Transcript Document

Airborne Pathogens and
Respirator Use
Objectives – The Illnesses
Discuss Airborne Diseases and the
healthcare provider
How they spread
Who is at risk
Possible causes
Symptoms
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Objectives – EMS Transport
What you should do to protect yourself
General considerations
Infection control
Waste disposal
Cleaning and Disinfection
Follow-up of EMS personnel
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Objectives - The N95 Respirator
What is it? Why do I
need it?
How do I use it?
Fit testing
What are the
limitations?
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Airborne Pathogens
Tuberculosis
Influenza
Avian Influenza
Smallpox
SARS
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Tuberculosis
Famous people who have had TB
Fredric Chopin*
Eleanor Roosevelt*
Nelson Mandela
Ringo Starr
Tom Jones
Tina Turner
*Died of TB
What is tuberculosis (TB)?
Disease caused by bacteria called
Mycobacterium tuberculosis
Chronic bacterial infection
Was once the leading cause of death in US
The number of cases declined in the 1940’s
when drugs were developed to treat TB
TB is still a problem worldwide (NIAID)
8 million people develop TB yearly
3 million die
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How is TB spread?
Through the air from person to
person by coughing
Usually attacks lungs
Two stages
Latent TB
• asymptomatic and not contagious
• can take medication to prevent development of disease
Active TB Disease
• May spread to others
• May have abnormal chest x-ray
• Usually have positive skin test
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Symptoms of TB
Chills
Fever
Weakness or fatigue
Sweating while sleeping, Night sweats
Cough that lasts longer than 2 weeks
Pain in chest
Coughing up blood or sputum
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Risk Factors
Close contact with someone who is infected
with TB
Traveling to a country where TB is common
Immune compromised
Foreign-born individuals and minorities have a
higher incidence of developing TB
2002: 50% of US cases were in foreign-born
individuals (CDC)
2002: 80% of all US TB cases were in ethnic and
racial minorities (CDC)
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Multi-drug resistant TB (MDR TB)
Bacteria become resistant
to antibiotics
Arose from improper use of
antibiotics in the treatment of TB
Treatment of one case can cost up to
$1.3 million (CDC)
45 states and Washington, DC have
confirmed cases of MDR TB (CDC)
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MDR TB continued
Treatment is difficult and costly
Can develop from not taking proper
course of antibiotics for TB
MDR TB can be spread by an infected
person
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How to protect yourself
BCG vaccine for TB is given in many
countries, but not the US
Not recommended for healthcare workers
unless a high percentage of patients are
infected with MDR TB (CDC)
PPD test if exposure is suspected
USE proper PPE when in contact with patients
who may have TB
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Tuberculosis Summary
Chronic bacterial infection
spread through the air
Fever, chills, sweating while sleeping,
persistent cough, coughing up blood or
sputum
MDR TB
Use proper PPE and get PPD test if
exposed
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Influenza
“I had a little bird,
His name was Enza,
I opened the window and in flew Enza.”
-Children’s nursery rhyme about the
flu epidemic of 1918
What is influenza (“the flu”)?
Disease caused by a virus
Respiratory
More severe than a cold
10%-20% of US residents will
get the flu each year (CDC)
Can lead to complications for some people
36,000 people die each year from
complications (CDC)
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Types of influenza virus
Influenza A
Most common and most serious
Can lead to epidemics
Influenza B
Can also cause epidemics
Symptoms are milder
Influenza C
Never connected with large epidemics
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How is influenza spread?
Flu season is from November to March
Respiratory droplets
Coughing
Sneezing
Droplets on objects
Contagious from 1 day before
symptoms start to 7 days after
symptoms start (CDC)
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Symptoms
Cough and congestion
Fever
Headache
Body Aches
General malaise
Sore throat
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Vaccine- The Flu Shot
Administered yearly
Injection or nasal spray (FluMist)
New vaccine made every year
Can prevent types A and B
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Who should get a flu shot? (CDC)
>50 years old
Diabetic
Live or work in a nursing home
Compromised immune system
Chronic heart, lung, or kidney disease
Will be more than 3 months pregnant during
flu season
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Protecting yourself
Get flu shot
Use proper PPE around patients
suspected of having the flu
Disinfect surfaces regularly
Keep yourself healthy during the flu
season!
Get enough rest
Eat well
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Influenza Summary
Flu season is from November to March
Use PPE
Disinfect
Get a flu shot
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Avian Influenza
February 2004: 72,000
chickens were slaughtered in
Delaware after two cases of
Avian Influenza were found at
a poultry farm under contract
for Perdue Farms, Inc.
What is Avian Influenza?
Influenza virus that can infect
birds and humans
Type A influenza
3 Type A viruses and each have 9 subtypes
H5: can be high or low pathogenic; can cause
severe illness or death
H7: can be high or low pathogenic; infections are
rare and symptoms are mild
H9: low pathogenic; very rare in humans
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Transmission
Contact with infected poultry or contaminated
surfaces
No documented cases of sustained human to
human transmission
Have been isolated incidents of human to human
transmission
Monitoring is important
Influenza viruses have the ability to change
May gain the ability to spread from person to
person
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Symptoms
Same as typical flu-like symptoms
Conjunctivitis
Pneumonia
Severe respiratory
distress
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Incidents of H5 Avian Influenza
1997: Hong Kong- First
documented transmission of
birds to humans
18 people hospitalized
6 died
1.5 million chickens
slaughtered to prevent further
spread of disease
Person to person transmission
was also documented
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Incidents of H5 Avian Influenza
2003: China and Hong Kong
2 people infected after traveling to China
1 died
Source of infection not identified
2004: Thailand and Vietnam
WHO reported cases of H5 influenza among bird populations
Ongoing since January 2003
Human cases found in Thailand and Vietnam (WHO)
• 37 reported cases
• 26 died
• Most recent cases were reported August 12, 2004
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Avian Influenza Summary
Can be transmitted from birds to
humans
Typical flu-like symptoms plus
Conjunctivitis
Respiratory distress
Pneumonia
Use PPE
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Questions?
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Smallpox
In 1972, a single case of small pox in Yugoslavia led to the
infection of 150 people, 34 deaths, 10,000 people quarantined
and 20 million vaccinated.
-World Health Organization
What is Smallpox?
Variola Virus
Contagious infectious disease
Eliminated in human populations
Laboratory stockpiles exist
Concern that it may be used as an agent of
bioterrorism
No treatment
Only prevention is vaccine
Two types
Variola major
Variola minor
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Variola Major
Most common
Severe
Very high fever
Large rash
4 types
Ordinary: most frequent
Modified: occurs in people who have been vaccinated; mild
Flat: rare and severe
Hemmorhagic:rare and severe
Fatality rate of 30% (CDC)
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Variola Minor
Less common
Less severe symptoms
Fatality rate of <1%
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From World Health Organization
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Transmission
Person to person
Prolonged contact with infected person
Contact with infected body fluids or
contaminated objects
Can be spread through the air in
enclosed settings, but this is rare
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Vaccine
Complete protection if given before
exposure
If given within 3 days after exposure, will
prevent or greatly lessen severity
4-7 days after exposure: lessens severity
of disease
No protection if given after rash appears
Not widely available to the public at this
time
Stockpiles are in place in case of an
outbreak
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Vaccine contraindications (CDC)
Vaccinia virus can be spread to others from the injection site of
an immunized person
Eczema and other exfoliative skin conditions
May develop eczema vaccinatum
Inadvertent autoinnoculation of affected area
• Could develop vaccinia
Immune compromised individuals
Pregnancy
Infants and children
Not given to infants <12 months of age
Only in emergency situations to children <18 years of age
Breastfeeding mothers should not get the vaccine
Heart disease
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Protecting yourself
Vaccine
Use PPE when in contact with infected
patient or contaminated fluids
Watch for signs/symptoms of smallpox
if you believe you were exposed
Early vaccination after exposure can
prevent or lessen the disease
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Smallpox Summary
Contagious infectious disease
Transmitted through close contact with
infected person
Vaccine
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SARS
Severe Acute Respiratory
Syndrome
The 2003 global SARS outbreak led to
over 8,000 people becoming ill, and 774
deaths. It is estimated the panic caused by
the disease cost Canada $1 billion in lost
tourism and all of Asia over $28 billion.
(BBC News)
What is SARS?
Center for Disease Control Definition
SARS is a respiratory illness of unknown etiology. It
was first identified in February 2003.
SARS was first noticed in Southeast Asia. To date
more than 100 cases have been reported in the
United States
Public health experts think that SARS is spread by
close contact between people
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How SARS Spreads
SARS is most likely spread
when someone sick from the
disease coughs droplets into
the air and someone else
breathes the virus in
It is possible that SARS may
spread more broadly through
the air or from touching an
object that is contaminated
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Who Is at Risk for SARS?
Individuals having close contact with
someone sick from the disease
Those sharing a household with
someone sick from the disease
Healthcare providers who do not
use the proper infection control
techniques when providing care
for patients sick from the disease
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Possible Causes of SARS
Scientists at the CDC and other
laboratories have detected a previously
unrecognized coronavirus in patients
with SARS.
While the new coronavirus is still the
leading hypothesis for the cause of
SARS, other viruses are still under
investigation as potential causes.
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What are Coronaviruses
These viruses are a common cause of
mild to moderate upper-respiratory
illness in humans and are associated
with respiratory, gastrointestinal, liver
and neurologic disease in animals.
Coronaviruses can survive in the
environment for as long as three
hours.
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Symptoms of SARS
Fever or hot to touch
AND
Cough
AND
Clinical findings of
respiratory distress
AND
Travel within 10 days to an area with suspected
community transmission
OR
Close contact within 10 days with a person with a
respiratory illness or someone sick from SARS
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How to protect yourself
Wear proper respiratory protection
Recognize signs and symptoms of SARS
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SARS Summary
Very little known about SARS
Possibly spread through droplets in air
Fever, chills, severe respiratory distress
Wear respiratory protection
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Questions?
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Transport of Patients with
Suspected Airborne Illness
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General Considerations
Patients should be transported using
the minimum number of EMT personnel
and without non-infectious patients or
passengers in the vehicle.
Sufficient infection control supplies
should be on board.
Receiving facilities must be notified
prior to transport of infectious patients.
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Infection Control - General
PPE may not be removed during
transport.
Personal activities (including: eating,
drinking, application of cosmetics, and
handling of contact lenses) should not be
performed during patient transport.
These diseases may be transmitted if
residual infectious particles on
environmental surfaces are brought into
direct contact with the eyes, nose or
mouth.
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Infection Control – PPE
Disposable, non-sterile gloves must be
worn for all patient contact.
Disposable fluid-resistant gowns
should be worn for all patient care
activity.
Goggles or face-shields must be worn
in the patient-care compartment and
when working within 6 feet of the
patient. Corrective eyeglasses alone
are not appropriate protection.
N-95 respirators should be worn by
personnel in the patient-care
compartment at all times.
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Infection Control - PPE
Gloves are removed in the
correct manner and discarded
in biohazard bags after patient
care is completed (e.g.,
between patients) or when
soiled or damaged.
Hands must be washed or
disinfected with a waterless
hand sanitizer immediately
after removal of gloves.
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Infection Control – Driver & Vehicle
N-95 respirators should be worn by the driver if the
driver's compartment is open to the patient-care
compartment.
Drivers that provide direct patient care must wear a
disposable gown, face shield, and gloves during patientcare activities.
Use vehicles with separate ventilation for driver and
patient compartments if possible.
Maximize air exchange
Open dashboard vents
Open rear vents to maximum level
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Infection Control
The patient may wear a
paper surgical mask to
reduce droplet production, if
tolerated.
Oxygen delivery with NRB
masks may be used for
patient oxygen support
during transport.
CPR should never be
performed using mouth-tomouth or mouth-to-mask.
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Infection Control – Patient Care
The BVM should be equipped with a
HEPA filter for expired air.
When using CPAP ensure that a HEPA
filter is attached to the exhalation port.
There is no documented additional risk
when using aerosol nebulizers if all of
the precautions just discussed are used
by the health care provider.
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Follow-up of EMS Personnel
Record the following information
Date and route of transport
Duration of patient transport
Names of personnel in contact with the patient
EMT services should closely monitor personnel who
have transported potentially infectious patients for
evidence of fever, rash or respiratory illness.
EMT personnel who transport SARS patients should be
assessed at least daily for 10 days after transporting a
SARS patient (directly or by telephone).
If the EMT was exposed to Smallpox, it is important to be
vaccinated as soon as possible. May be symptom-free for up to 17
days after contracting the disease.
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Follow-up of EMS Personnel
Personnel may continue working during
the follow-up period if they have no
symptoms of the disease.
Personnel who have transported a SARS
patient and become symptomatic within
the 10 day follow-up period should be
directed to seek medical evaluation and
should be reported to the state health
department and to the CDC.
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Questions?
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The N95 Respirator
The N95 Respirator
The most common respirator used
is the disposable particulate type
N95.
The “N” stands for respirator filters
that can be used when no oil is
present in the contaminants.
The“95” means that the product
has been tested and certified by
NIOSH to have a filter efficiency
level of 95% or greater against
particulate aerosols.
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Why a Respirator Is Necessary
Healthcare providers work in an
environment where there is a risk
of disease transmission through
airborne infectious particulates.
Respirators, such as the N-95,
provide protection from airborne
infectious particulates when
properly fitted and worn.
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OSHA 1910.134 Standards for
Respiratory Protection
Medical screening to determine if the
employee is physically able to wear a
respirator.
Fit-test to determine if the respirator fits
properly on the employee’s face.
Training on the selection, use, storage,
and limitations of the respirator used.
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The Medical Screening
A licensed health care professional will
perform the evaluation using a medical
questionnaire.
The contents of the medical questionnaire are
mandated by OSHA.
Administered to the HCW in a confidential
manner and the HCW can request to discuss
the results of the medical evaluation with the
licensed health care professional.
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Follow-up Medical Examination
Is Performed If:
1- If HCW reports medical signs or symptoms that
are related to ability to use the respirator.
2- If the supervisor informs employee health of the
need for re-evaluation.
3- If information from the respirator program
monitoring activities should indicate any need
for re-evaluation.
4- If the workplace conditions significantly change.
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FIT TEST Procedure is Done:
1- Before initial use of the respirator
2- Whenever a different size, style, model or make of
respirator is used
3- If HCW has a change in facial structure such as:
facial trauma, facial surgery, loss of body weight, or
dental changes.
4- If the HCW worker notifies the employer that the
respirator fit is unacceptable.
5- At least annually
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Types of Fit Testing
Qualitative Fit Test: Worker is assessed on a
pass/fail basis to determine the adequacy of
respirator fit. It relies on the individual’s
response to the test agent.
Quantitative Fit Test: Assessment of
respirator adequacy by numerically measuring
the amount of leakage into the respirator.
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Fit Testing the Respirator
Qualitative Testing
HCW puts on the respirator.
Hood is applied over the
head.
Sweet tasting aerosol mist is
introduced into the hood.
If the seal is tight the HCW
should not experience any
sweet taste.
The test simulates activities
such as turning the head,
talking, and other possible
activities that might occur
during job tasks.
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Fit Testing the Respirator
Quantitative Testing
HCW puts on respirator
attached to PortaCount
machine.
HCW performs series of
movements to test
respirator fit.
PortaCount machine
measures amount of
particles leaking into mask.
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Donning of the
N95 Respirator*
Step #1
Cup the respirator in your hand with the
nosepiece at your finger tips allowing the
headbands to hang freely below hands.
*Always refer to the instructions provided by manufacturer
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Donning of the
N95 Respirator
Step #2
Position the respirator under your
chin with the nosepiece up.
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Donning of the
N95 Respirator
Step #3
Pull the top strap over your head so
it rests high on the back of head.
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Donning of the
N95 Respirator
Step #4
Pull the bottom strap over your
head and position it around your
neck below ears.
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Donning of the
N95 Respirator
Step #5
Using two hands, mold the nosepiece to the
shape of your nose by pushing inward while
moving your fingertips down both sides of the
nosepiece.
Pinching the nosepiece using one hand may
result in less effective respirator performance.
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Fit Check of the
N95 Respirator
Face fit check - the
respirator seal should be
checked before each use.
To check fit, place both
hands completely over the
respirator and exhale.
If air leaks around your
nose, adjust the nosepiece
as described in step 5.
If air leaks at respirator
edges, adjust the straps
back along the sides of your
head.
Recheck.
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Facial Hair
Facial hair will make the seal loose
and will not provide protection
from harmful airborne hazards.
Even just one or two days beard
growth can effect the seal.
Males should be clean shaven.
This is to ensure that the respirator
is fully protective.
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Removal of the
N95 Respirator
Step #1
Cup the respirator in your hand to
maintain position on face.
Pull bottom strap over head.
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Removal of the
N95 Respirator
Step #2
Still holding respirator in position,
pull top strap over head.
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Removal of the
N95 Respirator
Step #3
Remove the respirator from your face
Discard as a Biohazard (Red Bag)
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Limitations of the N95 Respirator
If this respirator becomes wet, it is no longer
effective and must be replaced.
The N-95 respirator has the ability to filter
particles 1 micrometer with a filter efficiency
of > 95%.
The N-95 is not intended for protection from
organic vapors, toxic gases, or toxic
particulates.
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Waste Disposal
All solid waste, e.g., Used
gloves, dressings, etc.,
Should be collected in a
red biohazard bags for
regulated medical waste
disposal.
Any suctioned fluids and
secretions must be sealed
to prevent any splashes.
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Cleaning and Disinfection
Non-patient-care areas of the vehicle should be cleaned and
maintained according to vehicle manufacturer’s recommendations.
Cleaning personnel should wear non-sterile gloves, disposable
gowns and face shields while cleaning the patient-care
compartment.
Patient-care compartments (including stretchers, railings,
medical equipment control panels, and adjacent flooring,
walls and work surfaces likely to be directly contaminated
during care) should be cleaned using the department
approved disinfectant.
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Cleaning and Disinfection
Spills of body fluids during transport
should be cleaned by placing
absorbent material over the spill and
collecting the used cleaning material
in a biohazard bag.
The area of the spill should be
cleaned using an EPA-registered
hospital disinfectant.
Contaminated reusable patient care
equipment should be placed in
biohazard bags and labeled for
cleaning and disinfection.
Wear proper PPE when cleaning
equipment.
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Questions?
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For Additional Information
CDC
Center for Disease Control
www.cdc.gov
WHO
World Health Organization
www.who.int
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