer than 7 days after
illness onset should be considered potentially contagious until symptoms have resolved
bull Children especially younger children might potentially be contagious for longer periods
Case Definitions for Infection with Swine-origin Influenza A
(H1N1) Virus (S-OIV)bull A confirmed case of S-OIV infection is defined as a person with an acute febrile
respiratory illness with laboratory confirmed S-OIV infection at CDC bybull one or more of the following testsbull 1 real-time RT-PCRbull 2 viral culturebull A probable case of S-OIV infection is defined as a person with an acute febrile
respiratory illness who is positive for influenza A but negative for H1 andbull H3 by influenza RT-PCRbull A suspected case of S-OIV infection is defined as a person with acute febrile
respiratory illness with onsetbull 1048698 within 7 days of close contact with a person who is a confirmed case of S-OIV
infection orbull 1048698 within 7 days of travel to community either within the United States or internationally
where there are one or more confirmed cases of S-OIVbull infection orbull 1048698 resides in a community where there are one or more confirmed cases of S-OIV
infection
Recommendations for 9-1-1 Public Safety Answering Points(PSAP)
bull It is important for the PSAPs to question callers to ascertain if there is anyone at the incident location who is possibly afflicted by the swine-origin
bull influenza A (H1N1) virus to communicate the possible risk to EMS personnel prior to arrival and to assign the appropriate EMS resources PSAPs should
bull review existing medical dispatch procedures and coordinate any modifications with their EMS medical director and in coordination with their local
bull department of public healthbull Interim recommendationsbull 1048698 PSAP call takers should screen all callers for any symptoms of acute febrile
respiratory illness Callers should be asked if they or someone at thebull incident location has had nasal congestion cough fever or other flu-like symptomsbull 1048698 If the PSAP call taker suspects a caller is noting symptoms of acute febrile
respiratory febrile illness they should make sure any firstbull responders and EMS personnel are aware of the potential for ldquoacute febrile respiratory
illnessrdquo before the responders arrive on scene
If there HAS NOT been swine-origin influenza reported in the geographic area (httpwwwcdcgovswineflu) EMS providers should assess all patients as
follows
bull 1048698 Step 1 EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine
bull respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza
bull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following nasal congestion rhinorrhea
bull sore throat or cough)bull 1048698 If no acute febrile respiratory illness proceed with normal EMS carebull 1048698 If symptoms of acute febrile respiratory illness then assess all patients for travel to a
geographic area with confirmed cases of swine-originbull influenza within the last 7 days or close contact with someone with travel to these areasbull 1048698 If travel exposure don appropriate PPE for suspected case of swine-origin influenzabull 1048698 If no travel exposure place a standard surgical mask on the patient (if tolerated) and use
appropriate PPE for cases of acute febrilebull respiratory illness without suspicion of swine-origin influenza (as described in PPE section)
If the CDC confirmed swine-origin influenza in the geographic area (httpwwwcdcgovswineflu )
bull 1048698 Step 1 Address scene safetybull 1048698 If PSAP advises potential for acute febrile respiratory illness symptoms on scene
EMS personnel should don PPE for suspected cases ofbull swine-origin influenza prior to entering scenebull 1048698 If PSAP has not identified individuals with symptoms of acute febrile respiratory
illness on scene EMS personnel should stay more than 6bull feet away from patient and bystanders with symptoms and exercise appropriate
routine respiratory droplet precautions while assessing allbull patients for suspected cases of swine-origin influenzabull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following nasal congestion rhinorrheabull sore throat or cough)bull 1048698 If no symptoms of acute febrile respiratory illness provide routine EMS carebull 1048698 If symptoms of acute febrile respiratory illness don appropriate PPE for suspected
case of swine-origin influenza if not already on
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Medical Care
bull Persons with ILI and wish to seek medical care should contact their medical care provider by phone
bull Persons who have difficulty breathing or shortness of breath or are believed to be severely ill should seek immediate medical attention
Infection Control
bull The CDC recommends that standard droplet and contact precautions be used for all patient care activities for ILI patients
bull Maintain hand washing hygiene
Interim Guidance for Emergency Medical Services (EMS) Systems
and9-1-1 Public Safety Answering
Points (PSAPs) for Management ofPatients with Confirmed or
Suspected Swine-Origin Influenza A(H1N1) Infection
Infectious Period
bull Persons with swine-origin influenza A (H1N1) virus infection should be considered potentially infectious from one day before to 7 days following illness
onset bull Persons who continue to be ill longer than 7 days after
illness onset should be considered potentially contagious until symptoms have resolved
bull Children especially younger children might potentially be contagious for longer periods
Case Definitions for Infection with Swine-origin Influenza A
(H1N1) Virus (S-OIV)bull A confirmed case of S-OIV infection is defined as a person with an acute febrile
respiratory illness with laboratory confirmed S-OIV infection at CDC bybull one or more of the following testsbull 1 real-time RT-PCRbull 2 viral culturebull A probable case of S-OIV infection is defined as a person with an acute febrile
respiratory illness who is positive for influenza A but negative for H1 andbull H3 by influenza RT-PCRbull A suspected case of S-OIV infection is defined as a person with acute febrile
respiratory illness with onsetbull 1048698 within 7 days of close contact with a person who is a confirmed case of S-OIV
infection orbull 1048698 within 7 days of travel to community either within the United States or internationally
where there are one or more confirmed cases of S-OIVbull infection orbull 1048698 resides in a community where there are one or more confirmed cases of S-OIV
infection
Recommendations for 9-1-1 Public Safety Answering Points(PSAP)
bull It is important for the PSAPs to question callers to ascertain if there is anyone at the incident location who is possibly afflicted by the swine-origin
bull influenza A (H1N1) virus to communicate the possible risk to EMS personnel prior to arrival and to assign the appropriate EMS resources PSAPs should
bull review existing medical dispatch procedures and coordinate any modifications with their EMS medical director and in coordination with their local
bull department of public healthbull Interim recommendationsbull 1048698 PSAP call takers should screen all callers for any symptoms of acute febrile
respiratory illness Callers should be asked if they or someone at thebull incident location has had nasal congestion cough fever or other flu-like symptomsbull 1048698 If the PSAP call taker suspects a caller is noting symptoms of acute febrile
respiratory febrile illness they should make sure any firstbull responders and EMS personnel are aware of the potential for ldquoacute febrile respiratory
illnessrdquo before the responders arrive on scene
If there HAS NOT been swine-origin influenza reported in the geographic area (httpwwwcdcgovswineflu) EMS providers should assess all patients as
follows
bull 1048698 Step 1 EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine
bull respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza
bull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following nasal congestion rhinorrhea
bull sore throat or cough)bull 1048698 If no acute febrile respiratory illness proceed with normal EMS carebull 1048698 If symptoms of acute febrile respiratory illness then assess all patients for travel to a
geographic area with confirmed cases of swine-originbull influenza within the last 7 days or close contact with someone with travel to these areasbull 1048698 If travel exposure don appropriate PPE for suspected case of swine-origin influenzabull 1048698 If no travel exposure place a standard surgical mask on the patient (if tolerated) and use
appropriate PPE for cases of acute febrilebull respiratory illness without suspicion of swine-origin influenza (as described in PPE section)
If the CDC confirmed swine-origin influenza in the geographic area (httpwwwcdcgovswineflu )
bull 1048698 Step 1 Address scene safetybull 1048698 If PSAP advises potential for acute febrile respiratory illness symptoms on scene
EMS personnel should don PPE for suspected cases ofbull swine-origin influenza prior to entering scenebull 1048698 If PSAP has not identified individuals with symptoms of acute febrile respiratory
illness on scene EMS personnel should stay more than 6bull feet away from patient and bystanders with symptoms and exercise appropriate
routine respiratory droplet precautions while assessing allbull patients for suspected cases of swine-origin influenzabull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following nasal congestion rhinorrheabull sore throat or cough)bull 1048698 If no symptoms of acute febrile respiratory illness provide routine EMS carebull 1048698 If symptoms of acute febrile respiratory illness don appropriate PPE for suspected
case of swine-origin influenza if not already on
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Infection Control
bull The CDC recommends that standard droplet and contact precautions be used for all patient care activities for ILI patients
bull Maintain hand washing hygiene
Interim Guidance for Emergency Medical Services (EMS) Systems
and9-1-1 Public Safety Answering
Points (PSAPs) for Management ofPatients with Confirmed or
Suspected Swine-Origin Influenza A(H1N1) Infection
Infectious Period
bull Persons with swine-origin influenza A (H1N1) virus infection should be considered potentially infectious from one day before to 7 days following illness
onset bull Persons who continue to be ill longer than 7 days after
illness onset should be considered potentially contagious until symptoms have resolved
bull Children especially younger children might potentially be contagious for longer periods
Case Definitions for Infection with Swine-origin Influenza A
(H1N1) Virus (S-OIV)bull A confirmed case of S-OIV infection is defined as a person with an acute febrile
respiratory illness with laboratory confirmed S-OIV infection at CDC bybull one or more of the following testsbull 1 real-time RT-PCRbull 2 viral culturebull A probable case of S-OIV infection is defined as a person with an acute febrile
respiratory illness who is positive for influenza A but negative for H1 andbull H3 by influenza RT-PCRbull A suspected case of S-OIV infection is defined as a person with acute febrile
respiratory illness with onsetbull 1048698 within 7 days of close contact with a person who is a confirmed case of S-OIV
infection orbull 1048698 within 7 days of travel to community either within the United States or internationally
where there are one or more confirmed cases of S-OIVbull infection orbull 1048698 resides in a community where there are one or more confirmed cases of S-OIV
infection
Recommendations for 9-1-1 Public Safety Answering Points(PSAP)
bull It is important for the PSAPs to question callers to ascertain if there is anyone at the incident location who is possibly afflicted by the swine-origin
bull influenza A (H1N1) virus to communicate the possible risk to EMS personnel prior to arrival and to assign the appropriate EMS resources PSAPs should
bull review existing medical dispatch procedures and coordinate any modifications with their EMS medical director and in coordination with their local
bull department of public healthbull Interim recommendationsbull 1048698 PSAP call takers should screen all callers for any symptoms of acute febrile
respiratory illness Callers should be asked if they or someone at thebull incident location has had nasal congestion cough fever or other flu-like symptomsbull 1048698 If the PSAP call taker suspects a caller is noting symptoms of acute febrile
respiratory febrile illness they should make sure any firstbull responders and EMS personnel are aware of the potential for ldquoacute febrile respiratory
illnessrdquo before the responders arrive on scene
If there HAS NOT been swine-origin influenza reported in the geographic area (httpwwwcdcgovswineflu) EMS providers should assess all patients as
follows
bull 1048698 Step 1 EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine
bull respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza
bull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following nasal congestion rhinorrhea
bull sore throat or cough)bull 1048698 If no acute febrile respiratory illness proceed with normal EMS carebull 1048698 If symptoms of acute febrile respiratory illness then assess all patients for travel to a
geographic area with confirmed cases of swine-originbull influenza within the last 7 days or close contact with someone with travel to these areasbull 1048698 If travel exposure don appropriate PPE for suspected case of swine-origin influenzabull 1048698 If no travel exposure place a standard surgical mask on the patient (if tolerated) and use
appropriate PPE for cases of acute febrilebull respiratory illness without suspicion of swine-origin influenza (as described in PPE section)
If the CDC confirmed swine-origin influenza in the geographic area (httpwwwcdcgovswineflu )
bull 1048698 Step 1 Address scene safetybull 1048698 If PSAP advises potential for acute febrile respiratory illness symptoms on scene
EMS personnel should don PPE for suspected cases ofbull swine-origin influenza prior to entering scenebull 1048698 If PSAP has not identified individuals with symptoms of acute febrile respiratory
illness on scene EMS personnel should stay more than 6bull feet away from patient and bystanders with symptoms and exercise appropriate
routine respiratory droplet precautions while assessing allbull patients for suspected cases of swine-origin influenzabull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following nasal congestion rhinorrheabull sore throat or cough)bull 1048698 If no symptoms of acute febrile respiratory illness provide routine EMS carebull 1048698 If symptoms of acute febrile respiratory illness don appropriate PPE for suspected
case of swine-origin influenza if not already on
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Interim Guidance for Emergency Medical Services (EMS) Systems
and9-1-1 Public Safety Answering
Points (PSAPs) for Management ofPatients with Confirmed or
Suspected Swine-Origin Influenza A(H1N1) Infection
Infectious Period
bull Persons with swine-origin influenza A (H1N1) virus infection should be considered potentially infectious from one day before to 7 days following illness
onset bull Persons who continue to be ill longer than 7 days after
illness onset should be considered potentially contagious until symptoms have resolved
bull Children especially younger children might potentially be contagious for longer periods
Case Definitions for Infection with Swine-origin Influenza A
(H1N1) Virus (S-OIV)bull A confirmed case of S-OIV infection is defined as a person with an acute febrile
respiratory illness with laboratory confirmed S-OIV infection at CDC bybull one or more of the following testsbull 1 real-time RT-PCRbull 2 viral culturebull A probable case of S-OIV infection is defined as a person with an acute febrile
respiratory illness who is positive for influenza A but negative for H1 andbull H3 by influenza RT-PCRbull A suspected case of S-OIV infection is defined as a person with acute febrile
respiratory illness with onsetbull 1048698 within 7 days of close contact with a person who is a confirmed case of S-OIV
infection orbull 1048698 within 7 days of travel to community either within the United States or internationally
where there are one or more confirmed cases of S-OIVbull infection orbull 1048698 resides in a community where there are one or more confirmed cases of S-OIV
infection
Recommendations for 9-1-1 Public Safety Answering Points(PSAP)
bull It is important for the PSAPs to question callers to ascertain if there is anyone at the incident location who is possibly afflicted by the swine-origin
bull influenza A (H1N1) virus to communicate the possible risk to EMS personnel prior to arrival and to assign the appropriate EMS resources PSAPs should
bull review existing medical dispatch procedures and coordinate any modifications with their EMS medical director and in coordination with their local
bull department of public healthbull Interim recommendationsbull 1048698 PSAP call takers should screen all callers for any symptoms of acute febrile
respiratory illness Callers should be asked if they or someone at thebull incident location has had nasal congestion cough fever or other flu-like symptomsbull 1048698 If the PSAP call taker suspects a caller is noting symptoms of acute febrile
respiratory febrile illness they should make sure any firstbull responders and EMS personnel are aware of the potential for ldquoacute febrile respiratory
illnessrdquo before the responders arrive on scene
If there HAS NOT been swine-origin influenza reported in the geographic area (httpwwwcdcgovswineflu) EMS providers should assess all patients as
follows
bull 1048698 Step 1 EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine
bull respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza
bull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following nasal congestion rhinorrhea
bull sore throat or cough)bull 1048698 If no acute febrile respiratory illness proceed with normal EMS carebull 1048698 If symptoms of acute febrile respiratory illness then assess all patients for travel to a
geographic area with confirmed cases of swine-originbull influenza within the last 7 days or close contact with someone with travel to these areasbull 1048698 If travel exposure don appropriate PPE for suspected case of swine-origin influenzabull 1048698 If no travel exposure place a standard surgical mask on the patient (if tolerated) and use
appropriate PPE for cases of acute febrilebull respiratory illness without suspicion of swine-origin influenza (as described in PPE section)
If the CDC confirmed swine-origin influenza in the geographic area (httpwwwcdcgovswineflu )
bull 1048698 Step 1 Address scene safetybull 1048698 If PSAP advises potential for acute febrile respiratory illness symptoms on scene
EMS personnel should don PPE for suspected cases ofbull swine-origin influenza prior to entering scenebull 1048698 If PSAP has not identified individuals with symptoms of acute febrile respiratory
illness on scene EMS personnel should stay more than 6bull feet away from patient and bystanders with symptoms and exercise appropriate
routine respiratory droplet precautions while assessing allbull patients for suspected cases of swine-origin influenzabull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following nasal congestion rhinorrheabull sore throat or cough)bull 1048698 If no symptoms of acute febrile respiratory illness provide routine EMS carebull 1048698 If symptoms of acute febrile respiratory illness don appropriate PPE for suspected
case of swine-origin influenza if not already on
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Infectious Period
bull Persons with swine-origin influenza A (H1N1) virus infection should be considered potentially infectious from one day before to 7 days following illness
onset bull Persons who continue to be ill longer than 7 days after
illness onset should be considered potentially contagious until symptoms have resolved
bull Children especially younger children might potentially be contagious for longer periods
Case Definitions for Infection with Swine-origin Influenza A
(H1N1) Virus (S-OIV)bull A confirmed case of S-OIV infection is defined as a person with an acute febrile
respiratory illness with laboratory confirmed S-OIV infection at CDC bybull one or more of the following testsbull 1 real-time RT-PCRbull 2 viral culturebull A probable case of S-OIV infection is defined as a person with an acute febrile
respiratory illness who is positive for influenza A but negative for H1 andbull H3 by influenza RT-PCRbull A suspected case of S-OIV infection is defined as a person with acute febrile
respiratory illness with onsetbull 1048698 within 7 days of close contact with a person who is a confirmed case of S-OIV
infection orbull 1048698 within 7 days of travel to community either within the United States or internationally
where there are one or more confirmed cases of S-OIVbull infection orbull 1048698 resides in a community where there are one or more confirmed cases of S-OIV
infection
Recommendations for 9-1-1 Public Safety Answering Points(PSAP)
bull It is important for the PSAPs to question callers to ascertain if there is anyone at the incident location who is possibly afflicted by the swine-origin
bull influenza A (H1N1) virus to communicate the possible risk to EMS personnel prior to arrival and to assign the appropriate EMS resources PSAPs should
bull review existing medical dispatch procedures and coordinate any modifications with their EMS medical director and in coordination with their local
bull department of public healthbull Interim recommendationsbull 1048698 PSAP call takers should screen all callers for any symptoms of acute febrile
respiratory illness Callers should be asked if they or someone at thebull incident location has had nasal congestion cough fever or other flu-like symptomsbull 1048698 If the PSAP call taker suspects a caller is noting symptoms of acute febrile
respiratory febrile illness they should make sure any firstbull responders and EMS personnel are aware of the potential for ldquoacute febrile respiratory
illnessrdquo before the responders arrive on scene
If there HAS NOT been swine-origin influenza reported in the geographic area (httpwwwcdcgovswineflu) EMS providers should assess all patients as
follows
bull 1048698 Step 1 EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine
bull respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza
bull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following nasal congestion rhinorrhea
bull sore throat or cough)bull 1048698 If no acute febrile respiratory illness proceed with normal EMS carebull 1048698 If symptoms of acute febrile respiratory illness then assess all patients for travel to a
geographic area with confirmed cases of swine-originbull influenza within the last 7 days or close contact with someone with travel to these areasbull 1048698 If travel exposure don appropriate PPE for suspected case of swine-origin influenzabull 1048698 If no travel exposure place a standard surgical mask on the patient (if tolerated) and use
appropriate PPE for cases of acute febrilebull respiratory illness without suspicion of swine-origin influenza (as described in PPE section)
If the CDC confirmed swine-origin influenza in the geographic area (httpwwwcdcgovswineflu )
bull 1048698 Step 1 Address scene safetybull 1048698 If PSAP advises potential for acute febrile respiratory illness symptoms on scene
EMS personnel should don PPE for suspected cases ofbull swine-origin influenza prior to entering scenebull 1048698 If PSAP has not identified individuals with symptoms of acute febrile respiratory
illness on scene EMS personnel should stay more than 6bull feet away from patient and bystanders with symptoms and exercise appropriate
routine respiratory droplet precautions while assessing allbull patients for suspected cases of swine-origin influenzabull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following nasal congestion rhinorrheabull sore throat or cough)bull 1048698 If no symptoms of acute febrile respiratory illness provide routine EMS carebull 1048698 If symptoms of acute febrile respiratory illness don appropriate PPE for suspected
case of swine-origin influenza if not already on
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Case Definitions for Infection with Swine-origin Influenza A
(H1N1) Virus (S-OIV)bull A confirmed case of S-OIV infection is defined as a person with an acute febrile
respiratory illness with laboratory confirmed S-OIV infection at CDC bybull one or more of the following testsbull 1 real-time RT-PCRbull 2 viral culturebull A probable case of S-OIV infection is defined as a person with an acute febrile
respiratory illness who is positive for influenza A but negative for H1 andbull H3 by influenza RT-PCRbull A suspected case of S-OIV infection is defined as a person with acute febrile
respiratory illness with onsetbull 1048698 within 7 days of close contact with a person who is a confirmed case of S-OIV
infection orbull 1048698 within 7 days of travel to community either within the United States or internationally
where there are one or more confirmed cases of S-OIVbull infection orbull 1048698 resides in a community where there are one or more confirmed cases of S-OIV
infection
Recommendations for 9-1-1 Public Safety Answering Points(PSAP)
bull It is important for the PSAPs to question callers to ascertain if there is anyone at the incident location who is possibly afflicted by the swine-origin
bull influenza A (H1N1) virus to communicate the possible risk to EMS personnel prior to arrival and to assign the appropriate EMS resources PSAPs should
bull review existing medical dispatch procedures and coordinate any modifications with their EMS medical director and in coordination with their local
bull department of public healthbull Interim recommendationsbull 1048698 PSAP call takers should screen all callers for any symptoms of acute febrile
respiratory illness Callers should be asked if they or someone at thebull incident location has had nasal congestion cough fever or other flu-like symptomsbull 1048698 If the PSAP call taker suspects a caller is noting symptoms of acute febrile
respiratory febrile illness they should make sure any firstbull responders and EMS personnel are aware of the potential for ldquoacute febrile respiratory
illnessrdquo before the responders arrive on scene
If there HAS NOT been swine-origin influenza reported in the geographic area (httpwwwcdcgovswineflu) EMS providers should assess all patients as
follows
bull 1048698 Step 1 EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine
bull respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza
bull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following nasal congestion rhinorrhea
bull sore throat or cough)bull 1048698 If no acute febrile respiratory illness proceed with normal EMS carebull 1048698 If symptoms of acute febrile respiratory illness then assess all patients for travel to a
geographic area with confirmed cases of swine-originbull influenza within the last 7 days or close contact with someone with travel to these areasbull 1048698 If travel exposure don appropriate PPE for suspected case of swine-origin influenzabull 1048698 If no travel exposure place a standard surgical mask on the patient (if tolerated) and use
appropriate PPE for cases of acute febrilebull respiratory illness without suspicion of swine-origin influenza (as described in PPE section)
If the CDC confirmed swine-origin influenza in the geographic area (httpwwwcdcgovswineflu )
bull 1048698 Step 1 Address scene safetybull 1048698 If PSAP advises potential for acute febrile respiratory illness symptoms on scene
EMS personnel should don PPE for suspected cases ofbull swine-origin influenza prior to entering scenebull 1048698 If PSAP has not identified individuals with symptoms of acute febrile respiratory
illness on scene EMS personnel should stay more than 6bull feet away from patient and bystanders with symptoms and exercise appropriate
routine respiratory droplet precautions while assessing allbull patients for suspected cases of swine-origin influenzabull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following nasal congestion rhinorrheabull sore throat or cough)bull 1048698 If no symptoms of acute febrile respiratory illness provide routine EMS carebull 1048698 If symptoms of acute febrile respiratory illness don appropriate PPE for suspected
case of swine-origin influenza if not already on
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Recommendations for 9-1-1 Public Safety Answering Points(PSAP)
bull It is important for the PSAPs to question callers to ascertain if there is anyone at the incident location who is possibly afflicted by the swine-origin
bull influenza A (H1N1) virus to communicate the possible risk to EMS personnel prior to arrival and to assign the appropriate EMS resources PSAPs should
bull review existing medical dispatch procedures and coordinate any modifications with their EMS medical director and in coordination with their local
bull department of public healthbull Interim recommendationsbull 1048698 PSAP call takers should screen all callers for any symptoms of acute febrile
respiratory illness Callers should be asked if they or someone at thebull incident location has had nasal congestion cough fever or other flu-like symptomsbull 1048698 If the PSAP call taker suspects a caller is noting symptoms of acute febrile
respiratory febrile illness they should make sure any firstbull responders and EMS personnel are aware of the potential for ldquoacute febrile respiratory
illnessrdquo before the responders arrive on scene
If there HAS NOT been swine-origin influenza reported in the geographic area (httpwwwcdcgovswineflu) EMS providers should assess all patients as
follows
bull 1048698 Step 1 EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine
bull respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza
bull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following nasal congestion rhinorrhea
bull sore throat or cough)bull 1048698 If no acute febrile respiratory illness proceed with normal EMS carebull 1048698 If symptoms of acute febrile respiratory illness then assess all patients for travel to a
geographic area with confirmed cases of swine-originbull influenza within the last 7 days or close contact with someone with travel to these areasbull 1048698 If travel exposure don appropriate PPE for suspected case of swine-origin influenzabull 1048698 If no travel exposure place a standard surgical mask on the patient (if tolerated) and use
appropriate PPE for cases of acute febrilebull respiratory illness without suspicion of swine-origin influenza (as described in PPE section)
If the CDC confirmed swine-origin influenza in the geographic area (httpwwwcdcgovswineflu )
bull 1048698 Step 1 Address scene safetybull 1048698 If PSAP advises potential for acute febrile respiratory illness symptoms on scene
EMS personnel should don PPE for suspected cases ofbull swine-origin influenza prior to entering scenebull 1048698 If PSAP has not identified individuals with symptoms of acute febrile respiratory
illness on scene EMS personnel should stay more than 6bull feet away from patient and bystanders with symptoms and exercise appropriate
routine respiratory droplet precautions while assessing allbull patients for suspected cases of swine-origin influenzabull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following nasal congestion rhinorrheabull sore throat or cough)bull 1048698 If no symptoms of acute febrile respiratory illness provide routine EMS carebull 1048698 If symptoms of acute febrile respiratory illness don appropriate PPE for suspected
case of swine-origin influenza if not already on
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
If there HAS NOT been swine-origin influenza reported in the geographic area (httpwwwcdcgovswineflu) EMS providers should assess all patients as
follows
bull 1048698 Step 1 EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine
bull respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza
bull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following nasal congestion rhinorrhea
bull sore throat or cough)bull 1048698 If no acute febrile respiratory illness proceed with normal EMS carebull 1048698 If symptoms of acute febrile respiratory illness then assess all patients for travel to a
geographic area with confirmed cases of swine-originbull influenza within the last 7 days or close contact with someone with travel to these areasbull 1048698 If travel exposure don appropriate PPE for suspected case of swine-origin influenzabull 1048698 If no travel exposure place a standard surgical mask on the patient (if tolerated) and use
appropriate PPE for cases of acute febrilebull respiratory illness without suspicion of swine-origin influenza (as described in PPE section)
If the CDC confirmed swine-origin influenza in the geographic area (httpwwwcdcgovswineflu )
bull 1048698 Step 1 Address scene safetybull 1048698 If PSAP advises potential for acute febrile respiratory illness symptoms on scene
EMS personnel should don PPE for suspected cases ofbull swine-origin influenza prior to entering scenebull 1048698 If PSAP has not identified individuals with symptoms of acute febrile respiratory
illness on scene EMS personnel should stay more than 6bull feet away from patient and bystanders with symptoms and exercise appropriate
routine respiratory droplet precautions while assessing allbull patients for suspected cases of swine-origin influenzabull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following nasal congestion rhinorrheabull sore throat or cough)bull 1048698 If no symptoms of acute febrile respiratory illness provide routine EMS carebull 1048698 If symptoms of acute febrile respiratory illness don appropriate PPE for suspected
case of swine-origin influenza if not already on
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
If the CDC confirmed swine-origin influenza in the geographic area (httpwwwcdcgovswineflu )
bull 1048698 Step 1 Address scene safetybull 1048698 If PSAP advises potential for acute febrile respiratory illness symptoms on scene
EMS personnel should don PPE for suspected cases ofbull swine-origin influenza prior to entering scenebull 1048698 If PSAP has not identified individuals with symptoms of acute febrile respiratory
illness on scene EMS personnel should stay more than 6bull feet away from patient and bystanders with symptoms and exercise appropriate
routine respiratory droplet precautions while assessing allbull patients for suspected cases of swine-origin influenzabull 1048698 Step 2 Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following nasal congestion rhinorrheabull sore throat or cough)bull 1048698 If no symptoms of acute febrile respiratory illness provide routine EMS carebull 1048698 If symptoms of acute febrile respiratory illness don appropriate PPE for suspected
case of swine-origin influenza if not already on
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Personal protective equipment (PPE)
bull 1048698 When treating a patient with a suspected case of swine-origin influenza as defined above the following PPE should be worn
bull 1048698 Fit-tested disposable N95 respirator and eye protection (eg goggles eye shield) disposable non-sterile gloves and gown when coming
bull into close contact with the patientbull 1048698 When treating a patient that is not a suspected case of swine-origin
influenza but who has symptoms of acute febrile respiratory illness thebull following precautions should be takenbull 1048698 Place a standard surgical mask on the patient if tolerated If not tolerated
EMS personnel may wear a standard surgical maskbull 1048698 Use good respiratory hygiene ndash use non-sterile gloves for contact with
patient patient secretions or surfaces that may have beenbull contaminated Follow hand hygiene including hand washing or cleansing with
alcohol based hand disinfectant after contactbull 1048698 Encourage good patient compartment vehicle airflow ventilation to reduce
the concentration of aerosol accumulation when possible
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
1048698 All patients with acute febrile respiratory illness should wear a surgical mask if tolerated by the
patient
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
30 April 2009 -- The situation continues to evolve rapidly As of
1700 GMT 30 April 2009 11 countries have officially reported 257 cases of influenza A (H1N1) infection
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
The United States Government has reported 109 laboratory confirmed human
cases including one death Mexico has reported 97 confirmed human cases of
infection including seven deaths The following countries have reported
laboratory confirmed cases with no deaths - Austria (1) Canada (19)
Germany (3) Israel (2) Netherlands (1) New Zealand (3) Spain (13) Switzerland
(1) and the United Kingdom (8)
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Guidance for the Selection and Use of Personal Protective
Equipment (PPE) in Healthcare Settings
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
PPE Use in Healthcare SettingsProgram Goal
Improve personnel safety in the healthcare environment through appropriate use of PPE
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
PPE Use in Healthcare Settings Program Objectives
bull Provide information on the selection and use of PPE in healthcare settings
bull Practice how to safely don and remove PPE
PPE Use in Healthcare Settings
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Personal Protective Equipment Definition
ldquospecialized clothing or equipment worn by an employee for protection against infectious materialsrdquo (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Regulations and Recommendations for PPE
bull OSHA issues workplace health and safety regulations Regarding PPE employers mustndash Provide appropriate PPE for employeesndash Ensure that PPE is disposed or reusable PPE is cleaned
laundered repaired and stored after usebull OSHA also specifies circumstances for which PPE is
indicatedbull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Hierarchy of Safety and Health Controls
bull Training and administrative controlsbull Engineering controlsbull Work practice controlsbull Personal protective equipment
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Types of PPE Used in Healthcare Settings
bull Gloves ndash protect handsbull Gownsaprons ndash protect skin andor clothing bull Masks and respiratorsndash protect mouthnose
ndash Respirators ndash protect respiratory tract from airborne infectious agents
bull Goggles ndash protect eyesbull Face shields ndash protect face mouth nose and eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Factors Influencing PPE Selectionbull Type of exposure anticipated
ndash Splashspray versus touchndash Category of isolation precautions
bull Durability and appropriateness for the taskbull Fit
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or nonsterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Glovesbull Purpose ndash patient care environmental
services otherbull Glove material ndash vinyl latex nitrile otherbull Sterile or non-sterilebull One or two pairbull Single use or reusable
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Dorsquos and Donrsquots of Glove Usebull Work from ldquoclean to dirtyrdquobull Limit opportunities for ldquotouch contaminationrdquo -
protect yourself others and the environmentndash Donrsquot touch your face or adjust PPE with
contaminated glovesndash Donrsquot touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Dorsquos and Donrsquots of Glove Use (contrsquod)
bull Change glovesndash During use if torn and when heavily soiled (even
during use on the same patient)ndash After use on each patient
bull Discard in appropriate receptaclendash Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Gowns or Apronsbull Purpose of usebull Material ndash
ndash Natural or man-madendash Reusable or disposablendash Resistance to fluid penetration
bull Clean or sterile
PPE Use in Healthcare Settings
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Face Protectionbull Masks ndash protect nose and mouth
ndash Should fully cover nose and mouth and prevent fluid penetration
bull Goggles ndash protect eyesndash Should fit snuggly over and around eyesndash Personal glasses not a substitute for gogglesndash Antifog feature improves clarity
PPE Use in Healthcare Settings
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Face Protectionbull Face shields ndash protect face nose mouth and
eyesndash Should cover forehead extend below chin and wrap
around side of face
PPE Use in Healthcare Settings
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Respiratory Protectionbull Purpose ndash protect from inhalation of
infectious aerosols (eg Mycobacterium tuberculosis)
bull PPE types for respiratory protectionndash Particulate respiratorsndash Half- or full-face elastomeric respiratorsndash Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Elements of a Respiratory Protection Program
bull Medical evaluationbull Fit testingbull Trainingbull Fit checking before use
PPE Use in Healthcare Settings
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
For additional information on respiratorshellip
bull httpwwwcdcgovnioshnpptlrespirators respsarshtml
bull httpwwwcdcgovniosh99-143htmlbull httpwwwcdcgovnioshtopicsrespirators
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
PPE Use in Healthcare SettingsHow to Safely Don Use and
Remove PPE
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Key Points About PPEbull Don before contact with the patient generally
before entering the roombull Use carefully ndash donrsquot spread contaminationbull Remove and discard carefully either at the
doorway or immediately outside patient room remove respirator outside room
bull Immediately perform hand hygienePPE Use in Healthcare Settings
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Sequence for Donning PPEbull Gown firstbull Mask or respiratorbull Goggles or face shieldbull Gloves
Combination of PPE will affect sequence ndash be practical
PPE Use in Healthcare Settings
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
How to Don a Gownbull Select appropriate type and sizebull Opening is in the backbull Secure at neck and waistbull If gown is too small use two gowns
ndash Gown 1 ties in frontndash Gown 2 ties in back
PPE Use in Healthcare Settings
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
How to Don a Maskbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with ties or elasticbull Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
How to Don a Particulate Respirator
bull Select a fit tested respiratorbull Place over nose mouth and chinbull Fit flexible nose piece over nose bridgebull Secure on head with elasticbull Adjust to fitbull Perform a fit check ndash
ndash Inhale ndash respirator should collapsendash Exhale ndash check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
How to Don Eye and Face Protection
bull Position goggles over eyes and secure to the head using the ear pieces or headband
bull Position face shield over face and secure on brow with headband
bull Adjust to fit comfortablyPPE Use in Healthcare Settings
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
How to Don Glovesbull Don gloves lastbull Select correct type and sizebull Insert hands into glovesbull Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
How to Safely Use PPEbull Keep gloved hands away from facebull Avoid touching or adjusting other PPEbull Remove gloves if they become torn perform
hand hygiene before donning new glovesbull Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
PPE Use in Healthcare SettingsHow to Safely Remove PPE
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
ldquoContaminatedrdquo and ldquoCleanrdquo Areas of PPE
bull Contaminated ndash outside frontbull Areas of PPE that have or are likely to have been in
contact with body sites materials or environmental surfaces where the infectious organism may reside
bull Clean ndash inside outside back ties on head and back
bull Areas of PPE that are not likely to have been in contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Sequence for Removing PPEbull Glovesbull Face shield or gogglesbull Gownbull Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Where to Remove PPEbull At doorway before leaving patient room or in
anteroombull Remove respirator outside room after door
has been closed
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
How to Remove Gloves (1)bull Grasp outside edge near
wristbull Peel away from hand
turning glove inside-outbull Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
How to Remove Gloves (2)bull Slide ungloved finger
under the wrist of the remaining glove
bull Peel off from inside creating a bag for both gloves
bull DiscardPPE Use in Healthcare Settings
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Remove Goggles or Face Shieldbull Grasp ear or head
pieces with ungloved hands
bull Lift away from facebull Place in designated
receptacle for reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Removing Isolation Gownbull Unfasten tiesbull Peel gown away from
neck and shoulderbull Turn contaminated
outside toward the insidebull Fold or roll into a bundlebull Discard
PPE Use in Healthcare Settings
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Removing a Maskbull Untie the bottom then
top tiebull Remove from facebull Discard
PPE Use in Healthcare Settings
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Removing a Particulate Respiratorbull Lift the bottom elastic
over your head firstbull Then lift off the top
elasticbull Discard
PPE Use in Healthcare Settings
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Hand Hygienebull Perform hand hygiene immediately after
removing PPEndash If hands become visibly contaminated during PPE
removal wash hands before continuing to remove PPE
bull Wash hands with soap and water or use an alcohol-based hand rub
PPE Use in Healthcare Settings
Ensure that hand hygiene facilities are available at the point needed eg sink or alcohol-based hand rub
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
PPE Use in Healthcare SettingsWhen to Use PPE
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Standard and Expanded Isolation Precautions
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Standard Precautionsbull Previously called Universal Precautionsbull Assumes blood and body fluid of ANY patient
could be infectiousbull Recommends PPE and other infection control
practices to prevent transmission in any healthcare setting
bull Decisions about PPE use determined by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
PPE for Standard Precautions (1)bull Gloves ndash Use when touching blood body
fluids secretions excretions contaminated items for touching mucus membranes and nonintact skin
bull Gowns ndash Use during procedures and patient care activities when contact of clothing exposed skin with bloodbody fluids secretions or excretions is anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
PPE for Standard Precautions (2)bull Mask and goggles or a face shield ndash Use
during patient care activities likely to generate splashes or sprays of blood body fluids secretions or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
What Type of PPE Would You Wear
bull Giving a bed bathbull Suctioning oral secretionsbull Transporting a patient in a
wheel chairbull Responding to an
emergency where blood is spurting
bull Drawing blood from a vein
bull Cleaning an incontinent patient with diarrhea
bull Irrigating a woundbull Taking vital signs
PPE Use in Healthcare Settings
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
What Type of PPE Would You Wearbull Giving a bed bath
bull Generally none
bull Suctioning oral secretionsbull Gloves and maskgoggles or a
face shield ndash sometimes gown
bull Transporting a patient in a wheel chair
bull Generally none required
bull Responding to an emergency where blood is spurting
bull Gloves fluid-resistant gown maskgoggles or a face shield
bull Drawing blood from a veinbull Gloves
bull Cleaning an incontinent patient with diarrhea
bull Gloves wwo gown
bull Irrigating a woundbull Gloves gown maskgoggles
or a face shield
bull Taking vital signsndash Generally none
PPE Use in Healthcare Settings
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
PPE for Expanded Precautionsbull Expanded Precautions include
ndash Contact Precautionsndash Droplet Precautionsndash Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Use of PPE for Expanded Precautions
bull Contact Precautions ndash Gown and gloves for contact with patient or environment of care (eg medical equipment environmental surfaces)
bull In some instances these are required for entering patientrsquos environment
bull Droplet Precautions ndash Surgical masks within 3 feet of patient
bull Airborne Infection Isolation ndash Particulate respiratorNegative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Hand Hygienebull Required for Standard and Expanded Precautionsbull Performhellip
ndash Immediately after removing PPEndash Between patient contacts
bull Wash hands thoroughly with soap and water or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
PPE Use in Healthcare SettingsFinal Thoughts
bull PPE is available to protect you from exposure to infectious agents in the healthcare workplace
bull Know what type of PPE is necessary for the duties you perform and use it correctly
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
Cleaning EMS Transport Vehicles
bull Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturerrsquos recommendations
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
bull Non-patient-care areas of the vehicle such as the driverrsquos compartment may become indirectly contaminated such as by touching the steering wheel with a contaminated glove Personnel should be particularly vigilant to avoid contaminating environmental surfaces that are not directly related to patient care
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
bull Wear non-sterile disposable gloves that are recommended by the manufacturer of the detergentdisinfectant while cleaning the patient-care compartment and when handling cleaning and disinfecting solutions Dispose of gloves if they become damaged or soiled or when cleaning is completed
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
bull Frequently touched surfaces in patient-care compartments (including stretchers railings medical equipment control panels adjacent flooring walls ceilings and work surfaces door handles radios keyboards and cell phones) that become directly contaminated with respiratory secretions and other body fluids during patient care or indirectly by touching the surfaces with gloved hands should be cleaned first then disinfected
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
bull Non-porous surfaces in patient-care area that are not frequently touched can be cleaned with soap and water
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
bull Clean any small spills of bodily fluids with soap and water followed by disinfectant
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
bull Large spills of body fluids should be picked up with absorbent material then cleaned and disinfected
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
bull Wash hands after cleaning ambulance and equipment
bull Dispose of contaminated materials in approved containers
bull Thank you
bull Dispose of contaminated materials in approved containers
bull Thank you
bull Thank you
![swine flu kbk-1.ppt [Read-Only]ocw.usu.ac.id/.../1110000141-tropical-medicine/tmd175_slide_swine_… · MAP of H1 N1 Swine Flu. Swine Influenza (Flu) Swine Influenza (swine flu) is](https://static.documents.pub/doc/80x56/5f5a2f7aee204b1010391ac9/swine-flu-kbk-1ppt-read-onlyocwusuacid1110000141-tropical-medicinetmd175slideswine.jpg)
