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 B

bull And Influenza C

What is the current strain

bull The current swine flu strain in question is H1N1

bull 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 Precautions

bull Frequent hand washing

bull Use mask when treating patients that are coughing or sneezing

bull Get plenty of sleep

bull 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 flu

bull The drugs will not prevent infection

bull 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 B

bull And Influenza C

What is the current strain

bull The current swine flu strain in question is H1N1

bull 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 Precautions

bull Frequent hand washing

bull Use mask when treating patients that are coughing or sneezing

bull Get plenty of sleep

bull 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 flu

bull The drugs will not prevent infection

bull 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 B

bull And Influenza C

What is the current strain

bull The current swine flu strain in question is H1N1

bull 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 Precautions

bull Frequent hand washing

bull Use mask when treating patients that are coughing or sneezing

bull Get plenty of sleep

bull 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 flu

bull The drugs will not prevent infection

bull 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 B

bull And Influenza C

What is the current strain

bull The current swine flu strain in question is H1N1

bull 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 Precautions

bull Frequent hand washing

bull Use mask when treating patients that are coughing or sneezing

bull Get plenty of sleep

bull 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 flu

bull The drugs will not prevent infection

bull 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 H1N1

bull 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 Precautions

bull Frequent hand washing

bull Use mask when treating patients that are coughing or sneezing

bull Get plenty of sleep

bull 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 flu

bull The drugs will not prevent infection

bull 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Precautions

bull Frequent hand washing

bull Use mask when treating patients that are coughing or sneezing

bull Get plenty of sleep

bull 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 flu

bull The drugs will not prevent infection

bull 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Precautions

bull Frequent hand washing

bull Use mask when treating patients that are coughing or sneezing

bull Get plenty of sleep

bull 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 flu

bull The drugs will not prevent infection

bull 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Precautions

bull Frequent hand washing

bull Use mask when treating patients that are coughing or sneezing

bull Get plenty of sleep

bull 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 flu

bull The drugs will not prevent infection

bull 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Precautions

bull Frequent hand washing

bull Use mask when treating patients that are coughing or sneezing

bull Get plenty of sleep

bull 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 flu

bull The drugs will not prevent infection

bull 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 flu

bull The drugs will not prevent infection

bull 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 flu

bull The drugs will not prevent infection

bull 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 use

bull OSHA also specifies circumstances for which PPE is indicated

bull CDC recommends when what and how to use PPEPPE Use in Healthcare Settings

Hierarchy of Safety and Health Controls

bull Training and administrative controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 controls

bull Engineering controls

bull Work practice controls

bull Personal protective equipment

PPE Use in Healthcare Settings

Types of PPE Used in Healthcare Settings

bull Gloves ndash protect hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 hands

bull 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 eyes

bull Face shields ndash protect face mouth nose and eyes

PPE Use in Healthcare Settings

Factors Influencing PPE Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Selection

bull Type of exposure anticipatedndash Splashspray versus touch

ndash Category of isolation precautions

bull Durability and appropriateness for the task

bull Fit

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or nonsterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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

Gloves

bull Purpose ndash patient care environmental services other

bull Glove material ndash vinyl latex nitrile other

bull Sterile or non-sterile

bull One or two pair

bull Single use or reusable

PPE Use in Healthcare Settings

Dorsquos and Donrsquots of Glove Use

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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

bull Work from ldquoclean to dirtyrdquo

bull 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Aprons

bull Purpose of use

bull Material ndashndash Natural or man-made

ndash Reusable or disposable

ndash Resistance to fluid penetration

bull Clean or sterile

PPE Use in Healthcare Settings

Face Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Protection

bull Masks ndash protect nose and mouthndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Protection

bull 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Protection

bull 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 evaluation

bull Fit testing

bull Training

bull Fit checking before use

PPE Use in Healthcare Settings

For additional information on respiratorshellip

bull httpwwwcdcgovnioshnpptlrespirators respsarshtml

bull httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 httpwwwcdcgovniosh99-143html

bull httpwwwcdcgovnioshtopicsrespirators

PPE Use in Healthcare Settings

PPE Use in Healthcare SettingsHow to Safely Don Use and

Remove PPE

Key Points About PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 PPE

bull Don before contact with the patient generally before entering the room

bull Use carefully ndash donrsquot spread contamination

bull 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 PPE

bull Gown first

bull Mask or respirator

bull Goggles or face shield

bull Gloves

Combination of PPE will affect sequence ndash be practical

PPE Use in Healthcare Settings

How to Don a Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Gown

bull Select appropriate type and size

bull Opening is in the back

bull Secure at neck and waist

bull If gown is too small use two gownsndash Gown 1 ties in front

ndash Gown 2 ties in back

PPE Use in Healthcare Settings

How to Don a Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Mask

bull Place over nose mouth and chin

bull Fit flexible nose piece over nose bridge

bull Secure on head with ties or elastic

bull 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Gloves

bull Don gloves last

bull Select correct type and size

bull Insert hands into gloves

bull Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

How to Safely Use PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 PPE

bull Keep gloved hands away from face

bull Avoid touching or adjusting other PPE

bull Remove gloves if they become torn perform hand hygiene before donning new gloves

bull 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 PPE

bull Gloves

bull Face shield or goggles

bull Gown

bull Mask or respirator

PPE Use in Healthcare Settings

Where to Remove PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 PPE

bull At doorway before leaving patient room or in anteroom

bull 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 wrist

bull Peel away from hand turning glove inside-out

bull 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Shield

bull Grasp ear or head pieces with ungloved hands

bull Lift away from face

bull Place in designated receptacle for reprocessing or disposal

PPE Use in Healthcare Settings

Removing Isolation Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Gown

bull Unfasten ties

bull Peel gown away from neck and shoulder

bull Turn contaminated outside toward the inside

bull Fold or roll into a bundle

bull DiscardPPE Use in Healthcare Settings

Removing a Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Mask

bull Untie the bottom then top tie

bull Remove from face

bull Discard

PPE Use in Healthcare Settings

Removing a Particulate Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Respirator

bull Lift the bottom elastic over your head first

bull Then lift off the top elastic

bull Discard

PPE Use in Healthcare Settings

Hand Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Hygiene

bull 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Precautions

bull Previously called Universal Precautions

bull Assumes blood and body fluid of ANY patient could be infectious

bull 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 bath

bull Suctioning oral secretions

bull Transporting a patient in a wheel chair

bull Responding to an emergency where blood is spurting

bull Drawing blood from a vein

bull Cleaning an incontinent patient with diarrhea

bull Irrigating a wound

bull Taking vital signs

PPE Use in Healthcare Settings

What Type of PPE Would You Wear

bull Giving a bed bathbull 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Precautions

bull Expanded Precautions includendash Contact Precautions

ndash Droplet Precautions

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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 Hygiene

bull Required for Standard and Expanded Precautions

bull Performhellipndash Immediately after removing PPE

ndash 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