Infection prevention and control

DRAFT FOR FIELD TESTING

1 | Training module: infection prevention and control Risk assessm ent

ò A risk assessm enthelps determine whatm easures should be used and when to use them

ò Transmission of influenza increases if: œ Close contact(usually proximity < 1 metre) œ Direct contact (with infected patients then self contamination) œ Indirect contact (with surfaces/objects contaminated with virus then self contamination) œ Aerosol generating procedures (endotracheal intubation, suctioning)

2 | Training module: infection prevention and control Actions to prevent infection

1. Social distancing / separation of sick from well people 2. Respiratory etiquette 3. Hand hygiene 4. PPE according to risk

ò Most transmission occurs when infected people come into close contact with those who are susceptible.

3 | Training module: infection prevention and control Priority for PPE

1. Control transmission at the source(the patient)

2. Protect care givers/care providers - people in close contact with patients

(PPE - Personal Protective Equipment such as masks)

4 | Training module: infection prevention and control Control at the source

ò A patient should cover mouth and nose, if possible with a mask or scarf, when in close contactwith other people

ò During a pandemic, give a surgical or procedure maskto all patients presenting to health facilities withfever/acute respiratory symptoms (cough or shortness of breath)

œ Masks do not need to be used by patients when they are alone!

œ W earing a mask all day long is difficult and the mask gets wet.

5 | Training module: infection prevention and control Separation

ò In the home, separate the sick person from those who are well ò In health facilities- identify a completely separate building or structure, e.g. school, for use as temporary respiratory healthcare facility with respiratory waiting room.

œ Patients should be triagedbefore entering health units.

œ Separate waiting areasfor patients with fever/acute respiratory symptoms (cough or shortness of breath) from those with other symptoms Vital services for other illnesses should continue!

6 | Training module: infection prevention and control Protecting care givers/providers

ò Respiratory etiquette / social distancing / hand hygiene œ Everyone, always

ò Masks œ patients (source) when in close contact with others (receptors) œ health care workers and care givers when in close contact with anyone with respiratory symptoms œ other essential staff œ when in close contact with anyone with respiratory symptoms

ò Gloves/gowns/aprons/eye protection (staff) œ performing procedures (specialised medical, cleaning, burials) where eyes, hands or clothes could get contaminated with respiratory secretions. œ Use precautions according to the risk, as shown in the following tables.

7 | Training module: infection prevention and control Precautions for health staff

High risk Intensive care Inpatient care OPD care Health unit

procedures health worker health worker health worker non-health staff

Respiratory etiquette Yes Yes Yes Yes Yes

Social distance Yes Yes Yes Yes Yes

Hand Hygiene Yes Yes Yes Yes Yes

Gloves Yes Yes acc. to risk acc. to risk acc. to risk

Apron According to risk acc. to risk No No acc. to risk

Gown acc. to risk acc. to risk No No acc. to risk

Hair cover No No No No No

Surgical m ask No Yes Yes Yes acc. to risk

Particulate respirator Yes No No No No

Eye protection Yes Yes Yes No No

Surgical m ask on patient No acc. to risk acc. to risk acc. to risk acc. to risk

* According to risk: when transmission is possible because there is a source and a receptor. Exam ple, when patients (the source) are alone, there is no "receptor" so they do not need to wear a mask. W hen non-health staff are not in close contact with patients, they do not need to wear a mask. Gloves, aprons or gowns may be necessary when performing procedures (including cleaning) where hands or clothes will get contaminated with respiratory secretions.

8 | Training module: infection prevention and control Precautions for com m unities

Com m unity Distributor of Hom e care Patient Fam ily and

health worker essential services giver com m unity

Respiratory etiquette Yes Yes Yes Yes Yes

Social distance Yes Yes Yes Yes Yes

Hand Hygiene Yes Yes Yes Yes Yes

Gloves No No No No No

Apron No No No No No

Gown No No No No No

Hair cover No No No No No

Surgical m ask Yes acc. to risk acc. to risk acc. to risk acc. to risk

Particulate respirator No No No No No

Eye protection No No No No No

Surgical m ask on patient According to risk acc. to risk acc. to risk - acc. to risk

* According to risk: where transmission is possible because there is close contact between a source and a receptor. Exam ple, W hen patients are alone there is no receptor so they do not need to use a mask. People should maintain distance from others or at least cover their mouth and nose during a pandemic when near anyone with respiratory symptoms to prevent infection.

9 | Training module: infection prevention and control Hand hygiene

ò Hand hygiene is an important measure to prevent the spread of anyinfection in a health-care facility

ò Hands should be cleaned after touching people or contaminated objects or surfaces œ W ash with soap and water, rubbing for 20 seconds before rinsing œ Rub hands with an alcohol-based preparation until hands dry

10| Training module: infection prevention and control Hand hygiene with soap and water

Wet hands with apply enough rub hands palm to right palm over left water soap to cover all palm dorsum with interlaced hand surfaces fingers and vice versa

palm to palm with backs of fingers to rotational rubbing of rotational rubbing, fingers opposing left backwards and interlaced palms with fingers thumb clasped in right forwards with interlocked palm and vice versa clasped fingers of right hand in left palm and vice versa

rinse hands with dry thoroughly with use towel to turn …and your hands water a single use towel off faucet are safe.

11 | Training module: infection prevention and control Hand hygiene with alcoholœbased rub

Apply a palmful of the Rub hands palm to Right palm over left product in a cupped palm dorsum with interlaced hand and cover all fingers and vice versa surfaces.

palm to palm with backs of fingers to rotational rubbing of left fingers interlaced opposing palms with thumb clasped in right fingers interlocked palm and vice versa

rotational rubbing, …once dry, your hands backwards and forwards are with clasped fingers of safe. right hand in left palm and vice versa

12 | Training module: infection prevention and control Principles for use and rem oval of PPE

òOutside contaminated, inside clean

òThe front contaminated, the back clean

13 | Training module: infection prevention and control Gloves

ò Glovesshould be worn if contact with blood and body fluids is anticipated, but are not a substitute for hand hygiene

ò Gloves must be disposed of after each use

ò Handsshould be washed afterdisposal of gloves

14 | Training module: infection prevention and control Dos and Don‘ts of Glove Use

ò Protect yourself, others, and the environment

œ Limit opportunities for —touch contamination“

• Avoid touching:

œ your face or adjusting PPE with contaminated gloves

œ environmental surfaces except as necessary during patient care

15 | Training module: infection prevention and control Rem oving gloves

• Grasp outside edge near wrist • Peel away from hand, turning glove inside-out • Hold in opposite gloved hand

• Slide ungloved finger under the wrist of the remaining glove • Peel off from inside, creating a bag for both gloves

• Discard

16 | Training module: infection prevention and control Masks (1)

ò Masks, if worn and disposed of properly, are likely to be the most effective PPE intervention

œ Health-care workers with direct close contact with influenza patients should wear a tightly fittingsurgical mask and eye protection.

• o r a s c a rf o r a p ie c e o f c lo th o v e r th e n o s e a n d m o u th if m a s k s a re u n a v a ila b le

17 | Training module: infection prevention and control Masks (2)

ò Any respiratoryaerosol-generating proceduresmust NOT be performed without PPE (including particulate respirators and eye protection)

ò Masks (particulate respirators, surgical or procedure) should be thrown awaywhen leaving isolation wards, OR every 4 hours or when wet or visibly soiled

ò After removingor changing masks,hand hygieneshould be performed

18 | Training module: infection prevention and control Masks (3)

ò Other essential staff (without direct patient care responsibilities) œ can wear surgical or procedure masks but œ need to change masks twice a day, or when wet or visibly soiled.

19 | Training module: infection prevention and control Removinga surgical m ask

ò Do NOT touch the mask itself.

ò Lift the bottom elastic over your head first

ò Then lift off the top elastic

ò If no elastics, untie.

ò Discard

ò W ash hands afterwards.

20| Training module: infection prevention and control Preventing infection at hom e (1)

ò The patientshould:

œ Follow respiratory hygiene/cough etiquette. Use a mask or a scarf or a piece of cloth!

œ Ensure proper hand hygiene

œ Avoid close contact with uninfected people for at least 7 days after the beginning of flu symptoms

21 | Training module: infection prevention and control Preventing infection at hom e (2)

ò The caregivershould: œ Take proper precautions • R e s p ira to ry e tiq u e tte a n d h a n d h y g ie n e • P ro p e r u s e a n d d is p o s a l o f m a s k s , if a v a ila b le (o r s c a rf o r c lo th )

œ Limit close contact with people who are not sick.

œ Facilitate air circulation(open windows or tent) when climate allows

œ W ash clothes and bed linen that have been in contact with the patient's respiratory secretions or stools. • R u n n in g w a te r a n d s o a p s h o u ld b e u s e d fo r w a s h in g . • D ry c lo th e s /b e d lin e n in th e s u n .

22 | Training module: infection prevention and control Preventing infection in healthcare facilities (1)

ò Suspend elective and non-essentialmedical services

ò Continuation of essentialmedical services

ò Ensure as muchspatial separationbetween patientsas possible (at least 1m).

ò If possible, open windows to encourage air flow from the room.

23 | Training module: infection prevention and control Preventing infection in healthcare facilities (2)

ò Capacity for rapid expansion ensure an overflow area if there is a surge of patients with maximal separation between beds

ò Minimizethe number of entries and exitsto the respiratory isolation ward.

ò 8 hour shift limit for health-care workers on duty in the respiratory isolation ward.

24 | Training module: infection prevention and control Contam inated waste m anagem ent

ò Follow routine procedures for waste management generated at health facilities

25 | Training module: infection prevention and control I1 Dead bodies

ò The risk that dead bodies pose for public health is very small. The living pose a greater risk!

ò Respect culturally appropriate means of disposal of the deceased while avoiding contact with fluids from the body

ò Provide burial teams with gloves, aprons and boots as for any other burial

ò Identify burial sites in advance and ensure capacity for large numbers of bodies.

26 | Training module: infection prevention and control Slide 26

I1 Section on logistics of choosing brial site and handling many dead bodies should go to the text under the slide and not in the body bc it is managerial and not a first line worker competency Invite, 2006-08-13